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The effect of methylphenidate (MPH) on inhibitory control as assessed by the stop task in children with attention-deficit/hyperactivity disorder (ADHD) could be influenced by task difficulty and may be mediated by attention.
Subjects and methods
Fifteen children with ADHD performed the stop and the change task after placebo, 0.5 and 1.0 mg/kg MPH in a within-subject design.
Linear-trend analysis showed a similar effect of MPH in both tasks and a stronger effect for inhibitory control than for attention. Furthermore, a correlation was found between blood serum metabolites of norepinephrine and dopamine for attentional measures and inhibitory control measures, respectively.
Discussion and conclusion
In children with ADHD MPH could act primarily on inhibitory control, and is not influenced by task difficulty. Also, attention and inhibitory control could have differential pharmacological profiles.
To find out whether the neurodevelopmental disorders autism and childhood-onset schizophrenia have a common developmental pathway and whether the abnormalities detected are ‘disorder-specific’, by reviewing magnetic resonance imaging (MRI) studies.
As a result of a Medline search, we were able to access 28 studies on autism and 12 studies on childhood-onset schizophrenia, which focused on children and adolescents.
Larger lateral ventricles were found to be a common abnormality in both disorders. ‘Disorder-specific’ abnormalities in patients with autism were larger brains, a larger thalamic area, and a smaller right cingulate gyrus. Subjects with childhood-onset schizophrenia were found to have smaller brains, a smaller amygdalum and thalamus, and a larger nucleus caudatus. In subjects with childhood-onset schizophrenia, abnormalities appeared to progress over a limited period of time.
Because the study designs varied so much, the results should be interpreted cautiously. Before abnormalities found in the disorders can be designated as equal or ‘disorder-specific’, it will be essential to perform large longitudinal and cross-sectional follow-up studies.
In this study, we addressed the relation between specific deficits in cognitive control and schizotypal symptomatology in adolescents with autism spectrum disorders (ASD) diagnosed in childhood. We aimed to identify cognitive control deficits as markers of vulnerability to the development of schizophrenia spectrum pathology in ASD. Symptoms of autism and the risk for schizotypal symptomatology were assessed in 29 high-functioning adolescents with ASD, and compared with 40 typically developing adolescents. Cognitive control (response inhibition, mental flexibility, visuo-motor control, interference control, and perseveration) was evaluated for specific association with schizotypal symptomatology. Impaired response inhibition appeared to be strongly and specifically associated with schizotypal symptomatology in adolescents with ASD, especially those with positive and disorganized symptoms. Response inhibition problems could indicate vulnerability to the development of schizotypal symptomatology in ASD. (JINS, 2013, 19, 1–10)
Mentalising impairment (an impaired ability to think about people in terms of their mental states) has frequently been associated with schizophrenia.
To assess the magnitude of the deficit and analyse associated factors.
Twenty-nine studies of mentalising in schizophrenia (combined n = 1518), published between January 1993 and May 2006, were included to estimate overall effect size. Study descriptors predicted to influence effect size were analysed using weighted regression-analysis techniques. Separate analyses were performed for symptom subgroups and task types.
The estimated overall effect size was large and statistically significant (d= –1.255, P < 0.001) and was not significantly affected by sample characteristics. All symptom subgroups showed significant mentalising impairment, but participants with symptoms of disorganisation were significantly more impaired than the other subgroups (P<0.01).
This meta-analysis showed significant and stable mentalising impairment in schizophrenia. The finding that patients in remission are also impaired favours the notion that mentalising impairment represents a possible trait marker of schizophrenia.
El efecto del metilfenidato (MF) sobre el control inhibitorio evaluado por la tarea de parada (stop task) en niños con trastorno por déficit de atención e hiperactividad (TDAH) podría estar influido por la dificultad de la tarea y puede estar mediado por la atención.
Sujetos y métodos
Quince niños con TDAH realizaron la tarea de parada y la de cambio después de placebo, 0,5 y 1,0 mg/kg de MF en un diseño intrasujeto.
