Using the five to fifteen-collateral informant questionnaire for retrospective assessment of childhood symptoms in adults with and without autism or ADHD.

Due to lack of previous studies, we aimed at evaluating the use of the Five to Fifteen (FTF) questionnaire in adults with neurodevelopmental disorders (NDD) and in controls without NDD. The NDD group consisted of adults with autism spectrum disorder ASD (n = 183) or attention-deficit/hyperactivity disorder (ADHD) (n = 174) without intellectual disability, recruited from a tertiary outpatient clinic. A web survey was used to collect data from general population adult control group without NDD (n = 738). The participants were retrospectively rated by their parents regarding childhood symptoms, using five to fifteen-collateral informant questionnaire (FTF-CIQ). Adults with NDD had higher FTF-CIQ domain and subdomain scores than controls, and displayed similar test profiles as children with corresponding diagnosis in previous studies. Based on the FTF-CIQ domain scores, 84.2% of the study participants (93% of the controls; 64% of the adults with NDD) were correctly classified in a logistic regression analysis. Likewise, Receiver Operating Characteristic (ROC) curve analysis on FTF-CIQ total sum score indicated that a cut-off value of 20.50 correctly classified 90% of the controls and 67% of the clinical cases, whilst a cut-off value of 30.50 correctly classified 84% of the controls and 77% of the clinical cases. The factor analysis revealed three underlying components: learning difficulties, cognitive and executive functions; social skills and emotional/behavioural symptoms; as well as motor and perceptual skills. Whilst not designed as a diagnostic instrument, the FTF-CIQ may be useful for providing information on childhood symptoms and associated difficulties in individuals assessed for NDD as adults.

Tourette's disorder: epidemiology and comorbidity in primary school children.

OBJECTIVE: To study prevalence and comorbidity of Tourette's disorder in the general population of children and in a clinical setting. METHODS: School-age children in the general population and children attending a county-wide tic disorder clinic were screened and examined by the same doctor. Behavioral-psychometric instruments with demonstrated reliability and validity were used. RESULTS: Depending on the sample characteristics, 0.15% to 1.1% of all children had Tourette's disorder. Boys outnumbered girls by 4:1 through 6:1. Attention deficits and empathy/autism spectrum problems (including Asperger's disorder) were very common, each type of comorbidity affecting approximately two thirds of individuals with Tourette's disorder. Overall behavior problem scores were high, and affected children exhibited a marked degree of functional impairment. CONCLUSIONS: Tourette's disorder is a common disorder with high rates of significant comorbidity. In most cases, attention deficits and empathy problems are likely to cause more suffering than the tics per se.

Developmental coordination disorder in Swedish 7-year-old children.

OBJECTIVE: To estimate the prevalence, comorbidity, and outcome in developmental coordination disorder (DCD). METHOD: In this population study of 7-year-olds undergoing individual examination plus teacher and parent interviews, children were followed up at ages 8, 9, and 10 years. RESULTS: Severe DCD occurred in 4.9% and moderate DCD in another 8.6%. Boy-girl ratios ranged from 4:1 to 7:1. Children with severe and moderate DCD did not differ from each other on any measure, but both groups were clearly separated from children without DCD with respect to associated attention deficit symptoms. Asperger's disorder symptoms, school dysfunction scores, and outcome. Approximately half of all children with DCD had moderate to severe symptoms of attention-deficit/hyperactivity disorder (ADHD). CONCLUSIONS: DCD is a common problem, and it is strongly associated with ADHD symptoms. A diagnosis of DCD at age 7 years predicts DCD at age 8 years and restricted reading comprehension at age 10 years. Clinicians need to acquaint themselves with DCD and its comorbidity so that they can provide better services to affected children.

ADHD in Swedish 3- to 7-year-old children.

