Clinical distinction between cognitive disengagement syndrome and ADHD presentations in a nationally representative sample of Spanish children and adolescents.

BACKGROUND: This study sought to determine whether cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) has different external correlates relative to ADHD-inattentive presentation (INP), ADHD-hyperactive/impulsive presentation (HIP), and ADHD-combined presentation (CP). METHODS: Parents of a nationally representative sample of 5,525 Spanish youth (ages: 5-16, 56.1% boys) completed measures of CDS, ADHD-inattention (IN), and ADHD-hyperactivity/impulsivity (HI) and other measures. Scores greater/less than the top 5% on CDS, ADHD-IN, and ADHD-HI were used to create control (n = 5,013, 90.73%), CDS-only (n = 131, 2.37%), ADHD-INP-only (n = 83, 1.50%), ADHD-HIP-only (n = 113, 2.05%), ADHD-CP-only (n = 48, 0.97%), CDS + ADHD-INP (n = 44, 0.80%), CDS + ADHD-HIP (n = 25, 0.45%), and CDS + ADHD-CP (n = 68, 1.23%) groups. RESULTS: Forty-nine percent of youth with clinically elevated CDS did not qualify for any ADHD presentation, whereas 64% of youth with clinically elevated ADHD did not qualify for CDS. The CDS-only group was higher than the ADHD-INP-only, ADHD-HIP-only, and ADHD-CP-only groups on anxiety, depression, somatization, daytime sleep-related impairment, nighttime sleep disturbance, and peer withdrawal, whereas the CDS-only and ADHD-INP-only groups did not differ on ODD (ADHD-HIP-only and ADHD-CP-only higher) and academic impairment (ADHD-CP-only higher than CDS-only and ADHD-HIP-only lower than CDS-only). The CDS-only group also had higher rates of anxiety, depression, and bipolar disorder diagnoses than the ADHD-only group. CONCLUSIONS: A distinction was found between CDS and each ADHD presentation, thus providing support for CDS as a syndrome that frequently co-occurs with yet is distinct from each ADHD presentation.

Cognitive Disengagement Syndrome Symptoms from Early Childhood to Adolescence in a Nationally Representative Spanish Sample.

OBJECTIVE: The identification of a common set of symptoms for assessing cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) for early childhood (ages 5-8), middle childhood (ages 9-12), and adolescence (ages 13-16) is needed to advance research on the developmental psychopathology of CDS (i.e. a common symptom set with comparable internal and external validity for each age group). METHOD: Parents of a nationally representative sample of 5,525 Spanish children and adolescents (ages 5 to 16, 56.1% boys) completed measures of CDS, attention-deficit/hyperactivity disorder-inattention (ADHD-IN), and other measures. RESULTS: First, the 15 CDS symptoms showed convergent and discriminant validity relative to the ADHD-IN symptoms within each age group. Second, CDS showed stronger first-order and unique associations than ADHD-IN with anxiety, depression, somatization, daytime sleep-related impairment, and nighttime sleep disturbance, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-hyperactivity/impulsivity, oppositional defiant disorder, and academic impairment. Third, CDS showed stronger first-order and unique associations than ADHD-IN with a history of having an anxiety, depression, or bipolar disorder diagnosis, whereas ADHD-IN showed stronger first-order and unique associations with having an ADHD diagnosis. CONCLUSIONS: The identification of a common set of CDS symptoms spanning early childhood to adolescence allows for the advancement of research on CDS, with a particular need now for longitudinal studies and examination of CDS with other functional outcomes and across other cultural contexts.

Multisource Longitudinal Network and Latent Variable Model Analyses of ADHD Symptoms in Children.

Objective: Multisource longitudinal network analysis was used to determine if between-child and within-child variance of attention-deficit/hyperactivity disorder (ADHD) symptoms provided unique findings of ADHD relative to latent variable model (LVM) analyses.Method: Mothers and fathers of 802 Spanish first-grade children (54% boys) provided ratings of ADHD symptoms at two time points six weeks apart (assessment 1: 723 mothers and 603 fathers; assessment 2: 667 mothers and 584 fathers). Network and latent variable models were applied to the ratings.Results: Inattention, hyperactivity, and mixed hyperactive/impulsive symptom communities occurred for the within- and between-children's symptom networks with the results being consistent across mothers and fathers, especially for the between-children's symptom networks. LVM analyses identified three factors with the same symptoms on each factor as in the symptom communities. These models also showed invariance across mothers and fathers as well as assessments.Conclusions: Longitudinal networks provided several useful insights for ADHD, including centrality symptoms that differed across between- and within-child levels. However, many findings were also largely consistent with the LVM analyses. Future studies should use novel methods (e.g., intensive longitudinal measurement) and analytic tools to determine if more unique theoretical and clinical findings emerge when applying network analysis to longitudinally measured ADHD symptoms.

