Peder Rasmussen

Natural Outcome of ADHD With Developmental Coordination Disorder at Age 22 Years: A Controlled, Longitudinal, Community-Based Study

OBJECTIVE There is a need for controlled longitudinal studies in the field of attention disorders in the general population. METHOD In a community-based follow-up study, 55 of 61 subjects aged 22 years, who had attention-deficit/hyperactivity disorder (ADHD) with and without comorbid developmental coordination disorder (DCD) at initial workup at age 7 years, were compared, on a multitude of outcome variables, with 46 of 51 age-matched subjects without such diagnoses. None of the subjects had received stimulant treatment. Psychiatrists performing the follow-up study were blind to original diagnostic group status. RESULTS In the ADHD/DCD group 58% had a poor outcome compared with 13% in the comparison group (p < .001). Remaining symptoms of ADHD, antisocial personality disorder, alcohol abuse, criminal offending, reading disorders, and low educational level were overrepresented in the ADHD/DCD groups. The combination of ADHD and DCD appeared to carry a particularly gloomy outlook. CONCLUSIONS Childhood ADHD and DCD appears to be a most important predictor of poor psychosocial functioning in early adulthood. It would seem appropriate to screen for such disorders in schools and clinics so that therapies may be started early.

Co-existing disorders in ADHD - implications for diagnosis and intervention

Abstract.BackgroundIt is only recently that “comorbidity” in ADHD has come to the forefront as one of the most important aspects of the disorder. It is agreed that, often, these problems are at least as important as ADHD in contributing to the longer term outcome in the individual child.ObjectiveTo provide the reader with basic information about clinics and treatment of “comorbidity” in ADHD.MethodReview of the empirically based literature.ResultsADHD exists in a surprisingly high frequency together with a broad range of child neuropsychiatric disorders. This is accompanied with many still unresolved treatment problems.ConclusionIt would not be appropriate to develop ADHD–services where clinicians would only have expertise in ADHD as such. Anyone working with children, adolescents and adults with ADHD would need to have training in general neuropsychiatry. Further research in this field is urgently needed.

Autism, ADHD, Mental Retardation and Behavior Problems in 100 Individuals with 22q11 Deletion Syndrome.

This study assessed the prevalence and type of associated neuropsychiatric problems in children and adults with 22q11 deletion syndrome. One-hundred consecutively referred individuals with 22q11 deletion syndrome were given in-depth neuropsychiatric assessments and questionnaires screens. Autism spectrum disorders (ASDs) and/or attention deficit/hyperactivity disorder (ADHD) were diagnosed in 44 cases. ASD was diagnosed in 23 cases of whom only 5 had autistic disorder. ADHD was diagnosed in 30 individuals. In nine of these cases with ASD or ADHD there was a combination of these diagnoses. Mental retardation (MR) with or without ASD/ADHD was diagnosed in 51 individuals. ASD, ADHD, and/or MR were present in 67 cases. Females had higher IQ than males. The results of this study showed that the vast majority of all individuals with 22q11 deletion syndrome have behavior and/or learning problems and more than 40% meet criteria for either ASD, ADHD or both. Neuropsychiatric and neuropsychological evaluations are indicated as parts of the routine clinical assessment of individuals with 22q11 deletion syndrome.

Neuropsychiatric disorders in the 22q11 deletion syndrome.

Purpose: This study was undertaken with a view to establishing the occurrence of neuropsychiatric disorders in the 22q11 deletion syndrome.Methods: Thirty-two children and young adults with genetically confirmed 22q11 deletion were given comprehensive neuropsychiatric assessments.Results: Altogether, 56% had a neuropsychiatric disorder. Only 6% were of normal IQ and free of physchiatric disorder. Attention-deficit/hyperactivity disorder was diagnosed in 44% and 31% had an autism spectrum problem. In 16% criteria for both these diagnoses were met. Fifty-three percent had mental retardation, often with a test-profile suggesting a nonverbal learning disorder.Conclusion: The findings imply that a majority of children and adolescents with 22q11 deletion syndrome are in need of neuropsychiatric assessment and intervention.

Perceptual, Motor and Attentional Deficits in Seven‐year‐old Children: Background Factors

A total of 141 children selected from a pre‐school programme screening for problems in motor control, perception, attention and behaviour were examined blindly at age seven by two psychiatrists, a neurologist and a psychologist. Operational diagnoses of minimal brain dysfunction (MBD) were made, consisting of concomitant motor/perception dysfunction and attention deficit disorder. Background factors, with special regard to heredity, neuropathogeneity and psychosocial conditions, were analysed. Non‐optimal prenatal, perinatal or postnatal events and non‐optimal neurodevelopmental heredity‐or a combination of these‐were much more common in the MBD group than in comparison groups. Non‐optimal psychosocial conditions were found to interact with the other background factors in defining a clinically significant syndrome. Social disadvantage in itself did not appear to be a major aetiological factor.

