Children with oppositional-defiant disorder display deviant attentional processing independent of ADHD symptoms.

OBJECTIVE: To examine neurophysiological correlates of attentional processing in children with oppositional-defiant disorder (ODD) independent of ADHD symptoms. METHOD: Thirteen children with oppositional-defiant disorder without comorbid ADHD symptoms and 13 healthy control children (all 11 years) performed a cued Continuous Performance Test (CPT-AX). Event-related potentials (ERP) to cue and target stimuli were examined for group differences. RESULTS: Children with ODD showed significantly reduced parietal P3a and P3b amplitudes to cues and to targets, compared with healthy controls. ERP amplitudes correlated with oppositional and aggressive behavior scores. CONCLUSIONS: Event-related potentials revealed reduced orienting to cues and reduced executive target processing in children with ODD. These findings indicate that ODD children show neurophysiological deviances independent of ADHD comorbidity.

Attentional enhancement to NoGo stimuli in anxious children.

OBJECTIVE: To measure neurophysiological correlates of inhibition in children with anxiety disorders. METHOD: Anxiety-disordered children and healthy control children (11 years of age) performed a cued Continuous Performance Test (CPT-AX). Event-related potentials following NoGo and distractor stimuli as well as performance data were examined for group differences. RESULTS: Anxious children displayed a significantly larger NoGo-related N1 global field power than did control children while no group differences were found for the N2 and P3 potentials. Groups did not differ in CPT performance. CONCLUSIONS: Anxious children showed early attentional enhancement (N1) to stimuli indicating need for inhibition but not increased resource allocation to actual response inhibition.

Frontal EEG correlates of externalizing spectrum behaviors.

An atypical EEG pattern of frontal brain activation, which has been related to compromised emotional regulation in children and adults, is hypothesized to be also present in children with externalizing behavior problems. Seventy-eight children at 11 years of age were examined to answer the following questions: 1) do children with externalizing behaviors exhibit an atypical pattern of frontal brain activation which can be linked to the severity of their problem behaviors? and 2) are there gender differences in these frontal activation patterns? Spontaneous EEG activity was subjected to power spectral analysis. In externalizing girls, the well-known pattern of a significantly greater right than left frontal brain activation emerged that has been found previously in emotionally disordered children, whereas healthy girls showed a significantly greater left than right frontal activation. In contrast, healthy boys demonstrated a significantly greater right than left frontal activation, whereas externalizing boys did not display a frontal brain asymmetry. Thus, the pattern of frontal brain activation was gender specific. The atypical activation pattern in externalizing children is hypothesized to be a biological correlate of difficulties in regulating emotion.

[Evaluated treatment approaches in child and adolescent psychiatry I]. / Evaluierte Behandlungsansätze in der Kinder- und Jugendpsychiatrie I.

OBJECTIVES: The principle of evidence-based medicine is to integrate data concerning the efficacy of interventions into clinical practice. This article assesses the level of evaluation of psychosocial, psychopharmacological and combined interventions for mental disorders in childhood and adolescence (autistic disorders, hyperkinetic disorders, conduct disorders, tic disorders, enuresis, and encopresis). METHODS: Three different levels of evaluation were defined for both psychosocial and psychopharmacological interventions: A (> or = 2 randomized controlled studies), B (1 randomized controlled study), and C (open studies and case studies). The level of evaluation was judged on the basis of original papers found in a comprehensive literature search. RESULTS: For most disorders presented in this article there are several A-level treatments. The efficacy of both psychosocial and psychopharmacological interventions that target specific problem behaviors or symptoms, respectively, has been repeatedly demonstrated with regard to autistic disorders. Many studies have evaluated treatment approaches for hyperkinetic disorders and conduct disorders. With regard to the treatment of tic disorders in children and adolescents, far more studies evaluated the efficacy of pharmacotherapy than of psychotherapy. CONCLUSIONS: Further research should compare the efficacy of different treatment approaches, examine specific and differential treatment effects and investigate combined treatment approaches.

[Evaluated treatment approaches in child and adolescent psychiatry II]. / Evaluierte Behandlungsansätze in der Kinder- und Jugendpsychiatrie II.

OBJECTIVES: The principle of evidence-based medicine is to integrate data concerning the efficacy of interventions into clinical practice. This article assesses the level of evaluation of psychosocial, psychopharmacological and combined interventions for mental disorders in childhood and adolescence (schizophrenic disorders, affective disorders, phobias and anxiety disorders, obsessive-compulsive disorder, posttraumatic stress disorder, anorexia nervosa, and bulimia nervosa). METHODS: Three different levels of evaluation were defined for both psychosocial and psychopharmacological interventions: A (> or = 2 randomized controlled studies), B (1 randomized controlled study), and C (open studies and case studies). The level of evaluation was judged on the basis of original papers found in a comprehensive literature search. RESULTS: The number of controlled studies examining these disorders in children and adolescents is small, especially with regard to pharmacotherapy. However, the efficacy of (cognitive) behavior therapy for depressive disorders, phobias and anxiety disorders, as well as posttraumatic stress disorder has been demonstrated. CONCLUSIONS: There is still a considerable need to evaluate pharmacological treatment approaches for schizophrenic and affective disorders. Looking at psychosocial interventions in schizophrenic disorders, obsessive-compulsive disorder and eating disorders, specific aspects of treatment for young patients should be examined. Overall, the psychotherapy approach evaluated best is (cognitive) behavioral therapy.