Tic disorders in children and adolescents: does the clinical presentation differ in males and females? A report by the EMTICS group.

Tic disorders have a strong male predominance, with a male-to-female ratio of 4:1 in Tourette syndrome (TS) and 2:1 in persistent tic disorders. In other neurodevelopmental conditions, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), the disparity in sex distribution has been partially related to differences in symptom presentation between males and females. In tic disorders, however, little research has been conducted on this topic, probably due to the limited access to large samples with a significant proportion of females. The aim of this study was to describe sex differences in the clinical presentation of tic disorders in children and adolescents in one of the largest pediatric samples with TS/persistent tic disorders (n = 709, 23.3% females) recruited as part of the European Multicenter Tics in Children Study (EMTICS). Validated measures assessed the severity of tics and comorbid psychiatric symptoms. Using mixed-effect models, we found that sex had a significant influence on the severity of tics, ADHD symptoms, ASD symptoms, and emotional problems. Males had more severe symptoms than females, except for emotional problems. We also observed a statistically significant interaction between sex and age on the severity of tics and compulsions, with females showing higher symptom severity with increasing age than males. These findings indicate that the clinical presentation of TS/persistent tic disorders varies with sex. Males seem to exhibit a more noticeable pattern of clinical symptoms at a younger age that may contribute to their earlier detection in comparison to females.

Longitudinal associations of callous-unemotional and oppositional defiant behaviors over a three-year interval for Spanish children.

The objective was to determine the longitudinal associations between callous-unemotional (CU) and oppositional defiant (OD) behaviors from the first to fourth grades for Spanish children. Four possible outcomes were evaluated: (a) CU behaviors in the first grade predict increases in OD behaviors in the fourth grade, controlling for OD behaviors in the first grade; (b) OD behaviors in the first grade predict increases in CU behaviors in the fourth grade, controlling for CU behaviors in the first grade; (c) both unique effects are significant; and (d) neither unique effect is significant. A longitudinal panel model with two latent variables (CU and OD behaviors), three sources (mothers, fathers, teachers), and two occasions (spring of the first and fourth grades) was used to evaluate the four possibilities among 758 (54% boys) first grade and 469 (53% boys) fourth grade Spanish children. For mother-, father-, and teacher-reports, OD behaviors in the first grade predicted increases in CU behaviors in the fourth grade, after controlling for CU behaviors in the first grade, whereas CU behaviors in the first grade did not predict increases in OD behaviors in the fourth grade, after controlling for OD behaviors in the first grade. OD behaviors thus conferred independent vulnerability to increases in CU behaviors 3 years later among young children.

Optimal Items for Assessing Sluggish Cognitive Tempo in Children Across Mother, Father, and Teacher Ratings.

A recent meta-analysis identified optimal items for assessing sluggish cognitive tempo (SCT) as distinct from attention deficit/hyperactivity disorder inattention (ADHD-IN), and a preliminary study with teacher ratings of children in the United States found strong support for the convergent and discriminant validity of 15 SCT items. The current study evaluated whether the same 15 SCT items demonstrated convergent and discriminant validity from ADHD-IN in a large, community-based sample of children in Spain, and whether validity results were replicated across mother, father, and teacher ratings. Mothers, fathers, and teachers completed measures of SCT, ADHD-IN, ADHD-hyperactivity/impulsivity, oppositional defiant disorder, limited prosocial emotions, anxiety, depression, shyness, peer rejection, social impairment, and academic impairment on 2,142 Spanish children (49.49% girls; ages 8-13). The 15 SCT symptoms demonstrated convergent validity along with discriminant validity with ADHD-IN across all three informants. The SCT symptom ratings also showed measurement invariance across the informants. In addition, SCT and ADHD-IN factors had different and unique associations with the other symptom and impairment factors. The 15 SCT symptoms identified in this study-consistent across mother, father, and teacher ratings-appear appropriate to serve as a standard symptom set for assessing SCT in children. Use of a common set of symptoms in future studies will advance our understanding of the SCT construct, including its etiology and developmental progression, associations with ADHD and other psychopathologies, links to impairment, and implications for clinical intervention.

