Eric A. Youngstrom

Meta-analysis of intellectual and neuropsychological test performance in attention-deficit/hyperactivity disorder.

Cognitive measures are used frequently in the assessment and diagnosis of attention-deficit/hyperactivity disorder (ADHD). In this meta-analytic review, the authors sought to examine the magnitude of differences between ADHD and healthy participants on several commonly used intellectual and neuropsychological measures. Effect sizes for overall intellectual ability (Full Scale IQ; FSIQ) were significantly different between ADHD and healthy participants (weighted d =.61). Effect sizes for FSIQ were significantly smaller than those for spelling and arithmetic achievement tests and marginally significantly smaller than those for continuous performance tests but were comparable to effect sizes for all other measures. These findings indicate that overall cognitive ability is significantly lower among persons with ADHD and that FSIQ may show as large a difference between ADHD and control participants as most other measures.

Patterns and correlates of agreement between parent, teacher, and male adolescent ratings of externalizing and internalizing problems.

The authors examined how well 394 triads of male youths, caregivers, and teachers agreed about youth problems reported on the Achenbach checklists. Dyadic agreement was measured through difference scores (subtracting the raw score of youth self-report from the caregivers or teachers score for shared items), q correlations between pairs of raters across items, and D2 (generalized distance between item profiles) for both externalizing and internalizing items. Teachers reported fewer internalizing and externalizing problems than did caregivers or youths. Teacher-youth disagreement was higher for African American than European American males about externalizing criteria. Caregiver depression and stress (but not paternal antisocial behavior or maternal substance abuse) correlated with higher disagreement with other informants about all criteria. These factors appear to increase disagreement about the level of problems but not about specific symptom patterns.

Emotion Knowledge as a Predictor of Social Behavior and Academic Competence in Children at Risk

Following leads from differential emotions theory and empirical research, we evaluated an index of emotion knowledge as a long-term predictor of positive and negative social behavior and academic competence in a sample of children from economically disadvantaged families (N = 72). The index of emotion knowledge represents the childs ability to recognize and label emotion expressions. We administered control and predictor measures when the children were 5 years old and obtained criterion data at age 9. After controlling for verbal ability and temperament, our index of emotion knowledge predicted aggregate indices of positive and negative social behavior and academic competence. Path analysis showed that emotion knowledge mediated the effect of verbal ability on academic competence. We argue that the ability to detect and label emotion cues facilitates positive social interactions and that a deficit in this ability contributes to behavioral and learning problems. Our findings have implications for primary prevention.

ADHD and Achievement Meta-Analysis of the Child, Adolescent, and Adult Literatures and a Concomitant Study With College Students

This article presents results from two interrelated studies. The first study conducted a meta-analysis of the published literature since 1990 to determine the magnitude of achievement problems associated with attention-deficit/hyperactivity disorder (ADHD). Effect sizes were significantly different between participants with and without ADHD (sample weighted r = .32, sample weighted d = . 71; p = .001). Effects were also examined according to the moderators of age, gender, achievement domain (reading, math, spelling), measurement method (standardized tests vs. grades, parent/teacher ratings, etc.), sample type (clinical vs. nonclinical), and system used to identify ADHD (DSM-III-R vs. DSM-IV). Significant differences emerged from the moderator comparisons. The second study, using averaged effect sizes from the first study as a baseline for comparison, investigated achievement levels for an understudied age group with ADHD, namely, college students. Unlike previous studies at the college level, the sample incorporated both student and parent ratings (N = 380 dyads). The results were comparable to outcomes from the meta-analysis for college students and adults. Analyses demonstrated modest (R = .21) but meaningful predictive validity across 1 year to end-of-first-year grades. However, unlike earlier studies with children and adolescents, student ratings were as predictive as parent ratings. Findings are discussed in terms of the impact of moderator variables on ADHD and achievement.

Behavioral outcomes and evidence of psychopathology among very low birth weight infants at age 20 years.

