Impulsivity and internalizing disorders in childhood.

Impulsivity has often been related to externalizing disorders, but little is known about how it is related to symptoms of internalizing disorders. This study aims to examine the relationship between impulsivity and depression and anxiety symptoms of depression and anxiety in childhood, and compare it with its relationship with a measure of aggressive behavior, which is present in many externalizing disorders. We administered the Barratt Impulsiveness Scale-11 for children, the Children's Depression Inventory and the Screen for Children's Anxiety Related Emotional Disorders to a case-control sample of 562 children aged between 9 and 13 who were selected from an epidemiological study of anxiety and depression and whose teachers provided information about their proactive and reactive aggression. Impulsivity was related to measures of anxiety, depression and aggressive behavior, and showed higher relationships with measures of internalizing symptoms than with aggression. Motor impulsivity, a component of impulsivity related to inhibition deficits, was the component most related to anxiety and depression. Cognitive impulsivity, on the other hand, was negatively related to anxiety and depression. The relationships between impulsivity and symptoms of internalizing disorders seem to indicate that impulsivity should be taken into account not only in externalizing problems, but also in depression and anxiety in children and adolescents.

BDNF Val66Met polymorphism, energy intake and BMI: a follow-up study in schoolchildren at risk of eating disorders.

BACKGROUND: Eating disorders (ED) have a multifactorial aetiology in which genetics play an important role. Several studies have found an association between the Val66Met (G196A) polymorphism of the Brain-Derived Neurotrophic Factor (BDNF) and Eating disorders.The aim of this study was to determine the association of the Val66Met (G196A) polymorphism of the BDNF gene and its effect on eating disorders (ED), energy intake and BMI in schoolchildren. METHODS: Two-year cohort study (preadolescence to adolescence). From an initial sample of 1336 Caucasian children (mean age = 11.37 years), a group at risk of ED (n = 141) and a control group (n = 117) were selected using the Children's Eating Attitudes Test. Two years later, they were re-classified into an at-risk group (n = 41) and a control group (n = 159) using the Eating Attitudes Test. The diagnosis of the individuals at risk of ED was confirmed by means of the Diagnostic Interview for Children and Adolescents. BMI, energy intake and the Val66Met (G196A) polymorphism of the BDNF gene were analysed in the at-risk and control groups. RESULTS: The frequency of genotypes of the Val66Met (G196A) polymorphism of the BDNF gene is 28.6% (95% CI: 22.4-34.9) in the heterozygous form (Val/Met) and 5% (95% CI: 2.4-9) in the homozygous form (Met/Met). We detected no association between Val66Met genotypes and the severity of ED. Over time, the carriers of the Met66 allele with a persistent risk of ED significantly restricted energy intake (507 Kcal/day; p = 0.033). CONCLUSION: We have not found an association between Val66Met (G196A) polymorphism of the BDNF and ED in schoolchildren from general population. The relationship found between this polymorphism and energy intake restriction in adolescents with a persistent risk of ED should be replicated in a larger sample.

[Comorbidity between SCARED anxiety factors and depressive symptomatology in 8- to 12-year-old children]. / Comorbilidad entre los factores de ansiedad del SCARED y la sintomatología depresiva en niños de 8-12 años.

The aim of this study was to examine the comorbidity between the SCARED anxiety factors and depressive symptoms in 8-12-year-old children. Participants were 792 girls and 715 boys, who completed: the 41-ítem version of the Screen for Child Anxiety Related Emotional Disorder (SCARED), the Children's Depression Inventory (CDI) and a Socio-demographic questionnaire. Of the sample, 47% showed anxiety symptoms and 11.5% showed depressive symptoms. Heterotypic comorbidity was 82% in children at risk of depression and 20% in children at risk of anxiety. Homotypic Comorbidity between anxiety factors was 87%. Homotypic comorbidity and heterotypic comorbidity were high; their early detection will prevent the continuity of an anxious disorder and the development of depression.

Personality in non-clinical adolescents with eating disorders.