Invariance of parent ratings of attention deficit hyperactivity disorder symptoms for children with and without intellectual disability.

BACKGROUND: Although attention deficit hyperactivity disorder (ADHD) is considered a valid diagnosis for children with intellectual disability, no studies have evaluated the invariance of ADHD symptom ratings across children with and without intellectual disability. METHOD: Parents completed ratings on the ADHD symptoms for 189 children with intellectual disability and for 474 children without intellectual disability. Differential item functioning analysis was used to determine the equivalence of the ADHD symptoms across the two groups. RESULTS: The symptoms loses things, talks too much, and blurts out answers showed significant bias against children with intellectual disability. The prevalence of ADHD in children with intellectual disability was 18% (according to the symptom criterion), and 7.4% when the academic and/or social impairment criterion was also considered. CONCLUSIONS: Most of the ADHD symptoms can be valid for the assessment of ADHD in children with mild and moderate intellectual disability. ADHD symptoms may be used in further studies to establish base rates of the disorder in the intellectual disability population.

Trait and State Variance in Multi-Informant Assessments of ADHD and Academic Impairment in Spanish First-Grade Children.

OBJECTIVE: We examined the stable trait and variable state components of ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and academic impairment (AI) dimensions using mothers', fathers', primary and secondary teachers' ratings of children's behavior at home and school. We also examined between-informant agreement with regard to trait and state components. METHOD: Mothers, fathers, primary and secondary teachers rated HI, IN, and AI in N = 758 Spanish first grade children (55% boys) over three measurement occasions across 12 months. RESULTS: Latent state-trait analyses revealed that mothers', fathers', and primary teachers' (but not secondary teachers') ratings reflected more trait variance for ADHD-HI (M = 73%), ADHD-IN (M = 74%), and AI (M = 76%) than occasion-specific variance (M = 27%, M = 26%, and M = 24%, respectively). Fathers' ratings shared a meaningful level of trait variance with mothers' ratings of ADHD-HI and ADHD-IN (range 78% to 82%), whereas primary and secondary teachers' ratings shared lower levels of trait variance with mothers' ratings (range 41% to 63%). The trait components of fathers', primary teachers', and secondary teachers' ratings of AI showed high levels of convergence with mothers' ratings (88%, 70%, and 59% respectively). CONCLUSIONS: ADHD symptom reports reflect both trait (48 to 86%) and state (14 to 53%) variance components. The lower amount of shared variability between home and school suggests the setting-specificity of trait and state components of ADHD symptoms. Our findings indicate that ADHD symptom reports may reflect context-specific traits, suggesting the importance of differentiating and targeting ADHD behaviors across different settings.

Analysis of the effectiveness of a training program for parents of children with ADHD in a hospital environment.

INTRODUCTION: Regarding the Attention Deficit Hyperactivity Disorder (ADHD), treatments combined with pharmacological, psychoeducational and parents training programs interventions are recommended. Parenting programs have been proven efficacy in the experimental area, but there is few data about their effectiveness and feasibility in the professional area. The objective of the study is to analyze the effectiveness of a parenting program implemented in a hospital setting to improve internalized and externalized behaviors as well as parenting styles in a sample of ADHD children. METHODOLOGY: A training program for behavior management was applied to parents of 21 children with ADHD in a quasi-experimental pretest-posttest design, using measures from Child Behavior Checklist (CBCL) and Parenting Scale. RESULTS: Post-treatment data showed significant improvements specially on emotional, anxiety and oppositional defiant disorder measures. A significant but moderate improvement was found on ADHD, and non-significant on conduct problem measure. Additionally, there were moderate but significant improvements in parenting styles. CONCLUSIONS: Data support the effectiveness and feasibility of parent training programs for children with ADHD applied in hospital settings as they improve a large part of associated symptoms and parenting styles.

Longitudinal Correlates of Sluggish Cognitive Tempo and ADHD-Inattention Symptom Dimensions with Spanish Children.

