Gail S. Elkind

Attention Deficit, Conduct, Oppositional, and Anxiety Disorders in Children: I. A Review of Research on Differentiating Characteristics

Abstract Studies comparing Attention Deficit. Anxiety, and Conduct Disorders are reviewed. Most studies only compare one diagnostic group with normal subjects, and there are remarkable similarities to observed abnormalities across diagnostic groups. The few studies that have compared Attention Deficit with Hyperactivity (ADDH) with Conduct Disorder with or without Anxiety Disorder suggest that ADDH may be a cognitive disorder, possibly of neurodevelopmental origin; Conduct Disorder one of social relationships of psychosocial origin; and Anxiety Disorder less predominantly male, associated with parental anxiety, and less severe in every way than the other two. Coexistence of Attention Deficit and Conduct Disorders is probably common and increases the degree of disability.

Attention deficit, conduct, oppositional, and anxiety disorders in children: II. Clinical characteristics.

Abstract One hundred and five children aged 5-12 with diagnoses of Anxiety, Attention Deficit (ADDH), Conduct, or Oppositional Disorders were compared with each other and with normal subjects. Conduct and Oppositional Disorders resembled each other and seldom occurred in the absence of ADDH so were combined into an ADDH plus Conduct group. Anxiety Disorder children were less predominantly male, less socially or academically disabled, but had more anxious parents. The two ADDH groups resembled each other but the addition of Conduct Disorder brought greater social disability and more adverse family environments.

Attention Deficit, Conduct, Oppositional, and Anxiety Disorders in Children: III. Laboratory Differences.

Children aged 5–13 years with DSM-III diagnoses of Attention Deficit (ADDH), Anxiety, (ANX), or Conduct plus ADDH (HC) Disorder and matched normal controls were compared on a set of laboratory measures of impulsivity, arousal, motor performance, activity level, and cognition, and on behavior ratings during testing. While ANX patients did not differ from their controls, ADDH and HC patients did on Verbal IQ, most of the behavior ratings, and on about one-third of the test variables. ANX patients were about 1 year older, and more likely to be female, than ADDH and HC patients. When age, sex, and verbal IQ effects were partialed out, very few differences among the three diagnostic groups remained. The importance of precise control of such variables is emphasized and the impact of the failure to do so in past studies is discussed. The question is raised whether the deficit in verbal IQ is not so much a defect of matching as the essential feature of ADDH from which most of the other commonly reported cognitive symptoms stem.

Follow-up results from a randomised controlled trial evaluating in- and outpatient pain management programmes

&NA; This study reports a 9–18 month follow‐up of a randomised controlled trial of pain management programmes for chronic, non‐malignant pain. Twenty‐two inpatients, 18 outpatients and 12 control subjects completed the follow‐up assessments. Significant treatment effects were demonstrated by the inpatient group on pain ratings, the Pain Behaviour Checklist, and General Health Questionnaire, with similar effects demonstrated by the outpatient group on the former 2 measures. The findings were confounded by higher inpatient scores at pretreatment, in comparison with the 2 other conditions. There was a high drop‐out rate of subjects, particularly from the control condition which illustrates the limitations of controlled group designs in this area. Analgesic use, activity levels and pain ratings were also evaluated using the criteria for ‘success’ described by Malec et al. (1981). Results indicated that 68% of inpatients, 61% of outpatients and 21% of control subjects met all 3 criteria. Both treatment programmes were effective in returning patients to paid employment, whilst 3 control group patients gave up work. The cost‐benefit implications of these changes are discussed. We conclude that pain management programmes contribute substantially to the rehabilitation of chronic pain sufferers.

Maternity Blues: Phenomena and Relationship to Later Post Partum Depression

As part of a prospective investigation of postnatal psychiatric disorder, 66 women, randomly selected antenatally, completed visual analogue scales postpartum and rated their mood state daily for two weeks following childbirth. They were then interviewed using the Goldberg Standardised Psychiatric Interview on four occasions up to 14 months postpartum. Dysphoric mood was temporally related to childbirth. Emotional lability was the important affective component of the puerperium. A significant correlation was found between the blues and subsequent postnatal depression. Lability of mood in the puerperium was related to psychiatric symptoms up to 14 months postpartum and was the strongest predictor of later psychopathology. Maternity blues ratings were not accounted for by labour variables.

Unstress: A low-cost community psychology approach to stress-management: An evaluated case study from New Zealand.

This research concerns an attempt to design and evaluate a 10-week, lay- led, low-cost stress-management program for dissemination at the community level. It is based on community needs assessment, empowerment, community control and other community psychology principles, and is combined with a cognitive-behavioral approach to stress management derived from health psychology. An evaluated trial reported here covers a 5-year period involving 61 groups, 15 leaders, and 448 respondents in 14 different community locations. On all measures, significantly positive results were obtained, and these were maintained or increased over 12-month follow-up. These results, plus the low dropout rate (16%) and high participant satisfaction (90%), suggest that this is a successful program that owes much of its strength to a community psychology approach.

Scanning two memorized lists

Subjects were timed as they decided whether singly presented probe words belonged to one or the other of two memorized lists, or to neither list. Each list varied in length from one to four words. Reaction times increased linearly with the combined number of words in the two lists. When there was no a priori basis for distinguishing the lists, the slope of the function for positive test probes was 33–35 msec per word higher than that for negative probes. The slope for negative probes was 58 msec per word in one experiment and 46 msec per word in another. This suggests that subjects first scanned the combined lists exhaustively to determine whether the probe was present; if it was not, they made a negative response, and if it was, they scanned again to determine which list it was in. When the words in the two lists were conceptually distinct (one list representing animate and the other inanimate objects), the difference in slope was reduced to only 6 msec per word, suggesting that the second scan was all but eliminated.

Superhealth basic: Development and evaluation of a low-cost community-based lifestyle change programme

This research describes the development and evaluation of a community-based lifestyle change health promotion programme in New Zealand. The six-week small group programme, called Superhealth Basic, comes as a low-cost resource kit capable of widespread distribution in the community. It is based on a combination of health and community psychology principles and methods, and is designed to be run by untrained lay leaders. A quasi-experimental trial involving 141 participants in 19 groups produced results showing significant positive changes in behaviour, health and wellbeing, with a high level of participant satisfaction and low dropout rates. At 12-month follow-up, the benefits of the programme were found to have been maintained with continuing expression of satisfaction with the programme. As a result of this research, Superhealth Basic is now available as a community resource throughout New Zealand.