Development and Initial Validation of the Disruptive Mood Dysregulation Disorder Questionnaire Among Adolescents From Clinic Settings.

OBJECTIVES: Disruptive mood dysregulation disorder (DMDD) is a new DSM-5 diagnosis. It is observed in youths and is characterized by chronic irritability and temper outbursts. This study aimed (i) to develop a brief questionnaire administered during a semi-structured interview and (ii) to assess its psychometric properties with adolescents 12-15 years old by estimating its internal consistency and its concurrent association with measures of depressive symptoms and borderline personality traits. METHODS: A 10-item questionnaire was developed based on the DSM-5 criteria and input from mental health professionals. The questionnaire was administered to 192 adolescents from youth centres, inpatient units and specialized outpatient clinics in Montreal, as were the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS-PL), the Abbreviated version of the Diagnostic Interview for Borderlines revised (Ab-DIB), and the Dominic Interactive for Adolescents-Revised (DIA-R). RESULTS: A DMDD Questionnaire among adolescents from clinic settings is obtained. The content of the instrument's items was initially developed based on DSM-5 criteria and expert judgment to ensure that this new instrument covered the theoretical concepts of DMDD in English and French. Twelve participants (6.3%) met nine or more criteria and 11 youths (5.7%) met the three main criteria of DMDD (A, C, and D), which suggested the likely presence of DMDD. The total Cronbach's alpha was 0.90. In addition, the DMDD Questionnaire was significantly associated with depressive symptoms and borderline personality traits. CONCLUSION: The reliability and concurrent validity indices suggest that the questionnaire as a decision-support tool may be used with adolescents in clinical settings. It highlights that the DSM-5 DMDD criteria seem associated with depressive symptoms and borderline personality traits. Finally, future studies will be necessary to establish more robust calculations in relation to the validity and reliability of this questionnaire.

Prevalence and comorbidity of borderline personality traits in the Quebec general population aged 12-14 years.

PURPOSE: The early identification of borderline personality traits (BPT) in adolescents helps to prevent their progression. Data are available for the clinical population, but little has been published on the general population, especially regarding age and sex distribution in adolescence. Even less is known about the comorbidity of BPT with other mental disorders. METHODS: We estimated the prevalence of BPT, by sex, age, and comorbidity, in a sample of adolescents aged 12-14 years (n = 799) from the Quebec Mental Health Survey. A complex sampling design was used to ensure representativeness. BPT was assessed with the abbreviated-diagnostic interview for borderlines-revised, with the adolescent as an informant. Reliability coefficients were above 0.80. Several levels of severity were explored using an independent criterion, defined by impairment according to the Columbia impairment scale. RESULTS: The overall prevalence of BPT was 6.3%. Prevalence estimates for the most impaired were 3.2% for the entire sample and 1.3% for 12-year-olds. Prevalence increased significantly with age for most impairment levels but did not differ significantly between the sexes. In adolescents, BPT displayed moderate-to-strong comorbidity with anxiety (AD) and insomnia disorders, and very strong comorbidity with depressive (DD), attention deficit hyperactivity (ADHD), and oppositional defiant/conduct disorders (ODD/CD). CONCLUSION: We, therefore, make two clinical recommendations for child psychiatry practice: (1) with respect to the lower rate of male adolescents attending BPT Health Programs, increase BPT screening in male adolescents; (2) evaluate BPT when children with ADHD or ODD/CD develop AD or DD during adolescence.

Long-Term Metabolic Monitoring of Youths Treated with Second-Generation Antipsychotics 5 Years after Publication of the CAMESA Guidelines Are We Making Progress? Surveillance Métabolique à Long Terme des Jeunes Traités par Antipsychotiques de Deuxième Génération, Cinq ans Après la publication des Lignes Directrices Camesa: Faisons-Nous des Progrès?