The objective was to examine the longitudinal correlates of sluggish cognitive tempo (SCT) and attention deficit/hyperactivity disorder (ADHD)-Inattention (IN) dimensions with mothers' and fathers' ratings of Spanish children. Mothers and fathers rated SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), depression, academic impairment, and social impairment on 3 occasions (twice in first-grade year [6-week separation] and once in the second-grade year [12 months after the first assessment]) in Spanish children (758, 746, and 718 children at the 3 time-points with approximately 55% boys). The results showed that (a) higher levels of SCT from earlier assessments predicted higher levels of depression, academic impairment, and social impairment at Assessment 3 after controlling for ADHD-IN at earlier assessments; (b) higher levels of ADHD-IN from earlier assessments predicted higher levels of depression, academic impairment, and social impairment at Assessment 3 after controlling for SCT at earlier assessments; (c) higher levels of ADHD-IN from earlier assessments predicted higher levels of ADHD-HI and ODD at Assessment 3 after controlling for SCT from earlier assessments; and (d) higher levels of SCT from earlier assessments either showed no unique relationship with ADHD-HI and ODD or predicted lower levels of ADHD-HI and ODD at Assessment 3 after controlling for ADHD-IN from earlier assessments. Initial evidence is provided of SCT's unique longitudinal relationships with depression and academic/social impairment and different longitudinal relationships with ADHD-HI and ODD relative to ADHD-IN, thus adding to a growing body of research underscoring the importance of SCT as distinct from ADHD-IN.

Distinctions between sluggish cognitive tempo, ADHD-IN, and depression symptom dimensions in Spanish first-grade children.

The objective of this study was to evaluate the validity of a new parent rating scale of Sluggish Cognitive Tempo (SCT). SCT was defined with 10 symptom domains--daydreams; attention fluctuates; absentminded; loses train of thought; easily confused; seems drowsy; thinking is slow; slow-moving; low initiative; and easily bored, needs stimulation--with each domain represented by multiple examples. Mothers' and fathers' ratings of SCT, ADHD-IN, ADHD-HI, oppositional defiant disorder (ODD), and depression symptoms along with ratings of academic and social impairment were obtained for a sample of 802 Spanish first-grade children (54% boys). SCT Symptom Domains 4 to 8 showed substantial loadings on the SCT factor (i.e., convergent validity) and substantially higher loadings on the SCT factor than the ADHD-IN factor (i.e., discriminant validity). This 5-domain measure of SCT showed good interrater and test-retest reliability for a 6-week interval. Higher scores on the 5-domain measure of SCT predicted higher levels of academic and social impairment even after controlling for ADHD-IN and depression. In contrast, higher levels of SCT were not uniquely related (or uniquely negatively related) to ADHD-HI and ODD, whereas ADHD-IN and depression were uniquely positively related to ADHD-HI and ODD. The new measure of SCT more clearly establishes that SCT, ADHD-IN, and depression represent independent symptom dimensions, thus providing a measurement tool to help determine if SCT and ADHD-IN dimensions have unique biological correlates and if SCT and ADHD meet the criteria for different disorders.

Cognitive Disengagement Syndrome and Child Sleep Problems in ADHD, Anxiety and Depression.

The main objective of this study was to analyse the relationship and differential contribution of Cognitive Disengagement Syndrome (CDS) and sleep problems in children in different psychopathological measures. A total of 1133 participants (612 fathers/mothers and 521 children aged 7-13 years in Years 3-6 of Primary Education) completed the scales on CDS, sleep problems, depression (DEP), anxiety (ANX) and attention deficit and hyperactivity disorder (ADHD). Similar and significant correlations were identified in the measures of CDS and sleep problems between fathers and mothers, obtaining a high coefficient between the two parents. However, weak correlations were found between fathers/mothers and children. The scores of CDS and the sleep disturbance scale for children (SDSC) significantly predicted the internalising measures and ADHD, especially between SDSC and DEP. It was confirmed that sleep problems had a greater presence in the group of children with the highest ADHD scores, and especially in CDS and ADHD jointly. To conclude, the data indicate the importance of sleep problems in understanding CDS and its relationship with other psychopathological measures, especially ADHD, although to a greater extent with internalising symptoms, especially DEP.

Oppositional Defiant Disorder in the DSM-5: Does the Limited Prosocial Emotions Specifier Portend a More Severe Clinical Presentation?