Objective. Information on the mental health of very low birth weight (VLBW; <1500 g) children in young adulthood is sparse. We thus sought to examine gender-specific behavioral outcomes and evidence of psychopathology in a cohort of VLBW young adults at 20 years of age. Methods. We compared a cohort of 241 survivors among VLBW infants who were born between 1977 and 1979 (mean birth weight: 1180 g; mean gestational age at birth: 29.7 weeks), 116 of whom were men and 125 of whom were women, with 233 control subjects from the same population in Cleveland who had normal birth weights (108 men and 124 women). Young adult behavior was assessed at 20 years of age with the Achenbach Young Adult Self-Report and the Young Adult Behavior Checklist for parents. In addition, the young adults and parents completed the ADHD Rating Scale for Adults. Gender-specific outcomes were adjusted for sociodemographic status. Results. VLBW men reported having significantly fewer delinquent behaviors than normal birth weight (NBW) control subjects, but there were no differences on the Internalizing, Externalizing, or Total Problem Behavior scales. Parents of VLBW men reported significantly more thought problems for their sons than did parents of control subjects. VLBW women reported significantly more withdrawn behaviors and fewer delinquent behavior problems than control subjects. Their rates of internalizing behaviors (which includes anxious/depressed and withdrawn behaviors) above the borderline clinical cutoff were 30% versus 16% (odds ratio: 2.2; 95% confidence interval [CI]: 1.2-4.1). Parents of VLBW women reported significantly higher scores for their daughters on the anxious/depressed, withdrawn, and attention problem subscales compared with control parents. The odds ratios for parent-reported rates above the borderline-clinical cutoff among women for the anxious/depressed subscale was 4.4 (95% CI: 1.4-13.5), for thought problems was 3.7 (95% CI: 1.2-11.6), and for attention problems was 2.4 (95% CI: 1.0-5.5). There were no differences in the young adult self-report of attention-deficit/hyperactivity disorder (ADHD). Parents of VLBW men reported higher mean scores on the attention subtype of ADHD but not higher rates of ADHD. Conclusion. The increase in psychopathology among VLBW survivors in young adulthood indicates a need for anticipatory guidance and early intervention that might help to prevent or ameliorate potential psychopathology.

Validation of proposed DSM-5 criteria for autism spectrum disorder.

OBJECTIVE The primary aim of the present study was to evaluate the validity of proposed DSM-5 criteria for autism spectrum disorder (ASD). METHOD We analyzed symptoms from 14,744 siblings (8,911 ASD and 5,863 non-ASD) included in a national registry, the Interactive Autism Network. Youth 2 through 18 years of age were included if at least one child in the family was diagnosed with ASD. Caregivers reported symptoms using the Social Responsiveness Scale and the Social Communication Questionnaire. The structure of autism symptoms was examined using latent variable models that included categories, dimensions, or hybrid models specifying categories and subdimensions. Diagnostic efficiency statistics evaluated the proposed DSM-5 algorithm in identifying ASD. RESULTS A hybrid model that included both a category (ASD versus non-ASD) and two symptom dimensions (social communication/interaction and restricted/repetitive behaviors) was more parsimonious than all other models and replicated across measures and subsamples. Empirical classifications from this hybrid model closely mirrored clinical ASD diagnoses (90% overlap), implying a broad ASD category distinct from non-ASD. DSM-5 criteria had superior specificity relative to DSM-IV-TR criteria (0.97 versus 0.86); however sensitivity was lower (0.81 versus 0.95). Relaxing DSM-5 criteria by requiring one less symptom criterion increased sensitivity (0.93 versus 0.81), with minimal reduction in specificity (0.95 versus 0.97). CONCLUSIONS Results supported the validity of proposed DSM-5 criteria for ASD as provided in Phase I Field Trials criteria. Increased specificity of DSM-5 relative to DSM-IV-TR may reduce false positive diagnoses, a particularly relevant consideration for low base rate clinical settings. Phase II testing of DSM-5 should consider a relaxed algorithm, without which as many as 12% of ASD-affected individuals, particularly females, will be missed. Relaxed DSM-5 criteria may improve identification of ASD, decreasing societal costs through appropriate early diagnosis and maximizing intervention resources.

