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1.
J Am Acad Child Adolesc Psychiatry ; 36(6): 844-52, 1997 Jun.
Article in English | MEDLINE | ID: mdl-9183141

ABSTRACT

OBJECTIVE: To evaluate the reliability and validity of a semistructured measure of obsessive-compulsive symptom severity in children and adolescents with obsessive-compulsive disorder (OCD). METHOD: Sixty-five children with OCD (25 girls and 40 boys, aged 8 to 17 years) were assessed with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Interrater agreement was assessed by four raters in a subsample (n = 24). Discriminant and convergent validity were assessed by comparing CY-BOCS scores to self-ratings of depression, anxiety, and obsessive-compulsive symptoms. RESULTS: Internal consistency was high, measuring .87 for the 10 items. The intraclass correlations for the CY-BOCS Total, Obsession, and Compulsion scores were .84, .91, and .68, suggesting good to excellent interrater agreement for subscale and total scores. The CY-BOCS Total score showed a significantly higher correlation with a self-report of obsessive-compulsive symptoms (r = .62 for the Leyton survey) compared with the Children's Depression Inventory (r = .34) and the Children's Manifest Anxiety Scale (r = .37) (p = .02 and .05, respectively). CONCLUSIONS: The CY-BOCS yields reliable and valid subscale and total scores for obsessive-compulsive symptom severity in children and adolescents with OCD. Reliability and validity appear to be influenced by age of the child and the hazards associated with integrating data from parental and patient sources.


Subject(s)
Obsessive-Compulsive Disorder/diagnosis , Psychiatric Status Rating Scales , Adolescent , Adolescent Psychiatry , Child , Child Psychiatry , Female , Humans , Male , Obsessive-Compulsive Disorder/classification , Reproducibility of Results
2.
J Assist Reprod Genet ; 13(3): 266-74, 1996 Mar.
Article in English | MEDLINE | ID: mdl-8852891

ABSTRACT

PURPOSE: to assess parental attitudes regarding the IVF experience, the IVF pregnancy, and issues associated with raising their IVF child(ren). METHOD: parents (184 couples) of IVF children born between 1982 and 1992 were mailed individual anonymous questionnaires. RESULTS: (31%) parents responded: 62 mothers and 41 fathers. One hundred-three (41%) of the mothers felt that our staff could have been more helpful during their pregnancy. Half the women subjects (52%) stated that they wished they had contact with other IVF couples during pregnancy. Fifty-two percent of the mothers reported that IVF created special feelings of attachment to the child, causing some difficulty with their initial separation. This was comparatively less an issue for fathers, with only 19% reporting similar difficulties (chi 2 = 8.39, P < 0.01). Ninety-eight percent of the subjects have told someone else about the IVF experience. Interestingly, 25% of the parents remained uncertain about whether they would tell the child. Sixteen couples (15%) had already told the child, and of the 57 (66%) who intended to tell the child later, they varied greatly in their views about which age would be appropriate (mean, 7.3 years; SD, 6.5 years; range, 2-21 years). CONCLUSIONS: The results suggest that women undergoing IVF might profit from greater contact with staff during pregnancy and, again, later when dealing with issues of separation. A substantial proportion of couples expressed some concerns about the issue of disclosure to the child and might profit from counseling when they feel the issue is current.


Subject(s)
Attitude , Disclosure , Fertilization in Vitro , Parents/psychology , Child , Fathers/psychology , Female , Humans , Male , Mothers/psychology , Pregnancy , Surveys and Questionnaires
3.
J Child Adolesc Psychiatr Nurs ; 8(3): 33-42; quiz 43-4, 1995.
Article in English | MEDLINE | ID: mdl-7655791

ABSTRACT

TOPIC: The selection of appropriate clinical rating instruments and integration of their findings in child psychiatric nursing practice may not be clear. PURPOSE: To offer guidance concerning the selection and application of clinical rating instruments SOURCES: A review of recent literature of commonly used parent and teacher checklists, clinician-rated instruments, structured diagnostic interviews, and child self-reports. CONCLUSION: Clinical rating scales have an important place in clinical practice and research in child and adolescent psychiatric settings. Selecting an appropriate instrument depends on the purpose, developmental level of the child, and expertise of the clinician--and requires careful consideration.


