Neurodevelopmental disorders: prevalence and comorbidity in children referred to mental health services.

BACKGROUND: Accurate prevalence rates of the neurodevelopmental disorders (ND) and comorbid conditions in child and adolescent mental health services (CAMHS) are essential for treatment planning and organization of health care. However, valid and reliable prevalence estimates from Nordic CAMHS populations are scarce, and the published findings vary. AIMS: To report prevalence rates of ND (attention-deficit hyperactivity disorder: ADHD, tic disorder: TD or autism spectrum disorder: ASD) and comorbid disorders by a validated diagnostic instrument in children referred to CAMHS outpatient clinics. METHODS: Parents of 407 consecutively referred children aged 7-13 years were interviewed with the semistructured interview schedule for affective disorders and schizophrenia, present and lifetime version (Kiddie-SADS-PL) at time of admittance. RESULTS: One or more ND was diagnosed in 226 children (55.5%; 69.9% boys): ADHD (44.5%; 68.5% boys); TD (17.7%; 77.8% boys) and ASD (6.1%; 76% boys). Among children with ND 70 (31.0%) had only one ND with no comorbid disorder, 49 (21.7%) had more than one ND (homotypic comorbidity) and 131 (58%) had a non-ND psychiatric disorder (heterotypic comorbidity). Anxiety disorders were the most frequently occurring heterotypic comorbidity in all three ND. Comorbid depressive disorder was associated with older age, and comorbid anxiety disorder with female gender. CONCLUSION: In children referred to CAMHS, ND constitute the most frequently occurring group of disorders, with high rates of both homotypic and heterotypic comorbidity. This needs to be taken into consideration in health service planning and treatment delivery.

Non-obsessive-compulsive anxiety disorders in child and adolescent mental health services--Are they underdiagnosed, and how accurate is referral information?

BACKGROUND: Previous studies have reported low prevalence of non-obsessive-compulsive (OCD) anxiety disorders in child and adolescent mental health services (CAMHSs), suggesting that these disorders may go unrecognized. Possible reasons may be lack of routinely used standardized diagnostic instruments, and/or an under-reporting of anxiety symptoms in the referral information. AIMS: To examine the frequency of non-OCD anxiety disorders in referred children based on a standardized diagnostic interview, to compare the results with data from the Norwegian Patient Register (NPR), and to explore the correspondence between anxiety as a referral symptom and anxiety as a diagnosis, and the influence of heterotypic co-morbidity on this correspondence. METHODS: Parents of 407 consecutive referrals to CAMHS aged 7-13 years were interviewed with the semi-structured diagnostic interview Kiddie-SADS-PL at the time of admittance. Referral symptoms were collected from national referral forms. RESULTS: A total of 133 referred children (32.7%) met the criteria for a non-OCD anxiety disorder compared with about 5% in the NPR. Half of those who met diagnostic criteria for an anxiety disorder did not have anxiety as a referral symptom. Co-morbid ADHD or disruptive disorder was significantly associated with a lower probability of having anxiety as a referral symptom. CONCLUSIONS: The use of a standardized diagnostic interview in consecutively referred children yielded significantly higher rates of anxiety disorders than the NPR prevalence rates. Co-morbid ADHD or disruptive disorder may contribute to the underdiagnosing of anxiety disorders. Diagnostic instruments covering the whole range of child psychiatric symptoms should be implemented routinely in CAMHS.

Convergent and divergent validity of K-SADS-PL anxiety and attention deficit hyperactivity disorder diagnoses in a clinical sample of school-aged children.

Background The Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime Version (K-SADS-PL) is a commonly used diagnostic interview both in research and clinical settings, yet published data on the psychometric properties of the interview generated diagnoses are scarce. Aims To examine the convergent and divergent validity of the Norwegian version of the K-SADS-PL current diagnoses of anxiety disorders and attention deficit hyperactivity disorder (ADHD). Method Participants were 105 children aged 7-13 years referred for treatment at child mental health clinics and 36 controls. Diagnostic status was determined based on K-SADS-PL interviews with the mothers. Child and mother reported child symptoms of anxiety on the Multidimensional Anxiety Scale for Children and teachers reported anxiety symptoms on the Teacher Report Form. Mother and teacher reported on symptoms of ADHD on the Disruptive Behavior Rating Scale. Results Rating scale data from multiple informants in a clinical sample and healthy controls supported the convergent and divergent validity of K-SADS-PL anxiety diagnoses combined, and, specifically, the diagnoses of separation anxiety disorder, social phobia, and specific phobia. Support was also observed for convergent and divergent validity of ADHD diagnoses, including the predominately inattentive subtype. Conclusion The K-SADS-PL generates valid diagnoses of anxiety disorders and ADHD.

Associations between sleep problems and attentional and behavioral functioning in children with anxiety disorders and ADHD.