Family Instability and the Problem Behaviors of Children From Economically Disadvantaged Families

This longitudinal study examined the relation between family instability and the problem behaviors of children from economically disadvantaged families. Family instability was assessed when the children were ages 5 and 7 and included number of residence changes, changes of intimate caregiver relationships, and recent negative life events. The results showed direct concurrent relations between family instability and preschool childrens externalizing behavior in the context of other family process variables, relations between subsequent family instability and 1st-grade childrens internalizing behavior (i.e., with preschool behavior ratings controlled), and an effect for persistent instability across grade. Moderator effects were also found for child variables, including gender, temperamental adaptability, and prior externalizing scores.

Meta-analysis of epidemiologic studies of pediatric bipolar disorder

OBJECTIVE Meta-analyze all published epidemiologic studies reporting pediatric mania or bipolar disorder to investigate whether pediatric bipolar disorder is becoming more prevalent and whether rates vary significantly by country. DATA SOURCES Searches of PubMed and PsycInfo were conducted through the spring of 2010 using the following search terms: child, pediatric, young, adolescent, epidemiology, prevalence, bipolar, mania, suicide, and psychiatric. We also manually reviewed references in recent reviews of epidemiology of bipolar disorder. STUDY SELECTION All studies reporting rates for mania or hypomania in community epidemiologic samples with participants up to 21 years of age. DATA EXTRACTION All articles were coded to extract relevant variables. Prevalence rates were calculated from reported number of cases with bipolar disorders, then logit transformed. Twelve studies were included, enrolling 16,222 youths between the ages of 7 and 21 years during a period from 1985 to 2007. Six samples were from the United States; 6 were from other countries (the Netherlands, the United Kingdom, Spain, Mexico, Ireland, and New Zealand). RESULTS The overall rate of bipolar disorder was 1.8% (95% CI, 1.1%-3.0%). There was no significant difference in the mean rates between US and non-US studies, but the US studies had a wider range of rates. The highest estimates came from studies that used broad definitions and included bipolar disorder not otherwise specified. Year of enrollment was negatively correlated with prevalence (r = -0.04) and remained nonsignificant when controlling for study methodological differences. CONCLUSIONS Mean rates of bipolar disorder were higher than commonly acknowledged and not significantly different in US compared to non-US samples, nor was there evidence of an increase in rates of bipolar disorder in the community over time. Differences in diagnostic criteria were a main driver of different rates across studies.

Emotion knowledge in economically disadvantaged children: Self-regulatory antecedents and relations to social difficulties and withdrawal.

We examined the relations of verbal ability and self-regulation in preschool to emotion knowledge in first grade, and concurrent relations between emotion knowledge and indexes of social functioning in 143 children from low-income families. After controlling for childrens verbal ability in preschool, teacher reports of attentional control and caregiver reports of behavioral control in preschool predicted childrens emotion expression knowledge and emotion situation knowledge 2 years later. After controlling for verbal ability and attentional and behavioral control, childrens emotion knowledge predicted concurrent teacher-reported social problems and social withdrawal. Results suggest that low levels of emotion knowledge co-occur with many important aspects of childrens early social adaptation.

Who Are the Comorbid Adolescents? Agreement Between Psychiatric Diagnosis, Youth, Parent, and Teacher Report

The investigators examined the rates of psychiatric comorbidity for externalizing and internalizing behavior problems, using semistructured diagnostic interview and parent, teacher, and youth report on the Achenbach checklists. The study also evaluated the effects of conjunctive, compensatory, and disjunctive data combination strategies. Using the same data and identical diagnostic thresholds, between 5 and 74% of 189 youths presenting to an outpatient clinic were identified as having comorbid internalizing and externalizing problems. Parent report and semistructured interview indicated the highest comorbidity rates. Despite good cross-source agreement (rs .29–.58), there was very little agreement about which specific youths presented with comorbid internalizing and externalizing problems (kappas .14–.40). Results also indicate that single DSM-IV disorders, such as bipolar disorder, can manifest “comorbid” patterns of behavior problems on checklists.