Subject(s)
Child Psychiatry , Clinical Nursing Research/methods , Psychiatric Nursing , Psychiatric Status Rating Scales/standards , Adolescent , Child , Humans
4.
J Sch Nurs ; 11(2): 26-32, 1995 Apr.
Article in English | MEDLINE | ID: mdl-7626927

ABSTRACT

Tourette Syndrome is a movement disorder of childhood onset, characterized by multiple motor and phonic tics. In addition to tics, some children exhibit repetitive habits and recurring thoughts, and others may manifest problems of inattention, impulsiveness, and hyperactivity. Over the past two decades there has been increased interest in Tourette Syndrome, because it provides a useful model for examining the interaction of genes and environment, as well as neurobiology and behavior. This article provides school nurses and nurses working in school-based clinics with a general review of Tourette Syndrome and associated disorders.


Subject(s)
School Nursing , Tourette Syndrome , Child , Humans , Male , Tourette Syndrome/diagnosis , Tourette Syndrome/epidemiology , Tourette Syndrome/etiology , Tourette Syndrome/therapy
5.
Neuropsychopharmacology ; 12(1): 73-86, 1995 Feb.
Article in English | MEDLINE | ID: mdl-7766289

ABSTRACT

To examine the role of noradrenergic, dopaminergic, and serotonergic mechanisms in the pathobiology of obsessive compulsive disorder (OCD) and Tourette's syndrome (TS), concentrations of tyrosine (TYR), norepinephrine (NE), 3-methoxy-4-hydroxyphenylethylene glycol (MHPG), homovanillic acid (HVA), tryptophan (TRP), and 5-hydroxyindoleacetic acid (5-HIAA) were measured in the lumbar cerebrospinal fluid (CSF) of 39 medication-free OCD patients, 33 medication-free TS patients, and 44 healthy volunteers. CSF TYR concentrations were reduced (p < .05) in the OCD patients compared to the healthy subjects. CSF NE in TS patients was 55% higher than in healthy controls (p < .001) and 35% higher than in OCD patients (p < .001). After covarying for height, CSF HVA levels were reduced (p < .05) in the OCD group compared to TS patients but not compared to the normal volunteers. No mean differences in CSF MHPG, TRP, and 5-HIAA were observed in this study across the three groups. The CSF NE data support the hypothesis that noradrenergic mechanisms are involved in the pathobiology of TS. Alterations in the balance of noradrenergic, dopaminergic, and serotonergic systems are likely involved in the pathobiology of OCD.


Subject(s)
Biogenic Amines/cerebrospinal fluid , Obsessive-Compulsive Disorder/cerebrospinal fluid , Tourette Syndrome/cerebrospinal fluid , Adolescent , Adult , Analysis of Variance , Female , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/psychology , Psychiatric Status Rating Scales , Tourette Syndrome/psychology
6.
Arch Psychiatr Nurs ; 7(4): 203-8, 1993 Aug.
Article in English | MEDLINE | ID: mdl-8239723

ABSTRACT

Tourette's syndrome (TS) is a neuropsychiatric disorder characterized by a changing repertoire of motor and phonic tics that typically begin in childhood and exhibit a fluctuating course. Obsessive-compulsive symptoms and problems of inattention, overactivity, and impulsiveness are present in some cases. Historically, TS has been viewed as a severe disorder. However, data from epidemiologic and family-genetic studies indicate that it shows a wide range of severity. This article, the first of two parts, examines the current notions concerning the origin, pathophysiology, and diagnosis of TS. The second article will present three cases and describe contemporary approaches to treatment.


Subject(s)
Nursing Diagnosis , Tourette Syndrome/diagnosis , Adolescent , Adult , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/genetics , Attention Deficit Disorder with Hyperactivity/nursing , Attention Deficit Disorder with Hyperactivity/therapy , Child , Diagnosis, Differential , Female , Humans , Male , Patient Education as Topic , Tourette Syndrome/genetics , Tourette Syndrome/nursing , Tourette Syndrome/therapy
7.
Arch Psychiatr Nurs ; 7(4): 209-16, 1993 Aug.
Article in English | MEDLINE | ID: mdl-8239724

ABSTRACT

Clinical assessment of a child with Tourette's syndrome (TS) includes a careful review of motor and phonic tics. In addition, commonly associated problems of such as obsessive-compulsive symptoms, or symptoms of attention deficit hyperactivity disorder (inattention, impulsiveness, and overactivity) should also be evaluated. Treatment almost always includes education of the child, family, and school personnel concerning the natural history and behavioral boundaries of the disorder. Other treatment interventions depend to a great extent on the primary source of impairment. This article, the second of two parts, presents three illustrative cases and reviews current treatment interventions for children and adolescents with TS.


