Limited Prosocial Emotions in a Clinical Population of Children and Adolescents: Proposal for Core and Ancillary Characteristics.

OBJECTIVE: Limited prosocial emotions (LPE) has been recently incorporated into international classifications as a specifier for conduct disorder in the DSM-5 and for all disruptive behavioural disorders in the ICD-11. The aims of the current work were to determine (a) the accuracy of each of the characteristics used to assess the LPE specifier and (b) whether the manner in which symptoms group together supports the idea of LPE having core characteristics. METHOD: Trained clinicians conducted interviews and determined LPE characteristics using responses from 74 parent/guardian and child/adolescent participants. RESULTS: The distribution of LPE characteristics among those participants with LPE (n = 13) was compared to those with only one LPE characteristic (n = 11). The proposal of callous lack of empathy (CLE) and shallow deficient affect (SDA) as core characteristics was supported by strong associations with the presence of the LPE specifier, larger specificity, and sensitivity indices than those for unconcerned about performance and lack of remorse or guilt, as well as by a robust aggregation in a latent class analysis. CONCLUSIONS: CLE and SDA could be considered as core characteristics of LPE in children and adolescents.

Reaction time variability and attention-deficit/hyperactivity disorder: is increased reaction time variability specific to attention-deficit/hyperactivity disorder? Testing predictions from the default-mode interference hypothesis.

Increased reaction time variability (RTV) is one of the most replicable behavioral correlates of attention-deficit/hyperactivity disorder (ADHD). However, this may not be specific to ADHD but a more general marker of psychopathology. Here we compare RT variability in individuals with ADHD and those with other childhood internalizing and externalizing conditions both in terms of standard (i.e., the standard deviation of reaction time) and alternative indices that capture low-frequency oscillatory patterns in RT variations over time thought to mark periodic lapses of attention in ADHD. A total of 667 participants (6-12 years old) were classified into non-overlapping diagnostic groups consisting of children with fear disorders (n = 91), distress disorders (n = 56), ADHD (n = 103), oppositional defiant or conduct disorder (ODD/CD; n = 40) and typically developing controls (TDC; n = 377). We used a simple two-choice reaction time task to measure reaction time. The strength of oscillations in RTs across the session was extracted using spectral analyses. Higher RTV was present in ADHD compared to all other disorder groups, effects that were equally strong across all frequency bands. Interestingly, we found that lower RTV to characterize ODD/CD relative to TDC, a finding that was more pronounced at lower frequencies. In general, our data support RTV as a specific marker of ADHD. RT variation across time in ADHD did not show periodicity in a specific frequency band, not supporting that ADHD RTV is the product of spontaneous periodic lapses of attention. Low-frequency oscillations may be particularly useful to differentiate ODD/CD from TDC.

Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children.

OBJECTIVES: To use the latest data to estimate the prevalence and correlates of currently diagnosed depression, anxiety problems, and behavioral or conduct problems among children, and the receipt of related mental health treatment. STUDY DESIGN: We analyzed data from the 2016 National Survey of Children's Health (NSCH) to report nationally representative prevalence estimates of each condition among children aged 3-17 years and receipt of treatment by a mental health professional. Parents/caregivers reported whether their children had ever been diagnosed with each of the 3 conditions and whether they currently have the condition. Bivariate analyses were used to examine the prevalence of conditions and treatment according to sociodemographic and health-related characteristics. The independent associations of these characteristics with both the current disorder and utilization of treatment were assessed using multivariable logistic regression. RESULTS: Among children aged 3-17 years, 7.1% had current anxiety problems, 7.4% had a current behavioral/conduct problem, and 3.2% had current depression. The prevalence of each disorder was higher with older age and poorer child health or parent/caregiver mental/emotional health; condition-specific variations were observed in the association between other characteristics and the likelihood of disorder. Nearly 80% of those with depression received treatment in the previous year, compared with 59.3% of those with anxiety problems and 53.5% of those with behavioral/conduct problems. Model-adjusted effects indicated that condition severity and presence of a comorbid mental disorder were associated with treatment receipt. CONCLUSIONS: The latest nationally representative data from the NSCH show that depression, anxiety, and behavioral/conduct problems are prevalent among US children and adolescents. Treatment gaps remain, particularly for anxiety and behavioral/conduct problems.