This study investigated whether oppositional defiant disorder (ODD) with the DSM-5 limited prosocial emotions (LPE) specifier marks a more severe clinical presentation than ODD alone. Mothers, fathers, and teachers of 2,142 Spanish children (49.49% girls; ages 8 to 13 years) completed measures of ODD, LPE, ADHD-hyperactivity/impulsivity (HI), ADHD-inattention (IN), cognitive disengagement syndrome (CDS), anxiety, depression, social impairment, academic impairment, and peer rejection (teacher only measure). Scores greater or less than 1.50 SDs above the ODD and LPE means were used to create ODD-only (5.89-7.22% of the sample, depending on informant), LPE-only (7.61-8.25%), ODD + LPE (1.69-2.20%), and comparison groups (82.96-84.68%) for each source. For all three sources, the LPE-only group scored higher than the comparison group on social impairment, peer rejection, and academic impairment but did not differ significantly on anxiety. Although the ODD-only and ODD + LPE groups scored higher than the LPE-only group on all symptom and most impairment dimensions, the ODD + LPE group did not show a consistent pattern of higher scores than the ODD-only group. There were no differences on mother ratings, and higher scores for the ODD + LPE group emerged on only three of seven father-report measures (depression, CDS, and ADHD-IN) and three of eight teacher-report measures (peer rejection, social impairment, and academic impairment). Limited differences between the ODD + LPE and ODD-only groups raise questions about the usefulness of LPE as a severity specifier for ODD among children. Future studies need to address this issue with adolescents and clinical samples.

Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome.

OBJECTIVE: The aim of this work was 2-fold: (1) to evaluate current knowledge and identify key directions in the study of sluggish cognitive tempo (SCT); and (2) to arrive at a consensus change in terminology for the construct that reflects the current science and may be more acceptable to researchers, clinicians, caregivers, and patients. METHOD: An international Work Group was convened that, in early 2021, compiled an online archive of all research studies on SCT and summarized the current state of knowledge, noted methodological issues, and highlighted future directions, and met virtually on 10 occasions in 2021 to discuss these topics and terminology. RESULTS: Major progress has been made over the last decade in advancing our understanding of SCT across the following domains of inquiry: construct measurement and stability; genetic, environmental, pathophysiologic, and neuropsychological correlates; comorbid conditions; functional impairments; and psychosocial and medication interventions. Findings across these domains are summarized, and potential avenues to pursue in the next generation of SCT-related research are proposed. Following repeated discussions on terminology, the Work Group selected "cognitive disengagement syndrome" (CDS) to replace "SCT" as the name for this construct. This term was deemed to best satisfy considerations that should apply when selecting terms for a condition or syndrome, as it does not overlap with established terms for other constructs, is not offensive, and reflects the current state of the science. CONCLUSION: It is evident that CDS (SCT) has reached the threshold of recognition as a distinct syndrome. Much work remains to further clarify its nature (eg, transdiagnostic factor, separate disorder, diagnostic specifier), etiologies, demographic factors, relations to other psychopathologies, and linkages to specific domains of functional impairment. Investigators are needed with interests and expertise spanning basic, clinical, and translational research to advance our understanding and to improve the lives of individuals with this unique syndrome.

Consistency and source specificity of symptom ratings for Child and Adolescent Behavior Inventory Scales with mother, father, and teacher ratings of Spanish children.

The study determined consistency relative to a reference source (convergent validity for nonreference sources with a reference source) and specificity for nonreference sources in true score variance in Child and Adolescent Behavior Inventory (CABI) ADHD-inattentive (IN), ADHD-hyperactive/impulsive (HI), sluggish cognitive tempo (SCT), oppositional defiant disorder (ODD), limited prosocial emotions (LPE), depression, anxiety, academic impairment, and social impairment scale scores. A multiple indicator by single trait by correlated (methods-1) model with indicator-specific trait factors was used to evaluate CABI scale scores with mother, father, and teacher ratings of 2,142 Spanish children (49.49% girls; ages 8-13). Mother ratings served as the reference source with father and teacher ratings serving as nonreference sources. Father with mother ratings showed substantial convergent correlations for each CABI scale (.73 to .90). Teacher with mother ratings showed a substantial convergent correlation for academic impairment (.72), strong convergent correlations for ADHD-IN (.57), ADHD-HI (.46), SCT (.52), and depression (.46), and small-to-moderate convergent correlations for ODD (.33), LPE (.24), and anxiety (.22) scales. Source independent and context-specific measures with appropriate content validity for home and school settings are required to better understand the greater variability in consistency from teacher to mother ratings. These results provide new information for the use of the CABI with multiple sources. In addition, the study indicates how a multiple indicator by single trait by correlated (methods-1) model with indicator-specific trait factors can be used to better understand multiple source ratings of child and adolescent psychopathology and adjustment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The External Validity of Sluggish Cognitive Tempo Versus Inattention in Behavioral, Social Interaction, and Academic Performance Measures.