OBJECTIVE: The potential metabolic adverse effects of second-generation antipsychotics (SGA) need to be monitored. The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics (CAMESA) offers guidelines for this purpose. We aimed to evaluate the long-term rates of youths receiving monitoring in mental health clinics and document the factors that may influence them. METHOD: The charts of 180 patients (13.3 ± 3.1 years, 54.4% males) receiving SGA treatment for the first time between January 2016 and June 2018 were reviewed. Monitoring was divided into baseline and 1- to 6-month and 9- to 24-month periods. Population under study was stratified into children (4 to 12 years) and adolescents (13 to 18 years). Sociodemographic characteristics, psychiatric diagnosis and comorbidities, prescribed SGAs and comedications, anthropometric measures (AM), blood pressure (BP), blood tests (BT), electrocardiogram, and the psychiatrist's years of practice were collected. Cross tables were used to present the monitoring rates. Categories were compared by covariate analysis. Rates of patients monitored across categories were compared using Fisher exact test. RESULTS: Monitoring rates for AM, BT, and BP were 55%, 47.8%, and 46.7% at baseline; 50%, 41.7%, and 45.2% at 1 to 6 months; and 47.2%, 41.5%, and 40.6% at 9 to 24 months, respectively. Higher monitoring rates were significantly associated with adolescent status (baseline, 1 to 6 months), a diagnosis of psychotic and/or affective disorder (baseline, 1 to 6 months, 9 to 24 months), having ≤1 psychiatric comorbidities (1 to 6 months), high SGA dose (baseline, 1 to 6 months), and clinician's experience (baseline, 9 to 24 months). Significantly lower monitoring rates were associated with the psychostimulant/atomoxetine comedication (baseline, 1 to 6 months, 9 to 24 months). CONCLUSION: Five years after publication of the CAMESA guidelines, metabolic monitoring is conducted for less than half of patients. In our sample, age, diagnostic category, psychiatric comorbidities, SGA dose, clinician's experience, and comedications influenced the monitoring rates. Major progress still needs to be made before reaching a satisfactory level of monitoring.

Sleep Difficulties in Preschoolers with Psychiatric Diagnoses.

Background: Sleep problems among preschoolers are highly prevalent. Given the impact of poor sleep quality on development, this relationship is particularly relevant in vulnerable populations but is less documented. This study aims to document parental perception of sleep problems in preschoolers assessed in a psychiatric clinic, as a function of diagnosis type. Methods: Children (14-71 months, n = 228) were evaluated by a psychiatrist, and diagnoses were pooled into four categories: behavioral disorders, relational disorders/psychosocial problems, developmental coordination disorder (DCD), and communication disorders. Sleep problems were measured using the Child Behavior Checklist (CBCL). Results: In this clinical sample of preschoolers, 21.6% of children were identified as having a sleep problem by their parents. Behavioral disorders and communication disorders were associated with increased parental report of sleep problems (respectively, trouble falling asleep and nighttime awakenings), while DCD was associated with lower parental report of sleep problems (fewer nighttime awakenings and less difficulty falling asleep) (p < 0.05). Relational disorders were not associated with parental reports of sleep difficulties (p > 0.05). Moreover, some psychiatric categories were associated with specific sleep symptoms (such as difficulty falling asleep and night awakenings). Conclusion: Parents of preschoolers with behavioral disorders and communication disorders are more likely to report sleep problems in their children than parents of preschoolers with DCD and relational disorders. Since different categories of psychiatric disorders are associated with specific types of sleep complaints, screening, and treatment should be adapted accordingly.

A Developmental Perspective of Global and Local Visual Perception in Autism Spectrum Disorder.

Individuals with autism spectrum disorder (ASD) demonstrate superior performances on visuo-spatial tasks emphasizing local information processing; however, findings from studies involving hierarchical stimuli are inconsistent. Wide age ranges and group means complicate their interpretability. Children and adolescents with and without ASD completed a Navon task wherein they identified global and local stimuli composed of either consistent or inconsistent letters. Trajectories of reaction time in global and local conditions were similar within and between groups when consistent and inconsistent stimuli were considered together, but the effect of local-to-global interference was significantly higher in participants with than without ASD. Age was not a significant predictor of local-to-global interference, suggesting that this effect emerges in childhood and persists throughout adolescence in ASD.