Increased semantic and repetition priming in schizophrenic patients.

Positive and negative priming (PP and NP) in schizophrenia were studied with a lexical-decision task. Probe words, presented 800 ms after the response to the prime (containing a word and a nonword), were either identical to, semantically related to, or unrelated to the prime target word (PP) or to the prime distractor word (NP). Schizophrenic patients displayed stronger semantic and repetition PP than controls after controlling for their slower responses. Significant NP was observed in both groups for word repetition only. The PP findings contrast with results from studies with similar prime-probe intervals but without prime responses. It is proposed that schizophrenic patients, because of impaired (controlled) processes of response selection, strongly benefit from (or rely on) the automatic retrieval of processing episodes containing response information. Related findings indicating automatic response facilitation in schizophrenia are discussed.

Behavioral sequelae of perinatal insults and early family adversity at 8 years of age.

OBJECTIVE: This prospective longitudinal study investigated the simultaneous impact of early biological and psychosocial risk factors on behavioral outcome at school age. METHOD: A cohort of 362 children born between 1986 and 1988 with different biological (perinatal insults) and psychosocial risk factors (family adversity) was followed from birth to school age. When their children were aged 8 years, parents of 89.0% of the initial sample completed the Child Behavior Checklist (CBCL). RESULTS: More externalizing as well as internalizing problems were found in children born into adverse family backgrounds, whereas no differences at broad-band syndrome level were apparent between groups with varying obstetric complications. Children with family risk factors had higher scores on 5 of the 8 CBCL scales (including attention, delinquent, and aggressive problems), whereas children with perinatal risk factors had more social and attention problems than children in the nonrisk groups. With one exception, no interactions between risk factors emerged, indicating that perinatal and family risk factors contributed independently to outcome. The differences between risk groups applied irrespective of gender. CONCLUSIONS: The adverse impact of family adversity clearly outweighed the influence of obstetric complications in determining behavioral adjustment at school age.

[Psychological testing in theory and practice exemplified by intelligence testing]. / Testpsychologie zwischen Anspruch und Wirklichkeit am Beispiel der Intelligenzdiagnostik.

OBJECTIVES: The U.S.-American standards of quality for psychological diagnostics tests were published in 1998 in German translation under the title "Standards für pädagogisches und psychologisches Testen". The relevance of these Standards for studies of psychological testing in child and adolescent psychiatry is discussed. Important intelligence tests will be assessed on the basis of these standards for studies of psychological testing in children and adolescents. METHODS: Relevant standards were presented and discussed. The intelligence tests HAWIK-R, HAWIK-III, K-ABC, AID, PSB, I-S-T 70, SPM, CFT 20, CMM-LB, SON-R 2 1/2-7, SON-R 5 1/2-17 were analyzed with regard to whether or not they fulfilled the Standards under inclusion of the test manuals, test reviews, and empirical studies from the literature. RESULTS: The intelligence tests listed differ widely in the extent to which they meet the Standards. CONCLUSIONS: The Standards appear, at least in part, to be relevant to studies of psychological testing in child and adolescent psychiatry. The intelligence tests used in such studies should be critically examined with regard to their quality and whether or not they are suitable for the issues to be resolved. Given their completely outdated standard, it is recommended to refrain from further use of PBS and I-S-T 70.

Oppositional children differ from healthy children in frontal brain activation.

An atypical EEG pattern of frontal brain activation, which has been found in children and adults with emotional disorders, also is hypothesized to be present in disruptive behavior disorders. One hundred nineteen children (4 1/2 and 8 years of age) were examined with regard to the following questions: (1) Do children who are diagnosed with oppositional defiant disorder (ODD) exhibit an atypical pattern of frontal brain activation? (2) Can this pattern be demonstrated in preschool children (4 1/2 years of age) as well as in school children (8 years)? (3) Are there gender differences in these patterns similar to those that have been demonstrated in adults? Spontaneous EEG activity was subjected to power spectral analysis. In oppositional preschool and elementary school girls, the well-known pattern of lower left frontal than right frontal activation emerged that has been found previously in emotionally disordered children. Healthy girls showed no frontal brain asymmetry at 4 1/2 years of age, and left frontal activation at 8 years. In contrast, healthy boys demonstrated a greater right than left frontal activation, whereas ODD boys did not display any frontal brain asymmetry. Thus, the pattern of frontal brain activation seems to be gender-specific. The atypical activation pattern in oppositional children is hypothesized to be a biological substrate of negative affective style.