El análisis de tendencia lineal mostró un efecto similar del MF en ambas tareas y un efecto más fuerte para el control inhibitorio que para la atención. Además, se encontró una correlación entre los metabolitos en el suero sanguíneo de la norepinefrina y la dopamina para las medidas de atención y las de control inhibitorio, respectivamente.
Discusión y conclusión
En niños con TDAH, el MF podría actuar primariamente sobre el control inhibitorio y no está influido por la dificultad de la tarea. Además, la atención y el control inhibitorio podrían tener perfiles farmacológicos diferenciales.
Background. Autism is a neurodevelopmental disorder associated with slight increases in brain volume. There has been some suggestion that medial temporal lobe structures may be preferentially involved in this disorder, although results have not always been consistent. Here, we investigate amygdala and hippocampus volumes in medication-naive subjects with high-functioning autism.
Method. Whole-brain magnetic resonance imaging scans were acquired from 42 patients and 42 closely matched, healthy control subjects.
Results. Amygdala volume did not differ significantly between patients and controls. A significant increase in hippocampal volume was proportional to an increase in overall brain volume.
Conclusions. These results argue against preferential involvement of medial temporal lobe structures in autism, at least in high-functioning medication-naive individuals.
Background. Autism is a neurodevelopmental disorder with an estimated genetic origin of 90%. Previous studies have reported an increase in brain volume of approximately 5% in autistic subjects, especially in children. If this increase in brain volume is genetically determined, biological parents of autistic probands might be expected to show brain enlargement, or at least intracranial enlargement, as well. Identifying structural brain abnormalities under genetic control is of particular importance as these could represent endophenotypes of autism.
Method. Using quantitative anatomic brain magnetic resonance imaging, volumes of intracranial, total brain, frontal, parietal, temporal and occipital lobe, cerebral and cortical gray and white matter, cerebellum, lateral ventricle, and third ventricle were measured in biological, non-affected parents of autistic probands (19 couples) and in healthy, closely matched control subjects (20 couples).
Results. No significant differences were found between the parents of the autistic probands and healthy control couples in any of the brain volumes. Adding gender as a factor in a second analysis did not reveal a significant interaction effect of gender by group.
Conclusions. The present sample of biological, non-affected parents of autistic probands did not show brain enlargements. As the intracranium is not enlarged, it is unlikely that the brain volumes of the parents of autistic probands have originally been enlarged and have been normalized. Thus, increased brain volume in autism might be caused by the interaction of paternal and maternal genes, possibly with an additional effect of environmental factors, or increased brain volumes might reflect phenotypes of autism.
A cross-sectional study of 3426 referred children and adolescents showed that the presence of both migration history and family dysfunction was associated with a fourfold (95% CI 2–9) higher risk of psychotic symptoms compared with the absence of these factors. The relative risk was 2 (95% CI 1–4) for migration history only. Interaction between migration history and family dysfunction accounted for 58% (95% CI 5–91%) of those with psychotic symptoms. These results suggest a relationship between family dysfunction and migration in the development of psychosis.
Background. To establish whether high-functioning children with autism spectrum disorder (ASD) have enlarged brains in later childhood, and if so, whether this enlargement is confined to the gray and/or to the white matter and whether it is global or more prominent in specific brain regions.
Method. Brain MRI scans were acquired from 21 medication-naive, high-functioning children with ASD between 7 and 15 years of age and 21 comparison subjects matched for gender, age, IQ, height, weight, handedness, and parental education, but not pubertal status.
Results. Patients showed a significant increase of 6% in intracranium, total brain, cerebral gray matter, cerebellum, and of more than 40% in lateral and third ventricles compared to controls. The cortical gray-matter volume was evenly affected in all lobes. After correction for brain volume, ventricular volumes remained significantly larger in patients.
Conclusions. High-functioning children with ASD showed a global increase in gray-matter, but not white-matter and cerebellar volume, proportional to the increase in brain volume, and a disproportional increase in ventricular volumes, still present after correction for brain volume. Advanced pubertal development in the patients compared to the age-matched controls may have contributed to the findings reported in the present study.
