Carla J. DeVincent

Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples

This study compares DSM-IV symptoms in children (ages 6 to 12 years) with pervasive developmental disorder (PDD), clinic controls, and community-based samples. Parents/teachers completed the Child Symptom Inventory–4 for four samples: PDD (N= 284/284) and non-PDD psychiatric clinic referrals (N= 189/181) and pupils in regular (N= 385/404) and special (N= 61/60) education classes. The PDD group received higher symptom severity ratings than the regular education group, but was similar to the non-PDD clinic sample. Screening prevalence rates were highest for ADHD, ODD, and generalized anxiety disorder. PDD subtypes exhibited differentially higher rates of psychiatric symptoms. The magnitude of rater and gender differences in symptom severity ratings was modest. Clinic-referred children with PDD exhibit a pattern of psychiatric symptoms highly similar to nonPDD clinic referrals. Although much additional research is needed on comorbidity, these symptoms have important treatment implications.

Pregnancy-Specific Stress, Prenatal Health Behaviors, and Birth Outcomes

OBJECTIVE Stress in pregnancy predicts earlier birth and lower birth weight. The authors investigated whether pregnancy-specific stress contributes uniquely to birth outcomes compared with general stress, and whether prenatal health behaviors explain this association. DESIGN Three structured prenatal interviews (N = 279) assessing state anxiety, perceived stress, life events, pregnancy-specific stress, and health behaviors. MAIN OUTCOME MEASURES Gestational age at delivery, birth weight, preterm delivery (<37 weeks), and low birth weight (<2,500 g). RESULTS A latent pregnancy-specific stress factor predicted birth outcomes better than latent factors representing state anxiety, perceived stress, or life event stress, and than a latent factor constructed from all stress measures. Controlling for obstetric risk, pregnancy-specific stress was associated with smoking, caffeine consumption, and unhealthy eating, and inversely associated with healthy eating, vitamin use, exercise, and gestational age at delivery. Cigarette smoking predicted lower birth weight. Clinically-defined birth outcomes were predicted by cigarette smoking and pregnancy-specific stress. CONCLUSION Pregnancy-specific stress contributed directly to preterm delivery and indirectly to low birth weight through its association with smoking. Pregnancy-specific stress may be a more powerful contributor to birth outcomes than general stress.

Psychiatric Symptoms in Preschool Children with PDD and Clinic and Comparison Samples

AbstractObjective: This study describes and compares the severity of DSM-IV symptoms in preschool children with diagnosed pervasive developmental disorder (PDD), clinic controls, and two community-based samples. Method: Parents (/and teachers) completed the early child inventory-4 (ECI-4), a DSM-IV-referenced rating scale for four samples: PDD (n = 172/160) and nonPDD psychiatric clinic referrals (n = 135/101) and youngsters in regular (n = 507/407) and special (n = 64/140) early childhood programs. Children ranged in age from 3 to 5 years old. Results: With the exception of conduct problems, the PDD group generally received higher symptom severity ratings than the regular early childhood group, but the pattern of differences compared with the other two groups often varied by type of symptom and informant. Teachers rated the PDD and nonPDD clinic groups as having equally severe ADHD and oppositional defiant disorder symptoms. Teachers rated the PDD group as having more severe anxiety and depression symptoms than parents. The Asperger group was rated by both informants as more oppositional than the autism and PDDNOS subgroups. Teachers rated males in the regular early childhood sample as having more severe ADHD and aggressive symptoms than females, but this was not the case for the PDD sample. Conclusion: Preschoolers with PDD exhibit more severe DSM-IV psychiatric symptoms than children in regular and special early childhood programs, and to some extent nonPDD psychiatric referrals. The concept of comorbidity warrants further exploration, as does informant-specific syndromes as validators of diagnostic constructs.

Disruption of contactin 4 in three subjects with autism spectrum disorder

Background: Autism spectrum disorder (ASD) is a developmental disorder of the central nervous system of largely unknown aetiology. The prevalence of the syndrome underscores the need for biological markers and a clearer understanding of pathogenesis. For these reasons, a genetic study of idiopathic ASD was undertaken. Methods and results: Array based comparative genomic hybridisation identified a paternally inherited chromosome 3 copy number variation (CNV) in three subjects: a deletion in two siblings and a duplication in a third, unrelated individual. These variations were fluorescence in situ hybridisation (FISH) validated and the end points further delineated using a custom fine tiling oligonucleotide array. Polymerase chain reaction (PCR) products unique to the rearrangements were amplified and sequence analysis revealed the variations to have resulted from Alu Y mediated unequal recombinations interrupting contactin 4 (CNTN4). Conclusion: CNTN4 plays an essential role in the formation, maintenance, and plasticity of neuronal networks. Disruption of this gene is known to cause developmental delay and mental retardation. This report suggests that mutations affecting CNTN4 function may be relevant to ASD pathogenesis.

Beneficial Associations Between Optimistic Disposition and Emotional Distress in High-Risk Pregnancy

This study was conducted to examine whether optimistic women experience less distress in high-risk pregnancy than non-optimistic women, and if so, whether this difference is explained by differences in coping or perceptions of control over pregnancy. As predicted, optimistic women ( N = 167) were more likely to evaluate their high-risk pregnancy as controllable, which was associated with lower distress. They were also less likely to use avoidant coping, an emotionally deleterious form of coping. Furthermore, optimism had an independent association with emotional distress that was stronger than the associations mediated by perceived control and coping. Results suggest that there are emotional benefits of optimism in high-risk pregnancy which are only partly explained by the way optimists perceive and cope with this stressful life event.