Infant Iron Deficiency and Iron Supplementation Predict Adolescent Internalizing, Externalizing, and Social Problems.

OBJECTIVE: To evaluate associations between iron supplementation and iron deficiency in infancy and internalizing, externalizing, and social problems in adolescence. STUDY DESIGN: The study is a follow-up of infants as adolescents from working-class communities around Santiago, Chile who participated in a preventive trial of iron supplementation at 6 months of age. Inclusionary criteria included birth weight ≥3.0 kg, healthy singleton term birth, vaginal delivery, and a stable caregiver. Iron status was assessed at 12 and 18 months of age. At 11-17 years of age, internalizing, externalizing, and social problems were reported by 1018 adolescents with the Youth Self Report and by parents with the Child Behavior Checklist. RESULTS: Adolescents who received iron supplementation in infancy had greater self-reported attention-deficit/hyperactivity disorder but lower parent-reported conduct disorder symptoms than those who did not (Ps < .05). Iron deficiency with or without anemia at 12 or 18 months of age predicted greater adolescent behavior problems compared with iron sufficiency: more adolescent-reported anxiety and social problems, and parent-reported social, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, oppositional defiant, conduct, aggression, and rule breaking problems (Ps < .05). The threshold was iron deficiency with or without anemia for each of these outcomes. CONCLUSIONS: Iron deficiency with or without anemia in infancy was associated with increased internalizing, externalizing, and social problems in adolescence.

The development of externalizing symptoms from late childhood through adolescence: A longitudinal study of Mexican-origin youth.

Youth who exhibit externalizing problems during childhood and adolescence are at an increased risk for a wide range of detrimental life outcomes. Despite the profound consequences of externalizing problems for children, their families, and their communities, we know less about the precise trajectory of externalizing symptoms across late childhood and adolescence, because of the paucity of fine-grained longitudinal research. The present study examined the development of externalizing symptoms in a large sample (N = 674) of Mexican-origin youth, assessed annually from age 10 to 17. Specifically, we conducted analyses to better understand the trajectories of attention-deficit-hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms (and their codevelopment), as well as how gender and cultural factors influence symptom trajectories. On average, ADHD symptoms slowly declined from age 10 to 17; ODD symptoms increased until age 13 and then declined thereafter; and, CD symptoms slowly increased until age 15 and then leveled off. ADHD, ODD, and CD symptoms predicted change in each other, indicating youth may accumulate multiple forms of externalizing problems over time. Boys reported fewer externalizing problems than girls, contrary to expectations. Consistent with the Immigrant Paradox, we found that 2nd + generation youth, youth who endorsed fewer traditional Mexican cultural values (traditional gender roles, traditional family values, and religiosity), and youth who engaged in less Spanish/more English language use were at increased risk for exhibiting ADHD, ODD, and CD symptoms from childhood through adolescence. We discuss the theoretical and practical implications of these developmental patterns among Mexican-origin youth. (PsycINFO Database Record

QEEG and LORETA in Teenagers With Conduct Disorder and Psychopathic Traits.

BACKGROUND: Few studies have investigated the impact of the psychopathic traits on the EEG of teenagers with conduct disorder (CD). To date, there is no other research studying low-resolution brain electromagnetic tomography (LORETA) technique using quantitative EEG (QEEG) analysis in adolescents with CD and psychopathic traits. OBJECTIVE: To find electrophysiological differences specifically related to the psychopathic traits. The current investigation compares the QEEG and the current source density measures between adolescents with CD and psychopathic traits and adolescents with CD without psychopathic traits. METHODS: The resting EEG activity and LORETA for the EEG fast spectral bands were evaluated in 42 teenagers with CD, 25 with and 17 without psychopathic traits according to the Antisocial Process Screening Device. All adolescents were assessed using the DSM-IV-TR criteria. The EEG visual inspection characteristics and the use of frequency domain quantitative analysis techniques (narrow band spectral parameters) are described. RESULTS: QEEG analysis showed a pattern of beta activity excess on the bilateral frontal-temporal regions and decreases of alpha band power on the left central-temporal and right frontal-central-temporal regions in the psychopathic traits group. Current source density calculated at 17.18 Hz showed an increase within fronto-temporo-striatal regions in the psychopathic relative to the nonpsychopathic traits group. CONCLUSIONS: These findings indicate that QEEG analysis and techniques of source localization may reveal differences in brain electrical activity among teenagers with CD and psychopathic traits, which was not obvious to visual inspection. Taken together, these results suggest that abnormalities in a fronto-temporo-striatal network play a relevant role in the neurobiological basis of psychopathic behavior.

