Decision-making and cognitive control in adolescent suicidal behaviors: a qualitative systematic review of the literature.

Suicide and suicidal behaviors represent a leading cause of morbidity and mortality during adolescence. While several lines of evidence suggest that suicidal behaviors are associated with risky decisions and deficient cognitive control in laboratory tasks in adults, comparatively less is known about adolescents. Here, we systematically reviewed the literature on the association between these neurocognitive variables and adolescent suicidal behaviors. The online search strategy identified 17 neurocognitive studies examining either cognitive control or decision-making processes in adolescents with past suicidal behaviors. Several studies have reported that adolescents with a history of suicidal behaviors present neuropsychological differences in the cognitive control (using Go/NoGo, suicide Stroop Test, continuous performance test, suicide/death Implicit Association Test), and decision-making (Iowa Gambling Task, Cambridge Gambling Task, cost computation, delay discounting, loss aversion tasks) domains. Due to a lack of replication or conflicting findings, our systematic review suggests that no firm conclusion can be drawn as to whether altered decision-making or poor cognitive control contribute to adolescent suicidal behaviors. However, these results collectively suggest that further research is warranted. Limitations included scarcity of longitudinal studies and a lack of homogeneity in study designs, which precluded quantitative analysis. We propose remediating ways to continue neuropsychological investigations of suicide risk in adolescence, which could lead to the identification of novel therapeutic targets and predictive markers, enabling early intervention in suicidal youth.

Attention and Executive Function in Children Diagnosed with Attention Deficit Hyperactivity Disorder and Comorbid Disorders.

OBJECTIVE: The goal of this study was to examine the relationship between comorbid disorders and executive function (EF) in children diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD). METHODS: Three hundred and fifty-five, 6-12 year old children clinically diagnosed with ADHD were included in the study. Comorbid anxiety disorders, Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) were examined. The EF domains were assessed using the Conners' Continuous Performance Test (CPT), Wisconsin Card Sorting Test (WCST), Tower of London (ToL), Finger Windows (FW) and Self Ordered Pointing Test (SOPT). RESULTS: The findings indicate that children with comorbid anxiety disorders performed worse in domains measured by CPT and prior to controlling for age and sex, by FW. However, once sex was controlled for the results for FW were no longer significant. Children with CD obtained lower scores on WCST. Furthermore, a significant sex by CD interaction was observed. CONCLUSION: These results indicate that comorbid disorders should be carefully examined as they play a significant role in EF performance and subsequently in day-to-day functioning of children with ADHD.

OBJECTIF: Cette étude visait à examiner la relation entre les troubles comorbides et la fonction exécutive (FE) chez les enfants ayant reçu un diagnostic de trouble de déficit de l'attention avec hyperactivité (TDAH). MÉTHODES: Trois cent cinquante-cinq enfants de 6 à 12 ans chez qui le TDAH a été cliniquement diagnostiqué ont été inclus dans l'étude. Les troubles anxieux, le trouble oppositionnel avec provocation (TOP) et le trouble des conduites (TC) comorbides ont été examinés. Les domaines de la FE ont été évalués à l'aide du test de performance continu de Conners (CPT), du test de tri de cartes du Wisconsin (WCST), du test de la Tour de Londres (ToL), du test Finger Windows (FW) et du test de pointage auto-imposé (SOPT). RÉSULTATS: Les résultats indiquent que les enfants souffrant de troubles anxieux comorbides avaient un plus mauvais rendement dans les domaines mesurés par le CPT et avant le contrôle pour l'âge et le sexe, dans FW. Cependant, une fois le sexe contrôlé, les résultats de FW n'étaient plus significatifs. Les enfants souffrant du TC obtenaient des scores plus faibles au WCST. En outre, une interaction significative du sexe dans le TC a été observée. CONCLUSION: Ces résultats indiquent que les troubles comorbides devraient être examinés avec soin car ils jouent un rôle significatif dans le rendement de la FE et subséquemment, dans le fonctionnement quotidien des enfants souffrant du TDAH.