NREM sleep EEG activity and procedural memory: A comparison between young neurotypical and autistic adults without sleep complaints.

Delta EEG activity (0.75-3.75 Hz) during non-Rapid eye movement (NREM) sleep reflects the thalamo-cortical system contribution to memory consolidation. The functional integrity of this system is thought to be compromised in the Autism spectrum disorder (ASD). This lead us to investigate the topography of NREM sleep Delta EEG activity in young adults with ASD and typically-developed individuals (TYP). The relationship between Delta EEG activity and sensory-motor procedural information was also examined using a rotary pursuit task. Two dependent variables were computed: a learning index (performance increase across trials) and a performance index (average performance for all trials). The ASD group showed less Delta EEG activity during NREM sleep over the parieto-occipital recording sites compared to the TYP group. Delta EEG activity dropped more abruptly from frontal to posterior regions in the ASD group. Both groups of participants learned the task at a similar rate but the ASD group performed less well in terms of contact time with the target. Delta EEG activity during NREM sleep, especially during stage 2, correlated positively with the learning index for electrodes located all over the cortex in the TYP group, but only in the frontal region in the ASD group. Delta EEG activity, especially during stage 2, correlated positively with the performance index, but in the ASD group only. These results reveal an atypical thalamo-cortical functioning over the parieto-occipital region in ASD. They also point toward an atypical relationship between the frontal area and the encoding of sensory-motor procedural memory in ASD. Autism Res 2018, 11: 613-623. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Slow EEG waves recorded from the scalp during sleep are thought to facilitate learning and memory during daytime. We compared these EEG waves in young autistic adults to typically-developing young adults. We found less slow EEG waves in the ASD group and the pattern of relationship with memory differed between groups. This suggests atypicalities in the way sleep mechanisms are associated with learning and performance in a sensory-motor procedural memory task in ASD individuals.

Comorbidity of ADHD and Anxiety Disorders in School-Age Children: Impact on Sleep and Response to a Cognitive-Behavioral Treatment.

OBJECTIVE: This exploratory study measured the impact of comorbid anxiety disorders on sleep in children with ADHD and tested the effect of cognitive-behavioral therapy (CBT) on these measures. METHOD: Fifty-seven children (8-12 years old) were assessed with the Child Sleep Habits Questionnaire. Four groups were formed: ADHD ( n = 20), ADHD + Anxiety ( n = 20), Anxiety ( n = 8), and Healthy Controls ( n = 9). A subgroup of 10 children with ADHD + Anxiety underwent CBT for anxiety. RESULTS: The results showed that sleep difficulties were better associated with anxiety than with ADHD. CBT reduced sleep onset latency and marginally decreased the total amount of sleep problems. CONCLUSION: The present study demonstrates that comorbid anxiety in ADHD children is linked with specific sleep disturbances and is sensitive to CBT aimed at reducing anxiety.

Exploratory Study of the Clinical Characteristics of Adolescent Girls with a History of Physical or Sexual Abuse Consulting in a Mood Disorder Clinic.

OBJECTIVE: To examine the clinical characteristics of adolescent girls consulting in a mood disorder clinic with a history of physical or sexual abuse. METHOD: A retrospective review was conducted of the charts of 55 adolescent girls consulting in a mood disorder clinic. An analysis grid was used to gather data on demographics, personal antecedents, symptoms and diagnoses. Girls with a history of physical or sexual abuse were compared with girls without such a history. Univariate analyses and a logistic regression analysis were performed. RESULTS: Adolescent girls with a history of physical or sexual abuse did not differ statistically from those without such a history in terms of depressive symptoms or type and number of diagnoses. However, proportionally more girls with a history of physical or sexual abuse presented self-harm and relational problems with their parents and peers. CONCLUSION: Both history of physical or sexual abuse and self-destructive behaviors are rooted in relational problems. The results show that these are related to one another among those adolescent girls. Clinically, these findings suggest that it is important for clinicians do a thorough exploration of self-destructive behaviors and family and peer relations when assessing depressed adolescent girls.