OBJECTIVE: The aim of this study was to examine whether personality-related differences also exist in non-clinical adolescents with any given type of eating disorder (ED) and whether personality characteristics are associated with changes in the course of the diagnosis. METHOD: An initial sample of 1336 boys and girls (mean age: 11.37, SD = 0.62) was assessed in a two-phase long-term study. A total of 258 subjects were selected from the initial sample (T1) and contacted again 2 years later (T2) (n = 200). These subjects comprise the sample group of this study. Of these, 51 were diagnosed with ED (37 with diagnosis type anorexia (DTA) and 14 with diagnosis type bulimia (DTB)). An experimental version of the Junior Temperament and Character Inventory (JTCI) was applied. RESULTS: Subjects with DTA had significantly higher scores on Reward Dependence and Self-Directedness factors than subjects with no diagnosis or DTB, respectively. Subjects with DTB had higher scores on Novelty Seeking, Harm Avoidance and Spirituality factors than subjects with forms of anorexia or without diagnosed ED. Subjects with ED remission had significantly lower scores on Persistence and Self-Directedness scales. ED incident subjects had significantly higher scores on Harm Avoidance. CONCLUSIONS: Subjects without full-blown syndromes have similar temperament characteristics to subjects with full eating disorders. These results support the theory that non-full-blown syndromes differ from full syndromes only in pathological severity.

Functional and dysfunctional impulsivity in childhood and adolescence.

There are few self-reports of impulsivity dealing with children, although this personality trait has been related to many behaviour problems in both children and adolescents. The appropriateness of the Dickman Impulsivity Inventory for Children (DII-c) and the Dickman Impulsivity Inventory (DII) to measure impulsivity in children and adolescents was assessed. The factorial structure of the DII-c and the internal consistencies for both inventories suggest the measured dimensions are not consistent until adulthood. These self-report measures are not appropriate for children and adolescents.

Psychometric properties of the Spanish adaptation of the Barratt Impulsiveness Scale-11-A for children.

Given difficulty in having children assess their own behaviour, there are few self-reports on child impulsivity. With the exception of Eysenck's 16 questionnaire, there are no self-report measures of impulsivity in children with good psychometric properties. The present study tested the possibility of using the adolescent version of the Barratt Impulsiveness Scale-11 with children. For this purpose the questionnaire was translated and backtranslated and administered to school children (182 boys and 195 girls) ages 8 to 12 years (M = 10.4, SD = 0.9). The data were analysed by exploratory factor analysis, to evaluate the factorial structure of the questionnaire, the fit of the proposed solution, and internal consistency reliabilities. Results seem to indicate that this questionnaire may be useful in assessing impulsivity in children. The three-factor structure showed slight differences with the initial questionnaire proposed by Barratt and had good or sufficient internal consistency (depending upon the scale) across the 8- to 12-yr.-old age range.

Teacher reports of peer aggression in preschool: its relationship to DSM-IV externalizing symptoms.

OBJECTIVE: to establish the prevalence and associations of peer aggression as manifested in preschool children, in community-based populations and to study links with DSM-IV externalizing diagnoses. METHOD: Subjects were 1104 children, 3-to-5-year-olds attending rural and urban pre-schools classes. Teachers completed the Peer Conflict Scale (PCS) to inform about direct physical and verbal aggression, object aggression and symbolic aggression and the questionnaire on psychopathology ECI-4. RESULTS: 6.6% (n=73) had at least one positive item on the PCS. This percentage dropped to 2.6% (n=29) if we take into account a minimum of three positive items. Physical direct aggression was the more prevalent type of aggressive behavior, followed by verbal aggression, object aggression and symbolic aggression. Significant differences by gender and age were found. Peer aggression was associated with male gender from three years of age. Physical, object and verbal aggressive behavior was linked with externalizing disorders. This association was very strong with oppositional disorder. CONCLUSIONS: The present research with a Spanish population confirms the existence of peer aggression in preschoolers and the gender differences. Our chief contribution is about the age of emergence of sex differences and gender differences in different types of peer aggression.

Effect of B1-, B6- and iron intake during pregnancy on neonatal behavior.

The aim of this study was to analyze how micronutrient intake during preconception and pregnancy affects neonatal behavior. A total of 66 healthy women volunteers were studied during preconception and in weeks 6, 10, 26, and 38 of pregnancy using the seven-day dietary record. The behavior of the newborn infant was assessed after three days of life using the Neonatal Behavioral Assessment Scale (NBAS). Multiple linear regression models were built and adjusted for the confounding variables in each of the periods studied and for each one of the various NBAS clusters. The intake of vitamins B1 and B6 in the sixth week of pregnancy and of iron in the 38th week of pregnancy have a positive and significant effect on the motor cluster of the NBAS independently of the body mass index (BMI), preconception age, gestational age, educational level, whether the mother is a smoker, the mother's personality dimensions, and the weight and sex of the newborn. The intake of B1, B6, and iron during pregnancy might contribute to the neuromotor maturity of the newborn.

