Leonard A. Doerfler

Characteristics of Children and Adolescents Admitted to a Residential Treatment Center

Studies of youths in residential treatment that utilize systematic assessments and validated measures are rare. We examined psychopathology, family characteristics, occurrence of physical or sexual abuse, types of aggressive behavior, hyperactive/impulsive behavior, medical and neurological problems, and self-reported drug and alcohol use in 397 youth who were assessed using reliable measures and consecutively treated in a residential treatment center. Results indicate high rates of internalizing and externalizing psychopathology, aggressive behavior, and consistent gender differences, with girls having higher levels of internalizing and externalizing psychopathology and aggressive behavior. The sample was characterized by high rates of medical problems including asthma, seizures, and obesity, as well as evidence of extensive family dysfunction, including high rates of parental alcohol use, violence, and physical or sexual abuse. Residential treatment needs to progress beyond the one size fits all approach and develop more specific and empirically proven treatments for the specific needs of this population.

Symptoms of posttraumatic stress disorder following myocardial infarction and coronary artery bypass surgery

Psychosocial adjustment, particularly posttraumatic stress disorder (PTSD) symptoms, was assessed in a sample of 50 men 6-12 months after initial myocardial infarction (MI) or coronary artery bypass (CABG) surgery. Mean scores on the adjustment measures indicated relatively low levels of distress for the entire group. However, a small number of patients reported clinically significant elevations in anxiety, depression, anger, and ruminative thinking. Using DSM-III-R criteria, four patients met the criteria for PTSD on a self-report checklist. Four patients met the criteria for major depressive disorder on the Inventory to Diagnose Depression. Overall, the findings suggest that posttraumatic stress disorder-like reactions may be an unrecognized problem for some men who sustain an MI or undergo CABG surgery. These traumatic reactions are highly correlated with emotional distress, including depression, generalized anxiety, and anger.

An evaluation of the perceived stress scale in two clinical populations

The relation of perceived stress and psychosocial dysfunction was examined in two clinical samples identifying stress as a personal problem. Perceived stress was significantly correlated with self-reported negative affect and physical symptoms. Negative and total major life event scores also were significantly correlated with self-reported negative affect and physical symptoms. However, the perceived stress scale and the life events measures were moderately correlated, indicating that the two scales assess different features of the stress experience. A major finding of this study was that perceived stress scores were significantly correlated with affective and physical symptoms even after the variance associated with life events had been partialed out.

ADHD With Comorbid Oppositional Defiant Disorder or Conduct Disorder: Discrete or Nondistinct Disruptive Behavior Disorders?

Objective: In children with ADHD who have comorbid disruptive behavior diagnoses distinctions between oppositional defiant disorder (ODD) and conduct disorder (CD) remain unclear. The authors investigate differences between ODD and CD in a large clinical sample of children with ADHD. Method: Consecutively referred and systematically assessed male children and adolescents with either ADHD (n = 65), ADHD with ODD (n = 85), or ADHD with CD (n = 50) were compared using structured diagnostic interviews and parent, teacher, and clinician rating scales. Results: In children with ADHD, significant differences emerged between ODD and CD in the domains of delinquency, overt aggression, and ADHD symptom severity; ADHD with CD was most severe, followed by ADHD with ODD, and ADHD had the least severe symptoms. Distinctions between ADHD with CD and the other two groups were found for parenting, treatment history, and school variables. Conclusion: Within the limits of a cross-sectional methodology, results support clinically meaningful distinctions between ODD and CD in children with ADHD. (J. of Att. Dis. 2008; 12(2) 126-134)

Relationship of quality of life and perceived control with posttraumatic stress disorder symptoms 3 to 6 months after myocardial infarction

PURPOSE This study examined whether psychological variables were associated with posttraumatic stress disorder (PTSD) symptoms 3 to 6 months after myocardial infarction. METHODS The sample included 52 patients with myocardial infarction. A structured interview was used to obtain information about PTSD symptoms, quality of life, and ratings of perceived control, danger, and predictability, as well as information about stressful events that occurred during hospitalization. RESULTS Four patients (7.7%) met criteria for the diagnosis of PTSD. Elevated PTSD scores were associated with poorer quality of life (r = -0.32 to -0.79). Lower perceived control was associated with higher PTSD symptom scores (r = -0.30 to -0.52). Finally, PTSD scores were significantly correlated with the number of times patients were readmitted to the hospital (r = 0.35-0.57). CONCLUSIONS Approximately 8% of patients experienced PTSD 3 to 6 months following MI. Increasing levels of PTSD symptoms were correlated with poorer quality of life. Perceived lack of control during the MI and multiple hospitalizations may be related to the severity of PTSD symptoms.

Evaluating mental health outcomes in an inpatient setting: Convergent and divergent validity of the OQ-45 and BASIS-32

The evolution of managed behavioral health care has led to an increased emphasis on reliable and valid assessment of outcomes in clinical practice. The present study evaluated the convergent, divergent, and concurrent validity and sensitivity to change of two widely used measures: Behavior and Symptom Identification Scale (BASIS-32) and Outcome Questionnaire (OQ-45). Comparisons of the two measures revealed that both were sensitive to change over a relatively short inpatient stay. Both measures also showed evidence of convergent and divergent validity of specific subscales, although the total scores of each measure also were highly correlated. Evidence of concurrent validity was suggested by differences between diagnostic groups on specific subscale scores. Together with previous research, these results suggest that the BASIS-32 and OQ-45 can be useful measures for tracking patient functioning over a range of treatment contexts.

