Gunilla Thernlund

ADHD and language impairment A study of the parent questionnaire FTF (Five to Fifteen).

The parental questionnaire FTF (Five to Fifteen) was given to parents of 76 children (mean age 11 years) diagnosed with ADHD. About half of the children had at least once been referred to a speech- and language pathologist. Most of them had not received any intervention or follow-up. A factor analysis identified six problem areas, which explain close to 75% of the total variation: Cognitive Skills, Motor/Perception, Emotion/Socialisation/Behaviour, Attention, Literacy Skills and Activity Control. The majority of the children had pragmatic problems, which are associated with some of the core aspects of the ADHD symptoms, especially inattention and impulsiveness. Communication and language comprehension caused these children many more problems than expressive language. Problems of reading and writing were very frequent. IQ-score was associated with maths and reading/writing. Additional items reflecting language skills, in particular language comprehension and pragmatics, were also found in other domains in the FTF, mainly in Executive functions, Learning and Social skills. Problems with language and pragmatics thus seem to be associated with the typical problems with learning and social skills in children with ADHD.

Psychological Stress and the Onset of IDDM in Children: A case-control study

OBJECTIVE The purpose of the study was to determine whether psychosocial stress during different life periods could be a risk factor in the etiology/pathogenesis of insulin-dependent diabetes mellitus (IDDM) in children. RESEARCH DESIGN AND METHODS In a population-based sample of 67 case patients 0–14 years of age and 61 matched healthy control subjects, life events during the entire lifespan before the onset of IDDM were recorded as well as measures of child behavior before onset, social support, and family function. RESULTS Negative life events occurring during the first 2 years of life, life events with difficult adaptation, child behavioral deviances, and a more chaotic family function were more common in the case group. A stepwise logistic regression indicated that negative life events in the first 2 years increased the risk of IDDM and that premorbid child behavior as well as dysfunctional hierarchical family pattern affect the risk. CONCLUSIONS Stress early in life may increase the risk for IDDM, presumably by affecting the autoimmune process. To confirm these results, it is necessary to make a truly prospective study.

Associations between cerebral blood-flow measured by single photon emission computed tomography (SPECT), electro-encephalogram (EEG), behaviour symptoms, cognition and neurological soft signs in children with attention-deficit hyperactivity disorder (ADHD).

Twenty‐eight children with attention‐deficit hyperactivity disorder (ADHD) were examined with SPECT (single photon emission computed tomography). Seven of the children had abnormal distribution of the regional cerebral blood‐flow (rCBF) on visual evaluation and 10 had abnormal EEG findings. The only clinical finding that differentiated the group with normal from abnormal rCBF was behaviour symptom load. A factor analysis of the rCBF in different regions of interest yielded one factor with low rCBF in the temporal and cerebellar regions and high rCBF in the subcortical and thalamic regions, which was significantly associated with the degree of motor impairment and results on a cognitive test (WISC). Another factor consisting of high rCBF in frontal and parietal regions had a significant negative correlation with the degree of behaviour symptoms. There was a negative correlation between the rCBF in the right frontal regions and the degree of behaviour symptoms. The number of minor physical anomalies (MPA) was negatively correlated to the rCBF in the frontal lobes bilaterally.

Reliability and validity of the assessment of neurological soft-signs in children with and without attention-deficit-hyperactivity disorder.

Aim  To study the value and reliability of an examination of neurological soft‐signs, often used in Sweden, in the assessment of children with attention‐deficit–hyperactivity disorder (ADHD), by examining children with and without ADHD, as diagnosed by an experienced clinician using the DSM‐III‐R.

Psychological reactions at the onset of insulin-dependent diabetes mellitus in children and later adjustment and metabolic control

The initial psychological reactions at the onset of insulin‐dependent diabetes mellitus (IDDM) in a population‐based sample of 76 children were studied with staff observations and a self‐report questionnaire for children 12 years of age and more. Younger children reacted with more anger and less distress than the older children. High initial self‐reported distress was associated with poorer subjective psychological IDDM adjustment at a follow‐up 10 months later for the older children. The childrens initial reactions as well as later adjustment were intimately associated with maternal initial reactions in the total group. The metabolic control, estimated as the mean level of the major fraction of glycosylated haemoglobin (Hb AIc) during the first 2 years, was poorer in the adolescent group. Initial anxiety over injections and protest but low general distress in mothers and children were associated with better metabolic control.