Measuring child maltreatment using multi-informant survey data: a higher-order confirmatory factor analysis.

OBJECTIVE: To investigate the validity and reliability of a multi-informant approach to measuring child maltreatment (CM) comprising seven questions assessing CM administered to children and their parents in a large community sample. METHODS: Our sample comprised 2,512 children aged 6 to 12 years and their parents. Child maltreatment (CM) was assessed with three questions answered by the children and four answered by their parents, covering physical abuse, physical neglect, emotional abuse and sexual abuse. Confirmatory factor analysis was used to compare the fit indices of different models. Convergent and divergent validity were tested using parent-report and teacher-report scores on the Strengths and Difficulties Questionnaire. Discriminant validity was investigated using the Development and Well-Being Assessment to divide subjects into five diagnostic groups: typically developing controls (n = 1,880), fear disorders (n = 108), distress disorders (n = 76), attention deficit hyperactivity disorder (n = 143) and oppositional defiant disorder/conduct disorder (n = 56). RESULTS: A higher-order model with one higher-order factor (child maltreatment) encompassing two lower-order factors (child report and parent report) exhibited the best fit to the data and this model's reliability results were acceptable. As expected, child maltreatment was positively associated with measures of psychopathology and negatively associated with prosocial measures. All diagnostic category groups had higher levels of overall child maltreatment than typically developing children. CONCLUSIONS: We found evidence for the validity and reliability of this brief measure of child maltreatment using data from a large survey combining information from parents and their children.

Measuring child maltreatment using multi-informant survey data: a higher-order confirmatory factor analysis / Dados de levantamento com múltiplos informantes para a mensuração de maus-tratos na infância: uma análise fatorial confirmatória de segunda ordem

Objective To investigate the validity and reliability of a multi-informant approach to measuring child maltreatment (CM) comprising seven questions assessing CM administered to children and their parents in a large community sample. Methods Our sample comprised 2,512 children aged 6 to 12 years and their parents. Child maltreatment (CM) was assessed with three questions answered by the children and four answered by their parents, covering physical abuse, physical neglect, emotional abuse and sexual abuse. Confirmatory factor analysis was used to compare the fit indices of different models. Convergent and divergent validity were tested using parent-report and teacher-report scores on the Strengths and Difficulties Questionnaire. Discriminant validity was investigated using the Development and Well-Being Assessment to divide subjects into five diagnostic groups: typically developing controls (n = 1,880), fear disorders (n = 108), distress disorders (n = 76), attention deficit hyperactivity disorder (n = 143) and oppositional defiant disorder/conduct disorder (n = 56). Results A higher-order model with one higher-order factor (child maltreatment) encompassing two lower-order factors (child report and parent report) exhibited the best fit to the data and this model's reliability results were acceptable. As expected, child maltreatment was positively associated with measures of psychopathology and negatively associated with prosocial measures. All diagnostic category groups had higher levels of overall child maltreatment than typically developing children. Conclusions We found evidence for the validity and reliability of this brief measure of child maltreatment using data from a large survey combining information from parents and their children.

