Roscoe A. Dykman

Prevalence of post traumatic stress disorder and other psychiatric diagnoses in three groups of abused children (sexual, physical, and both)

OBJECTIVEnThe purpose of this study was to compare the prevalence of Post Traumatic Stress Disorder and other diagnoses in three groups of abused children, sexual only (N = 127), physical only (N = 43), and BOTH (N = 34).nnnMETHODnThe children, aged 7 to 13 years, were referred to the project from several sources at Arkansas Childrens Hospital and from associated local agencies. The victims and caregivers were separately administered the Diagnostic Interview for Children and Adolescents, Revised Version (DICA). Additionally, caregivers and classroom teachers completed the Child Behavior Checklist (CBCL). Characteristics of the abuse were obtained from an investigative questionnaire.nnnRESULTSnBoth victims and caregivers endorsed high rates of disorders, with caregivers generally giving higher rates than children and boys having more externalizing diagnoses than girls. Children in the BOTH group had more diagnoses overall. Concordance between victims and caregivers was modest. PTSD was significantly comorbid with most affective disorders. On the CBCL, caregivers rated girls less disturbed than boys and the sexually abused only group less disturbed than the other groups. Teachers rated the boys more adversely than girls but did not see differences by abuse group. A younger age of onset of sexual abuse and coercion to maintain secrecy predicted a higher number of total diagnoses. Also, children who were physically abused by males had more diagnoses than those physically abused by females.nnnCONCLUSIONSnChildren who have been both physically/sexually abused appear to be at highest risk of psychiatric disturbance. PTSD, though common (circa one-third of victims), is generally comorbid with other affective disorders.

Attention Deficit Disorder and Specific Reading Disability: Separate but Often Overlapping Disorders

Within a large (N = 182) heterogeneous sample of clinic-referred children with DSM-III-diagnosed attention deficit disorder (ADD), three behavioral subgroups were identified via cluster analysis of teacher ratings: 40% of the children had ADD with hyperactivity (ADDH), 30% had ADD with hyperactivity and aggressivity (ADDHA), and 31% had ADD without hyperactivity or aggressivity. Proportionally more girls were in the ADD-only subgroup. Over half the sample (n = 94) were poor readers, with 82 meeting discrepancy criteria for specific reading disability (RD). Proportionately more boys than girls met the RD criteria (9.2:1.0), whereas the sex ratio of males to females for the whole sample was 5.1 to 1.0. Focusing just on white males, the three behavioral subgroups were significantly different on convergent validity measures, such as other teacher ratings, parent ratings, and interview-elicited ratings of externalizing behavior, but were not different on such divergent validity measures as IQ and achievement scores, self-ratings, and laboratory performance tasks. Boys in the ADD sample who did not meet criteria for RD had significantly higher IQs than those who did, but subgroups with and without RD still differed significantly on WRAT-R reading and spelling scores with IQ covaried out. Both groups with and without RD could be differentiated from a control group on laboratory measures of sustained attention and impulse control. Methylphenidate benefited all subgroups equally, whether RD or not, and whether given a low (0.3 mg/kg) or high (0.6 mg/kg) dose.

Phonological Processes, Confrontational Naming, and Immediate Memory in Dyslexia

A group of poor readers classified as dyslexic by age/IQ discrepancy criteria (n=42) were contrasted with two clinic control groups: 56 adequate-for-age readers with attention deficit disorder (ADD) and 21 poor-for-age readers not meeting the IQ discrepancy criterion (slow/borderline group). The children (33 girls, 86 boys) ranged in age from 7.5 years to 12 years. Variables chosen for study included simple and complex phonological processing, speech rate, continuous naming speed, running memory span, serial memory span, and mental addition. Evidence is presented that the two poor reader groups are distinguishable. Unlike the dyslexic group, the slow/borderline group did not differ from the ADD group on three key measures: simple auditory phonological sensitivity, continuous naming speed, and running memory span. Stepwise regression to predict word list reading level showed that once age and verbal IQ were removed (51% of variance), these three key measures accounted for an additional 22% of the variance (R=0.86, R2=0.73). The single best predictor of word list reading level was nonsense word list reading level, which was explained by the same set of five variables that explained real word reading (R=0.77, R2=.60). Severity of attentional problems was not linearly related to reading skill in this clinic sample.

Arithmetic Automatization Failure in Children with Attention and Reading Disorders: Associations and Sequela

Evidence is presented that both Reading Disabled (RD) and normal reading Attention Deficit Disorder (ADD) children are at high risk to become numerically incompetent adults. It is theorized that this incompetence is in many instances rooted in a failure to automatize (memorize) basic number combinations. Yet standardized arithmetic tests may fail to reveal automatization failure in younger school children because of overly generous time limits. While mathematical excellence appears to require superior spatial reasoning ability in addition to the memory and attentive abilities thought to underpin automatization, it is argued that a pubertal spurt in spatial ability is more felicitous than early exceptional spatial competence.