Psychological problems and nutritional status in 6-year-old children.

There were no relations between nutritional status and psychological problems in 83 nonclinical 6-yr.-old children from low-risk socioeconomic and family backgrounds. Only Vitamin B12 and weight were significantly lower in the group with psychological problems. More in-depth longitudinal studies are necessary to confirm these results.

Parental reports of somatic symptoms in preschool children: prevalence and associations in a Spanish sample.

OBJECTIVE: To document prevalence and associations of somatic symptoms in Spanish preschool children. METHOD: Subjects were 3- to 5-year-olds attending nurseries (8 urban, 30 rural). Parental questionnaires (response rate 77%) were used to inquire about somatic symptoms in the child in the 2 weeks prior to assessment, about preschool absence and pediatric help-seeking, chronic family health problems, and recent stressful life events for the child. Parents completed questionnaires on child psychopathology (Early Childhood Inventory 4) and their own mental health (General Health Questionnaire). Children who were reported as complaining of symptoms frequently (four or more times) were compared to noncomplaining children. RESULTS: Parents reported that 452 of the 807 (56%) children complained of somatic symptoms at least once, significantly more so in urban than in rural areas. Frequent somatic complaints were reported for 165 of the 807 (20%) (abdominal pains 7.9%, tiredness 5.7%, leg pains 4%, headaches 2%, dizziness 0.4%). There were significant associations of frequent symptom reporting with days off preschool and pediatric clinic attendance, with emotional and behavioral symptoms in children, mental distress in parents, and urban abode. CONCLUSIONS: Somatic symptoms are common in preschool children. Results point to family influences.

Discriminant validity of the Eating Attitudes Test according to American Psychiatric Association and World Health Organization criteria of eating disorders.

The purpose of this study was to assess the sensitivity, the specificity, and the positive predictive value of the Eating Attitudes Test in a sample of Spanish nonclinical 18-yr.-olds. 304 subjects answered the Eating Attitudes Test-40, 290 of whom were interviewed individually with the Spanish version of the Schedules for Clinical Assessment in Neuropsychiatry. Eating disorders were diagnosed using ICD-10 and DSM-III-R criteria. The prevalence of eating disorders was higher for ICD-10 (5.2%) than for DSM-III-R (2.6%) and only affected the rate of diagnosis in women. According to ICD-10 criteria, the cut-off of 25 was more sensitive (87.5%) than the cut-off of 30 (75%) and varied little in specificity (93.9% vs 97.1%). The positive predictive value of the Eating Attitudes Test cut-off of 30 for eating disorders (ICD-10) was 36%. Our results support the test as useful for identifying eating disturbances in 18-yr.-olds and suggest assessment of a cut-off lower than 30 may be appropriate in the general population if confirmed in further research with a representative sample of adults.

Psychological problems and associated factors at 6 years of age: differences between sexes.

In a non-clinical group of 130 children (65 boys and 65 girls), we evaluated the relationships between psychological problems using the Child Behavior Checklist (CBCL) reported by parents, the Inattention Overactivity With Aggression (IOWA) scale reported by teachers, individual factors (Intellectual quotient [IQ], temperament and heart rate) and environmental factors (stress events, mother's profession and being or not being an only child). We found no differences between the sexes in the prevalence of total psychological problems in the clinical range, but girls had significantly more borderline total problems than boys. Girls tended to have more externalizing problems than boys. In boys, there were more links between individual and environmental factors and psychological problems, especially externalizing problems. A high score in psychological problems assessed by the CBCL affected the school performance of boys and the social performance of girls. For boys, IQ was significantly lower when the score for total behavioral problems was higher, and for girls IQ was significantly lower when the score for externalizing problems was higher. Understanding the different levels of vulnerability of the sexes at different periods of development may help to improve the treatment children in this age group receive.

Psychological and family factors associated with suicidal ideation in pre-adolescents.

To assess the psychological and family factors associated with suicidal ideation in pre-adolescent children, we studied a sample of 361 students, average age 9 years old. Two groups were formed, on the basis of the presence (n = 34) or absence (n = 44) of suicidal ideation. Suicidal ideation was assessed with the Children's Depression Inventory and the Children's Depression Rating Scale-Revised. Depression, hopelessness, self-esteem, and perceived family environment were compared in both the suicidal ideation and the control groups. Students with suicidal ideation generally presented greater depressive symptoms and hopelessness, and lower self-esteem and family expressiveness, although there were differences both between sexes, and when the variable depression was controlled. Identifying these risk factors in pre-adolescents may have an impact on prevention of suicidal behavior at higher risk ages.

