ADHD symptoms and maturity--a study in primary school children.

AIM: To study if age and non-behavioural measures of biological maturity have any associations with attention deficit hyperactivity disorder (ADHD). METHODS: Two hundred fifty-one children 7 to 9 years of age in a Swedish school were screened for ADHD-symptom. ADHD-symptoms were estimated by Conners Abbreviated Questionnaire by both parents and teachers. Motor function, body weight and body height were measured. Skeletal age was estimated through hand radiographs. RESULTS: Height, weight and skeletal bone-age did correlate significantly with age (rs = 0.44-0.69, p < 0.001) but not with ADHD symptom scores. Motor dysfunction had a weak negative correlation with age (rs =-0.21, p < 0.05). Parent and teacher scores of ADHD-symptoms did not correlate with age. CONCLUSION: This study showed that the variables measuring general biological maturity had a strong association with age, whereas motor dysfunction and ADHD symptoms had no significant association with age. ADHD symptoms did not correlate with the variables measuring general biological maturity. These results do not support the hypothesis that a general biological immaturity is an important etiologic factor for ADHD symptomatology.

Associations between cerebral blood-flow measured by single photon emission computed tomography (SPECT), electro-encephalogram (EEG), behaviour symptoms, cognition and neurological soft signs in children with attention-deficit hyperactivity disorder (ADHD).

Twenty-eight children with attention-deficit hyperactivity disorder (ADHD) were examined with SPECT (single photon emission computed tomography). Seven of the children had abnormal distribution of the regional cerebral blood-flow (rCBF) on visual evaluation and 10 had abnormal EEG findings. The only clinical finding that differentiated the group with normal from abnormal rCBF was behaviour symptom load. A factor analysis of the rCBF in different regions of interest yielded one factor with low rCBF in the temporal and cerebellar regions and high rCBF in the subcortical and thalamic regions, which was significantly associated with the degree of motor impairment and results on a cognitive test (WISC). Another factor consisting of high rCBF in frontal and parietal regions had a significant negative correlation with the degree of behaviour symptoms. There was a negative correlation between the rCBF in the right frontal regions and the degree of behaviour symptoms. The number of minor physical anomalies (MPA) was negatively correlated to the rCBF in the frontal lobes bilaterally. These results suggest that there may be at least two functional disturbances in ADHD, one specific neurodevelopmentally determined disturbance of the frontal lobes, especially of the right hemisphere, related to behaviour deviance, and another disturbance of the integration of the temporal lobes, the cerebellum and subcortical structures, related to motor planning and aspects of cognition.

Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms. A randomized, double-blind, placebo-controlled trial.

BACKGROUND: We wanted to study the effects of amphetamine on symptoms of attention-deficit hyperactivity disorder (ADHD) over a longer period than has been reported in previous studies of central stimulants in this condition. METHODS: Sixty-two children, aged 6 to 11 years, meeting DSM-III-R symptom criteria for ADHD participated in a parallel-group design, randomized, double-blind, placebo-controlled study of amphetamine treatment. Treatment was not restricted to children with "pure" ADHD, ie, some had comorbid diagnoses. In the amphetamine group, children received active treatment for 15 months. RESULTS: Amphetamine was clearly superior to placebo in reducing inattention, hyperactivity, and other disruptive behavior problems and tended to lead to improved results on the Wechsler Intelligence Scale for Children--Revised. Treatment failure rate was considerably lower and time to treatment failure was longer in the amphetamine group. Adverse effects were few and relatively mild. CONCLUSION: The results of this long-term, placebo-controlled study of the central stimulant amphetamine in the treatment of ADHD indicate that there are remaining positive effects of the drug 15 months after starting treatment.

Psychological reactions at the onset of insulin-dependent diabetes mellitus in children and later adjustment and metabolic control.

The initial psychological reactions at the onset of insulin-dependent diabetes mellitus (IDDM) in a population-based sample of 76 children were studied with staff observations and a self-report questionnaire for children 12 years of age and more. Younger children reacted with more anger and less distress than the older children. High initial self-reported distress was associated with poorer subjective psychological IDDM adjustment at a follow-up 10 months later for the older children. The children's initial reactions as well as later adjustment were intimately associated with maternal initial reactions in the total group. The metabolic control, estimated as the mean level of the major fraction of glycosylated haemoglobin (Hb AIc) during the first 2 years, was poorer in the adolescent group. Initial anxiety over injections and protest but low general distress in mothers and children were associated with better metabolic control.

