Christina Schwenck

Empathy in children with autism and conduct disorder: group-specific profiles and developmental aspects.

BACKGROUND   A deficit in empathy is discussed to underlie difficulties in social interaction of children with autism spectrum disorder (ASD) and conduct disorder (CD). To date, no study has compared children with ASD and different subtypes of CD to describe disorder-specific empathy profiles in clinical samples. Furthermore, little is known about age influences on the development of empathic skills. The aim of the current study was to compare cognitive and emotional empathy in different age groups of children with ASD, CD with elevated or low callous-unemotional-traits (CU+ vs. CU-) and a matched control group (CG). METHODS   Fifty-five boys with ASD, 36 boys with CD-CU+, 34 boys with CD-CU- and 67 controls were included. The study implemented three tasks on emotion recognition, perspective taking and emotional affection induced by another persons situation. Multivariate Analysis of variance with the factors group and age (median split) including their interaction term was performed to describe disorder-specific profiles. RESULTS   Empathy profiles showed differential impairment in children with ASD and CD-CU+. Boys with ASD were impaired in cognitive empathy while participants with CD-CU+ were impaired in emotional empathy. Children with CD-CU- did not differ from the CG. However, boys with CD-CU- were less emotionally reactive in response to film stimuli than children with ASD. Furthermore, we found strong age effects indicating an increase in cognitive and affective empathic skills beyond early infancy in all groups. CONCLUSIONS   In this study, distinct empathic profiles in children with ASD and CD-CU+ were found. Furthermore, the work demonstrates improvement of empathic skills throughout childhood and adolescence, which is comparable for individuals with psychiatric disorders and control children. These results yield implications for further research as well as for therapeutic interventions.

ADHD and autism: differential diagnosis or overlapping traits? A selective review

According to DSM-IV TR and ICD-10, a diagnosis of autism or Asperger Syndrome precludes a diagnosis of attention-deficit/hyperactivity disorder (ADHD). However, despite the different conceptualization, population-based twin studies reported symptom overlap, and a recent epidemiologically based study reported a high rate of ADHD in autism and autism spectrum disorders (ASD). In the planned revision of the DSM-IV TR, dsm5 (www.dsm5.org), the diagnoses of autistic disorder and ADHD will not be mutually exclusive any longer. This provides the basis of more differentiated studies on overlap and distinction between both disorders. This review presents data on comorbidity rates and symptom overlap and discusses common and disorder-specific risk factors, including recent proteomic studies. Neuropsychological findings in the areas of attention, reward processing, and social cognition are then compared between both disorders, as these cognitive abilities show overlapping as well as specific impairment for one of both disorders. In addition, selective brain imaging findings are reported. Therapeutic options are summarized, and new approaches are discussed. The review concludes with a prospectus on open questions for research and clinical practice.

A systematic review on olfaction in child and adolescent psychiatric disorders

There is substantial evidence that olfactory function may serve as biomarker in adult neuropsychiatric disorders, e.g. overall diminished olfaction in Parkinson’s disease as parameter for early pre-motor and differential diagnosis. Here, we present data from a systematic literature review in olfactory function in child and adolescent psychiatric disorders and report two unpublished data sets of autism and obsessive–compulsive disorder. The overall number of olfaction studies is low—even after taking into account adult samples. In addition, heterogeneity of findings is high due to methodological limitations such as the use of different olfactory tests and odours targeting the olfactory and/or the trigeminal system and neglecting possible confounders, e.g., intelligence or oto-rhino-laryngological affections. Despite these limitations, there is some indication for specific alterations of olfactory function especially in disorders with dopaminergic pathology (e.g. attention deficit/hyperactivity disorder, autism, schizophrenia, 22q11 deletion syndrome). Dopamine is a relevant modulator of early processes in the olfactory bulb. Our systematic review provides the basis for future confirmatory studies investigating olfaction as putative biomarker in child and adolescent psychiatric disorders. We further propose studies of thorough and elaborate methodological standards in combination with imaging techniques and the investigation of the influence of genetic variation on olfactory function.

Cognitive and emotional empathy in typically developing children: The influence of age, gender, and intelligence

In the current study, the influence of age, gender and IQ on cognitive and emotional empathy in school-aged children and adolescents was examined adopting two behavioural paradigms: participants were shown film clips with different scenes of social interaction to which they were asked to respond. Thus, 134 children aged seven to 17 years (mean age = 138.4 months, sd = 31.66 months) were tested for emotion recognition, perspective taking and emotional empathy. Age strongly influenced components of cognitive empathy and explained 33.5% to 39.1% of the variance. Gender and IQ also were significant predictors, yet only explained 3% to 5%, respectively 8% to 9% of the variance. In contrast, neither age, gender nor IQ were related to emotional empathy. Results suggest developmental maturation of cognitive, but not emotional empathy throughout childhood and adolescence. To explain variability in emotional empathy, additional biological and psychosocial factors need to be studied.

