Cynthia W. Santos

Patterns of behavioral adjustment and maladjustment in mental retardation : Comparison of children with and without ADHD

A variety of behavioral and emotional problems have been associated with attention deficit disorder with hyperactivity (ADHD) in children of average intellect. In contrast, little is known about concomitant behavioral and emotional problems in children with ADHD and mental retardation. In this study, we used the Personality Inventory for Children-Revised to assess the behavioral adjustment of 48 children with mental retardation and ADHD compared to that of 47 children with mental retardation without ADHD. The ADHD group had significantly more symptoms of depression, family conflict, noncompliance, anxiety, hyperactivity, inadequate social skills, and academic problems. Results are strongly suggestive of significant behavioral and emotional problems in children with ADHD and mental retardation, thus mirroring the pattern associated with ADHD in the general school-age population.

Effects of extended release methylphenidate treatment on ratings of attention-deficit/hyperactivity disorder (ADHD) and associated behavior in children with autism spectrum disorders and ADHD symptoms.

OBJECTIVE The purpose of this study was to examine the behavioral effects of four doses of psychostimulant medication, combining extended-release methylphenidate (MPH) in the morning with immediate-release MPH in the afternoon. METHOD The sample comprised 24 children (19 boys; 5 girls) who met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV-TR) criteria for an autism spectrum disorder (ASD) on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS), and had significant symptoms of attention-deficit/hyperactivity disorder (ADHD). This sample consisted of elementary school-age, community-based children (mean chronological age=8.8 years, SD=1.7; mean intelligence quotient [IQ]=85; SD=16.8). Effects of four dose levels of MPH on parent and teacher behavioral ratings were investigated using a within-subject, crossover, placebo-controlled design. RESULTS MPH treatment was associated with significant declines in hyperactive and impulsive behavior at both home and school. Parents noted significant declines in inattentive and oppositional behavior, and improvements in social skills. No exacerbation of stereotypies was noted, and side effects were similar to those seen in typically developing children with ADHD. Dose response was primarily linear in the dose range studied. CONCLUSIONS The results of this study suggest that MPH formulations are efficacious and well-tolerated for children with ASD and significant ADHD symptoms.

The Brief Psychiatric Rating Scale for Children (BPRS-C): Validity and Reliability of an Anchored Version

OBJECTIVE Because the accuracy of problems reported by referred children may be compromised by their academic, cognitive, or motivational limitations, clinician rating forms may contribute to the accurate assessment of youth adjustment. One such measure, the 21-item Brief Psychiatric Rating Scale for Children (BPRS-C), received psychometric study to estimate its potential contribution to the measurement of symptom dimensions. BPRS-C reliability and concurrent validity were calculated for youths who were receiving psychiatric services within a medical school department. METHOD Five hundred forty-seven children aged 3 to 18 years were rated by faculty or trainees; a subsample of 90 was concurrently rated by two observers. BPRS-C psychometric performance was demonstrated through interrater agreement, factor analysis, and multivariate analyses of variance across seven diagnosis-based groups. RESULTS Although items and scales demonstrated substantial reliability and concurrent validity, item factor analysis revealed a few apparent errors in item-to-scale assignment. These errors were minimized by the use of three new second-order factor-derived scales: Internalization, Developmental Maladjustment, and Externalization. CONCLUSIONS The BPRS-C can be easily integrated into academic clinical practice and is a reliable and valid method of child description. Additional study of three new BPRS-C factor scales and the application of the BPRS-C to the quantification of clinician observation of child symptomatic status are warranted.

Effects of methylphenidate on behavioral adjustment in children with mental retardation and ADHD: Preliminary findings from a study in progress

In this preliminary report from a study in progress, the effects of methylphenidate on behavioral adjustment in children (N=13) with mental retardation (MR) and Attention Deficit Hyperactivity Disorder (ADHD) were investigated using a placebo-controlled, double blind, crossover design. Parent and teacher behavioral ratings, and reports of side effects, were obtained with placebo, 0.15 mg/kg, 0.30 mg/kg, and 0.60 mg/kg BID dosages of methylphenidate. Results revealed significant declines in ADHD symptomatology (e.g., inattention, hyperactivity) with medication treatment, with the most significant declines appearing at the 0.60 mg/kg dose of the medication. No significant behavioral improvements (relative to placebo) were noted below the 0.60 mg/kg threshold, i.e., at the 0.15 mg/kg or 0.30 mg/kg dosages. These preliminary results strongly suggest that teachers may be more sensitive raters of symptoms of ADHD, or else may simply have more opportunity to observe the core symptoms of ADHD in a setting in which such symptoms are most likely to be problematic. Although teachers appeared to be more sensitive raters of ADHD symptomatology, parents may have been more sensitive raters of symptoms of side effects than were teachers. Results suggest that both parents and teachers provide important information in titrating stimulant medication in children with MR and ADHD.

Comparing and Contrasting the Use of Problem-Based Learning in Child and Adolescent Psychiatry Programs

ObjectiveProblem-based learning (PBL) is one of the core components of medical education. To facilitate the spread and use of PBL in child and adolescent psychiatry (CAP) fellowship training, a special interest study group (SISG) was formed at the American Academy of Child and Adolescent Psychiatry (AACAP). Different approaches to the implementation of PBL between programs represented at the SISG are compared in this report.MethodsThe authors distributed a survey to SISG participants after the 2015 annual AACAP meeting, which gathered information about the different approaches programs use to implement PBL in graduate medical education.ResultsSix CAP training programs responded to the survey, providing descriptions of the structure and content of PBL seminars. Programs chose to include a wide variety of topics in PBL courses and approach course organization in a number of ways. To the degree that PBL draws from identified reference texts, programs were similar in selecting definitive textbooks, practice parameters, and seminal articles.ConclusionsThis small pilot study is intended to provide a snapshot of the state of PBL implementation in CAP fellowship programs. It reflects that programs can incorporate PBL in a variety of ways, tailored to the needs of the institution. Future directions of research include assessment of resident satisfaction with PBL, impact on resident education, and identifying successful methods of implementation of PBL.