Parent-youth agreement on self-reported competencies of youth with depressive and suicidal symptoms.

OBJECTIVE: A multi-informant approach is often used in child psychiatry. The Achenbach System of Empirically Based Assessment uses this approach, gathering parent reports on the Child Behaviour Checklist (CBCL) and youth reports on the Youth Self-Report (YSR), which contain scales assessing both the child's problems and competencies. Agreement between parent and youth perceptions of their competencies on these forms has not been studied to date. METHOD: Our study examined the parent-youth agreement of competencies on the CBCL and YSR from a sample of 258 parent-youth dyads referred to a specialized outpatient clinic for depressive and suicidal disorders. Intraclass correlation coefficients were calculated for all competency scales (activity, social, and academic), with further examinations based on youth's sex, age, and type of problem. RESULTS: Weak-to-moderate parent-youth agreements were reported on the activities and social subscales. For the activities subscale, boys' ratings had a strong correlation with parents' ratings, while it was weak for girls. Also, agreement on activities and social subscales was stronger for dyads with the youth presenting externalizing instead of internalizing problems. CONCLUSION: Agreement on competencies between parents and adolescents varied based on competency and adolescent sex, age, and type of problem.

The CBCL dysregulated profile: an indicator of pediatric bipolar disorder or of psychopathology severity?

BACKGROUND: To evaluate whether the Child Behavior Checklist Dysregulated Profile (CBCL-DP) can be used as an effective predictor of psychopathological severity as indicated by suicidality and comorbidities, as well as a predictor of pediatric bipolar disorder (PBD). METHOD: CBCL-DP scores for 397 youths seeking treatment for mood disorders were calculated by summing the t-scores of the Anxious/Depressed, Aggressive Behaviors, and Attention Problems subscales such that a clinical cut-off of 210 was used to indicate the presence of a dysregulated profile. Suicidality and an increased number of diagnoses were used as markers of illness severity. RESULTS: Those with a dysregulated profile presented more severe suicidal ideation when compared to those without the profile. They also had a significantly larger number of Axis I diagnoses. Groups did not differ in the amount of individuals diagnosed with PBD. LIMITATIONS: Suicidal ideation was assessed by a third-party informant and not from the youths themselves. No other forms of suicidal behavior such as self-harm or suicide attempt were measured. Also there may not be complete convergence between parental reports on behavior and youth reports, which might have affected the results. CONCLUSIONS: These findings suggest that the CBCL-DP is an effective indicator of psychopathological severity through its association with more comorbidities and more severe suicidality. Earlier detection of psychopathological severity through an initial screening tool could aid clinicians in planning treatment and providing quicker and more structured care based on the client's needs.

Physical activity experiences of boys with and without ADHD.

Physical activity experiences of 12 age-matched boys with and without attention-deficit hyperactivity disorder (ADHD) were explored by converging information from Test of Gross Motor Development-2 assessments and semistructured interviews. The knowledge-based approach and the inhibitory model of executive functions, a combined theoretical lens, enabled the description of similarities and differences in experiences that emerged during interviews. Skill assessments indicated boys with ADHD were not as proficient movers as their peers without ADHD. Thematic analysis revealed that boys with ADHD reported playing with friends, paid little attention to detail, possessed superficial knowledge about movement skills, and expressed many negative feelings about physical activity. Task-specific interventions and a wider range of mixed methods research are recommended for future research studies in ADHD.

Factor structure of the restricted academic situation scale: implications for ADHD.