Altered mRNA expression of monoaminergic candidate genes in the blood of children with attention deficit hyperactivity disorder and autism spectrum disorder

Abstract Objectives. In absence of objective clinical characteristics the identification of peripheral biomarkers in neuropsychiatric disorders is highly relevant for the diagnostic process and an individualized therapy. We analyzed mRNA-expression of monoaminergic candidate genes (DRD4, DRD5, TPH1) in peripheral tissue of patients with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD), highly comorbid with ADHD, searching for possible molecular markers for these disorders. Methods. mRNA was obtained from children and adolescents with ADHD (n = 51) and ASD (n = 26), diagnosed according to ICD-10 criteria, as well as healthy controls (n = 39). mRNA expression was determined via quantitative realtime PCR (qRT-PCR) from whole blood cells. Results. The concentrations of DRD4-mRNA in the whole blood were significantly lower in ADHD and ASD children (19 of 26 comorbid with ADHD) compared to healthy controls. ASD patients revealed a significantly decreased DRD5 mRNA expression in comparison to the two other groups. Conclusions. Alterations in mRNA expression patterns provide further evidence for a relevant effect of the respective candidate genes in the pathophysiology of ADHD. Given their potential as biomarkers mRNA expression patterns may be useful tools in (differential-) diagnostic procedures of ADHD and ASD. Future studies may determine the sensitivity and specificity of these putative biomarkers in larger samples including further neuropsychiatric diagnoses.

Emotion recognition in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).

Children with attention-deficit/hyperactivity disorder (ADHD) are impaired in social adaptation and display deficits in social competence. Deficient emotion recognition has been discussed to underlie these social problems. However, comorbid conduct problems have not been considered in the majority of studies conducted so far, and the influence of medication on emotion recognition has rarely been studied. Here, emotion recognition performance was assessed in children with ADHD without medication compared with children with ADHD under stimulant medication and a matched control group. In order to rule out confounding by externalizing symptoms, children with comorbid conduct problems were excluded. Video clips with neutral faces developing a basic emotion (happiness, sadness, disgust, fear and anger) were presented in order to assess emotion recognition. Results indicated between-group differences neither concerning the number of correctly identified emotions nor concerning reaction times and their standard deviations. Thus, we suggest that ADHD per se is not associated with deficits in emotion recognition.

Diagnostik der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung im Kindes- und Jugendalter

ZusammenfassungDie Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) hat meistens erhebliche Konsequenzen über die gesamte Lebenszeit für die Betroffenen und ihre Familien. Die Störung ist im Kindes- und Jugendalter klar von anderen Vehaltensauffälligkeiten abzugrenzen, die im Rahmen psychischer oder somatischer Störungen auftreten können. Anhand mehrerer anamnestischer Quellen und unter Zuhilfenahme standardisierter klinischer Diagnoseverfahren sind bei jedem Patienten die diagnostischen Kriterien zu überprüfen. Komorbide Störungen, insbesondere Sozialverhaltensstörungen, affektive Erkrankungen und Teilleistungsprobleme, sind in der Diagnostik aufgrund ihrer Häufigkeit obligat zu berücksichtigen. Eine erfolgreiche Therapie der betroffenen Kinder umfasst häufig auch, eine ADHS bei weiteren Familienmitgliedern zu überprüfen und gegebenenfalls zu behandeln.SummaryAttention-deficit hyperactivity disorder (ADHD) has severe psychosocial consequences over the whole life course of patients and their families. During childhood and adolescence ADHD needs to be discriminated from other psychiatric or somatic disorders. Clinical diagnosis is met according to the diagnostic criteria by integrating several anamnestic sources and standardised diagnostic means. Diagnosis of comorbid disorders is obligatory due to their high prevalence rates. In some cases successful treatment of a child suffering from ADHD requires the additional diagnosis and treatment of ADHD in further family members.Attention-deficit hyperactivity disorder (ADHD) has severe psychosocial consequences over the whole life course of patients and their families. During childhood and adolescence ADHD needs to be discriminated from other psychiatric or somatic disorders. Clinical diagnosis is met according to the diagnostic criteria by integrating several anamnestic sources and standardised diagnostic means. Diagnosis of comorbid disorders is obligatory due to their high prevalence rates. In some cases successful treatment of a child suffering from ADHD requires the additional diagnosis and treatment of ADHD in further family members.

Die Bedeutung des Vorliegens einer Aufmerksamkeitsdefizit- und Hyperaktivitätsstörung (ADHS) bei Müttern für die Behandlung ihrer Kinder mit ADHS - Überblick und Skizze des Studienprotokolls einer multizentrischen randomisierten kontrollierten Psychotherapiestudie