BACKGROUND: The main objective was to replicate data on the external validity of the Sluggish Cognitive Tempo (SCT) dimension, versus ADHD Inattention (IN), with the Spanish version of the Child and Adolescent Behavior Inventory (CABI) SCT subscale [ Cuestionario sobre el Comportamiento de Niños ] (Burns et al., 2015). METHOD: 273 mothers and 255 fathers evaluated their 9 to13 year old children on SCT, IN and other CABI internalizing externalizing, academic impairment and social interaction measures. RESULTS: As hypothesized, the relationship between SCT and externalizing measures, in contrast to IN, was practically nonexistent, whereas both measures were related to internalizing and social interaction measures. Thus, the unique predictive capacity of SCT and IN was significant and similar on internalizing measures, except in the case of shyness, where SCT was better, while IN was better on externalizing measures. CONCLUSIONS: The data largely replicated previous results: SCT, despite its relationship with IN, is capable of predicting a significant proportion of anxiety, depression, and excessive shyness problems and, unlike IN, functions as a protective measure for externalizing problems.

Multisource Network and Latent Variable Models of Sluggish Cognitive Tempo, ADHD-Inattentive, and Depressive Symptoms with Spanish Children: Equivalent Findings and Recommendations.

Multisource network and latent variable models were used to examine the construct validity of sluggish cognitive tempo (SCT) symptoms relative to attention-deficit/hyperactivity disorder-inattentive (ADHD-IN) and depressive symptoms. The five objectives were to determine the (1) distinctiveness of SCT, ADHD-IN, and depressive symptom communities, (2) similarity of the three symptom communities across mother, father, and teacher ratings, (3) individual symptoms with the strongest influence on other symptoms, (4) individual symptoms with the strongest relations to academic and social impairment, and (5) similarity between network and latent variable model results. Mothers, fathers, and teachers rated SCT, ADHD-IN, and depressive symptoms for 2,142 Spanish children (49.49% girls, ages 8-13 years, third to sixth grade). Walktrap community analysis resulted in SCT, ADHD-IN, and depressive symptom communities with three SCT symptom communities within the overall SCT symptom community (daydreams, mental confusion, and hypoactive communities). The symptom networks were also similar across mothers, fathers, and teachers, especially mothers and fathers. Finally, for all three sources, the same two SCT and two ADHD-IN symptoms showed unique relations with academic impairment and the same depressive symptom showed unique relations with social impairment. A latent variable model yielded equivalent results. Both models thus supported the validity of SCT symptoms relative to ADHD-IN and depressive symptoms. Complexities are noted in the selection of network and latent variable models to study child and adolescent psychopathology with recommendations for their selection.

Psychometric Properties and Normative Information on the Child and Adolescent Behavior Inventory with Ratings for Spanish Children from Parents and Teachers.

BACKGROUND: Psychometric properties and initial normative information are provided for the sluggish cognitive tempo, attention-deficit/hyperactivity disorder-inattention, attention-deficit/hyperactivity disorder-hyperactivity/impulsivity, oppositional defiant disorder, callous-unemotional behavior (limited prosocial emotions specifier), anxiety, depression, social impairment, and academic impairment scales of the Spanish Child and Adolescent Behavior Inventory. METHOD: Mothers, fathers, and teachers of 2,142 third to sixth grade Spanish children (49.49% girls; ages 8-13) from randomly selected schools on the Balearic Islands completed the Child and Adolescent Behavior Inventory. RESULTS: Scores from the scales demonstrated reliability (internal consistency and inter-rater), structural validity, and convergent/discriminant validity with attention-deficit/hyperactivity disorder and learning disorder diagnoses for boys and girls separately for each source. Normative information (T-scores) is provided for the nine scales separately for boys and girls, with test information functions supporting use of the symptom scales for screening purposes. CONCLUSIONS: Although more comprehensive Spanish norms are still needed, the initial normative information on the scales should be useful to inform the clinical care of individual Spanish children, with the positive psychometric properties of the scores also supporting the use of the scale for research. Copies of the Spanish Child and Adolescent Behavior Inventory and norms are available for free to clinicians and researchers.