OBJECTIF: Examiner les caractéristiques cliniques des adolescentes consultant à une clinique des troubles de l'humeur et ayant été victime d'abus physique ou sexuel dans le passé. MÉTHODE: Une étude rétrospective de 55 dossiers d'adolescentes a été réalisée. Une grille d'analyse fut utilisée pour recueillir les données sociodémographiques, les antécédents personnels, les symptômes et les diagnostics. Les adolescentes ayant été victime d'abus physique ou sexuel dans le passé ont été comparées à d'autres adolescentes sans histoire d'abus. Une analyse univariée et une analyse de régression logistique ont été effectuées. RÉSULTATS: Les adolescentes ayant été victimes d'abus physiqueou sexuel ne différaient pas statistiquement de celles sans histoire d'abus, en ce qui a trait aux symptômes dépressifs, ou au type et au nombre de diagnostics. Toutefois, elles présentaient une proportion plus élevée d'automutilation et de problèmes relationnels avec leurs parents et leurs pairs. CONCLUSION: Un passé de victimisation physique ou sexuel et des comportements autodestructeurs traduisent des problèmes relationnels. Les résultats montrent que ces variables sont reliées l'une à l'autre chez ces adolescentes ayant été victimes d'abus physique ou sexuel. Ce résultat suggère l'importance pour le clinicien d'explorer en profondeur les comportements autodestructeurs ainsi que les relations avec la famille et les pairs lors de l'évaluation des adolescentes dépressives.

Reliability, Validity, and Clinical Utility of the Dominic Interactive for Adolescents-RevisedA DSM-5-Based Self-Report Screen for Mental Disorders, Borderline Personality Traits, and Suicidality.

OBJECTIVES: The Dominic Interactive for Adolescents-Revised (DIA-R) is a multimedia self-report screen for 9 mental disorders, borderline personality traits, and suicidality defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5). This study aimed to examine the reliability and the validity of this instrument. METHODS: French- and English-speaking adolescents aged 12 to 15 years ( N = 447) were recruited from schools and clinical settings in Montreal and were evaluated twice. The internal consistency was estimated by Cronbach alpha coefficients and the test-retest reliability by intraclass correlation coefficients. Cutoff points on the DIA-R scales were determined by using clinically relevant measures for defining external validation criteria: the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, the Beck Hopelessness Scale, and the Abbreviated-Diagnostic Interview for Borderlines. Receiver operating characteristic (ROC) analyses provided accuracy estimates (area under the ROC curve, sensitivity, specificity, likelihood ratio) to evaluate the ability of the DIA-R scales to predict external criteria. RESULTS: For most of the DIA-R scales, reliability coefficients were excellent or moderate. High or moderate accuracy estimates from ROC analyses demonstrated the ability of the DIA-R thresholds to predict psychopathological conditions. These thresholds were generally capable to discriminate between clinical and school subsamples. However, the validity of the obsessions/compulsions scale was too low. CONCLUSIONS: Findings clearly support the reliability and the validity of the DIA-R. This instrument may be useful to assess a wide range of adolescents' mental health problems in the continuum of services. This conclusion applies to all scales, except the obsessions/compulsions one.

Familial and Clinical Correlates in Depressed Adolescents with Borderline Personality Disorder Traits.

INTRODUCTION: Chart review is a low-cost, but highly informative, method to describe symptoms, treatment, and risk factors associated with borderline personality disorder (BPD) and to adapt screening and intervention to clinical reality. Previous chart review studies report more aggressiveness/anger and psychotic features in youths with BPD. They show that adverse family environment and parental psychopathology constitute important factors for BPD pathology. OBJECTIVES: To examine clinical characteristics of depressed BPD adolescents (12-17 years old) outpatients according to gender and to explore variables which are associated with BPD traits. METHODS: A retrospective chart review using the child and adolescent version of the retrospective diagnostic instrument for borderlines was conducted on 30 depressed adolescents with BPD traits and 28 depressed patients without BPD traits. Participants who reached the retrospective diagnostic instrument for borderlines threshold for BPD were included in the BPD traits group. Comparison analyses were performed using Pearson's Chi-square test. Associated factors were determined using regression analyses. RESULTS: BPD traits participants were characterized by higher family problems (parental psychopathology, parent disagreement/argument, and parent-child relational problem), more aggressive symptoms, and higher rates of family intervention and hospitalization. A number of familial factors (parental history of delinquency, substance use, personality disorders, having siblings, or parental disagreement/argument in boys) were associated with BPD traits. Attention seeking and problematic functioning (does not adapt well to group activities) were also associated with BPD traits. DISCUSSION: Our study stresses the need to assess BPD traits in adolescent psychiatric evaluation, especially in the presence of aggressive behaviors, family problems and attention seeking. Our results also highlight the importance of exploring family characteristics intervention in adolescents with BPD traits.

