Co-occurring weight problems among children with attention deficit/hyperactivity disorder: the role of executive functioning.

OBJECTIVE: To explore the link between pediatric obesity and attention deficit/hyperactivity disorder (ADHD) by examining whether executive functioning (EF) and medication status are associated with body mass index (BMI) and weight status in children with ADHD. METHOD: Participants for this study included 80 children (mean age=10 years, 9 months) with a DSM-IV diagnosis of ADHD, confirmed by a comprehensive clinical diagnostic assessment. Children's EF was measured using three neuropsychological tests, and severity of ADHD symptoms and medication status were obtained from parent report. Children's height and weight were also measured during the visit using a wall-mounted stadiometer and a balance beam scale. RESULTS: Children with ADHD who performed poorly on the neuropsychological battery had greater BMI z-scores, and were more likely to be classified as overweight/obese compared with children with ADHD who performed better on the neuropsychological battery. In addition, children with ADHD who were taking a stimulant medication had significantly lower BMI z-scores compared with children with ADHD who were not taking medication or who were taking a non-stimulant medication. CONCLUSION: EF is more impaired among children with ADHD and co-occurring weight problems, highlighting the importance of self-regulation as a link between pediatric obesity and ADHD.

Symptom dimensions and cognitive-behavioural therapy outcome for pediatric obsessive-compulsive disorder.

OBJECTIVE: To examine whether obsessive-compulsive disorder (OCD) symptom subtypes are associated with response rates to cognitive-behavioural therapy (CBT) among pediatric patients. METHOD: Ninety-two children and adolescents with OCD (range = 7-19 years) received 14 sessions of weekly or intensive (daily psychotherapy sessions) family-based CBT. Assessments were conducted at baseline and post-treatment. Primary outcomes included scores on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), remission status, and ratings on the Clinical Global Improvement (CGI) and Clinical Global Impression - Severity (CGI-Severity) scales. RESULTS: Seventy-six per cent of study participants (n = 70) were classified as treatment responders. Patients with aggressive/checking symptoms at baseline showed a trend (P = 0.06) toward improved treatment response and exhibited greater pre/post-treatment CGI-Severity change than those who endorsed only non-aggressive/checking symptoms. Step-wise linear regression analysis indicated higher scores on the aggressive/checking dimension were predictive of treatment-related change in the CGI-Severity index. Regression analysis with CY-BOCS score as the dependent variable showed no difference between OCD subtypes. CONCLUSION: Response to CBT in pediatric OCD patients does not differ substantially across subtypes.

A family with a grand-maternally derived interstitial duplication of proximal 15q.

About 1% of individuals with autism or types of pervasive developmental disorder have a duplication of the 15q11-q13 region. These abnormalities can be detected by routine G-banded chromosome study, showing an extra marker chromosome, or demonstrated by fluorescence in situ hybridization (FISH) analysis, revealing an interstitial duplication. We report here the molecular, cytogenetic, clinical and neuropsychiatric evaluations of a family in whom 3 of 4 siblings inherited an interstitial duplication of 15q11-q13. This duplication was inherited from their mother who also had a maternally derived duplication. Affected family members had apraxia of speech, phonological awareness deficits, developmental language disorder, dyslexia, as well as limb apraxia but did not have any dysmorphic clinical features. The observations in this family suggest that the phenotypic manifestations of proximal 15q duplications may also involve language-based learning disabilities.

Poor metabolic control during menstruation and sexual abuse issues in an adolescent with diabetes.

A case study is presented that describes the deterioration of a patient's diabetes control during her menstrual cycle in terms of her psychological functioning and family context. Therapeutic interventions pertinent toward improving diabetes control, resolving issues of abuse, and increasing family communication are addressed. The outcome of this case study supports the contention that psychological factors can impact diabetes control significantly during menstruation in young women.

Diagnosis and treatment of an adolescent with comorbid type 1 diabetes mellitus and anorexia nervosa.

The authors describe the successful treatment of a 17-year-old female with comorbid type 1 diabetes mellitus and anorexia nervosa within the context of a residential program in a tertiary care facility. Assessment and treatment of the complex combinations of the psychological and medical symptoms involved in this patient required the interaction of medical, psychological, and nutritional services. Diagnostic and treatment challenges are discussed.

Psychiatric morbidity in endocrine disorders.

Psychiatric disturbances are frequently observed during the course of endocrine disorders. This article discusses the history, current knowledge, assessment, and treatment of psychiatric morbidity in endocrine disorders. The primary focus is on biologic links between psychiatric symptoms and endocrine dysfunction. Psychiatric disorders associated with abnormalities of the pituitary, thyroid, parathyroids, adrenals, and gonads are discussed as well as the chronic illness of diabetes mellitus.

Residential treatment for youngsters with difficult-to-manage insulin dependent diabetes mellitus.