Comparative study of children with ADHD only, autism spectrum disorder + ADHD, and chronic multiple tic disorder + ADHD.

Objective: Identification of differences among children with ADHD only, autism spectrum disorder (ASD)+ADHD, and chronic multiple tic disorder (CMTD)+ADHD may lead to better understanding of clinical phenotypes. Method: Children were evaluated using the parent- and teacher-completed questionnaires. Results: All three groups were highly similar in severity of oppositional defiant disorder and conduct disorder symptoms; however, the ASD+ADHD group generally exhibited the most severe anxiety, although the CMTD+ADHD group had the most severe generalized anxiety. The two comorbid groups had the most involved medical histories and the greatest likelihood of a family history of psychopathology. Conclusion: Groups differed in clinically meaningful ways, and the apparent association between tics and anxiety may explain in part the elevated levels of anxiety in both comorbid groups. Collectively, results suggest that ADHD may be better conceptualized as a family of interrelated syndromes defined in part by comorbid conditions and that continued research is clearly warranted. (J. of Att. Dis. 2009; 12(5) 474-485)

1H-Magnetic Resonance Spectroscopy Markers of Cognitive and Language Ability in Clinical Subtypes of Autism Spectrum Disorders

This study assessed metabolic functioning of regional brain areas to address whether there is a neurometabolic profile reflecting the underlying neuropathology in individuals with autism spectrum disorders, and if varied profiles correlate with the clinical subtypes. Thirteen children (7-16 years) with autism spectrum disorders and 8 typically developing children were compared on 1H-magnetic resonance spectroscopy data collected from hippocampus-amygdala and cerebellar regions. The autism spectrum disorder group had significantly lower N-acetyl-aspartate/creatine ratios bilaterally in the hippocampus-amygdala but not cerebellum, whereas myo-inositol/creatine was significantly increased in all measured regions. Choline/creatine was also significantly elevated in the left hippocampus-amygdala and cerebellar regions of children with autism spectrum disorder. Comparisons within the autism spectrum disorder group when clinically subdivided by history of speech delay revealed significant metabolic ratio differences. Magnetic resonance spectroscopy can provide important information regarding abnormal brain metabolism and clinical classification in autism spectrum disorders.

Sleep disturbance and its relation to DSM-IV psychiatric symptoms in preschool-age children with pervasive developmental disorder and community controls.

This study describes the relation between sleep problems and psychiatric symptoms in preschool-age children (3 to 5 years old) with pervasive developmental disorder and a community-based sample of children attending early childhood programs. Parents completed the Early Childhood Inventory—4, a Diagnostic and Statistical Manual of Mental Disorders (fourth edition)—referenced rating scale for 2 samples: children with pervasive developmental disorder (n = 112) and nondisabled youngsters (n = 497). Although children with pervasive developmental disorder had a significantly greater number and severity of sleep problems than the community preschoolers did, sleep-disturbed children in both samples exhibited more severe behavioral difficulties—primarily symptoms of attention-deficit hyperactivity disorder and oppositional defiant disorder—than did children without sleep problems. Sleep problems are an indicator of similar comorbid psychiatric symptoms in both children with and without pervasive developmental disorder, which suggests commonalities in their etiology.

Anxiety Symptoms in Boys with Autism Spectrum Disorder, Attention-Deficit Hyperactivity Disorder, or Chronic Multiple Tic Disorder and Community Controls

We compared symptoms of generalized anxiety disorder (GAD) and separation anxiety disorder (SAD) in 5 groups of boys with neurobehavioral syndromes: attention-deficit/hyperactivity disorder (ADHD) plus autism spectrum disorder (ASD), ADHD plus chronic multiple tic disorder (CMTD), ASD only, ADHD only, and community Controls. Anxiety symptoms were assessed using parent and teacher versions of a DSM-IV-referenced rating scale. All three groups of boys with co-morbid ADHD evidenced more severe anxiety than Controls. Group differences in anxiety varied as a function of symptom, disorder, informant, and co-morbidity supporting the notion that co-morbid neurobehavioral syndromes differentially impact clinical features of co-occurring anxiety symptoms. Findings also suggest that GAD and SAD are phenomenologically unique, even in children with ASD. Implications for nosology are discussed.

Deconstructing the PDD clinical phenotype: internal validity of the DSM‐IV

BACKGROUND Empirical studies of the structure of autism symptoms have challenged the three-domain model of impairment currently characterizing pervasive developmental disorders (PDD). The objective of this study was to assess the internal validity of the DSM as a conceptual model for describing PDD, while paying particular attention to certain subject characteristics. METHODS Parents and teachers completed a DSM-IV-referenced rating scale for 3- to 12-year-old clinic referrals with a PDD (n = 730). Ratings were submitted to confirmatory factor analysis and different models were assessed for fit. RESULTS Measures of fit indicated that the three-factor solution based on the DSM was superior to other models. Most indices of fit were acceptable, but showed room for improvement. Fit indices varied according to the rater (parent or teacher), childs age (preschool versus school aged), PDD subtype (autism, Aspergers, pervasive developmental disorder not otherwise specified (PDDNOS)), and IQ. CONCLUSIONS More research needs to be done before discarding current classification systems. Subject characteristics, modality of assessment, and procedural variations in statistical analyses impact conclusions about the structure of PDD symptoms.