Relations between age, metabolic control, disease adjustment and psychological aspects in insulin-dependent diabetes mellitus.

The relations between age, metabolic control, disease adjustment, and psychological factors in boys and girls with recently diagnosed insulin-dependent diabetes mellitus (IDDM) were studied. Older girls had significant higher postremission glycosylated haemoglobin A (Hb AIc) levels (p = 0.008). Girls with more hospitalizations had a lower developmental level (p = 0.05), and had significantly more problems in the behavioural rating (p = 0.05). Boys with more hospitalizations had a more external locus of control (p = 0.01), more difficulties with disease adjustment, more emotional problems, and were also clinically assessed as having more behavioural problems. Boys showing more difficulties in psychological adjustment to the disease also had higher postremission Hb AIc levels (p = 0.02). Although Swedish children with IDDM of short disease duration do not differ from healthy children in important psychological aspects, older girls and a small group of problematic younger boys are at risk of developing metabolic imbalance after a short disease duration.

Psychological stress and the onset of IDDM in children.

OBJECTIVE: The purpose of the study was to determine whether psychosocial stress during different life periods could be a risk factor in the etiology/pathogenesis of insulin-dependent diabetes mellitus (IDDM) in children. RESEARCH DESIGN AND METHODS: In a population-based sample of 67 case patients 0-14 years of age and 61 matched healthy control subjects, life events during the entire lifespan before the onset of IDDM were recorded as well as measures of child behavior before onset, social support, and family function. RESULTS: Negative life events occurring during the first 2 years of life, life events with difficult adaptation, child behavioral deviances, and a more chaotic family function were more common in the case group. A stepwise logistic regression indicated that negative life events in the first 2 years increased the risk of IDDM and that premorbid child behavior as well as dysfunctional hierarchical family pattern affect the risk. CONCLUSIONS: Stress early in life may increase the risk for IDDM, presumably by affecting the autoimmune process. To confirm these results, it is necessary to make a truly prospective study.

Life events and behavioural deviances in childhood: a longitudinal study of a normal population.

A semi-structured interview based upon Coddington's life event questionnaire was revised and modified to measure life changes in children of possible importance for the development of physical and mental illness. A normal population of 193 children was investigated in 1981-83 and followed up after six years. The life events during the intervening period are described and correlated to child behavioural symptom load and family function before and after. Both the life event load and the adjustment ability of the child make significant contributions to the prediction of child disturbance in the follow-up.

Psychosocial aspects of type 1 diabetes mellitus in children 0-14 years of age.

A total clinic sample of 67 diabetic and their parents were followed prospectively together with a referent group in this longitudinal study of psychosocial factors in childhood diabetes. Measurements of psychosocial stress showed statistically more negative life events and coping problems in the diabetic group during the first two years of life. The crisis/coping pattern at onset of the disease varied but most parents/and children scored low distress already after 4 weeks. High distress at onset correlated to high distress at a twelve month follow-up interview. Among the parents planful problem solving and distancing were the most prevalent coping mechanisms. The diabetic children had a rather good adaptation to the disease after 12 months of disease duration. Psychiatric problems were not more common in the diabetic children compared to a normal group. Metabolic imbalance correlated to external locus of control, low development quotient and many life events.

Parental social support and child behaviour problems in different populations and socioeconomic groups: a methodological study.

In many research projects there is a need to apply a multifactorial approach. Practical reasons often make it necessary to use instruments that are not too time-consuming for each factor to be investigated. The Interview Schedule of Social Integration (ISSI) is proposed by Undén and Orth-Gomér as a suitable tool in measuring social support. It is increasingly used in Sweden. To further investigate its usefulness in measuring parental social support of importance for the children, an examination of the relation between the ISSI variables and Child Behaviour as well as Parental Psychopathology was undertaken, based on data from four studies: Psychosocial Factors and Child Diabetes, Single Parent Families in a child guidance clinic, a Clinical Child Psychiatric Ward Group and an Epidemiological Study of a Normal Swedish Population. The findings were that social support measured by ISSI had the expected associations to child behaviour as well as to parental psychopathology in the higher socioeconomic groups but not in the lower ones. The interpretation is made that ISSI does not measure qualitative aspects of social support but the sense of satisfaction with it. In the higher socioeconomic groups the sense of satisfaction may be a fairly good approximation of the actual quality even if it is probably confounded with personality trait factors. The same approximation cannot be made in lower socioeconomic groups and in psychiatric populations. In these cases there is a need to pay more attention to the actual quality of the social network.