Given its high heritability, ADHD frequently affects both children and their parents. In addition to co-morbid psychiatric disorders, adults with ADHD often complain of psychosocial difficulties, including family conflicts and poor parenting skills. Inconsistent childrearing practices and parent-child conflicts negatively affect the course of ADHD in children. Moreover, in the case of parental ADHD, the efficacy of parent training as part of the treatment for the childs ADHD seems to be reduced. This article presents a review of the impact of ADHD in mothers on the treatment of their ADHD children. Subsequently, the study protocol of a randomized controlled multi-centre trial to resolve the question of the efficacy of combined treatment of mothers and children is outlined. The main objective of the study is to evaluate whether the treatment of maternal ADHD enhances the efficacy of subsequent parent training as part of the treatment of ADHD in their children. 144 mother-child-pairs (both affected by ADHD according to DSM-IV criteria) are allocated to the trial. Mothers are randomized either to the treatment group (cognitive-behavioural group psychotherapy in combination with open methylphenidate treatment (Medikinet retard) titrated upward individually until the maximum dose of 1.3 mg/kg/day) or to the control group (supportive counselling). After 13 weeks of treatment individualised parent training is administered to both groups of mothers. Treatment comparisons of the primary endpoint (externalizing symptoms in the children) will be performed within a linear regression model.Zusammenfassung: Die ADHS weist eine hohe Erblichkeit auf. Kinder mit ADHS haben deswegen haufiger auch betroffene Eltern. Im Erwachsenenalter ist die Storung gekennzeichnet durch hohe Komorbiditatsraten und psychosoziale Beeintrachtigungen, die sich auch negativ auf Familienklima und erzieherische Kompetenzen auswirken. Inkonsistente Erziehungspraktiken und haufige Eltern-Kind-Konflikte tragen zur Stabilisierung der Storung bei Kindern bei. Es gibt auch Hinweise darauf, dass bei Vorliegen einer ADHS auf Elternseite die Wirksamkeit psychosozialer Interventionen zur Behandlung der ADHS des Kindes vermindert ist. Im Artikel wird ein Uberblick uber die Bedeutung des Vorliegens einer ADHS bei Muttern fur die Behandlung ihrer Kinder mit ADHS gegeben. Im Anschluss wird das Studienprotokoll einer kontrollierten randomisierten Behandlungsstudie zur Fragestellung skizziert, ob die Behandlung der ADHS der Mutter die Wirksamkeit eines Elterntrainings zur Behandlung der ADHS des Kindes erhoht. 144 Mutter-Kind-Paare (...

Empirically determined, psychopathological subtypes in children with ADHD

Objective: The aim of this study was to empirically determine subgroups of ADHD defined by specific patterns of psychopathology. Method: A clinical sample of 223 children with ADHD, aged 5 to 14 years, was examined with the Child Behavior Checklist (CBCL). In addition, comorbid psychiatric disorders, psychosocial risk factors, and socioeconomic status were assessed. Results: Cluster analysis of CBCL subscales yielded a solution with four distinct subgroups. While “externalizers” showed a high rate of comorbid oppositional defiant disorder (ODD) and conduct disorder (CD), “obsessive-compulsives” exhibited thought problems, low rates of comorbid CD, and high symptoms of inattention. “High psychiatric symptom carriers” had high rates of familial risk factors, acute life events, comorbid ODD, and CD. “Low psychiatric symptom carriers” also scored low in all other variables studied. Conclusion: Children with ADHD can be divided into four subgroups according to their CBCL-based psychopathology, and these subgroups differ in their risk factor profiles.

[Diagnosis of attention-deficit hyperactivity disorder in childhood and adolescence].

ZusammenfassungDie Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) hat meistens erhebliche Konsequenzen über die gesamte Lebenszeit für die Betroffenen und ihre Familien. Die Störung ist im Kindes- und Jugendalter klar von anderen Vehaltensauffälligkeiten abzugrenzen, die im Rahmen psychischer oder somatischer Störungen auftreten können. Anhand mehrerer anamnestischer Quellen und unter Zuhilfenahme standardisierter klinischer Diagnoseverfahren sind bei jedem Patienten die diagnostischen Kriterien zu überprüfen. Komorbide Störungen, insbesondere Sozialverhaltensstörungen, affektive Erkrankungen und Teilleistungsprobleme, sind in der Diagnostik aufgrund ihrer Häufigkeit obligat zu berücksichtigen. Eine erfolgreiche Therapie der betroffenen Kinder umfasst häufig auch, eine ADHS bei weiteren Familienmitgliedern zu überprüfen und gegebenenfalls zu behandeln.SummaryAttention-deficit hyperactivity disorder (ADHD) has severe psychosocial consequences over the whole life course of patients and their families. During childhood and adolescence ADHD needs to be discriminated from other psychiatric or somatic disorders. Clinical diagnosis is met according to the diagnostic criteria by integrating several anamnestic sources and standardised diagnostic means. Diagnosis of comorbid disorders is obligatory due to their high prevalence rates. In some cases successful treatment of a child suffering from ADHD requires the additional diagnosis and treatment of ADHD in further family members.Attention-deficit hyperactivity disorder (ADHD) has severe psychosocial consequences over the whole life course of patients and their families. During childhood and adolescence ADHD needs to be discriminated from other psychiatric or somatic disorders. Clinical diagnosis is met according to the diagnostic criteria by integrating several anamnestic sources and standardised diagnostic means. Diagnosis of comorbid disorders is obligatory due to their high prevalence rates. In some cases successful treatment of a child suffering from ADHD requires the additional diagnosis and treatment of ADHD in further family members.