Objetivo Investigar a validade e confiabilidade de uma abordagem de múltiplos informantes para a mensuração de maus-tratos na infância, composta por sete questões avaliando maus-tratos na infância respondidas pelas crianças e seus pais em uma ampla amostra comunitária. Métodos A amostra foi composta por 2.512 crianças com idades entre 6 e 12 anos e seus pais. Maus-tratos na infância foram avaliados com três questões respondidas pelas crianças e quatro respondidas pelos seus pais, investigando violência física, negligência física, violência emocional e violência sexual. Análises fatoriais confirmatórias foram utilizadas para comparar os índices de ajuste de diferentes modelos. Validade convergente e divergente foi testada utilizando escores de relato parental e de relato dos professores no Strengths and Difficulties Questionnaire. Validade discriminante foi investigada utilizando a entrevista Development and Well-Being Assessment para dividir os participantes em cinco grupos diagnósticos: controles com desenvolvimento típico (n = 1.880), transtornos do medo (n = 108), transtornos do estresse (n = 76), transtorno de déficit de atenção-hiperatividade (n = 143) e transtorno opositivo-desafiador/conduta (n = 56). Resultados Um modelo de segunda ordem com um fator de segunda ordem (maus-tratos na infância) englobando dois fatores de primeira ordem (relato da criança e relato parental) demonstrou o melhor ajuste aos dados, e os resultados de confiabilidade desse modelo foram aceitáveis. Como esperado, maus-tratos na infância estiveram positivamente associados a medidas de psicopatologia e negativamente associados a medidas pró-sociais. Todos os grupos de categorias diagnósticas tiveram níveis mais altos de maus-tratos na infância do que as crianças com desenvolvimento típico. Conclusões Foram encontradas evidências de validade e confiabilidade dessa medida breve de maus-tratos na infância utilizando dados de um grande levantamento combinando o relato de pais e seus filhos.

Trastornos conductuales: actualización en intervenciones con niños y adolescentes / Behavioral disorders: update on interventions with children and adolescents

El presente trabajo, es una revisión actualizada tanto de la conceptualización de los Trastornos Conductuales, como de las principales intervenciones psicoterapéuticas para el tratamiento de estos trastornos, en la infancia y adolescencia; para esto, se consideró las intervenciones que presentan evidencia positiva de su efectividad. Las últimas investigaciones realizadas sobre este trastorno concluyen que las intervenciones psicosociales debieran ser la primera línea de tratamiento y que se debiera considerar las intervenciones psicofarmacológicas sólo en casos específicos, para tratar la sintomatología asociada.

This paper is an updated review of both the conceptualization and the major psychotherapeutic interventions in Behavioral Disorders in childhood and adolescence. We considered the interventions that have positive evidence of their effectiveness. The latest research on Behavioral Disorders conclude that psychosocial interventions should be the first line of treatment and that psychopharmacological interventions should be considered only in specific cases, to treat associated symptoms.

Disruptive behavior in preschool children: distinguishing normal misbehavior from markers of current and later childhood conduct disorder.

OBJECTIVES: To investigate which disruptive behaviors in preschool were normative and transient vs markers of conduct disorder, as well as which disruptive behaviors predicted the persistence of conduct disorder into school age. STUDY DESIGN: Data from a longitudinal study of preschool children were used to investigate disruptive behaviors. Caregivers of preschoolers ages 3.0-5.11 years (n = 273) were interviewed using the Preschool Age Psychiatric Assessment to derive the following diagnostic groups: conduct disorder, externalizing disorder without conduct disorder, internalizing disorder without externalizing disorder, and healthy. At school age, participants were again assessed via an age-appropriate diagnostic interview. Logistic and linear regression with pairwise group comparisons was used to investigate clinical markers of preschool conduct disorder and predictors of school age conduct disorder. RESULTS: Losing one's temper, low-intensity destruction of property, and low-intensity deceitfulness/stealing in the preschool period were found in both healthy and disordered groups. In contrast, high-intensity argument/defiant behavior, both low- and high-intensity aggression to people/animals, high-intensity destruction of property, high-intensity deceitfulness/stealing, and high-intensity peer problems were markers of preschool conduct disorder and predictors of school age conduct disorder. Inappropriate sexual behavior was not a marker for preschool conduct disorder but was a predictor of school age conduct disorder. CONCLUSION: These findings provide a guide for primary care clinicians to help identify preschoolers with clinical conduct disorder and those who are at risk for persistent conduct disorder in childhood. Preschoolers displaying these symptoms should be targeted for mental health assessment.