Patterns of lower autonomic nervous system (ANS) and
hypothalamic–pituitary–adrenal (HPA) axis activity have
been found in children with oppositional defiant disorder (ODD). The
aim of the present study was to investigate whether children with
attention-deficit/hyperactivity disorder (ADHD) differ from ODD
children with (OD/AD) or without comorbid ADHD in ANS and HPA axis
activity under baseline and stressful conditions. The effects of stress
on cortisol, heart rate (HR), and skin conductance level (SCL) were
studied in 95 children (26 normal control [NC] children and
69 child psychiatric patients referred for externalizing behavior
problems [15 ODD, 31 OD/AD, and 23 ADHD]). No baseline
differences were found in cortisol between the four groups. However,
the ODD and OD/AD groups showed a significantly weaker cortisol
response to stress compared to the ADHD and NC groups; the ADHD group
had a similar cortisol response as the NC group. Within the ODD group
this pattern of low cortisol responsivity was most clearly present in
the more severely affected inpatients. With respect to HR, the ODD
group had a significantly lower HR during baseline and stressful
conditions. The higher HR levels in the OD/AD and ADHD groups were
likely to be caused by methylphenidate. The externalizing groups had
significantly lower SCL levels, and no differences were found between
these groups. It was concluded that differences in cortisol
responsivity during stress exposure are important in distinguishing
within a group of children with externalizing behavior between those
with ODD and ADHD.
In both theory and research the general issue of the extent to which children's problem behaviour is generalised across situations, and to what extent it is situation specific, has been neglected. In the clinical assessment of disordered children, too, little attention has been paid to the specific situations in which these children display their inappropriate behaviour. In this study the Taxonomy of Problematic Social Situations (TOPS) (Dodge, McClaskey, & Feldman, 1985) was employed. This is a questionnaire in which the child's teacher is asked to rate the likelihood of a child responding in an inappropriate manner in a specific situation. Characteristics of TOPS were investigated both in randomly selected normal school children and in boys with a conduct disorder. Four factors appeared to underlie the TOPS scores from 652 randomly selected boys and girls from grades 1 to 6, these being: teachers' scores for the types of problem situation Being Disadvantaged, Coping with Competition, Social Expectations of Peers, and Teacher Expectations. Because of the high internal consistency of the four factors, TOPS was abbreviated to a TOPS-Short Form (18 instead of 44 items). The four-factor model was cross-validated by means of a second sample of 326 boys and girls. A model with only one general problem behaviour factor did not fit the data of both samples. When the four specific factors were added a satisfactory fit resulted. Moreover, it was found that in the first sample 52% of the variance was explained by the general factor, whereas 18% of the variance was explained by the four specific factors together. Thus, the extent to which problem behaviour is situation specific should not be disregarded. In all four types of problem situation, boys showed more inappropriate behaviour than girls. With increasing age, children were rated as being more competent in dealing with the problem situation Being Disadvantaged. Teachers rated the four types of problem situation as more problematic for boys with a conduct disorder (N = 42) than for normal control boys (N = 67). Conduct disordered boys also differed individually in the number of situational types that were problematic for them. With respect to clinical implications, the identification of the particular social context in which a conduct disordered child displays his or her inappropriate behaviour may help refine treatment goals: more adequate social functioning should be aimed at specifically in those situations that are problematic.
This study on children with a Pervasive Developmental Disorder (PDD; N = 32), children
with developmental language disorder (N = 22), and normally developing children (N = 28)
sought to answer questions concerning attachment and autistic behaviour. We could
replicate the finding that children with a PDD are able to develop secure attachment
relationships to their primary caregiver. Children with PDD who had an insecure attachment
showed fewer social initiatives and responses than children with PDD who had a secure
attachment, even when the insecurely and securely attached PDD children were matched on
chronological and mental age. Children with both a PDD and mental retardation were more
often classified as disorganised.
Three findings suggested that a disorganised attachment does not merely reflect the
presence of “autistic” behaviour: (1) children with PDD did not reveal higher rates of a
disorganised attachment than matched comparison children; (2) having a PDD diagnosis
and having a disorganised attachment were found to be associated with opposite effects on
an ethological measure of level of behavioural organisation; and (3) a disorganised
attachment but not a PDD diagnosis was associated with an increase in heart rate during
parting with the caregiver and a decrease in heart rate during reunion.