Subject(s)
Nursing Assessment , Tourette Syndrome/nursing , Adolescent , Adult , Child , Clonidine/administration & dosage , Clonidine/adverse effects , Combined Modality Therapy , Education, Special , Female , Haloperidol/administration & dosage , Haloperidol/adverse effects , Humans , Male , Neurologic Examination , Patient Education as Topic , Tourette Syndrome/genetics , Tourette Syndrome/therapy
8.
J Autism Dev Disord ; 23(1): 135-45, 1993 Mar.
Article in English | MEDLINE | ID: mdl-8463193

ABSTRACT

Adaptive behavior in males with fragile X syndrome was longitudinally examined in 17 subjects, ages 1 to 17. Subjects received adaptive behavior evaluations on two occasions within one of three age periods. All domains of the Vineland Adaptive Behavior Scales increased from youngest to oldest age groups, yet older subjects (ages 10 to 17) showed significant declines in their adaptive behavior scores from first to second testing. A relative strength in Daily Living Skills and weakness in Socialization emerged only among older subjects. There was a significant relationship between adaptive behavior and mental age scores in all subjects. Discussion emphasized the parallels between declines in IQ and adaptive behavior as well as the need for further research on adaptive skills in young adults with fragile X syndrome.


Subject(s)
Fragile X Syndrome/complications , Intellectual Disability/etiology , Activities of Daily Living , Adaptation, Psychological , Adolescent , Age Factors , Child , Fragile X Syndrome/genetics , Humans , Intelligence , Intelligence Tests , Male , Socialization
9.
J Am Acad Child Adolesc Psychiatry ; 31(6): 1062-9, 1992 Nov.
Article in English | MEDLINE | ID: mdl-1429406

ABSTRACT

Rigorously designed clinical trials have demonstrated the efficacy and safety of fluoxetine in adults with major depressive disorder and obsessive-compulsive disorder (OCD) but not in patients below 18 years old. This report describes a randomized, double-blind, placebo-controlled, fixed-dose (20 mg qd) trial of fluoxetine in 14 children and adolescents with OCD, ages 8 to 15 years old; the study was 20 weeks long with crossover at 8 weeks. Obsessive-compulsive symptom severity was measured on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and the Clinician's Global Impression-Obsessive Compulsive Disorder scale (CGI-OCD). The CY-BOCS total score decreased 44% (N = 7, p = .003) after the initial 8 weeks of fluoxetine treatment, compared with a 27% decrease (N = 6, p = .13) after placebo. During the initial 8 weeks, the magnitude of improvement for the fluoxetine group significantly exceeded that for the placebo group as measured by the CGI-OCD (p = .01) but not by the CY-BOCS (p = .17). The most common drug side effects were generally well tolerated. The results suggest that fluoxetine is a generally safe and effective short-term treatment for children with OCD.


Subject(s)
Fluoxetine/therapeutic use , Obsessive-Compulsive Disorder/drug therapy , Adolescent , Child , Double-Blind Method , Female , Fluoxetine/adverse effects , Humans , Male , Obsessive-Compulsive Disorder/psychology , Personality Assessment
10.
Am J Ment Retard ; 97(1): 39-46, 1992 Jul.
Article in English | MEDLINE | ID: mdl-1386742

ABSTRACT

Etiology-specific profiles of intellectual abilities were compared in three groups of males with mental retardation using the Kaufman Assessment Battery for Children (K-ABC). Subjects included 10 males with fragile X syndrome, 10 with Down syndrome, and 10 with nonspecific mental retardation who were equated on both mental and chronological age. Across all three groups, sequential processing was lower than simultaneous processing or achievement, and particular subtests (e.g., Gestalt Closure) were relative strengths. Although boys with Down syndrome showed less extreme patterns of domain strengths and weaknesses, they showed a significant strength in the Sequential Processing Hand Movements subtest. In contrast, the Hand Movements subtest was lowest of all K-ABC subtests for males with fragile X syndrome. Implications were discussed for more fine-tuned research and intervention efforts.