A descriptive outcome study of 52 children with insulin-dependent diabetes mellitus (IDDM) admitted to a residential treatment program over 6 years. Criteria for admission included repeated hospitalizations for diabetes-related problems, excessive school absences, and/or familial disruption. Residential treatment included individual, group, and family psychotherapy, diabetes education, and close medical supervision. The design included collection of data before, during and after treatment. Children admitted to the residential unit were compared to a population of pediatric IDDM outpatients from the same geographical area. Treatment was associated with a reduction in diabetes-related hospitalizations, improved school attendance, decreased glycosylated hemoglobin levels, weight gain, individualized insulin changes, improved knowledge about diabetes, and a normalization of attitudes towards this disease.

Accuracy of injection site identification among children with insulin dependent diabetes mellitus: a comparison of traditional and new visual aids.

Children with insulin-dependent diabetes mellitus (IDDM) typically self-inject insulin twice daily. Injection sites must be rotated with each insulin administration to avoid lipohypertrophy. Lipohypertrophy results in erratic insulin release and threatens metabolic stability. To aid rotation, children are usually provided with a picture of a human figure with injection sites identified within a grid. Children often have difficulty using the charts or lack the skills necessary to identify injection sites. An alternative three-dimensional visual aid, a pair of "injection bears", simplifies injection site identification. Fifty-eight 6- to 11-year-old children with IDDM identified 10 injection sites using both the injection chart and the injection bears. Accuracy of injection site identification was compared on five subcomponents. Forty-four percent of informants recalled that their doctors recommended using injection charts. Of those recalling the recommendation, 81% never or rarely used charts at home. Thirty-nine percent of the informants reported a history of lipohypertrophy. Matched sample t-tests demonstrated that children committed significantly fewer identification errors on all subcomponents (P < or = .05) when using the injection bears. Chi square analyses indicated a significant preference (P < or = .05) for the injection bears, which may be a useful tool for insulin injection rotation with younger children.

Behavioral intervention to reduce child distress during self-injection.

We investigated the effects of a cognitive-behavioral treatment package on reduction of anticipatory fear of pain during self-administered insulin injections. Two patients diagnosed with insulin-dependent diabetes mellitus participated. An ABAB design was employed; the intervention conditions consisted of cue-controlled breathing, filmed modeling, pacing, and reinforcement. A substantial reduction in the mean time for injection and a reduction in behaviors indicative of anticipatory distress were achieved under intervention conditions. The clinical importance of the study is discussed and areas for future research are identified.

Children awaiting invasive medical procedures: do children and their mothers agree on child's level of anxiety?

Examined correspondence between mother and child reports of child anxiety immediately preceding a scheduled invasive medical procedure. The State-Trait Anxiety Inventory for Children (STAIC) was administered to 101 children ages 10-18 years. Mothers completed the STAIC and the State-Trait Anxiety Inventory to assess their perceptions of the child's anxiety and their own level of anxiety, respectively. Children were reported to have significantly more state anxiety as perceived by themselves and their mothers relative to the normative sample. Results also revealed low overall mother-child correspondence on child anxiety, particularly for mothers reporting more anxiety in themselves. Additionally, while age, gender, and socioeconomic status were not associated with mother-child correspondence, an unexpected relationship between race and correspondence emerged. Overall, our findings indicate that reliance on parents' perceptions of child anxiety prior to an invasive medical procedure is not sufficient.

Parent-child agreement on ratings of anxiety in children.

Research on congruence of parents' and children's reports of children's symptomatology has typically yielded low to moderate agreement. This study extended past research by examining the rate of parent-child agreement on reported anxiety for a nonclinical sample of children. 85 children ages 8 to 16 years and attending recreational summer camps completed measures of their own anxiety and parents completed the same scales on their children twice; once according to their perceptions of their own child's anxiety and once for how they predicted their own child would complete the measures. Analysis indicated that (a) parent-child correspondence was low when using either parents' perceptions or predictions of their child's anxiety, (b) mother-father correspondence on their child's anxiety was moderately high, (c) the children's gender and age were not significantly associated with correspondence, and (d) mothers' and fathers' anxiety was negatively associated with parent-child correspondence. The implications of these findings for research and clinical practice are discussed.

Parenting satisfaction and efficacy among caregivers of children with diabetes.

This study assessed parenting satisfaction and efficacy in 53 parents of children with diabetes and 39 parents of physically healthy children. In addition, the relationship between parenting self-esteem and perceptions of child behavior, child age, disease duration, and metabolic control were examined. Parents of children with diabetes reported significantly lower levels of parenting satisfaction and efficacy compared to parents of healthy children, and their negative parental cognitions are most influenced by perceptions of more internalizing child problems, shorter diabetes duration, and poorer metabolic control. Parenting self-esteem was significantly inversely correlated with both internalizing and externalizing child behavior problems for parents of healthy children. The clinical implications of poor parental cognitions and directions for future research are highlighted.

Perceived competence and behavioral adjustment of siblings of children with autism.