Aggressive Behavior in Abused Children

Abstract: Our objective was to investigate the relationship between a lifetime history of traumatic stress, defined as physical and/or sexual abuse and aggression and psychosocial functioning in a sample of clinically referred and nonclinically referred children and adolescents. This is a retrospective case comparison study. Three groups of children were identified, assessed, matched for age, and partially matched for gender. Children clinically referred to residential treatment with a history of abuse (N= 29) were compared with children clinically referred to residential treatment without a history of abuse (N= 29), and a nonclinical group of children residing in the community (N= 29). Variables investigating specific types of aggression, IQ, and psychopathology were assessed across the three groups. Clinically referred children scored worse on all measures compared with nonclinical community children. Clinically referred abused children scored higher on measures of aggression and significantly higher on measures of reactive aggression and verbal aggression than clinically referred nonabused children. Clinically referred abused children had significantly lower verbal IQ scores than clinically referred nonabused children, but no difference in psychopathology. Results support the importance of assessing specific types of aggression in samples of traumatized youths. Verbal information processing may be especially vulnerable in abused children and adolescents and enhance vulnerability to aggressive responding.

Conduct disorder subtype and comorbidity.

BACKGROUND Conduct disorder is considered difficult to treat, but comorbid psychiatric disorders may be a basis for treating some youths with conduct disorder. We sought to identify patterns of comorbid psychiatric diagnoses and psychopathology associated with conduct disorder by reported age-of-onset. METHODS Referred children and adolescents, aged 4-17 years old, were clinically evaluated. Ages of onset of CD symptoms (N=53) were ascertained and divided according to DSM-IV criteria as childhood onset (<10 years old) or adolescent onset (>or=10 years old). RESULTS Childhood-onset conduct disorder was associated with higher rates of ADHD and anxiety disorders, male gender, and perceived and total hostility scores than adolescent-onset conduct disorder. Adolescent-onset was associated with higher rates of PTSD, alcohol and substance use disorders, complex comorbidity (i.e., 6+ diagnoses lifetime), and female gender. CONCLUSIONS Understanding age-of-onset-related patterns of comorbidity may facilitate psychiatric treatment planning in children and adolescents with conduct disorder.

Self-initiated attempts to cope with depression

Depression has recently been conceptualized as involving deficits in selfcontrol (Mathews, 1977; Rehm, 1977). According to this model specific dysfunctions in self-control are responsible for depression. Initial evidence indicates that self-control programs designed to remediate these deficits are effective in alleviating depression (Fuchs & Rehm, 1977; Rehm, Fuchs, Roth, Kornblith, & Romano, 1979). Another line of research indicates that most people try to cope with depression on their own (Rippere, 1976, 1977, 1979). This suggests that selfinitiated attempts to cope with depression are a frequent occurrence. Surprisingly, very little is known about these naturally occurring attempts at self-control. The present study explored the role of behavioral self-control techniques in these self-initiated efforts to alleviate depression. Specifically, this study focused on the differences between people who had successfully coped with depression on their own and those who had not (cf. Perri & Richards, 1977).

Aggression, ADHD symptoms, and dysphoria in children and adolescents diagnosed with bipolar disorder and ADHD

BACKGROUND This study had two objectives: (1) examine characteristics of aggression in children and adolescents diagnosed with bipolar disorder and (2) determine whether the CBCL pediatric bipolar disorder profile differentiated youngsters with bipolar disorder from youngsters with ADHD. METHOD Children and adolescents referred to a pediatric psychopharmacology clinic were systematically evaluated for psychopathology using a psychiatrist-administered diagnostic interview, parent- and teacher-report rating scales assessing the childs behavior, and child-completed self-report scales. In this sample, 27 children and adolescents were diagnosed with bipolar disorder and 249 youngsters were diagnosed with ADHD without co-occurring bipolar disorder. These two groups were compared to determine whether there were significant differences on various measures of psychopathology. RESULTS Youngsters diagnosed with bipolar disorder were more verbally aggressive and exhibited higher levels of reactive aggression than youngsters with ADHD without co-occurring bipolar disorder. Youngsters with bipolar disorder also reported higher levels of depressive symptoms than youngsters with ADHD without bipolar disorder. The CBCL pediatric bipolar disorder profile did not accurately identify youngsters diagnosed with bipolar disorder. CONCLUSIONS The present findings present a picture of manic youngsters as verbally aggressive and argumentative, who respond with anger when frustrated. Youngsters diagnosed with bipolar disorder and ADHD exhibited significant levels of impulsive behavior and attention problems, but youngsters with bipolar disorder also exhibited significant levels of aggressive behavior and dysphoric mood. Finally, the CBCL pediatric bipolar disorder profile did not accurately identify youngsters who were diagnosed with bipolar disorder.