On the basis of Gray's theory, Quay suggested that conduct
(CD) is associated with
a Behavioural Activation System (BAS) that dominates over the Behavioural
System (BIS), whereas attention deficit hyperactivity disorder (ADHD)
is characterised by
an underactive BIS. Two studies were conducted to test the hypothesis that
of the BAS over the BIS is more pronounced in CD comorbid with ADHD (CD/ADHD)
than in CD alone. First of all, a response perseveration task was used,
i.e. the door-opening
task (Daugherty & Quay, 1991). In this game, the subject chooses either
to open the next
door or to stop playing; there is a steadily increasing ratio of punished
responses to rewarded
responses and a large number of doors opened is indicative of response
expected, a steady increase in the number of doors opened was found across
(NC) boys, CD boys, and CD/ADHD boys (NC<CD<CD/ADHD). Second,
dominance of the BAS over the BIS was examined by observing the social
behaviour of the
child in interaction with a research assistant who alternately activated
the BAS and the BIS
while a game was played. The behaviour of the children was analysed according
ethological methods. Group differences in the frequencies of three out
of five behavioural
categories were in line with the results of the door-opening task (NC<CD<CD/ADHD).
A randomised clinical trial was carried out in suicide attempters to assess clinical efficacy of an intensive psychosocial intervention compared with treatment as usual.
Two hundred and seventy-four suicide attempters presenting for medical treatment were randomly assigned to either intensive psychosocial treatment or ‘care as usual’. Intensive psychosocial treatment consisted of brief admission to a special crisis-intervention unit and problem-solving aftercare. ‘Care as usual’ included any form of treatment the assessing clinicians thought appropriate. Psychological well-being was evaluated by the SCL–90 and the Hopelessness Scale at 3, 6 and 12 months following entry in the study.
No differences in outcome were found. The probability of repeat suicide attempts in the 12-month follow-up was 0.17 for patients in the experimental group and 0.15 for the control group. There were no differences in ratings on the SCL–90 and the Hopelessness Scale. Patients in the experimental group attended significantly more out-patient treatment sessions.
General implementation of an intensive in-patient and community intervention programme for suicide attempters does not seem justified.
Successive DSM versions struggle with the heterogeneity of the eating disorders. Criteria were mainly based on clinical impressions and on descriptive and inferential studies.
In a study of 55 eating-disordered adolescents, we investigated whether patients could be grouped on an empirical basis, using principal components analysis (PCA) with optimal scoring (scaling), i.e. PCA with no a priori assumptions. Clustering was based on Morgan-Russell subscales, each measured four times over the course of illness.
Contrary to DSM – IV criteria, patients did not cluster primarily on the basis of anorectic symptoms; the occurrence of bulimic symptoms was more dominant. Core symptomatology (preoccupation with food, disturbed body perception and inadequate sexual behaviour) did not differ between patients, either at referral or over time.
These results support the spectrum hypothesis of the eating disorders, which considers them as one syndrome with different manifestations.
It has been suggested that the key variable in reduced plasma immunoreactive β-endorphin concentrations in autistic subjects may be concomitant self-injurious behaviour.
We studied morning levels of plasma β-endorphin in 33 learning disabled people with self-injurious and/or autistic behaviour.
The β-endorphin level of the subjects with severe self-injurious behaviour proved to be significantly lower than that of autistic subjects without severe self-injurious behaviour (3.6 (1.4) pmol/l v. 5.8 (4.3) pmol/l; t-test: P = 0.045. Replication: 3.7 (1.1) pmol/l v. 5.7 (3.8) pmol/l; t-test P = 0.043). Individuals with mild and occasional self-injurious behaviour were found to have β-endorphin levels comparable to those without self-injurious behaviour. Further, subjects being treated with neuroleptics had lower β-endorphin levels than untreated subjects.
These results stress that in any study of opioid systems of learning disabled people, it is very important to differentiate between people with and without severe self-injurious behaviour. The results support the idea that severe self-injurious behaviour may be related to functional disturbances in the endogenous opioid system.
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