Steven P. Cuffe

Frequency of obsessive-compulsive disorder in a community sample of young adolescents.

OBJECTIVEnTo investigate the frequency and phenomenology of obsessive-compulsive disorder (OCD) and subclinical OCD in young adolescents.nnnMETHODnA two-stage epidemiological study originally designed to investigate adolescent depression was conducted between 1986 and 1988 in the southeastern United States. In the first stage, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Childrens Global Assessment Scale were administered to 488 mother-child pairs.nnnRESULTSnThe prevalences of OCD and subclinical OCD were found to be 3% and 19%, respectively. Prevalences were similar in males and females. Females reported more symptoms of compulsions although males reported more obsessions. About 55% of adolescents with OCD reported both obsessions and compulsions. The most common compulsions were arranging (56%), counting (41%), collecting (38%), and washing (17%). Major depressive disorder (45%), separation anxiety (34%), dysthymia (29%), suicidal ideation (15%), and phobia (8%) were the diagnoses most frequently comorbid with OCD.nnnCONCLUSIONSnFindings suggest that OCD is not infrequent among adolescents and that the characteristic comorbidity and symptomatology of OCD may facilitate earlier identification and treatment by clinicians.

Prevalence of PTSD in a community sample of older adolescents

OBJECTIVEnTo examine prevalence and correlates of trauma and posttraumatic stress disorder (PTSD) symptoms and diagnosis in older adolescents aged 16 through 22 years.nnnMETHODnThe second cycle of a longitudinal epidemiological study in the Southeast included a semistructured interview assessing PTSD symptomatology administered to 490 adolescents.nnnRESULTSnApproximately 3% of female subjects and 1% of male subjects satisfied the DSM-IV criteria for PTSD. Females reported more traumatic events than males, and black subjects reported more events than white subjects. Being female (odds ratio = 12.32), experiencing rape or child sexual abuse (odds ratio = 49.37), and witnessing an accident or medical emergency (odds ratio = 85.02) were associated with increased risk of PTSD.nnnCONCLUSIONSnWhile relatively few adolescents satisfy the criteria for PTSD, most subjects who experienced a traumatic event reported some PTSD symptoms. Specific types of traumatic events were associated with occurrence of PTSD.

Prevalence and Correlates of ADHD Symptoms in the National Health Interview Survey.

Objective: Study the prevalence and correlates of ADHD symptoms in the National Health Interview Survey (NHIS). Methods: NHIS includes 10,367 children ages 4 to 17. Parents report lifetime diagnosis of ADHD and complete the Strengths and Difficulties Questionnaire (SDQ). Prevalences of clinically significant ADHD and comorbid symptoms by race and ethnicity, gender, and age are presented. Results: Prevalence of clinically significant SDQ ADHD symptoms is 4.19% (males) and 1.77% (females). Male prevalence by race is 3.06% for Hispanics, 4.33% for Whites, and 5.65% for Blacks. Significant differences in prevalence occur across gender (p < .01) and among males across race (p < .01), age (p < .01), and income (p < .02). In the full sample, 6.80% of males and 2.50% of females have a parent-reported lifetime ADHD diagnosis but are negative for SDQ ADHD. Likewise, 1.59% of males and 0.81% of females are positive for SDQ ADHD but negative for parent report of ADHD diagnosis. SDQ ADHD positive children have substantially higher proportions of elevated scores on other SDQ subscales. Conclusion: ADHD symptoms vary by race and ethnicity, gender, and age and are associated with other emotional and behavioral difficulties. Both overdiagnosis and underdiagnosis of ADHD may be issues in the U.S. population of 4- to 17-year-olds.

Incidence and Predictors of Suicidal Behaviors in a Longitudinal Sample of Young Adolescents

OBJECTIVEnThis analysis examines 1-year transition probabilities and baseline predictors for suicidal behaviors in young adolescents.nnnMETHODnAdolescents from a two-stage, community-based longitudinal study were classified into suicidal behavior categories (attempt, plan, ideation, and none) for baseline and follow-up years. Transition probabilities for movement among categories were calculated, and polytomous logistic regression analysis was used to examine predictors of suicidal behaviors.nnnRESULTSnAmong those with no suicidal behaviors at baseline, 1-year incidence rates were 1.3% for attempts and 1.7% each for plans and ideation. Increasing family cohesion was protective for suicide attempts (odds ratio [OR] = 0.9). Female subjects were more likely than males to report plans (OR = 8.9) and ideation (OR = 4.1). Increasing impulsivity (OR = 2.3), prior suicidal behavior (OR = 10.6), and undesirable life events (OR = 1.1) were significant predictors of plans.nnnCONCLUSIONSnWhile there are a number of predictors of suicidal behaviors, the false-positive rate is high. Focusing on proximal risk factors, particularly stressors in adolescent development, may overlook the fundamental role of underlying mental disorder and familial factors--both biological and environmental. Suicide and suicidal behaviors are the result of a constellation of adverse factors requiring a range of interventions for prevention.

Race and Gender Differences in the Treatment of Psychiatric Disorders in Young Adolescents

OBJECTIVEnMost children and adolescents with mental illness remain untreated. Evidence suggests that race is a factor in the referral of children for treatment. This study examines race and gender differences in treatment of adolescent psychiatric disorders.nnnMETHODnDuring a two-stage, school-based, epidemiological study of depression, data were collected on 478 adolescents. Instruments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Childrens Global Assessment Scale.nnnRESULTSnTwenty-two percent of the sample had contact with professionals during the prior year, including 56% of adolescents with a psychiatric diagnosis. Significant odds ratios (ORs) were found between all diagnoses and treatment. Trends for undertreatment of females and African-Americans were evident in univariable and multivariable models. The OR (0.34) for African-American females was significant in the multivariable model. African-Americans were significantly more likely to receive only one or two treatment contacts.nnnCONCLUSIONnData suggest race and gender differences in the treatment of adolescent psychiatric disorders. Possible explanations include referral bias, low cultural competence of mental health professionals, and cultural differences in the expression and tolerance of symptoms and help-seeking behaviors. Further study of factors influencing treatment decisions is needed.