Subject(s)
Down Syndrome/psychology , Fragile X Syndrome/psychology , Intellectual Disability/psychology , Intelligence Tests/statistics & numerical data , Achievement , Child , Child, Preschool , Down Syndrome/diagnosis , Fragile X Syndrome/diagnosis , Humans , Intellectual Disability/diagnosis , Male , Psychometrics
12.
J Autism Dev Disord ; 21(4): 503-16, 1991 Dec.
Article in English | MEDLINE | ID: mdl-1778963

ABSTRACT

Examined the changing profiles of intelligence in males with fragile X syndrome as these individuals increased in chronological age. Using a psychometric instrument designed to measure styles of information processing, 21 males aged 4 to 27 years were examined cross-sectionally in sequential processing, simultaneous processing, and achievement. The age of the subject was associated with age-equivalent levels of both simultaneous processing and achievement, but fragile X males did not show higher levels of sequential processing with increasing chronological age. Compared to younger fragile X males, the older subjects were more delayed in sequential processing skills relative to their in other areas. A smaller longitudinal study confirmed the presence of a plateau in sequential processing among those subjects tested two times after the age of 10 years. Implications are discussed for diagnosis, intervention, and the matching of subject groups in mental retardation research.


Subject(s)
Aptitude , Fragile X Syndrome/psychology , Intelligence , Personality Development , Achievement , Adolescent , Adult , Attention , Child , Child, Preschool , Fragile X Syndrome/diagnosis , Fragile X Syndrome/genetics , Humans , Male , Neuropsychological Tests/statistics & numerical data , Psychometrics , Serial Learning
13.
Arch Gen Psychiatry ; 48(4): 324-8, 1991 Apr.
Article in English | MEDLINE | ID: mdl-2009034

ABSTRACT

The safety and effectiveness of clonidine hydrochloride (3 to 5 micrograms/kg per day) were evaluated in 47 subjects with Gilles de la Tourette's syndrome, aged 7 to 48 years. Twenty-four subjects were randomly assigned to clonidine treatment and 23 to placebo. Forty subjects (21 given clonidine and 19 placebo) successfully completed the 12-week, double-blind clinical trial. Clinical ratings of tic severity improved for both groups. The magnitude of response was greater in the group receiving clonidine. Clinician-rated measures of motor tic severity, the degree to which the tics are "noticeable to others," motor tic counts from videotaped interviews, and parent-rated measures of impulsivity and hyperactivity were the most responsive to clonidine treatment. These results indicate that clonidine is more effective than placebo in reducing some of the tic and other behavioral symptoms associated with Gilles de la Tourette's syndrome.


Subject(s)
Clonidine/therapeutic use , Tourette Syndrome/drug therapy , Administration, Oral , Adolescent , Adult , Clonidine/administration & dosage , Double-Blind Method , Drug Administration Schedule , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Parents/psychology , Personality Inventory , Placebos , Psychiatric Status Rating Scales , Tourette Syndrome/psychology , Videotape Recording
14.
J Am Acad Child Adolesc Psychiatry ; 29(5): 766-72, 1990 Sep.
Article in English | MEDLINE | ID: mdl-2228931

ABSTRACT

Phenomenology and family history in 21 clinically referred children and adolescents with obsessive compulsive disorder are described. Each child and family participated in a standard clinical psychiatric assessment. The most frequently reported symptoms were repeating rituals, washing, ordering and arranging, checking, and contamination concerns. Controlling behaviors involving other family members were seen in 57% of the patients. Associated psychopathology was common: 38% received an anxiety disorder diagnosis; 29% received a mood disorder diagnosis; tics were observed in 24%. Fifteen (71%) of the children had a parent with either obsessive compulsive disorder (N = 4) or obsessive-compulsive symptoms (N = 11). The clinical and research implications of these findings are discussed.


Subject(s)
Child of Impaired Parents/psychology , Obsessive-Compulsive Disorder/diagnosis , Personality Development , Adolescent , Child , Female , Humans , Male , Obsessive-Compulsive Disorder/genetics , Risk Factors
15.
Yale J Biol Med ; 63(4): 293-9, 1990.
Article in English | MEDLINE | ID: mdl-2125773

ABSTRACT

Twelve males with fragile-X syndrome between the ages of three and 28 years underwent assessment of thyroid function. All 12 subjects demonstrated normal baseline values for thyroid stimulating hormone (TSH), thyroxine, thyroid binding globulin (TBG), and estimated free thyroxine (EFT). Relative to a control group reported in the literature, however, the fragile-X subjects exhibited a blunted TSH response to thyrotropin releasing hormone (TRH). This finding suggests the presence of subtle dysfunction within the hypothalamic-pituitary-thyroid axis. Elevated baseline prolactin levels were also observed among the fragile-X subjects. These results support previous reports of hypothalamic-pituitary abnormalities among fragile-X syndrome males.