The developmental trajectory of contrast sensitivity in autism spectrum disorder.

Autism Spectrum Disorder (ASD) is characterized by a detail-driven visual processing strategy, evidence for which has been based largely on cross-sectional studies in small participant groups of limited age ranges. It is therefore unknown when sensitivity to detailed information emerges and develops in ASD. Contrast sensitivity to sinusoidal gratings of different spatial frequencies (0.5, 1, 2, 4, and 8 cycles per degree (cpd)) was measured for 34 participants with ASD and 55 typically developing participants (aged 6-16 years). Cross-sectional, developmental trajectories were constructed to examine within and between group differences across the range of spatial frequencies tested. Developmental trajectories indicated that sensitivity across low (i.e., 0.5 and 1 cpd) and mid (2 and 4 cpd) spatial frequencies varied by chronological age within each group, with mid frequencies developing at a more significant rate than low frequencies. There was no overall difference between groups in terms of the relationship of sensitivity and age across spatial frequencies, yet the ASD group had an overall lower level of sensitivity. Closer examination revealed that the youngest participants with ASD had a reduced sensitivity for mid frequencies. Moreover, the ASD group showed a statistically significant developmental relationship at 8 cpd, which suggests that a trend for increased sensitivity to early detailed information may manifest beyond the ages tested. These findings demonstrate a differential development of contrast sensitivity for spatial frequencies in ASD and underscore the need to better identify what drives such differences in the "building blocks" of visual perception. Autism Res 2016, 9: 866-878. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.

Psychometric properties of three measures of protective factors for depression and suicidal behaviour among adolescents.

OBJECTIVES: To assess the reliability of French versions of the Adolescent Coping Scale (ACS), the Reasons for Living Inventory for Adolescents (RFL-A), and the Spirituality Scale (SS); to examine the construct validity of these psychometric instruments; and to determine their convergent validity with French versions of the Life Events Questionnaire for Adolescents (LEQ-A), the Beck Depression Inventory-Second Edition (BDI-II), and the Beck Hopelessness Scale (BHS) among French-Canadian adolescents. METHODS: Participants were 429 adolescents from high schools (n = 283) and the Mood Disorder Clinic (n = 146) in Montreal. The instruments were translated into French following the back-translation method. The internal consistency was assessed through Cronbach alpha coefficients. Exploratory analyses were conducted to document the content of their dimensions. Convergent validity was examined by correlating the ACS, the RFL-A, and the SS with the French versions of the LEQ-A, the BDI-II, and the BHS. RESULTS: The findings confirm that the ACS, RFL-A, and SS are psychometric instruments well suited to assess protective factors for depression and suicidal behaviour among French-speaking adolescents in community and clinical settings. However, results must be interpreted with some circumspection as 2 SS subscales obtained reliability coefficients in the moderate range only and the instructions for the RFL-A were reframed in response to ethical considerations. CONCLUSIONS: Our results add to those already available on the original English versions of the ACS, RFL-A, and SS and advance the knowledge of the psychometric properties of protective measures.

Protective factors against depression and suicidal behaviour in adolescence.