Compared 19 siblings of severely autistic children with 20 siblings of children with Down syndrome and 20 siblings of developmentally normal children. Results reveal that siblings of autistic children have more internalizing and externalizing behavior problems than siblings of developmentally normal children; however, the three groups did not differ significantly on measures of perceived self-competence or parents' report of social competence. Examination of demographic variables indicate that age of sibling and parents' marital satisfaction were associated with siblings' psychological functioning. Implications for future research are discussed.

Psychosocial adaptation of fathers of children with autism, Down syndrome, and normal development.

Fathers have been largely neglected in previous research of families of autistic children. We compared fathers of 20 autistic, 20 Down syndrome, and 20 developmentally normal children on several measures of psychosocial adaptation. Groups were matched on child's adaptive behavior age equivalent, gender, birth order, family size, and SES. The three groups differed significantly on measures of intrapersonal and family functioning but not on social-ecological variables. Fathers of children with autism or Down syndrome reported more frequent use of wish-fulfilling fantasy and information seeking as coping strategies as well as more financial impact and disruption of family activities than did fathers of developmentally normal children. There were few significant differences between fathers of children with autism and those of children with Down syndrome. These results suggest that fathers adapt relatively well to the demands associated with raising a child with a developmental disability.

The death of a child with diabetes from neglect. A case study.

This case report of a child with insulin-dependent diabetes mellitus (IDDM) describes a naturally occurring ABABCA design. The A condition represents poor diabetes management provided in the home setting, and the B and C conditions represent improved diabetes management in residential treatment (condition B) or foster care (condition C). The A condition was consistently associated with episodes of diabetic ketoacidosis, high glycosylated hemoglobin percentage, and school failure. In contrast, the B/C conditions were consistently associated with improved health status and school performance. On two occasions, the child was returned to condition A by the state's protective service agency (HRS) in direct conflict with the recommendations of the child's psychological and medical treatment staff. During her last condition A placement, the youngster died. Chronically ill children who are neglected may not receive the protection they need because of lack of awareness about the psychosomatic aspects of their problem.

Behavioral treatment of nocturnal enuresis in children with insulin-dependent diabetes mellitus.

Examined whether a well-established treatment program for functional enuresis, the urine alarm procedure, would be useful for children with both enuresis and diabetes. 5 children between the ages of 7 and 14 whose pretreatment physical examination suggested no neurological impairment were treated. A multiple baseline design across children indicated that the urine alarm procedure was successful in stopping enuretic episodes for all 5 children with treatment gains maintained for the 4 children available for assessment at 2-month follow-up. These results suggest that if no diabetes-related organic impairment is evident, behavioral treatment for enuresis can be beneficial for children with diabetes.

A comparative evaluation of adaptive behavior in children and adolescents with autism, Down syndrome, and normal development.

The adaptive behaviors of 20 autistic, 20 Down syndrome, and 20 developmentally normal children were compared using the Vineland Adaptive Behavior Scale. Unlike previous studies, we included a comparison group of very young normally developing children and matched subjects on overall adaptive behavior as well as several pertinent demographic characteristics. Findings revealed that, relative to children with Down syndrome or normal development, autistic children displayed significant and pervasive deficits in the acquisition of adaptive social skills, and greater variability in adaptive skills. These findings underscore the need to longitudinally assess the development of socialization in autistic children and further highlight the utility of the Vineland in operationally defining the nature of social dysfunction in autistic children.

Behavioral interventions for childhood nocturnal enuresis: the differential effect of bladder capacity on treatment progress and outcome.

Study participants were fifty 5- to 13-year-old children (33 boys and 17 girls) with nocturnal enuresis of at least 3 months duration. All wet their beds at least twice per week, were of normal intelligence, and were without demonstrable organic cause for their enuresis. Each youngster's pretreatment maximum functional bladder capacity (MFBC) was used to classify the child as having small or large MFBC based on available norms. Youngsters were then randomly assigned to treatment with the urine alarm (UA) alone or with the urine alarm supplemented with retention control training (UA plus RCT). Of the 40 youngsters who completed treatment, 37 (92.5%) achieved the treatment goal of 14 consecutive dry nights. Two additional children became dry during follow-up, leaving only one child who failed to stop wetting. Sixteen children (41%) subsequently relapsed, but all who reentered treatment became dry. Because treatment outcome was uniformly excellent across all groups, treatment progress was evaluated by analyzing wetting frequency and arising at night to use the bathroom during treatment, as well as prechange and postchange in MFBC For both wetting frequency and arising at night, there was a significant interaction between bladder capacity and treatment. Small MFBC children treated with the UA plus RCT and large MFBC youngsters treated with the UA alone had the fewest wetting episodes and got up at night to use the bathroom less often; these youngsters took less time to be successfully treated. Prechanges and postchanges in MFBC indicated that RCT did not lead to consistent increases in bladder capacity in the sample studies. The 10 children who terminated treatment prematurely had lower self-esteem and more parent-reported conduct problems than the 40 children who completed treatment.