OBJECTIVE: To study characteristics of attention-deficit/hyperactivity disorder (ADHD) in a representative group of clinically impaired young children in Sweden with the disorder. METHOD: One hundred thirty-one children with ADHD (aged 3-7 years) were examined, and their parents were interviewed. Independent parent questionnaire data (Child Behavior Checklist, ADHD Rating Scale-IV, Conners) were collected. For comparison 131 children without ADHD were matched for age, gender, parents' marital status, child's adoption status, and social class. RESULTS: Children with ADHD had extremely high ADHD symptom levels--on average four to eight times higher than the comparison group. Sociodemographic correlates of ADHD symptoms were more pronounced in parent questionnaire data than in parent interview data, underscoring the importance of diagnostic interview when dealing with clinical issues. Very few of the children with ADHD (6%) appeared "normal" with regard to attention/activity level at clinical examination. CONCLUSIONS: Clinic children with a diagnosis of DSM-IV ADHD have typical and impairing symptoms already before starting school. The variance of ADHD in this age group appears to be accounted for by primary psychosocial factors only to a limited degree. It would seem reasonable to establish supportive and treatment measures for these young children so that the psychosocial and academic problems shown by so many individuals with ADHD later in their development might be reduced.

[DAMP and ADHD as "hidden" functional disabilities. Carefully prepared care of children at risk is beneficial for an optimal development]. / DAMP och ADHD "osynliga" funktionshinder. Genomtänkt omhändertagande av riskbarn främjar optimal utveckling.

A current study of seven-year-olds in Karlstad showed the incidence of DAMP (deficits in attention, motor function and perception) to be 1.7 per cent, and that of ADHD (attention deficit hyperactivity disorder) to be 2.0 per cent, figures consistent with those obtained in previous studies. A further 4.9 per cent were found to have milder forms of DAMP. Research during the past few decades has yielded comprehensive knowledge of the effect of such disability on the child's development. Manifestation of the child's problems is dependent on how the child is treated by others, and on the understanding and help deriving from the family and from the preschool or school. It is essential to evolve a well considered management programme of health care for which the school or preschool is responsible. The programme should include methods for early detection, access to a competent investigatory team, support and treatment facilities for the child and the parents, and assistance at school or preschool.

The comorbidity of ADHD in the general population of Swedish school-age children.

This study examined patterns of comorbid/associated diagnoses and associated problems in a population sample of children with and without DSM-III-R attention-deficit hyperactivity disorder (ADHD). Half (N = 409) of a mainstream school population of Swedish 7-year-olds were clinically examined, and parents and teachers were interviewed and completed questionnaires. The children were followed up 2-4 years later. Eighty-seven per cent of children meeting full criteria for ADHD (N = 15) had one or more and 67% at least two--comorbid diagnoses. The most common comorbidities were oppositional defiant disorder and developmental coordination disorder. Children with subthreshold ADHD (N = 42) also had very high rates of comorbid diagnoses (71% and 36%), whereas those without ADHD (N = 352) had much lower rates (17% and 3%). The rate of associated school adjustment, learning, and behaviour problems at follow-up was very high in the ADHD groups. We concluded that pure ADHD is rare even in a general population sample. Thus, studies reporting on ADHD cases without comorbidity probably refer to highly atypical samples. By and large, such studies cannot inform rational clinical decisions.

Attention deficits and clumsiness in Swedish 7-year-old children.

A population study of 409 seven-year-old children in a middle-sized Swedish town was performed. All children were examined by the same doctor and evaluated by means of parent interview, motor examinations, and teacher reports on behaviour in the classroom. Follow-up was carried out 8 months later. The rate of severe problems in the fields of attention deficit-hyperactivity disorder (ADHD), developmental coordination disorder (DCD), and deficits in attention, motor control, and perception (DAMP) (the combination of ADHD and DCD) was 6.1%, with boys being affected more frequently than girls. There was considerable overlap between ADHD and DCD, with about half of each diagnostic group also meeting criteria for the other diagnosis. Attention deficits at diagnosis strongly predicted attention deficits at follow-up. If parents had noted attention deficits in the home setting, then teachers almost always independently agreed that there were similar problems in the classroom. However, the reverse did not always apply. Clumsiness also showed striking stability over time. The diagnosis of DAMP, particularly severe DAMP, had a stronger association with classroom dysfunction and with high Conners scores than did diagnoses of ADHD or DCD. It is concluded that DAMP may be a clinically valid diagnostic construct.