OBJECTIVES: To examine whether protective factors in the Protection for Adolescent Depression Study (PADS) moderate the impact of stressful events on depression and suicidal behaviour in the community and a clinical setting; and to study the influence of sex. METHOD: Participants were 283 adolescents from the community and 119 from a mood disorder clinic in Montreal. The participants were evaluated on 6 instruments measuring individual risk and protective factors. Descriptive analyses and univariate and multiple logistic regression models were carried out. RESULTS: Risk factors predicted higher levels of depression and presence of suicidal behaviour, and protective factors predicted lower levels of depression and absence of suicidal behaviour, as expected under the vulnerability-resilience stress model. Several sex differences were observed in terms of the predictive power of risk factors (for example, hopelessness among girls and keep to themselves among boys) and protective factors (for example, focusing on the positive among girls and self-discovery among boys). CONCLUSIONS: Findings from the PADS suggest that protective factors moderate the impact of stress on depression and suicidal behaviour. Developing protection appears important in the presence of chronic conditions, such as depressive disorders, to reduce the likelihood of further episodes. The influence of sex makes it all the more relevant to target different factors for boys and girls to increase protection and decrease risk in prevention and intervention programs.

Autism-specific covariation in perceptual performances: "g" or "p" factor?

BACKGROUND: Autistic perception is characterized by atypical and sometimes exceptional performance in several low- (e.g., discrimination) and mid-level (e.g., pattern matching) tasks in both visual and auditory domains. A factor that specifically affects perceptive abilities in autistic individuals should manifest as an autism-specific association between perceptual tasks. The first purpose of this study was to explore how perceptual performances are associated within or across processing levels and/or modalities. The second purpose was to determine if general intelligence, the major factor that accounts for covariation in task performances in non-autistic individuals, equally controls perceptual abilities in autistic individuals. METHODS: We asked 46 autistic individuals and 46 typically developing controls to perform four tasks measuring low- or mid-level visual or auditory processing. Intelligence was measured with the Wechsler's Intelligence Scale (FSIQ) and Raven Progressive Matrices (RPM). We conducted linear regression models to compare task performances between groups and patterns of covariation between tasks. The addition of either Wechsler's FSIQ or RPM in the regression models controlled for the effects of intelligence. RESULTS: In typically developing individuals, most perceptual tasks were associated with intelligence measured either by RPM or Wechsler FSIQ. The residual covariation between unimodal tasks, i.e. covariation not explained by intelligence, could be explained by a modality-specific factor. In the autistic group, residual covariation revealed the presence of a plurimodal factor specific to autism. CONCLUSIONS: Autistic individuals show exceptional performance in some perceptual tasks. Here, we demonstrate the existence of specific, plurimodal covariation that does not dependent on general intelligence (or "g" factor). Instead, this residual covariation is accounted for by a common perceptual process (or "p" factor), which may drive perceptual abilities differently in autistic and non-autistic individuals.

An early origin for detailed perception in Autism Spectrum Disorder: biased sensitivity for high-spatial frequency information.

Autistics demonstrate superior performances on several visuo-spatial tasks where local or detailed information processing is advantageous. Altered spatial filtering properties at an early level of visuo-spatial analysis may be a plausible perceptual origin for such detailed perception in Autism Spectrum Disorder. In this study, contrast sensitivity for both luminance and texture-defined vertically-oriented sine-wave gratings were measured across a range of spatial frequencies (0.5, 1, 2, 4 & 8 cpd) for autistics and non-autistic participants. Contrast sensitivity functions and peak frequency ratios were plotted and compared across groups. Results demonstrated that autistic participants were more sensitivity to luminance-defined, high spatial frequency gratings (8 cpd). A group difference in peak distribution was also observed as 35% of autistic participants manifested peak sensitivity for luminance-defined gratings of 4 cpd, compared to only 7% for the comparison group. These findings support that locally-biased perception in Autism Spectrum Disorder originates, at least in part, from differences in response properties of early spatial mechanisms favouring detailed spatial information processing.

Reliability, validity, and clinical use of the Dominic Interactive: a DSM-based, self-report screen for school-aged children.