Transtorno da conduta: uma oportunidade para a prevenção em saúde mental? / Conduct disorder: an opportunity for prevention in mental health? / El trastorno de conducta: ¿una oportunidad para la prevención en salud mental?

Este artigo tem como objetivo analisar criticamente o diagnóstico de transtorno da conduta como uma possível oportunidade para a formulação de estratégias de prevenção no campo da saúde mental. Considerado o transtorno psiquiátrico mais frequente na infância e preocupação constante para familiares e clínicos, o transtorno da conduta vem sendo entendido por alguns pesquisadores do campo psiquiátrico como uma oportunidade para a intervenção preventiva. Com o intuito de compreendermos as potencialidades, fragilidades e implicações éticas dessa proposta, analisamos as principais características, controvérsias e debates em torno de sua definição e as peculiaridades que concernem possíveis ações de prevenção. A idade de surgimento do transtorno, a história psiquiátrica familiar, a antecipação do diagnóstico para crianças em idade pré-escolar e a diferenciação entre categorias diagnósticas aplicadas aos comportamentos antissociais são identificados como aspectos controversos do transtorno que acarretam importantes consequências para possíveis propostas de prevenção.

This article aims to critically analyze the diagnosis of conduct disorder as a possible opportunity for the formulation of prevention strategies in the field of mental health. Considered the most common psychiatric disorder in childhood and a constant concern for family and clinicians, conduct disorder has been understood by some researchers of the psychiatric field as an opportunity for preventive intervention. In order to understand the potential, fragility and the ethical implications of this proposal we analyze the main features, controversies and debates concerning its definition and the peculiarities regarding possible preventive actions. The age of onset of the disorder, the family's psychiatric history, an early diagnosis for preschool children and the differentiation between diagnostic categories applied to antisocial behavior are identified as controversial aspects of the disorder that bring important consequences for possible prevention proposals.

Este artículo tiene como objetivo realizar un análisis crítico del diagnóstico de trastorno de conducta como una oportunidad para la formulación de estrategias de prevención en el ámbito de la salud mental. Considerado el trastorno psiquiátrico más frecuente en la infancia y una constante preocupación por la familia y los clínicos, el trastorno de conducta ha sido entendido por algunos investigadores del ramo de la psiquiatría como una oportunidad para la intervención preventiva. A fin de comprender las capacidades, debilidades y las implicaciones éticas de esta propuesta se analizan sus características principales, las controversias y debates acerca de su definición y las particularidades que se refieren a medidas de prevención posible. La edad de aparición de la enfermedad, los antecedentes familiares psiquiátricos, un diagnóstico precoz para los niños en edad preescolar y la diferenciación entre las categorías de diagnóstico aplicado a la conducta antisocial se consideran los aspectos controvertidos de los trastornos conductuales que causan importantes consecuencias para las posibles propuestas de prevención.

Identification of attention-deficit-hyperactivity disorder and conduct disorder in Mexican children by the scale for evaluation of deficit of attention and hyperactivity.

The objective was weighing the usefulness of a Spanish-language Scale for the evaluation of deficit of attention and hyperactivity (EDAH) to identify children with attention deficit-hyperactivity disorder (AD-HD) and conduct disorder (CD) in a sample of school-aged children. We studied 132 children from a government-run public elementary school previously selected by teachers as having learning and attention disorders. We screened children of the sample with parents' and teachers' EDAH and Diagnostic and Statistical Manual of Mental Disorders-IV edition Text Revision (DSM-IV-TR) questionnaires, and performed an interdisciplinary clinical examination for the final diagnosis. We found 81 children with AD-HD and 51 children without AD-HD. AD-HD was classified as follows: AD-HD-combined (-C), n=32; AD-HD-inattentive (-I), n=17 and AD-HD-hyperactive (-H), n=32. Cronbach's alpha calculation for the EDAH parents' questionnaire was 0.76, and for teachers, 0.80. Sensitivity of the teachers' EDAH questionnaire was 0.94, and specificity, 0.91. Sensitivity of the parents' EDAH questionnaire was 0.91, while specificity was 0.87. The data of EDAH parents' and teachers' questionnaires have a concordance of 93.1% and 80%, respectively. The correlation of scores among parents' and teachers' EDAH scales was significant. The correlation between results from parents' and teachers' DSM-IV-TR and EDAH questionnaires was also significant. Our results partially support the use of EDAH questionnaires for AD-HD and CD screening in Spanish-speaking populations.