Parent-child agreement in SCARED and its relationship to anxiety symptoms.

The aim of this study is to analyze parent-child agreement in the Spanish version of the Screen for Anxiety Related Emotional Disorders and its relationship with the anxiety symptoms reported in a scheduled interview and the Mini-International Neuropsychiatric Interview for Children and Adolescents in order to establish the best informant and the degree of incremental validity when both sources of information are combined. Results indicated that, as in the original English version, parent-children agreement is low, with parents clearly tending to report fewer severe symptoms than children. When both parent and child versions were related to anxiety symptoms of the scheduled interview, children showed higher relationships than parents with all the anxiety categories reported by the scheduled interview. Children's scores were also the best predictors of anxiety symptoms, while incremental validity of parent's reports was quite low.

Neonatal behaviour characteristics and psychological problems at 6 years.

AIM: To examine the predictive capacity of the Neonatal Behavioral Assessment Scale (NBAS) on psychological problems at the age of 6 y. METHODS: Eighty full-term infants of optimal health were evaluated at 3 d and 4 wk of age with the NBAS and at 6 y with the Child Behavior Checklist (CBCL) and the Inattention-Overactivity with Aggression Conners Teacher's Rating Scale (IOWA). RESULTS: The NBAS clusters' predictive value was different at 3 d and at 4 wk. Orientation at 3 d and habituation at 4 wk were the best predictors of psychological problems. At 3 d, lower orientation scores and higher motor and habituation scores predicted higher scores in externalizing problems. Externalizing problems were least influenced by background variables. Only in girls were internalizing problems associated with lower orientation scores. At 4 wk, lower habituation cluster scores predicted higher scores in internalizing problems. CONCLUSION: These findings suggest that the NBAS could be useful for identifying neonates at risk of later psychological problems.

Parents and teachers reports of DSM-IV psychopathological symptoms in preschool children: differences between urban-rural Spanish areas.

BACKGROUND: This study used DSM-IV criteria to analyse reports from teachers and parents and to compare behavioural and emotional symptoms in Spanish preschool children from both urban and rural populations. METHOD: The field survey was conducted in two geographical areas in Catalonia (Spain). A sample of 1104 children (56.67% boys and 43.32% girls) aged 3-6 years participated in this study: 697 were from urban areas and 408 from rural ones. The Early Childhood Inventory-teachers' and parents' versions (ECI-4) [Gadow KD, Sprafkin J (1997)-was used as the screening instrument. RESULTS: The teachers' and parents' reports assigned 32.7 and 46.7%, respectively, to one or more ECI-4 categories. Significant differences between sexes were found in teachers' reports. The whole disorders were significantly more prevalent in the urban sample than in the rural one (30.6 vs. 20.3%). The most prevalent disorders in both areas were Anxiety Disorders and Behavioural Problems, and the least prevalent were Mood Disorders and Autistic Disorders. CONCLUSIONS: The findings indicate that there are some differences in the prevalence rates of preschool psychopathological disorders between rural and urban Spanish areas.

Predictors of depression at eighteen. A 7-year follow-up study in a Spanish nonclinical population.

This study prospectively examined predicting factors and depressive antecedents of depression in early adulthood and determined differences by sex. 199 adolescents aged 11-12 from the general community were followed up annually for 4 years and reassessed at 18 years of age. Sociodemographic data, depressive symptomatology, anxiety level, personality dimensions, self-esteem, academic aptitude and pubertal development were reported throughout this period and tested as possible risk variables of depression. At 18, depression was diagnosed using ICD-10 criteria. Of the cases of major depression (MDD) at eighteen, 30% had been diagnosed as MDD between 12 and 14 years of age. Of the cases of MDD at eighteen, 80% had had depressive symptomatology between the ages of 11 and 14. Subclinical scores in the Children's Depression Inventory (CDI) were early indicators of long-term risk. Gender differences were found in the risk pattern; depressive symptoms were more significant in girls than in boys. In boys, early anxious symptomatology was a significant predictor. This study reports cross-cultural data that support a continuity of depression from adolescence to young adulthood.