Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial.

A crossover 'placebo'-controlled, double-blind design was used to examine the effectiveness of an oligoantigenic diet in 49 children with hyperactive/disruptive behavior disorder. Effects of diet were compared with those yielded by stimulant medication (methylphenidate). The study was conducted in an inpatient unit at the Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, Mannheim. Change in behavior was measured in standardized situations by trained raters, including behavior assessment when testing with CPT and PAT, during a free play situation, and at school. Twelve children (24%) showed significant behavioral improvement in two behavior ratings during diet relative to control diet conditions. Methylphenidate used in 36 children yielded more responders (44%) than diet. The amount of positive changes in behavior in those who received both treatments was about the same. Although only effective in a minority of children, dietary treatment cannot be neglected as a possible access to treating hyperactive/disruptive children and merits further investigation.

[Evaluation of disruptive behavioral disorders: how situation specific and temporally accurate are behavior observations?]. / Beurteilung expansiver Verhaltensstörungen: Wie situations-spezifisch und zeitstabil sind Verhaltensbeobachtungen?

The stability of expert behavior ratings was analyzed in an unselected inpatient sample of 49 children admitted for disruptive behavior disorders. Expert behavior ratings were obtained for two highly standardized situations (play behavior on ward, on-task behavior during tests) at two time points (T1: 1 week and T2: 4 weeks after admission). These scores were compared with initial diagnostic assessments (clinical judgement) and objective behavior data (actometer) in the test situation. A comparison of the standardized behavior ratings over time showed that in both settings problem behavior was more pronounced at T2 than at T1. Actometer data indicating a higher activity level at T2 were significantly correlated with behavior ratings. There was only a weak association between expert behavior ratings and an initial diagnosis of conduct disorder; the correlation between an initial diagnosis of attention-deficit hyperactivity disorder and the behavior ratings was statistically significant. In general, T2 behavior ratings corresponded better to the initial clinical judgement. Implications for the use of multiple sources of information and of repeated measurements are discussed.

[Diagnosis of expansive behavior in children: how do different observers assess in various situations?]. / Zur Diagnose expansiven Verhaltens bei Kindern: Wie urteilen verschiedene Beobachter in unterschiedlichen Situationen?

The present study addressed the question of the extent to which parental assessment of expansive behavior disorders can be validated by clinical assessment and how both types of assessment are correlated with behavior ratings by trained outside observers. The agreement between these different sources of information was analyzed in an unselected sample of 49 children aged 5 to 11 admitted to our inpatient unit for expansive behavior disorder. Most of the children met the clinical criteria for both attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD). With regard to diagnoses, there was good agreement between the parents' assessment and the clinical assessment made one week after admission. However, the parents rated ADHD as more severe than the clinicians did. Ratings of the children's overt behavior in two standardized situations (play situation, test situation) by trained outside observers had only weak correlations with the parental and clinical assessments. The only significant correlation was between the clinical assessment of hyperactivity and the behavior ratings. The contribution of the situational variability of the children's behavior to the low agreement between the different sources of information is discussed. Where feasible, multiple perspectives should be taken into consideration.