This study examined associations between sleep problems and attentional and behavioral functioning in 137 children aged 7 to 13 years with anxiety disorders (n = 39), attention deficit hyperactivity disorder (ADHD; n = 38), combined anxiety disorder and ADHD (n = 25), and 35 controls. Diagnoses were made using the semistructured diagnostic interview Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime Version. Sleep problems were assessed using the Children's Sleep Habits Questionnaire, attention was measured by the Attention Network Test, and behavioral problems were measured by teacher ratings on the Achenbach System of Empirically Based Assessment, Teacher Report Form. Sleep problems were associated with reduced efficiency of the alerting attention system for all children and with increased internalizing problems in children with anxiety disorders.

Persistence of sleep problems in children with anxiety and attention deficit hyperactivity disorders.

This study examines the persistence of sleep problems over 18 months in 76 referred children with anxiety disorders and/or attention deficit hyperactivity disorders (ADHD) and 31 nonreferred controls, and explores predictors of sleep problems at follow-up (T2) in the referred children. Diagnoses were assessed at initial assessment (T1) using the semi-structured interview Kaufman Schedule for Affective Disorders and Schizophrenia. Sleep problems were assessed using the Children's Sleep Habit Questionnaire at T1 and at T2. Persistence rate of total sleep problems in the clinical range was 72.4 % in referred children, and did not differ significantly between children with a T1 diagnosis of anxiety disorder (76.0 %), ADHD (70.6 %), anxiety disorder and ADHD (68.8 %) or nonreferred controls (50.0 %) The total sleep problems score at T1 significantly predicted the total sleep problems score at T2, whereas age, sex, parent education level and total number of life events did not.

Comparison of sleep problems in children with anxiety and attention deficit/hyperactivity disorders.

This cross-sectional case-control study compared sleep problems in consecutively referred children aged 7-13 years meeting DSM-IV criteria for anxiety disorder, attention deficit/hyperactivity disorder (ADHD), comorbid anxiety disorder and ADHD, and a group of control children of similar age and gender. Diagnoses were assessed with the Kiddie-SADS PL interview, parent form, and the sleep problems with a standardized sleep questionnaire, the Children's Sleep Habits Questionnaire (CSHQ), as reported by the mother. A total of 141 children were included (anxiety disorder (n = 41), ADHD (n = 39), comorbid condition (n = 25), controls (n = 36)). Children in the clinical groups had more sleep problems than controls. Children with anxiety disorders and children with comorbid condition were reported to have more sleep problems than children with ADHD alone. Night waking was associated with comorbid anxiety disorder and ADHD. Bedtime resistance was associated with anxiety disorder, while daytime sleepiness affected all clinical groups. Clinical management of children with ADHD and anxiety disorders needs to include assessment of sleep problems.

Motor impairment in children with anxiety disorders.

This study examined the frequency and degree of motor impairment in referred children with anxiety disorders (AnxDs), compared with children with attention deficit/hyperactivity disorder (ADHD), children with comorbid AnxDs and ADHD, and nonreferred controls. All participants (n=141; 90 males, 51 females; mean age: 10 years, 1 month; range: 7-13 years) had an IQ greater than 70. Diagnoses of mental disorders were established using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (Kiddie-SADS). Motor ability was assessed using the Movement Assessment Battery for Children (M-ABC). We found that children with AnxDs exhibited significantly higher total impairment scores on the M-ABC than controls, but were not significantly different from children with ADHD or children with comorbid AnxDs and ADHD. All clinical groups exhibited similar profiles of motor impairment. A total of 19 (46%) children with AnxDs scored below the 5th percentile on the M-ABC, indicating that motor function is impaired in many children with AnxDs to a degree that probably interferes with their activities of daily living. These results support the notion that assessment of motor function is important in understanding the daily challenges of children with AnxDs.

The relationship between sluggish cognitive tempo, subtypes of attention-deficit/hyperactivity disorder, and anxiety disorders.

The objective of the present study was to examine the relationship between sluggish cognitive tempo (SCT), subtypes of attention-deficit/hyperactivity disorder (ADHD), and anxiety disorders (AnxDs). One hundred and forty-one children (90 males, 51 females) aged 7-13 years were assigned to four groups, i.e., referred children with comorbid AnxDs and ADHD (n = 25), ADHD (n = 39), AnxDs (n = 41), and nonreferred controls (n = 36). Furthermore we explored the association between SCT and several neurocognitive measures (reaction time, verbal memory, and spatial memory). Diagnoses were established using Kiddie-SADS P/L. SCT was assessed using a 17-item mother-reported questionnaire. SCT correlated significantly with inattentiveness, regardless of the subtype of ADHD. Furthermore, we found significant differences in the levels of SCT among the four groups, with the highest SCT scores observed in the comorbid group. SCT correlated with variability in spatial memory; in contrast, there was no correlation between SCT and reaction time.