Lauren D. Haisley

Can Screening with the Ages and Stages Questionnaire Detect Autism

Objective: Parents rely on pediatricians to monitor their childs development. The American Academy of Pediatrics recommends routine developmental screening with both broadband and autism-specific instruments at specified ages. If broadband screeners can detect autism risk, this might minimize the burden of administering autism-specific screens to all children. The current study examines the ability of the Ages and Stages Questionnaire—Third Edition (ASQ-3) to identify children at risk for autism. We looked at ASQ-3 scores of children who screen positive on the Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R), children who continue to screen positive on the M-CHAT-R Follow-up Interview, and children diagnosed with autism spectrum disorder (ASD). Methods: A total of 2848 toddlers, aged 16 to 30 months, were screened with the ASQ-3 and M-CHAT-R across 20 pediatric sites. Children who screened positive on the M-CHAT-R and its follow-up interview were offered a diagnostic evaluation. Results: Using the “monitor and/or fail” cutoff on any domain, the ASQ-3 identified 87% of the children who screened positive on the M-CHAT-R with follow-up and 95% (20/21) of those diagnosed with an ASD. Monitor and/or fail on the Communication domain alone also identified 95% of the diagnosed children. Conclusions: Scores below the “monitor” cutoff on the Communication domain of the ASQ-3 can indicate initial concern requiring autism-specific follow-up. If these results are confirmed with a sample large enough to separately examine toddlers of different ages and different cultural backgrounds, it may be feasible to implement a 2-stage screening strategy, with autism-specific screening reserved for those who are positive on a broadband screen.

Failure to maintain set as a predictor of childhood depression within a children's psychiatric inpatient sample

Despite a wealth of studies in adults and adolescents, only a handful of studies have examined executive function in childhood depression. This study utilized retrospective chart review of a childrens psychiatric inpatient program to evaluate executive function via Wisconsin Card Sorting Test (WCST) in 33 children (6-12 years old) with a depressive disorder and 61 age/sex-matched children without a depressive disorder referred for neuropsychological evaluation. WCST categories, perseverative errors, and failure to maintain set errors were examined as potential predictors of depressive disorder diagnosis and self-reported depressive symptoms. After controlling for age, length of hospital stay, and ADHD, failure to maintain set significantly predicted depressive disorder diagnosis. Failure to maintain set was also significantly associated with self-reported depressive symptoms. Current findings provide preliminary evidence to suggest that failure to maintain set may reflect a core deficit of childhood depression. While findings are preliminary, this may have important implications for the diagnosis and treatment of childhood depression.

The role of inhibitory control in the hospitalization of children with severe psychiatric disorders

Objective: Inhibitory control is a heterogeneous domain involving multiple inhibitory processes at levels of behavior, attention/cognition, and emotion/motivation. Prior studies have identified an underlying role of inhibitory control in the manifestation of childhood-onset psychiatric symptoms. This study investigated the inhibitory control abilities of children within a severe, childhood psychiatric sample. Method: A medical chart review was conducted for 100 children who received a neuropsychological evaluation during a children’s psychiatric inpatient program hospitalization from 2010 to 2014. Three measures neurocognitive of inhibitory control, Stroop Color–Word Score, CPT-II Commission Errors, and WCST Failure to Maintain Set were used in the present study. The presence of externalizing behaviors at hospital admission was classified as poor behavioral/self-control. Results: Forty-eight percent of the sample displayed evidence of inhibitory control impairment on neurocognitive measures, with 40% displaying response inhibition impairment and only 5–7% displaying interference control impairment. Similarly elevated rates of impairment were found in those children without attention deficit hyperactivity disorder (ADHD). Depressive disorders were associated with interference control, while ADHD was associated with interference control and response inhibition. Receiver Operating Characteristic analysis found that response inhibition predicted a prolonged hospitalization in an older males subgroup but not in the younger males or females subgroups. Conclusions: Current findings suggest that inhibitory control impairments are highly prevalent in the children’s psychiatric inpatient setting and associated with specific psychiatric disorders, although the influence of these impairments on subsequent outcome may be limited to a select portion of children. These findings highlight the importance of neuropsychological evaluation and management in childhood psychiatric disorders.

Neurocognitive Phenotypes in Severe Childhood Psychiatric Disorders.

Abstract This study investigated the presence of potential neurocognitive phenotypes within a severe childhood psychiatric sample. A medical chart review was conducted for 106 children who received a neuropsychological evaluation during children’s psychiatric inpatient program hospitalization. A hierarchical cluster analysis was conducted to identify distinct clinical clusters based on neurocognitive measures. Cluster analysis identified four distinct clusters, subsequently labeled neurocognitive phenotypes: “intact cognition” (27%), “global dysfunction” (20%), “organization/planning” (21%), and “inhibition-memory” (32%). Significant differences were identified in history of legal involvement and antipsychotic medications at hospital admission. Differences between none-minimal and moderate-high neurocognitive dysfunction were identified in age, amount of diagnoses and antipsychotic medications at admission, and hospital length of stay. Current findings provide preliminary evidence of underlying neurocognitive phenotypes within severe childhood psychiatric disorders. Findings highlight the importance of neuropsychological evaluation in the treatment of childhood psychiatric disorders.

Executive and nonexecutive demands of constructional measures within a children’s psychiatric inpatient setting

ABSTRACT This study examined the role of executive functioning in constructional task performance (measured with the Rey Complex Figure Test-Copy Condition [RCFT] and Beery-Buktenica Developmental Test of Visual-Motor Integration [Beery-VMI]) within a children’s psychiatric inpatient setting. A chart review was conducted for 88 children (aged 6–12) who received a neuropsychological evaluation during a psychiatric inpatient hospitalization. Multiple regression analyses investigated the role of executive and nonexecutive demands on RCFT and Beery-VMI performance. Forty-three percent of the sample displayed a constructional weakness. Children with a constructional weakness had lower FSIQ scores and a higher rate of executive dysfunction. Performance on the RCFT was independently predicted by perceptual ability (i.e., Matrix Reasoning; p = .008; β = .340) and attention/executive dysfunction (p = .003; β = −.342; 9.4% of variance), while performance on the Beery-VMI was independently predicted by constructional ability (i.e., Block Design; p = .004, β = .338). Results of this study demonstrate that the RCFT has greater executive demand than the VMI and yields a greater rate of impaired performance in an inpatient child sample as compared to the VMI. Clinical and research practices should consider the distinct differences between various constructional measures to ensure their proper use and interpretation with consideration to their varying executive and nonexecutive demands.