Mark A. Stewart

Hyperactive children as teenagers: a follow-up study.

We studied 83 children between the ages of 12 and 16 who had been diagnosed as having the hyperactive syndrome 2 to 5 years earlier. About half of the children were markedly improved, one-quarter remained unchanged, and the remaining quarter lay in between. The symptoms of restlessness, distractibility, impulsiveness, excitability, and aggressiveness seemed to persist in most of the children, and were associated with poor performance in school and low self-esteem. A number of the children were involved in delinquent behavior.

An adoption study of attention deficit/hyperactivity/aggression and their relationship to adult antisocial personality

This study used an adoption design to investigate the relationships among genetic background, environmental factors, and clinical outcome of attention deficit/hyperactivity, aggressivity, and adult antisocial personality (ASP) in a sample of 283 male adoptees. A biologic parent adjudged to be delinquent or to have an adult criminal conviction predicted increased attention deficit/hyperactivity in the adopted away sons, as well as increased adult ASP diagnosis. Aggressivity in the adoptee was predicted by attention deficit/hyperactivity, and aggressivity in turn predicted increased adult ASP. Environmental factors of socioeconomic status (SES), and psychiatric problems in adoptive family members correlated significantly with various clinical outcomes of aggressivity, attention deficit/hyperactivity, and ASP. The results suggest that attention deficit/hyperactivity should be considered a syndrome that has a variety of correlated behaviors, such as aggressivity, and that each of these correlated behaviors is influenced by different genetic and environmental factors and their interactions. Depending on the mix of factors, adult ASP can be one of the outcomes.

Implication of sex differences in the familial transmission of infantile autism

There are studies suggesting possible hereditary influence in autism. Data on 102 autistic children, 78 boys and 24 girls, showed that there was a significantly greater proportion of autistic girls than boys with IQs less than 50 and with evidence of brain damage. The autistic girls also had a greater proportion of relatives affected with autism or cognitive-language deficit than did the boys. The implication of sex differences in the possible mode of familial transmission of autism is discussed.

An adoption study of drug abuse/dependency in females.

In a sample of 102 women who had been adopted at birth, drug abuse/dependency was found by log-linear analyses to have a major pathway of genetic etiology that started with a biologic parent with antisocial personality and led to an adoptee with conduct disorder and then through aggressivity to drug abuse/dependency, as well as from conduct disorder directly to drug abuse. This result was similar to findings from a male sample collected from the same agencies and at the same time, wherein antisocial biologic parents produced aggressive and conduct-disordered off-spring, who in turn became drug abusers/dependents as adults. Results are compatible with family studies demonstrating that female drug abusers stem from deviant families and themselves demonstrate socially deviant behavior early in life. The present study shows that one element of familial factors is genetic, and that, in addition, the family environment directly affects behavior (aggressivity) that leads to drug abuse/dependency.

Familial subtypes of childhood hyperactivity.

On the basis of family history data we defined two subtypes of childhood hyperactivity: family history-positive (FH+), in which at least one biological parent of the child had a diagnosis in the antisocial spectrum; and family history-negative (FH-), in which neither parent had such a diagnosis. While children in both subgroups were equally deviant on measures of the core components of childhood hyperactivity (e.g., inattention and reactivity), the FH+ children were also deviant on dimensions of conduct disturbance and had siblings with a high prevalence of conduct disorder. FH- children showed little evidence of conduct disturbance, had more learning and academic problems, and had siblings with attentional and learning disabilities, but not conduct disorder. These findings suggest that the study of family constellations should be a fruitful method for resolving the heterogeneity of the hyperactive child syndrome.

Etiological implication of maternal age and birth order in infantile autism

Birth orders and maternal ages of the 113 autistic patients were compared with those of the general population. An excess of mothers aged 35 or older was observed in the autistic group, though the mean maternal age for the whole group was very similar to those of the general population. A deviation from average in birth order was observed in autistics. Significantly more autistics were products of at-risk pregnancies (defined as either first, fourth, or later born, or born to mothers aged 30 or older) than the base population. The results suggest that at least some environmental factors are involved in the causation of autism. The findings support the idea that a multifactorial mechanism is responsible for some or all of the cases.

Psychiatric disorder in the parents of adopted children with aggressive conduct disorder

The authors found that adoptive fathers of children with aggressive conduct disorder less often had alcoholism and antisocial personality than the natural fathers of nonadopted children with the same disorder. This evidence suggests that social factors which are widely held to produce the disorder are not necessary causes.

Use of propranolol to decrease aggressive outbursts in younger patients

Abstract The effect of the β-blocker propranolol on the frequency and intensity of aggressive outbursts was studied in 16 patients aged four to 24 years, including eight with mild to severe mental retardation. Ten of the 16 were rated as responders, including six of the eight retarded patients. Guidelines are presented for selecting patients for a treatment trial, for adjusting dosage, and for monitoring vital signs.

An adoption study of DSM-IIIR alcohol and drug dependence severity

OBJECTIVE The objective of this study was to evaluate the role of genetic factors in alcohol and drug dependence at various levels of DSM-IIIR psychoactive substance dependence severity. METHOD One-hundred-and-ninety-seven adoptees (95 case adoptees with biological parental alcoholism, drug dependence or antisocial personality disorder and 102 control adoptees) were interviewed for the presence of alcohol abuse or dependence and drug abuse or dependence using the Diagnostic Interview Schedule-DIS IIIR. RESULTS Adoptees with five or more DSM-IIIR criteria for alcohol dependence demonstrated evidence of a genetic effect using this adoption paradigm (odds ratio = 2.3, 95% C.I. (1.1, 4.9)). Adoptees with one or more DSM-IIIR criteria for drug dependence demonstrated a genetic effect (odds ratio = 2.4, 95% C.I. (1.3, 4.4). CONCLUSIONS This study suggests genetic factors influence the risk for alcohol and drug dependence at different thresholds of severity as determined by DSM-IIIR symptom severity count.

The diagnosis of depression in children

Operational criteria for depression in children were derived from diagnostic criteria designed for adults. These criteria were applied to a series of outpatients and inpatients on a Child Psychiatry Service. Thirteen per cent of girls and 5% of boys admitted to the clinic met the criteria for depression. (For this calculation autistic, brain-damaged and seriously retarded were excluded from the clinic population.) The frequencies of criterion symptoms and some related symptoms are reported. Generally the data suggest that the significant depression does occur as an independent syndrome in children, it is relatively common in a clinic population and it does not differ obviously from depression in adults.