Reading‐disabled students with and without comorbid arithmetic, disability

Two subgroups of learning disabled students, reading disabled only (RD) and reading/arithmetic disabled (RAD), were contrasted at two age levels, 8 to 12 years old and 12 to 17 years old. At both age levels, RAD students were significantly poorer spellers and weaker on the Arithmetic and Coding subtests of the Wechsler Intelligence Scale for Children (WISC) than RD‐only students. The younger subgroups were also differentiated by four other WISC‐R sub‐tests: Information, Similarities, Comprehension, and Block Design. The adolescent subgroups differed on the new Symbol Search subtest of the WISC‐III. The subgroups did not differ at either age level on phonological skills, memory tasks, naming speed, and picture vocabulary. Nor did they differ on parent ratings of externalizing and internalizing behavior problems. Evidence is presented that arithmetic disabled children fall relatively further behind with increasing age. A core weakness in reading and arithmetic disability is processing speed, and students wi...

Children with Specific Learning Disabilities WISC Profiles

In this study 82 children with specific learning disabilities (CLD) and 34 controls with adequate academic performance were given the Wechsler Intelligence Scale for Children (WISC). The CLD group scored lower, on the average, than the control group, particularly on Arithmetic, Digit Span, In formation, and Similarities. For 29 CLD-control pairs, matched for chronological age and mental age, the verbal superiority of controls was more rigorously demonstrated. No characteristic WISC profiles were found for CLD grouped as to activity level and neurological status. Serious reading disabilities were associated more reliably with verbal deficiencies than with nonverbal deficits as tapped by the WISC performance scale, but this study demonstrated that the child with either a Verbal or Performance IQ in the low average or dull normal range appears high risk for a smooth academic career in middle-class urban schools.

Physiological Reactivity to Different Stressors and Methods of Evaluation

&NA; Several variables shown in past studies to be important determines of autonomic activation in humans are re‐examined in 2 test situations spaced 1 year apart. There is considerable individual variation in responsivity not explicible in terms of the variables studied. However, nearly all subjects exhibited in at least one autonomic system levels of reactivity paralleling the presume stress effects of different conditions of stimulation. Subjective and objective measures of personality and emotionally appear to be less important determiners of physiological levels than the intensity of stress. A new method of scaling autonomic responses is outlined.

Internalizing and externalizing characteristics of sexually and/or physically abused children

This study evaluates the behavioral consequences of childhood abuse (sexual, physical, or both), with particular focus on prevalence of posttraumatic stress disorder (PTSD). Three abuse type groups and nonabused controls were contrasted on behavioral rating scales and on structured psychiatric interview data. The participants (109 abused children and 16 normal control children) were recruited from Arkansas Children’s Hospital and local agencies for abused children. As expected, proportionately more females than males were sexually abused. Overall, males were rated as more disturbed than females. Type of abuse did not consistently influence behavioral ratings. Externalizing scores were significantly higher than internalizing scores in all abused groups. PTSD was diagnosed in 50% of the abused children, with a higher rate for boys who had been sexually abused as opposed to physically abused only (58% versus 13%). The most frequent comorbid condition with PTSD was Separation Anxiety. Sexually abused boys were hospitalized for psychiatric treatment at a higher rate than were other abused children.

Effects of methylphenidate on selective and sustained attention in hyperactive, reading-disabled, and presumably attention-disordered boys.

Performance on a visual search task was contrasted for hyperactive boys and non hyperactive reading-disabled and presumably attention-disordered boys participating in a double blind, crossover study (methylphenidate vs. placebo). Mean dosage levels, individually titrated by the team psychiatrist, were highest for the reading-disabled group, lowest for those with suspected attention disorders. All three groups were seen by teachers and parents as significantly improved while on medication, and all groups dramatically reduced extraneous responses and attention lapses on the laboratory task. On a composite measure of performance and behavior, the non hyperactive subjects improved significantly more than the hyperactive subjects. Although given rather high average dosage levels (about 37.5 mg/ day or 1.25 mg/kg-day), the subjects did not deteriorate in search behavior, which entails short term memory. It is argued that the cerebral stimulants may be as beneficial for non hyperactive reading-disabled and attention-disordered children as for hyperactive patients, for the former have just as great difficulty sustaining attention as the latter.

EFFECT OF NUTRITIONAL SUPPLEMENTS ON ATTENTIONAL-DEFICIT HYPERACTIVITY DISORDER

This study reports the effects of two nutritional products upon the severity of symptoms in children with confirmed diagnoses of Attention-Deficit Hyperactivity Disorder (ADHD): a glyconutritional product containing saccharides known to be important in healthy functioning and a phytonutritional product containing flash-dried fruits and vegetables. Seventeen ADHD children were recruited from a local parent support group. Parents of five of the subjects did not have their children on methylphenidate. Of the remaining twelve, all on methylphenidate, six were left on prescribed doses (random assignment). The other six had their doses reduced by half after two weeks (study duration was six weeks). The subjects were assessed initially and three subsequent times over a period of six weeks (longitudinal nonrandomized design). The behavior disorder items for ADHD, Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) as listed in the Diagnostic and Statistical Manual for Mental Disorders (DSM IV) (American Psychiatric Association, 1994) were rated by teachers and parents on a 3-point scale. Also included was a Side Effects Scale described by Barkley (1990). The children received the glyconutritional supplement for the entire six weeks. After three weeks, the phytonutritional supplement was added to the diet to increase the probability of positive results. The glyconutritional supplement decreased the number and severity of ADHD, associated ODD and CD symptoms, and side effects in all groups during the first two weeks of the study. There was little further reduction with the addition of the phytonutritional supplement. The three study groups did not differ statistically in degree of reduction over observations. Present results suggest that symptoms of ADHD may be reduced by the addition to the diet of saccharides used by the body in glycoconjugate synthesis.