OBJECTIVES: As no single informant can be considered the gold standard of child psychopathology, interviewing of children regarding their own symptoms is necessary. Our study focused on the reliability, validity, and clinical use of the Dominic Interactive (DI), a multimedia self-report screen to assess symptoms for the most frequent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, mental disorders in school-aged children. METHODS: A sample of 585 children aged 6 to 11 years from the community and psychiatric clinics was used to analyze the internal consistency, the test-retest estimate of reliability, and the criterion-related validity of the DI against the referral status. In addition, cross-informant correlation coefficients between this instrument (child report) and the Child Symptom Inventory (parent report) were explored in a subsample of 292 participants. RESULTS: For the total sample, Cronbach alpha coefficients ranged from 0.63 to 0.91. Test-retest kappas varied from 0.42 to 0.62 for categories based on cut-off points, except for specific phobias. Intraclass correlation coefficients ranged from 0.70 to 0.81 for symptom scales. The DI discriminated between referred and non-referred children in psychiatric clinics for all symptom scales. Significant cross-informant correlation coefficients were higher for the externalizing symptoms (0.35 to 0.48) than the internalizing symptoms (0.14 to 0.27). CONCLUSIONS: Findings of our study reasonably support adequate psychometric properties of the DI. This instrument offers a developmentally sensitive screening method to obtain unique information from young children about their mental health problems in front-line services, psychiatric clinics, and research settings.

Objectifs : Comme aucun indicateur unique ne peut être considéré comme étant l'étalon de référence de la psychopathologie pédiatrique, il est nécessaire d'interviewer les enfants à l'égard de leurs propres symptômes. Notre étude portait sur la fiabilité, la validité et l'utilisation clinique du Dominique interactif (DI), un instrument multimédia auto-déclaré servant à évaluer chez les enfants d'âge scolaire, les symptômes des troubles mentaux les plus fréquents du Manuel diagnostique et statistique des troubles mentaux, 4e édition, texte révisé. Méthodes : Un échantillon de 585 enfants de 6 à 11 ans de cliniques communautaires et psychiatriques a été utilisé pour analyser la cohérence interne, l'estimation test­retest de la fiabilité, et la validité liée à un critère du DI contre l'état des sujets référés. En outre, les coefficients de corrélation inter-indicateurs entre cet instrument (rapport des enfants) et l'inventaire des symptômes des enfants (rapport des parents) ont été explorés dans un sous-échantillon de 292 participants. Résultats : Pour le total de l'échantillon, les coefficients alpha de Cronbach se situaient entre 0,63 et 0,91. Les kappas test­retest variaient de 0,42 à 0,62 pour les catégories basées sur les seuils d'inclusion, excepté pour les phobies spécifiques. Les coefficients de corrélation intraclasse allaient de 0,70 à 0,81 pour les échelles de symptômes. Le DI discriminait entre les enfants référés et non référés à des cliniques psychiatriques pour toutes les échelles de symptômes. Les coefficients de corrélation inter-indicateurs significatifs étaient plus élevés pour les symptômes externalisants (0,35 à 0,48) que pour les symptômes internalisants (0,14 à 0,27). Conclusions : Les résultats de notre étude soutiennent raisonnablement les propriétés psychométriques adéquates du DI. Cet instrument offre une méthode de dépistage sensible au stade du développement afin d'obtenir des renseignements uniques de la part des jeunes enfants sur leurs problèmes de santé mentale dans les services de première ligne, les cliniques psychiatriques, et les milieux de recherche.

Relationship between poor sleep and daytime cognitive performance in young adults with autism.

Poor sleep is a common feature in autism even though patients themselves do not necessarily complain. The impact of poor sleep on daytime cognitive functioning in autism is not well-known and we therefore investigated whether sleep in autism correlates with daytime cognitive performance. A battery of non-verbal tasks was administered, in the morning after a second night of sleep in the laboratory, to 17 young adults with autism and normal intelligence, and 14 typically developed individuals matched for age and IQ; none of the participants complained about sleep problems. Two dimensions of attention (sustained and selective) and 4 types of memory (working, declarative, sensory-motor and cognitive procedural) were tested. Individuals with autism showed clear signs of poor sleep. Their performance differed from the controls in response speed but not in accuracy. Signs of poor sleep in the autism group were significantly correlated with either normal performance (selective attention and declarative memory) or performance inferior to that of the controls (sensory-motor and cognitive procedural memories). Both groups presented a significant negative correlation between slow-wave sleep (SWS) and learning a sensory-motor procedural memory task. Only control participants showed a positive association between SWS duration and number of figures recalled on the declarative memory task. Correlation patterns differed between groups when sleep spindles were considered: they were negatively associated with number of trials needed to learn the sensory-motor procedural memory task in autism and with reaction time and number of errors on selective attention in the controls. Correlation between rapid eye movements (REMs) in REM sleep and cognitive procedural memory was not significant. We conclude that some signs reflecting the presence of poor sleep in adults with high-functioning autism correlate with various aspects of motor output on non-verbal performance tasks. The question is raised whether poor sleep in non-complaining persons with autism should be treated.