A leitura das emoções e ocomportamento violento mapeado no cérebro / Reading emotions and violent behaviors on the brain

O presente ensaio faz uma interpretação de estudos neurocientíficos que relacionam lesões e funções neurofisiológicas ao comportamento emocional violento, tecendo considerações sobre o impacto dessas hipóteses em campo, seja na justiça criminal, na educação ou em outras áreas. Embora até mesmo autores das neurociências afirmem não haver evidências suficientes de que o potencial criminoso possa ser ligado diretamente a funções discretas do cérebro, e ainda ser controverso o apoio em exames neurocriminológicos em julgamentos criminais, há uma tendência atual de mapear cérebros para intervir precocemente no intuito de prevenir a violência. Analisa-se com cautela o investimento em políticas de escaneamento e intervenção nos cérebros de crianças e adolescentes que apresentem comportamento desajustado ou violento. Com base em alguns equívocos históricos, como os estigmas sociais realçados pelo lombrosionismo e pela frenologia, e, também, com base em premissas psicanalíticas e contribuições construtivistas, critica-se a apropriação imediatista dos achados neurocientíficos no que concerne às origens da violência, ressaltando a irredutibilidade do aporte linguístico, social e histórico como planos potenciais de formação e transformação da subjetividade.

This essay makes an interpretation of the neuroscience's theories that relate neurophysiologic functions and brain damages to the violent behavior in order to present some critical points about the use of these hypotheses in some work fields as criminal justice, education or any others. Although even neuroscientists acknowledge there aren't enough proves that criminal behavior could not be linked to discrete brain's functions, and also being controversial the use of neuroimages in criminal judgments, there is a present tendency to map children and teenager's brains to intervene as early as possible to prevent violence. It analyzes with caution these investments in brain scan polices. It remembers the core of historical mistakes made by Criminal Anthropology and Phrenology in XIX century, to advertise the risk of reducing the multiplicity of human emotions and violent reactions to neural causes, supposedly determining a criminal potential. In such sense, supported by psychoanalytical and constructivist premises, this work criticizes the reductionism of such a criminal neuroscience, showing the irreducibility of the linguistic, social and historical contribution as the potential plans for formation and transformation of subjectivity.

Síndrome vestibular periférica / Peripheral vestibular syndrome

Doenças do sistema vestibular são comuns em pequenos animais, e resultam em uma síndrome clínica caracterizada por inclinação de cabeça, nistagmo e ataxia com preservação do tônus muscular. A doença vestibular periférica pode ser resultante de alteração congênita, infecção, neoplasia, hipotiteoidismo, pólipos, traumatismo; degeneração dos receptores induzida por aminoglicosídeos ou uma síndrome idiopática transitória. O objetivo do presente trabalho é revisar os sinais clínicos que auxiliam na localização da lesão vestibular e discorrer sobre as possíveis causas da síndrome vestibular periférica em cães e gatos.

Vestibular diseases are common in small animals and result in a clinical syndrome characterized by head inclination, nystagmus and ataxia with preserved muscle tonus. Peripheral vestibular disease may be a result of congenital alteration, infection, neoplasia, hypothyroidism, polyps, trauma, aminoglycoside-induced receptor degeneration or may be an idiopathic transitory syndrome. The objective of the present study is to review clinical signs that help to determine the localization of vestibular injuries and discuss possible causes of peripheral vestibular syndrome in dogs and cats.