[Obsessive-compulsive disorder, frontostriatal system and the effect of the serotonergic system]. / Zwangsstörung, frontostriatales System und Beeinflussung des serotonergen Systems.

OBJECTIVES: Focal issues of recent research on obsessive-compulsive disorders have been the involvement of the frontostriatal system in the patho-physiology, as well as the manner of effect and efficacy of the serotonin reuptake inhibitors that unfold their specific efficacy in the frontostriatal system. The course of treatment among adolescent inpatients with obsessive-compulsive disorder was analyzed with regard to the medications used and their effects upon the course of treatment. METHODS: The data for all adolescents with obsessive-compulsive disorder admitted as inpatients to the Hospital for Child and Adolescent Psychiatry and Psychotherapy in Mannheim since 01.01.1990 were analyzed with regard to medication and the parameters for course and outcome. RESULTS: Five patients dropped out of treatment, five patients received no medication, eight received sulpiride, ten were treated with clomipramine, and three with fluvoxamine. The average length of inpatient stay was longer for the groups treated with sulpiride and clomipramine than for the group that received no medication, but equivalent for these two medication groups. The success of treatment for obsessive-compulsive disorder was rated as higher in these two groups than in the group without medication. On sulpiride, patients gained weight and exhibited fatigue and increased levels of prolactin. On clomipramine, half of the patients exhibited cardiac side effects. CONCLUSIONS: This small, nonrandomized medicated sample analyzed under non-double-blind conditions shows no difference in the efficacy of clomipramine and sulpiride under post hoc analysis. Rather, the side effects that occurred in patients on clomipramine indicate a more frequent use of SSRI to increase compliance as regards medication intake.

Atypical frontal brain activation in ADHD: preschool and elementary school boys and girls.

OBJECTIVE: To investigate patterns of frontal brain activation in unmedicated preschool and school boys and girls with attention-deficit/hyperactivity disorder (ADHD). METHOD: Baseline electroencephalographic activity of 117 children (66 aged 4 years, 51 aged 8 years) was subjected to power spectral analysis, and laterality scores were determined. RESULTS: Boys with ADHD exhibited a less right-lateralized frontal activation pattern than normal control boys. Girls with ADHD displayed a more right-lateralized frontal activation pattern than normal control girls. This finding applied to children at both 4 1/2 and 8 years of age. There was no difference between children with ADHD and children with ADHD plus oppositional defiant disorder. CONCLUSIONS: This pattern of frontal brain activation is in line with magnetic resonance imaging studies of ADHD. It could be demonstrated in children as young as 4 1/2 years, as well as in school-age children. The opposite direction of asymmetry in boys and girls stresses the importance of gender-specific analyses in ADHD.

Can negative self-schemes in depressives be altered through sleep deprivation?

This paper addresses the question whether negative cognitive style represents a state or trait variable of depressive patients. For this reason, it studies the influence of sleep deprivation on negative self-schemes of those patients. 10 patients suffering from DSM-III-R major depression were compared with 10 age- and sex-matched controls on a task for rating the self-descriptiveness of positive and negative adjectives as well as a subsequent word recognition task. Three sessions were involved: an initial session (baseline), the second following a night of sleep deprivation, and the third after a successive full night's sleep. During the baseline examination, depressives showed a relatively negative cognitive bias; that is, the same number of positive and negative self-scheme elements. In comparison to controls, they showed significantly more negative and significantly less positive self-scheme elements. The same pattern emerged in a word recognition task for the number of recognized self-scheme elements. These variables indicated no change in the depressive group following sleep deprivation. Depressive subjects' reaction times on self-descriptiveness rating were significantly longer for positive than for negative self-scheme elements at the baseline session. The opposite was true for controls. Here, a sleep deprivation effect was evident. There was no longer a difference in the speed of information processing for positive as compared to negative self-scheme elements. This applied to both depressive and control groups.

[Anxiety in alcohol-dependent patients]. / Angst bei Alkoholabhängigen.

Alcoholism and anxiety disorders are concomitant far more frequently than might be expected. The great prevalence of anxiety disorders in alcoholics constitutes an important clinical issue because alcoholic subjects with a coexisting anxiety disorder suffer more frequent and more severe relapses than nonalcoholic control subjects. The former also how greater liability to psychotropic drug abuse and overdose behaviour, and are at greater risk of suicide. The type of relationship between alcohol dependence and anxiety disorders has considerable theoretical meaning. Four possible non-mutually exclusive ways of association are discussed: 1. the ingestion of alcohol may be an attempt at self-medication of anxiety symptoms; 2. anxiety and alcohol abuse may, independent of each other, be based on a third underlying, possibly genetic, factor; 3. anxiety may be a toxic effect of alcohol abuse or of withdrawal; 4. anxiety may result from cognitive processes in connection with alcohol abuse or withdrawal. Clinical guidelines for the pharmacotherapy of anxiety in patients suffering from alcoholism are outlined.