Incidence of Major Depressive Disorder and Dysthymia in Young Adolescents

OBJECTIVEnAn epidemiological study conducted between 1987 and 1989 in a single school district in the southeastern United States investigated the incidence, transition probabilities, and risk factors for major depressive disorder (MDD) and dysthymia in adolescents aged 11 to 16 years.nnnMETHODnDiagnoses were based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, which was administered to 247 mother-adolescent pairs at 12-month intervals.nnnRESULTSnOne-year MDD and dysthymia incidences were 3.3% (n = 11) and 3.4% (n = 9), respectively. Transition probabilities demonstrated movement from disorder to no disorder over time. Family cohesion (odds ratio = 0.95) was the only significant predictor of incident MDD. No factors were significant for dysthymia. While baseline MDD was a significant risk factor for depression at follow-up, 80% of subjects with baseline MDD did not meet the criteria for diagnosis at follow-up.nnnCONCLUSIONnFindings suggest perceived family support or cohesion may be more important to adolescent mental health than family structure.

Dual diagnosis and successful participation of adolescents in substance abuse treatment

A retrospective record review of one year of admissions to a residential adolescent substance abuse treatment program (N = 91) examined the prevalence of comorbid psychiatric disorders and factors associated with successful treatment participation. Psychiatric and substance use disorders (SUD) were diagnosed by DSM-IV criteria. Successful participation was based on multiple factors assessed by the treatment team. Consistent with prior studies, there was considerable comorbidity (63.7%) with both disruptive (Attention Deficit Hyperactivity Disorder [ADHD], 11%; Conduct Disorder [CD], 24%) and other disorders (depression, 24%; adjustment disorder, 7.7%; bipolar disorder, 3.3%). Male gender was negatively associated (OR = 0.23, P = 0.019) with successful participation in univariate analyses, as was ADHD (OR = 0.18, P = 0.007). CD (OR = 0.37, P = 0.053) approached significance. Multivariate analysis reveals ADHD was significant while having CD and being male approached significance. Psychotropic medication use and other diagnoses were not associated with successful participation. It is concluded that further research on the relationship between ADHD, CD, and substance abuse treatment is needed.

Influence of Race on Diagnosis in Adolescent Psychiatric Inpatients

OBJECTIVEnTo examine racial differences in 352 psychiatric inpatients, aged 12 to 18 years, at a state hospital facility that accepted admissions from throughout South Carolina. These were all the adolescent admissions during an entire calendar year (1988). There were 101 African-American and 251 white subjects.nnnMETHODnThe data were abstracted from patients hospital medical records and nursing incident reports. DSM-III-R discharge diagnoses were assigned to five non-mutually exclusive groupings (organic/psychotic, mood/anxiety, disruptive, personality, substance abuse). Racial differences were analyzed using chi 2, logistic regression, and T statistics.nnnRESULTSnAfrican-Americans were more likely to be involuntarily committed at the time of admission (p = .010). Organic/psychotic diagnoses were much more frequent in African-Americans (odds ratio = 3.15, p < .003). Whites (p = .0347) were almost two times more likely to receive mood/anxiety diagnoses even when controlling for gender, type of admission, and comorbid diagnoses. Substance abuse was more often diagnosed in whites (odds ratio = 5.46, p < .0001).nnnCONCLUSIONSnThis study identifies significant racial differences in the discharge diagnoses of psychiatrically hospitalized adolescents. African-Americans have fewer mood/anxiety and substance abuse diagnoses but significantly more organic/psychotic diagnoses. Some of these differences may reflect ethnocentric clinician bias in the diagnostic assessment of youth from differing cultural/racial backgrounds.

Nonsuicidal physically self-damaging acts in adolescents

To determine the frequency and correlates of nonsuicidal physically self-damaging acts in 12–14 year olds, a two stage epidemiologic survey with a self-administered questionnaire (N=3283) followed by a psychiatric interview of a subsample of the adolescents and their parents (N=444) was used. Prevalence estimates of interview validated nonsuicidal physically self-damaging acts were 2.46% in males and 2.79% in females. Significant relationships were found between nonsuicidal physically self-damaging acts and suicidal ideation, major depression and undesirable life events. Data suggest that physically self-damaging acts occur at substantial rates during early adolescence. The strong correlation between nonsuicidal self-destructive acts and both suicidal ideation and major depression clarifies prior conflicting reports in the literature and suggests that a history of self-damaging acts should be taken into consideration when evaluating for possible depression and suicide risk.

Comorbidity of attention Deficit Hyperactivity Disorder and Post-Traumatic Stress Disorder

Attention Deficit Hyperactivity Disorder (ADHD) and Post-Traumatic Stress Disorder (PTSD) show a high degree of comorbidity in traumatized children. Two hypotheses may help explain this relationship: children with ADHD are at higher risk for trauma due to their impulsivity, dangerous behaviors, and parents who may have a genetic predisposition for impairment of their own impulse control; and hyperarousal induced by severe trauma and manifested by hypervigilance and poor concentration may impair attention to create an ADHD-like syndrome. Four illustrative cases are presented, and implications for treatment are discussed.