BACKGROUND: To study the factor structure of the Restricted Academic Situation Scale (RASS), a psychometric tool used to assess behavior in children with ADHD, 117 boys and 21 girls meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for ADHD and aged between 6 and 12 years were recruited. Assessments were carried out before and 65 min after the administration of either a placebo or 0.25 mg/kg of methylphenidate. Placebo and methylphenidate were each administered according to a double-blind placebo-controlled crossover design. RESULTS: Principal component analysis, followed by a confirmatory maximum likelihood factor analysis, revealed two main factors for the RASS, task disengagement (TD) and motor activation (MA). Only TD was inversely correlated with age, indicating that TD and MA may be differentially modulated during development. CONCLUSIONS: MA and TD are distinct traits of ADHD. It may be important to consider them separately when conducting studies on ADHD.

Dopamine transporter 3'UTR VNTR genotype is a marker of performance on executive function tasks in children with ADHD.

BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) is a heterogeneous disorder from both clinical and pathogenic viewpoints. Executive function deficits are considered among the most important pathogenic pathways leading to ADHD and may index part of the heterogeneity in this disorder. METHODS: To investigate the relationship between the dopamine transporter gene (SLC6A3) 3'-UTR VNTR genotypes and executive function in children with ADHD, 196 children diagnosed with ADHD were sequentially recruited, genotyped, and tested using a battery of three neuropsychological tests aimed at assessing the different aspects of executive functioning. RESULTS: Taking into account a correction for multiple comparisons, the main finding of this study is a significant genotype effect on performances on the Tower of London (F = 6.902, p = 0.009) and on the Wechsler Intelligence Scale for Children, Third Edition (WISC-III) Freedom From Distractibility Index (F = 7.125, p = 0.008), as well as strong trends on Self Ordered Pointing Task error scores (F = 4,996 p = 0.026) and WISC-III Digit Span performance (F = 6.28, p = 0.023). Children with the 9/10 genotype exhibited, on average, a poorer performance on all four measures compared to children with the 10/10 genotype. No effect of genotype on Wisconsin Card Sorting Test measures of performance was detected. CONCLUSION: Results are compatible with the view that SLC6A3 genotype may modulate components of executive function performance in children with ADHD.

Fundamental movement skills and children with attention-deficit hyperactivity disorder: peer comparisons and stimulant effects.

The purpose of this study was to compare the fundamental movement skills of 22 children with attention-deficit hyperactivity disorder (ADHD), from 6 to 12 years of age, to gender- and age-matched peers without ADHD and assess the effects of stimulant medication on the movement skill performance of the children with ADHD. Repeated measures analyses revealed significant skill differences between children with and without ADHD (p

Perinatal complications in children with attention-deficit hyperactivity disorder and their unaffected siblings.

OBJECTIVES: Genetic and nonshared environmental factors (experienced by 1 family member to the exclusion of the others) have been strongly implicated in the causes of attention-deficit hyperactivity disorder (ADHD). Pregnancy, labour/delivery and neonatal complications (PLDNC) have often been associated with ADHD; however, no investigations aimed at delineating the shared or nonshared nature of these factors have been reported. We aimed to identify those elements of the PLDNC that are more likely to be of a nonshared nature. METHODS: We used an intrafamily study design, comparing the history of PLDNC between children diagnosed with ADHD, according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and their unaffected siblings. Children with ADHD were recruited from the outpatient, day-treatment program of the Child Psychiatry Department, Douglas Hospital, Montreal. The unaffected sibling closest in age to the child with ADHD was used as a control. The history of PLDNC was assessed using the Kinney Medical and Gynecological Questionnaire and the McNeil-Sjostrom Scale for both children with ADHD and their siblings. Seventy children with ADHD along with 50 of their unaffected siblings agreed to participate in the study. Child Behavior Checklist (CBCL), Continuous Performance Test (CPT) and Restricted Academic Situation Scale (RASS) scores were also used as measures of ADHD symptoms in children with ADHD. RESULTS: The children with ADHD had significantly higher rates of neonatal complications compared with their unaffected siblings (F4,196 = 3.67, p < 0.006). Furthermore, neonatal complications in the children with ADHD were associated with worse CBCL total and externalizing scores and with poorer performance on the CPT. CONCLUSIONS: These results suggest that neonatal complications are probably a nonshared environmental risk factor that may be pathogenic in children with ADHD.