Síndrome vestibular periférica / Peripheral vestibular syndrome

Doenças do sistema vestibular são comuns em pequenos animais, e resultam em uma síndrome clínica caracterizada por inclinação de cabeça, nistagmo e ataxia com preservação do tônus muscular. A doença vestibular periférica pode ser resultante de alteração congênita, infecção, neoplasia, hipotiteoidismo, pólipos, traumatismo; degeneração dos receptores induzida por aminoglicosídeos ou uma síndrome idiopática transitória. O objetivo do presente trabalho é revisar os sinais clínicos que auxiliam na localização da lesão vestibular e discorrer sobre as possíveis causas da síndrome vestibular periférica em cães e gatos.(AU)

Vestibular diseases are common in small animals and result in a clinical syndrome characterized by head inclination, nystagmus and ataxia with preserved muscle tonus. Peripheral vestibular disease may be a result of congenital alteration, infection, neoplasia, hypothyroidism, polyps, trauma, aminoglycoside-induced receptor degeneration or may be an idiopathic transitory syndrome. The objective of the present study is to review clinical signs that help to determine the localization of vestibular injuries and discuss possible causes of peripheral vestibular syndrome in dogs and cats.(AU)

Psychiatry and politics in Pelotas, Brazil: the equivocal quality of conduct disorder and related diagnoses.

The world-wide emergence of categories for diagnosing mental health problems in children and youth such as conduct disorder is often attributed to the globalization of a highly biomedical form of psychiatry. In Brazil, a small group of therapists are resisting biomedicalization by keeping psychodynamic traditions alive and aiming to transform psychotherapy into a resource for politicized youth empowerment. Nevertheless, clinical practices demonstrate an increased use of biomedical diagnoses and therapeutic routines. On the basis of fieldwork with therapists and teachers, and a nine-year-long ethnography of young people, this article explores the localized effects of these potentially contradictory developments. Results show that the growth of biomedical practices alongside politicized therapeutic approaches is not indicative of underlying ambiguities but has, rather, emerged from the purposefully equivocal nature of Brazilian social, medical, and professional life. The article uses this Brazilian case study to critically debate theories of medicalization in the anthropology of psychiatry.

Switching from methylphenidate immediate release to MPH-SODAS in attention-deficit/hyperactivity disorder.

OBJECTIVE: To assess ADHD symptoms after switching from Methylphenidate Immediate-release (MPH-IR) to Methylphenidate Spheroidal Oral Drug Absorption System (MPH-SODAS) in clinically stable patients with ADHD and to identify predictors of dissatisfaction with MPH-SODAS. METHODS: This is an 8-week open clinical trial. Patients were assigned to MPH-SODAS according to their pre-study dose of MPH-IR. Assessments at baseline were conducted using the Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV), and the Barkley's Side Effect Rating Scale (SERS). Potentials predictors of treatment response were evaluated. RESULTS: From 62 patients, 47 completed the protocol. There was no significant change in the total score at the SNAP-IV (F (1,51.26) = 0.01; P = 0.91) and its subscales scores during the trial. Although no significant effect on the SERS total score (F (1,111.49) = 0.75; P = 0.39) was found, one adult patient with a previous cardiovascular condition presented a hemorrhagic cerebral vascular accident resulting in her obit. Overall, 46 (74.2%) patients reported to be satisfied. No factor assessed predicted dissatisfaction in univariated analyses. CONCLUSION: Results suggested that switching from MPH-IR to MPH-SODAS did not affect stabilization of ADHD symptoms in the majority of patients. MPH prescription in patients with previous cardiovascular conditions must be extremely careful. Further studies with long-acting MPH including larger samples and patients not responsive to MPH-IR are needed especially in countries outside the US.

Labeling disorder: the relationship between conduct problems and drug use in adolescents

OBJECTIVE: To verify how conduct disorder and conduct problems are associated with gender, age at onset of drug use and categories of drugs used. METHOD: A test of association was conducted between the presence of comorbidity and gender. Mean age of first use of each drug was compared to mean age of first arrest, of first robbery/theft, and of first drug dealing. RESULTS: In this sample, approximately 59 percent of adolescents had already robbed and/or stolen, 38.6 percent had already been arrested, 32.3 percent had prior history of drug dealing, 24.1 percent had depression, and 9.6 percent had conduct disorder. Prevalence of conduct problems was 65.2 percent. Tobacco, alcohol, marijuana and cocaine were used before the first robbery and/or theft, first drug dealing, and first arrest. DISCUSSION: The fact that drug use onset preceded illegal acts suggests that the latter are the consequence of the consumption of the former, or perhaps, the consequence of "social invisibility" (feeling of not belonging to anything or to anybody) by which these youths undergo. CONCLUSIONS: Labeling these youths as conduct-disordered adolescents may cloud a rather different reality, and it may submit them to more social isolation and stigmatization as well.

