Children's Inattention and Hyperactivity, Mother's Parenting, and Risk Behaviors in Adolescence: A 10-Year Longitudinal Study of Chilean Children.

OBJECTIVE: To examine how mothers' nurturant and, separately, hostile parenting mediate the effects of young children's inattentiveness and hyperactivity on risk behaviors in adolescence. METHOD: Data were analyzed from 920 healthy Chilean children, studied at 5.5, 10 years, and adolescence. Children's hyperactivity and inattentiveness at 5.5 years were assessed by mother ratings on the Children's Adaptive Behavior Inventory. Mothers' nurturance and hostility toward the child at 10 years were assessed by maternal interview on the Home Observation for Measurement of the Environment. Youth's delinquent and aggressive behaviors in adolescence were compiled from the Youth Self-Report questionnaire, and youth's substance use in adolescence was assessed by an extensive self-report substance use inventory. Structural equation modeling was used to identify direct and indirect effects. RESULTS: Findings supported a mediating effect, with more severe child hyperactivity at 5.5 years leading to mothers' greater hostility toward her child at age 10, which, in turn, led to greater delinquency and aggression in adolescence. Marginal mediating effects were also found from child hyperactivity and inattention at 5.5 years to mothers' lower nurturance at 10 years to youth substance use in adolescence. CONCLUSION: Mothers' hostile treatment of children with hyperactive or inattentive behaviors contributed to adolescent risk behaviors and is an area of intervention.

Persistent Encopresis, Enuresis, and Anxiety in a 7-Year-Old Girl.

CASE: Sonia is a 7-year-old old girl who was referred to the Developmental-Behavioral Pediatrics Clinic by the Pediatric Urology Clinic because of persistent wetting and soiling behaviors. Since age 3 years, she has had a history of encopresis (and wetting) for which she has seen gastroenterology and urology specialists. The mother reports that Sonia has accidents almost daily, and she is not upset when sitting in her urine or feces. She dislikes going into the bathroom or sitting on the toilet by herself. She participated in a behavior modification program associated with the pediatric urology clinic, which helps children learn healthy voiding habits and achieve continence.Sonia also has anxious behaviors. She bites her nails and chews on her hair or shirt. She is afraid of small spaces such as those between the bed and the wall and needs to have stuffed animals cover them. Other instances that trigger her anxious behaviors include loud noises, having a substitute teacher, being separated from her mother, and going to certain bathrooms or new places. She also has severe tantrums, which involve throwing and breaking objects, kicking, and hitting her head against doors.A cognitive behavioral therapy program was recommended to target anxiety symptoms, in addition to timed toileting after meals and polyethylene glycol. At a clinic visit several months later, symptoms of anxiety, encopresis, and enuresis persisted. Cognitive behavior therapy was continued and sertraline 25 mg was prescribed for anxiety. In addition, she was referred to a pediatrician who specializes in relaxation techniques and hypnotherapy.Sonia showed modest improvement with these interventions. There were fewer episodes of angry outbursts and a decrease in soiling and wetting, but at times, but she continued to have intermittent periods of wetting and soiling and fear of going to the bathroom by herself persisted.(This Challenging Case extends observations reviewed in a previous Challenging Case: J Dev Behav Pediatr 2010;531:513-515; DOI: 10.1097/DBP.0b013e3181e5a464.).

Weeding Out the Justification for Marijuana Treatment in Patients with Developmental and Behavioral Conditions.

CASE: Alex is a 13-year-old adolescent with high-functioning autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD)-combined type, anxiety, and depression. He has been resistant to engaging in therapy and treatment with various medications has been unsuccessful. Alex's parents are concerned about his anxiety, isolation, oppositional behaviors, academic underachievement, truancy, and substance use. A recent altercation with his stepfather led to a police intervention and a brief removal of Alex from the home. Alex previously used alcohol and other drugs; at present, he reports that his current drug use consists of frequently smoking pot. Alex states that he uses marijuana to relieve his anxiety and does not understand why this is problematic as marijuana is now legal in his state.Kevin is a 24-year-old adult man with diagnoses of autism spectrum disorder, mild intellectual disability, and schizoaffective disorder. He has a long history of challenging and problematic behaviors including aggression toward self and others, property destruction, inappropriate sexual behaviors, elopement, emotional outbursts, anxiety, and suicidal ideation. Past diagnoses include bipolar affective disorder, depression, and intermittent explosive disorder. Kevin is notably obese and somnolent. His current medications include 8 psychotropic medications, 3 antiallergy medications, levothyroxine, and a fish oil supplement. His father reports that medications have gradually been added and dosages increased over time. Two weeks ago, his new psychiatrist initiated a trial of medical marijuana. His father hopes that the marijuana will allow Kevin's other medications to be decreased or discontinued.Linda is an 11-year-old girl with high-functioning autism spectrum disorder, anxiety, and ADHD-inattentive subtype. Anxiety has been her most impairing condition, and Linda has been responding well to a treatment with cognitive behavioral therapy and a selective serotonin reuptake inhibitor. She is also working with her therapist on strategies to address her symptoms of ADHD. Linda has had no side effects from her medication and she and her family have been pleased with her progress. At a follow-up appointment, her mother brings an article from the lay press authored by a parent who claims that marijuana "saved" her autistic son. Linda's mother asks if marijuana should be considered for her daughter.