Catechol-O-methyltransferase (COMT) Val108/158 Met polymorphism does not modulate executive function in children with ADHD.

BACKGROUND: An association has been observed between the catechol-O-methyltransferase (COMT) gene, the predominant means of catecholamine catabolism within the prefrontal cortex (PFC), and neuropsychological task performance in healthy and schizophrenic adults. Since several of the cognitive functions typically deficient in children with Attention Deficit Hyperactivity Disorder (ADHD) are mediated by prefrontal dopamine (DA) mechanisms, we investigated the relationship between a functional polymorphism of the COMT gene and neuropsychological task performance in these children. METHODS: The Val108/158 Met polymorphism of the COMT gene was genotyped in 118 children with ADHD (DSM-IV). The Wisconsin Card Sorting Test (WCST), Tower of London (TOL), and Self-Ordered Pointing Task (SOPT) were employed to evaluate executive functions. Neuropsychological task performance was compared across genotype groups using analysis of variance. RESULTS: ADHD children with the Val/Val, Val/Met and Met/Met genotypes were similar with regard to demographic and clinical characteristics. No genotype effects were observed for WCST standardized perseverative error scores [F2,97 = 0.67; p > 0.05], TOL standardized scores [F2,99 = 0.97; p > 0.05], and SOPT error scores [F2,108 = 0.62; p > 0.05]. CONCLUSIONS: Contrary to the observed association between WCST performance and the Val108/158 Met polymorphism of the COMT gene in both healthy and schizophrenic adults, this polymorphism does not appear to modulate executive functions in children with ADHD.

Sensitivity of tests to assess improvement in ADHD symptomatology.

OBJECTIVE: To assess which measurements best predict improvement on ADHD symptomatology after medication is given. METHODS: 147 children aged 6 to 12 years, diagnosed with ADHD, participated in a double-blind placebo controlled twoweek crossover trial of methylphenidate. RESULTS: There were statistically significant differences on all measures between placebo and medication. Effect size for the overall group was 0.33 (CGI-P), 0.80 (CGI-T), 1.33 (CGI), 0.56 (CPT), 0.82 (RASS). CONCLUSIONS: Acute behavioural response measures, where children are observed by clinicians (RASS and CGI), were overall more reliable than parent reports in detecting improvement on ADHD symptomatology. Teacher reports were also very important, especially in the 9 to 12 year old group.

Child and parent variables associated with treatment response in narcissistic youths: the role of self-blame and shame.

INTRODUCTION: this retrospective study aimed at exploring the impact of parental and youth narcissism on service utilization and response to psychotherapy. METHOD: thirty-six 9-13 years-old narcissistic youths receiving a combined treatment (psychodynamic psychotherapy + parental counselling) were independently assessed for child pathological narcissism, parental narcissism, child's treatment attitude and psychiatric/ psychosocial services utilization. RESULTS: Parent and child narcissistic characteristics were negatively correlated with the use of OPD services. Child self-blame and lack of empathy predicted a lesser OPD utilization. Child pathological narcissism was significantly correlated with the specific treatment response pattern composed of the set of attitudes consistently observed in psychotherapy with narcissistic youths. Sixty percent of the variance in treatment response was accounted for by four narcissistic characteristics of the child: devaluation of others, avoidance of vulnerability, boredom, and self-blame. Post hoc analyses highlighted the role of the child's self-blame, which mediated the relation between parental narcissism and service use while acting as a moderator in reversing the relation between parent narcissism and treatment response. Relationships between self-blame, shame-proneness and guilt, and limitations of the study are discussed. CONCLUSION: Prospective studies with a larger sample are needed to confirm the association between self-blame and response to treatment in narcissistic youths.