OBJETIVO: Verificar como o transtorno de conduta e os problemas de conduta se associam ao gênero, a idade de início do uso de drogas e aos tipos de drogas consumidas. MÉTODO: Realizou-se teste de associação entre presença de comorbidade e sexo. As médias de idade do primeiro uso de cada droga foram comparadas com as médias de idade da primeira prisão e das práticas do primeiro roubo e do primeiro tráfico. RESULTADOS: Aproximadamente 59 por cento dos adolescentes já haviam praticado algum tipo de roubo, 38,6 por cento já haviam sido presos, 32,3 por cento possuíam história pregressa de tráfico de drogas, 24,1 por cento tinham depressão e 9,6 por cento transtorno de conduta. A prevalência de problemas de conduta foi de 65,2 por cento. Tabaco, álcool, maconha e cocaína foram usados antes do primeiro roubo, do primeiro tráfico e da primeira prisão. DISCUSSÃO: Os atos ilegais ocorreram posteriormente ao início do uso de drogas, denotando ser conseqüência deste consumo ou, talvez, conseqüência da "invisibilidade social" (sensação de não-pertencimento a nada ou a ninguém) pela qual passam estes jovens. CONCLUSÕES: A rotulação destes jovens como portadores de transtorno de conduta pode ofuscar uma realidade bem diferente, além de submetê-los a uma maior marginalização e estigmatização.

Labeling disorder--the relationship between conduct problems and drug use in adolescents.

OBJECTIVE: To verify how conduct disorder and conduct problems are associated with gender, age at onset of drug use and categories of drugs used. METHOD: A test of association was conducted between the presence of comorbidity and gender. Mean age of first use of each drug was compared to mean age of first arrest, of first robbery/theft, and of first drug dealing. RESULTS: In this sample, approximately 59% of adolescents had already robbed and/or stolen, 38.6% had already been arrested, 32.3% had prior history of drug dealing, 24.1% had depression, and 9.6% had conduct disorder. Prevalence of conduct problems was 65.2%. Tobacco, alcohol, marijuana and cocaine were used before the first robbery and/or theft, first drug dealing, and first arrest. DISCUSSION: The fact that drug use onset preceded illegal acts suggests that the latter are the consequence of the consumption of the former, or perhaps, the consequence of "social invisibility" (feeling of not belonging to anything or to anybody) by which these youths undergo. CONCLUSIONS: Labeling these youths as conduct-disordered adolescents may cloud a rather different reality, and it may submit them to more social isolation and stigmatization as well.

Prevalence of psychiatric disorders among children of different ethnic origin.

The present study assesses the population prevalence of DSM-IV disorders among native and immigrant children living in low socio-economic status (SES) inner-city neighborhoods in the Netherlands. In the first phase of a two-phase epidemiological design, teachers screened an ethnically diverse sample of 2041 children aged 6-10 years using the Strengths and Difficulties Questionnaire (SDQ). In the second phase, a subsample of 253 children was psychiatrically examined, while their parents were interviewed. In addition, teachers completed a short questionnaire about 10 DSM-IV items. Prevalence was estimated using the best-estimate diagnosis based on parent, child and teacher information. Projected to the total population, 11% of the children had one or more impairing psychiatric disorders, which did not differ between native and non-native children. In the total group a clear relationship was observed between the prevalence of psychiatric disorders and gender, parental psychopathology, peer problems and school problems, but not among all ethnic groups separately. This study suggests that the prevalence of psychiatric disorders among non-treated minority and native children in low SES inner-city neighborhoods does not materially differ. However, associated mechanisms may be influenced by ethnicity.