PERCEPTUAL, MOTOR AND ATTENTIONAL DEFICITS IN SEVEN-YEAR-OLD CHILDREN: NEUROLOGICAL AND NEURODEVELOPMENTAL ASPECTS

This study presents the results of neurological assessments of a representative sample of seven‐year‐old Swedish children with perceptual, motor and attentional deficits and their controls (N=141). Among those children diagnosed as suffering from minimal brain dysfunction (MBD), the majority showed neurodevelopmental deviations indicative of the ‘clumsy child syndrome’. However, 20 per cent had slight signs of choreoathetosis, diparesis, hemiparesis or ataxia. Other associated neurodevelopmental deviations are considered. The correlation between neurological findings and background factors is discussed: the MBD group had higher scores for various ‘organic’ background factors than the comparison children, and the children with neurological syndromes had somewhat higher scores than the remaining children with MBD. The difficulties in distinguishing MBD from mental retardation, cerebral palsy and childhood psychoses is clearly illustrated. Long‐term follow‐up will indicate the prognostic significance of these findings.

Chromosome 22q11 deletion syndrome (CATCH 22): neuropsychiatric and neuropsychological aspects

Twenty children and young adults (age range 5 to 33 years, 12 females and eight males) with genetically confirmed 22q11 deletion syndrome (CATCH 22: Cardiac anomaly, Anomalous face, Thymus hypoplasia/aplasia, Cleft palate, and Hypocalcaemia), recruited from a large ongoing study, were given comprehensive assessments with a view to determining the pattern of neuropsychiatric and neuropsychological deficits thought to be part of the syndrome in many cases. IQ ranged between 46 and 100 with a mean score of 70. Half the group had an IQ < 70. In 13 individuals, attention‐deficit‐hyperactivity disorder (ADHD), mainly inattentive or combined type in most cases, and/or autism spectrum problems were diagnosed. Many participants, even among those who had an IQ within the normal range and had neither ADHD nor autistic spectrum problems, showed a characteristic and pronounced behavioural profile with low mental energy, initiation difficulties, deficits in sustained attention, and social interaction (often augmented by limited facial expression and communication and speech problems).

Autistic disorders in Down syndrome: background factors and clinical correlates.

A study of a clinic-based sample of 25 individuals (12 females, 13 males; age at diagnosis 14.4 years, SD 7.4 years; age range 4 to 33 years) with Down syndrome (DS) and autism spectrum disorders, demonstrates that autism is by no means rare in DS. Results showed that there was a considerable delay in the diagnosis of autism as compared with children with autism who did not have DS. In 11 participants medical factors were identified that were likely to be of importance in contributing to the development of autism, and in four further participants there were factors of possible significance. Such factors include a history of autism or autism-related disorders in first- or second-degree relatives (n=5), infantile spasms (n=5), early hypothyroidism (n=3), evidence of brain injury after complicated heart surgery (n=2), or a combination of these factors. It is important that autism is recognised, identified, and fully assessed in individuals with DS in order for them to receive appropriate education and support.

Brief report: Four case histories and a literature review of williams syndrome and autistic behavior

This paper summarizes the case histories of four young children who had concurrent autistic disorder and Williams syndrome

Perceptual, motor and attentional deficits in seven-year-old children. Paediatric aspects.

ABSTRACT. 42 children representative of Swedish urban seven‐year‐olds with a combination of various minor neurodevelopmental deficits in the form of so‐called minimal brain dysfunction (MBD) syndromes were compared with 51 children of the same age without such problems as regards general health data from parents’interviews and questionnaires and from paediatric examinations. The findings at the physical examination revealed only few and small differences concerning minor physical anomalies that, in part, is dealt with in a separate report. Children with MBD had experienced simple febrile convulsions significantly more often than controls, and an abnormal EEG was a common finding in these cases. So‐called psychosomatic complaints were not overrepresented in the MBD group, but enuresis and encopresis was somewhat more common. The parents’answers to a set of 6 questions (concerned with late speech development, late motor development, gross motor clumsiness, fine motor clumsiness, “shuffling” and difficulties to concentrate) were found to have a high discriminating capacity detecting for MBD syndromes. The possibility of a clinical application of this finding is discussed.