Subject(s)
Fragile X Syndrome/physiopathology , Thyroid Gland/metabolism , Thyroid Hormones , Adolescent , Adult , Carrier Proteins/metabolism , Child , Child, Preschool , Humans , Male , Membrane Proteins/metabolism , Pituitary Gland/metabolism , Prolactin/metabolism , Thyroid Function Tests , Thyrotropin/metabolism , Thyrotropin-Releasing Hormone/metabolism , Thyroxine/metabolism , Thyroid Hormone-Binding Proteins
16.
J Am Acad Child Adolesc Psychiatry ; 28(4): 566-73, 1989 Jul.
Article in English | MEDLINE | ID: mdl-2768151

ABSTRACT

Despite the overt nature of most motor and phonic tic phenomena, the development of valid and reliable scales to rate tic severity has been an elusive goal. The Yale Global Tic Severity Scale (YGTSS) is a new clinical rating instrument that was designed for use in studies of Tourette's syndrome and other tic disorders. The YGTSS provides an evaluation of the number, frequency, intensity, complexity, and interference of motor and phonic symptoms. Data from 105 subjects, aged 5 to 51 years, support the construct, convergent, and discriminant validity of the instrument. These results indicate that the YGTSS is a promising instrument for the assessment of tic severity in children, adolescents and adults.


Subject(s)
Psychological Tests , Tourette Syndrome/diagnosis , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Interpersonal Relations , Male , Middle Aged , Pilot Projects , Tourette Syndrome/psychology
17.
J Autism Dev Disord ; 18(3): 343-54, 1988 Sep.
Article in English | MEDLINE | ID: mdl-3170453

ABSTRACT

Fragile X syndrome is a newly recognized X-linked disorder which has been associated with a high prevalence of psychiatric disturbance, particularly attention deficit disorder and autism. The present study involved the neuropsychiatric evaluation of 14 males with the disorder who were between the ages of 3 to 27 years. Pervasive hyperactivity, impulsivity, and attentional deficits were found among all of the subjects, while a significant degree of anxiety was manifested by more than half. Although the majority of subjects exhibited poor eye contact, atypical speech and language functioning, and stereotyped behavior, only one met DSM-III diagnostic criteria for a persistent pervasive developmental disorder. Gaze aversion, noted among half of the subjects, was attributed to underlying anxiety rather than to autistic social dysfunction because of the otherwise socially engaged and affectionate behavior exhibited by the subjects. Failure to make this distinction in the context of cognitive and linguistic impairments associated with fragile X syndrome may account for the high rates of autism reported by other investigators.


Subject(s)
Fragile X Syndrome/complications , Mental Disorders/complications , Sex Chromosome Aberrations/complications , Adolescent , Adult , Anxiety Disorders/complications , Attention Deficit Disorder with Hyperactivity/complications , Child , Child Development Disorders, Pervasive/complications , Child, Preschool , Humans , Male , Social Behavior
18.
Biol Psychiatry ; 24(4): 391-8, 1988 Aug.
Article in English | MEDLINE | ID: mdl-2457395

ABSTRACT

Within- and across-day stability of unconjugated plasma 3-methoxy-4-hydroxyphenethyleneglycol (pMHPG, the major metabolite of norepinephrine) levels were assessed in several subgroups of 47 primarily child and adolescent subjects with Tourette's syndrome (TS). Mean morning pMHPG levels remained stable over a 20-min period from 8:30 to 8:50 AM at 3.5 +/- 0.8 ng/ml. However, the mean intraindividual fluctuation in pMHPG levels over 20 min was +/- 12%. Mean pMHPG levels remained stable in the morning from 8:00-8:30 AM to noon. However, an 11% decrease (p less than 0.01) in mean pMHPG levels was observed in the afternoon between noon and 3:00-4:00 PM. Monitored on consecutive days, mean morning pMHPG levels fell 12% (p less than 0.002). The afternoon and across-day falls in pMHPG levels observed in this study of primarily children and adolescents with TS have not been observed in studies of adult control subjects. The results suggest that the design of research protocols involving children and adolescents that use pMHPG should take into consideration the effects of time, both within- and across-day, in pMHPG levels.


Subject(s)
Circadian Rhythm , Glycols/blood , Methoxyhydroxyphenylglycol/blood , Tourette Syndrome/blood , Adolescent , Adult , Age Factors , Attention Deficit Disorder with Hyperactivity/blood , Child , Developmental Disabilities/blood , Female , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/blood , Sex Factors
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