Long-Term Profiles of Bullying Victims and Aggressors: A Retrospective Study.

Bullying is a widespread and worrying phenomenon, related to many different personal, behavioral, and social variables which can modulate it and its outcomes, also in the long term. These relationships are usually studied in children and adolescents, but less often in adults who have suffered or perpetrated bullying in the past. The present work explored the long-term characteristics of bullying victims and aggressors using a retrospective design. A sample of 138 adults of different ages completed an on-line protocol that included measures of bullying and victimization, substance use, sensitivity to reward and punishment, social skills, antisocial behavior, emotional regulation strategies, depression, anxiety, stress, self-esteem, and risk of suicide. The sample was divided into three groups (victims, aggressors, and controls) based on their responses to bullying-related questions. A set of Multiple Analyses of Variance with group as a fixed factor was carried out for each dependent variable. Victims and aggressors did not significantly differ in their self-reported substance consumption. Victims showed higher global depression, anxiety and stress in the past than aggressors (M = 34.66, SD = 11.74; aggressors: M = 19.70, SD = 16.53), higher emotional lack of control (M = 23.97, SD = 10.62; controls: M = 17.11, SD = 7.95) and rejection (M = 21.72, SD = 7.24; controls: M = 16.33, SD = 5.67), lower self-esteem (M = 27.72, SD = 6.70; controls: M = 31.60, SD = 6.60), and a larger frequency of suicidal thoughts (in the past) than controls. Aggressors showed higher sensitivity to reward (M = 12.03, SD = 3.66; controls: M = 8.42, SD = 3.92), larger communicational and relational skills (M = 22.10, SD = 7.20; controls: M = 17.96, SD = 7.16), and lower emotional sensitivity (M = 14.80, SD = 4.10; controls: M = 16.76, SD = 2.21). Accordingly, the logistic regression analysis identified sensitivity to reward and low psychological adjustment as the main predictors of the aggressor and victim profiles, respectively. The present results are discussed considering the extant literature on bullying and may help to improve prevention programs for this relevant social scourge.

Perinatal psychological interventions to promote breastfeeding: a narrative review.

BACKGROUND: Emotional distress in mothers inhibits the let-down reflex, thus affecting breastfeeding self-efficacy. A breastfeeding mother may have to cope with both physical discomfort and psychological distress. However, literature on initiatives to improve breastfeeding rates has focused mainly on providing community-based peer support, or social policies. The aim of this review is to assess evidence on the effectiveness of a broad range of psychological interventions to facilitate breastfeeding for mothers facing difficulties around the time of delivery. METHODS: The review of the literature is derived from a search on Cochrane Library, PubMed, EBSCOhost, and PsycINFO for papers published since 1980. The approach was to explore quantitative and qualitative parameters. Quantitative parameters included breastfeeding initiation, duration, and composition. Qualitative parameters recorded the evaluation of maternal perceptions on breastfeeding success. The high heterogeneity of the studies led to a narrative review; 20 selected papers that report on breastfeeding outcomes and psychological programs met the inclusion criteria. RESULTS: The evidence on breastfeeding support through psychotherapy is heterogeneous and scant. Out of the included studies, 11 were randomized controlled trials, two were non-randomised trials, and two used a quasi-experimental design. None of the studies reported an increase in adverse breastfeeding outcomes. Three studies failed to report an association between psychological procedures and improved breastfeeding outcomes. A literature review showed that 17 (85%) analyses support stress-releasing techniques to facilitate breastfeeding. CONCLUSIONS: This review suggests that relaxation interventions carefully tailored to address perinatal emotional distress may lead to important health benefits, including improvement in breastfeeding outcomes. There is also some indication that psychotherapy support while breastfeeding may have more impact than routine counselling. Conversely, this review did not find an association between self-hypnosis and breastfeeding outcomes. Data from this study can be used in designing prevention programs and future research with appropriate theoretical underpinning.