Cognitive correlates of serious suicidal ideation in a community sample of adolescents.

BACKGROUND: Studies indicate that a dysfunctional attributional style, problem-solving deficits and hopelessness place youths at risk of developing suicidal thoughts and engaging in suicidal behaviour. However, in the realm of suicidality in adolescent, no study has examined the linkages between these three cognitive variables and suicidal ideation in non-clinical samples while taking into account the moderating role of gender on the relationships and controlling for depression. METHODS: In this community study of 712 adolescents 14-18 years of age, through a multivariate approach, the interaction between the cognitive variables, depression and gender was examined with depression controlled in the analyses. RESULTS: Problem-solving deficits and hopelessness proved predictive of such ideation whether or not depressive symptoms were controlled in the analyses. Negative problem orientation/avoidant style was more predictive of ideation in boys than in girls. On the other hand, hopelessness was more predictive for girls than boys. LIMITATIONS: Results were based on a convenience community sample of adolescents and a cross-sectional survey. CONCLUSIONS: Results suggest that a unique explanatory model of the suicide process in adolescence that fails to take account of gender would be ill informed. Suicide prevention strategies should be differentiated according to gender with a stronger emphasis in hopelessness in female adolescents, and problem-solving deficits in male adolescents.

Clinical characteristics of depressed youths in child psychiatry.

OBJECTIVE: To describe the clinical characteristics of depressed children and adolescents according to age groups and sex. METHODS: A retrospective chart review study was conducted on 75 youths aged 6-17 years referred for depressive disorders to child psychiatry in 2002-2003. Descriptive statistics and tests of association were completed to compare boys aged 6-11 years, boys aged 12-17 years and girls aged 12-17 years. RESULTS: One out of two youths has repeated a school year. About 60% of depressed boys aged 6-11 years are referred to child psychiatry services for behavioral difficulties and 71% of boys in this age group have a depressive disorder comorbid with disruptive behavior disorder. Adolescent boys and girls are more likely to present internalized symptoms than children. However, suicidal ideation is as widespread in children (71%) as in adolescent population, both boys (72%) and girls (85%). Parent-child relational problems are observed in the majority of the sample with a higher prevalence among adolescent girls. CONCLUSION: : It is as important to assess depressive symptoms and suicidal ideation among young boys with behavioral difficulties as in adolescent boys and girls. Family functioning is important to consider in evaluating and treating youth.

Pre-adoption adversity and self-reported behavior problems in 7 year-old international adoptees.

To further investigate the long-term impact of pre-adoption adversity on international adoptees, externalizing and internalizing symptoms were assessed using a self-report measure at school-age in addition to mothers' reports. The sample consisted of 95 adopted children and their mothers. Children's health and developmental status were assessed soon after arrival in their adoptive family. At age 7, the Dominic Interactive, a self-report measure, was used to evaluate externalizing and internalizing symptoms while mothers completed the CBCL. Children's self-reports were compared to their non-adopted peers'. Adopted children reported more symptoms of specific phobia than their peers. A significant correlation was found between mothers' and children's reports but only for externalizing symptoms. Self-reported symptoms were related to indices of nutritional and psychosocial deprivation at arrival, such as low height/age and weight/height ratios. Our results emphasize the importance of considering international adoptees' perception of their psychological adjustment and the long-term impact of early risk factors.