Relations between age, metabolic control, disease adjustment and psychological aspects in insulin-dependent diabetes mellitus

The relations between age, metabolic control, disease adjustment, and psychological factors in boys and girls with recently diagnosed insulin‐dependent diabetes mellitus (IDDM) were studied. Older girls had significant higher postremission glycosylated haemoglobin A (Hb Alc) levels (p= 0.008). Girls with more hospitalizations had a lower developmental level (p= 0.05), and had significantly more problems in the behavioural rating (p= 0.05). Boys with more hospitalizations had a more external locus of control (p= 0.01), more difficulties with disease adjustment, more emotional problems, and were also clinically assessed as having more behavioural problems. Boys showing more difficulties in psychological adjustment to the disease also had higher postremission Hb A1clevels (p= 0.02). Although Swedish children with IDDM of short disease duration do not differ from healthy children in important psychological aspects, older girls and a small group of problematic younger boys are at risk of developing metabolic imbalance after a short disease duration.

Parental social support and child behaviour problems in different populations and socioeconomic groups: A methodological study

In many research projects there is a need to apply a multifactorial approach. Practical reasons often make it necessary to use instruments that are not too time-consuming for each factor to be investigated. The Interview Schedule of Social Integration (ISSI) is proposed by Undén and Orth-Gomér as a suitable tool in measuring social support. It is increasingly used in Sweden. To further investigate its usefulness in measuring parental social support of importance for the children, an examination of the relation between the ISSI variables and Child Behaviour as well as Parental Psychopathology was undertaken, based on data from four studies: Psychosocial Factors and Child Diabetes, Single Parent Families in a child guidance clinic, a Clinical Child Psychiatric Ward Group and an Epidemiological Study of a Normal Swedish Population. The findings were that social support measured by ISSI had the expected associations to child behaviour as well as to parental psychopathology in the higher socioeconomic groups but not in the lower ones. The interpretation is made that ISSI does not measure qualitative aspects of social support but the sense of satisfaction with it. In the higher socioeconomic groups the sense of satisfaction may be a fairly good approximation of the actual quality even if it is probably confounded with personality trait factors. The same approximation cannot be made in lower socioeconomic groups and in psychiatric populations. In these cases there is a need to pay more attention to the actual quality of the social network.

ADHD symptoms and maturity--a study in primary school children.

Aim: To study if age and non‐behavioural measures of biological maturity have any associations with attention deficit hyperactivity disorder (ADHD).

Treatment of Attention Deficit/Hyperactivity Disorder With Amphetamine: Short-Term Effects on Family Interaction.

Objective: This research seeks to study the impact on family function after 3 months of treatment with amphetamine. Method: A total of 43 children, 6 to 11 years of age, with ADHD were treated with amphetamine for 3 months. Family function was studied before and after treatment by parent self-rating and independent observer ratings of videotaped parent—child interactions. Results: The families with a child with ADHD were found to be more dysfunctional than control families. Families with children with severe ADHD behavior showed evidence of more family dysfunction compared to families with children with less severe ADHD behavior. After 3 months of treatment with amphetamine, the childrens behavior and the mothers well-being and some aspects of parent-reported and observer-rated family functioning improved. Conclusion: This study gives support to the notion that some aspects of family dysfunction may be related to the childs ADHD behavior. (J. of Att. Dis. 2008; 12(1) 83-91)Objective: This research seeks to study the impact on family function after 3 months of treatment with amphetamine. Method: A total of 43 children, 6 to 11 years of age, with ADHD were treated with amphetamine for 3 months. Family function was studied before and after treatment by parent self-rating and independent observer ratings of videotaped parent—child interactions. Results: The families with a child with ADHD were found to be more dysfunctional than control families. Families with children with severe ADHD behavior showed evidence of more family dysfunction compared to families with children with less severe ADHD behavior. After 3 months of treatment with amphetamine, the childrens behavior and the mothers well-being and some aspects of parent-reported and observer-rated family functioning improved. Conclusion: This study gives support to the notion that some aspects of family dysfunction may be related to the childs ADHD behavior.

Atomoxetine's Effect on Societal Costs in Sweden

Objective: To compare societal costs between patients treated with atomoxetine and placebo in Sweden. Method: Ninety-nine pediatric ADHD patients were randomized to a 10-week double-blind treatment with atomoxetine (n = 49) or placebo (n = 50). All parents received four sessions of psycho-education. Parents filled out a resource utilization questionnaire covering the 10 weeks prior to treatment and the 10-week on-treatment period. Published unit costs/prices were used to calculate costs. Results: Mean on-treatment costs in the atomoxetine group (SEK [Swedish Krona] 4,558) were significantly lower compared with placebo (SEK 7,684) after adjusting for baseline costs and site (p = .007). All 99 patients entered an open atomoxetine extension phase. Both groups had numerical reductions in direct and indirect costs while on atomoxetine treatment during the extension phase. The atomoxetine medication costs were offset by the reductions in direct nonmedical and indirect costs. Conclusions: These data provide preliminary evidence that atomoxetine together with parental psycho education reduces nonmedication costs associated with ADHD in Sweden. (J. of Att. Dis. 2010; 13(6) 618-628)