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Attention-Deficit Hyperactivity Disorder (ADHD) and Thyroid Abnormalities
NEW RESEARCH
and/or mood disorders, the Center for Epidemiological Studies-Depression (CES-D) Scale and Modified Maudsley Obsessive-Compulsive Inventory (MMOCI) were administered to parents of children with autistic disorder and parents of children with Down syndrome. CES-D scores were higher in hyperserotonemic parents of children with autistic disorder (mean ± SD 17.5 ± 6.2) than in normoserotonemic parents of children with autistic disorder (11.8 ± 9.5) and parents of children with Down syndrome (10.9 ± 10.2; Kruskall= 7.79, N = 71, P < .03). There was a trend Wallis toward higher MMOCI scores for hyperserotonemic parents (11.29 ± 7.2) compared to the Down (7.8 ± 6.69), and normoserotonemic groups (8.95 ± 6.49) (Kruskall-Wallis X2 = 4.87, N = 95, P < .09). Hyperserotonemic parents of children with autistic disorder had significantly higher MMOCI scores than parents of children with Down syndrome (U = 242, P < .04). Familiality of whole blood serotonin levels and lesser variants of autistic disorder may be related. More extensive assessment of the phenotype of hyperserotonemic parents is necessary.
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Attention-Deficit Hyperactivity Disorder (ADHD) and Thyroid Abnormalities. T. Spencer, M.D., J. Biederman, M.D.; T. Wilens, M .D.; J. Guite , B.A. Recently, high rates ofattention deficit-hyperactivity disorder (ADHD) were reported in children and adolescents with generalized resistance to thyroid hormone (GRTH). GRTH is characterized by reduced tissue responsiveness to the thyroid hormone. The incidence of thyroid abnormalities inADHD populations is unknown. To this end we systematically reviewed thyroid function in a large group of children and adolescents (N = 95) clinically referred for ADHD who had never been treated with lithium. Thyroxine (T4), the thyroid hormone binding index (THBI) , the free T4 index (FT4I), triiodothyronine (T3), and thyroid stimulating hormone (TSH) levels were all essentially normal. Only four subjects had any thyroid values outside of laboratory cutoffs. While these subjects had T3 values that were slightly above 195 ng/dL , all four had low TSH values and no clinical symptoms . There was a negative correlation for most thyroid values with age, which has been well described in the pediatric endocrine literature . Also, there were modest effects of comorbid major depressive disorders on several thyroid measures, but none for other comorbid diagnoses. There were no gender effects. While there were modest associations of stimulant trials on several thyroid parameters, no associations were found with other medication trials. This study failed to identify any association berween thyroid abnormalities and ADHD. Not a single subject in this study had a clinically significant abnormal thyroid parameter. In spite of the high rate of ADHD in GRTH patients, this study failed to identify a link berween thyroid abnormalities and ADHD in non-GTRH patients.
J.
Are Perinatal Complications Relevant to the Manifestation ofAttention-Deficit Disorder? S. Milberger, M.S., J. Biederman , M.D.; S. Sprich-Buckminster, B.A.; S. V Faraone, Ph.D.; B. Krifcher Lehman, B.A. This study evaluates the role of pregnancy, delivery, and infancy complications (PDICs) in the etiology of attention deficit disorder (ADD). We address issuesof comorbidity and familiality by formulating and testing multiple hypotheses. Subjects were 6- to 17-year-old boys with DSM-III ADD (N = 73), psychiatric (N = 26) and normal (N = 26) controls and their relatives. Information on PDICs was obtained from the mothers in a standardized manner blind to the proband's clinical status. Using odds ratio analyses, an association was found berweenAD D and PDICs that was strongest for the comorbid and nonfamilial subtypes. In contrast, non-comorbid and familial ADD subgroups differed less from normal controls in the risk for PDICs. The increased risk for PDICs in nonfamilial ADD children and the lack of evidence for increased risk among familial ADD patients suggests that PDICs may represent nongenetic etiological mechanisms in this disorder, especially for children who have comorbid disorders. Do Children Aged 9 to 11 Understand Questions from the DISC-2? J. J. Breton, M.D., L. Bergeron, M.Sc.; J. P. Valla, M.D. A research study was designed to assess the relevance of using the Diagnostic Interview Schedule for Children (DISC2) with 9- to l l-year-old children in a province-wide child mental health survey in Quebec (QCMHS). Two studies were realized, with French-speaking and English-speaking children. Each study was completed for the following diagnoses evaluated in the QCMHS: simple phobia, separation anxiety disorder, overanxious disorder and generalized anxiety disorder, major depressive disorder and dysthymia, attention-deficit hyperactivity disorder, oppositional defiant disorder and conduct disorder. Two hundred forty Englishspeaking subjects berween 9 and 11 years old were recruited from four elementary schools in the Montreal area. Every child was interviewed about the meaning of each question . Sixty DISC-2 interviews were completed. Two experienced child psychiatrists separately evaluated the children's answers. The agreement was approximately 65% to 70% for the questions taken as a whole, and 80% for the time concepts in the interview. Overall, 45% of the questions were understood. However, only 25% of the questions in which time concepts were required were understood. There was some improvement in understanding as children got older, and girls performed slightly better than boys. Shorter questions were significantly better understood than longer ones. Regression analysis was performed for each DISC-2 diagnosis. The dependent variable was the mean percentage of questions understood . The significant independent variable in the regression analysis models were age, repeated grade, location of the school, sex, and siblings.
AM . ACAD. CHILD ADOL ESC. PSYCHIATRY, 33:6, JULY/AUGUST 199 4
919
and/or mood disorders, the Center for Epidemiological Studies-Depression (CES-D) Scale and Modified Maudsley Obsessive-Compulsive Inventory (MMOCI) were administered to parents of children with autistic disorder and parents of children with Down syndrome. CES-D scores were higher in hyperserotonemic parents of children with autistic disorder (mean ± SD 17.5 ± 6.2) than in normoserotonemic parents of children with autistic disorder (11.8 ± 9.5) and parents of children with Down syndrome (10.9 ± 10.2; Kruskall= 7.79, N = 71, P < .03). There was a trend Wallis toward higher MMOCI scores for hyperserotonemic parents (11.29 ± 7.2) compared to the Down (7.8 ± 6.69), and normoserotonemic groups (8.95 ± 6.49) (Kruskall-Wallis X2 = 4.87, N = 95, P < .09). Hyperserotonemic parents of children with autistic disorder had significantly higher MMOCI scores than parents of children with Down syndrome (U = 242, P < .04). Familiality of whole blood serotonin levels and lesser variants of autistic disorder may be related. More extensive assessment of the phenotype of hyperserotonemic parents is necessary.
t
Attention-Deficit Hyperactivity Disorder (ADHD) and Thyroid Abnormalities. T. Spencer, M.D., J. Biederman, M.D.; T. Wilens, M .D.; J. Guite , B.A. Recently, high rates ofattention deficit-hyperactivity disorder (ADHD) were reported in children and adolescents with generalized resistance to thyroid hormone (GRTH). GRTH is characterized by reduced tissue responsiveness to the thyroid hormone. The incidence of thyroid abnormalities inADHD populations is unknown. To this end we systematically reviewed thyroid function in a large group of children and adolescents (N = 95) clinically referred for ADHD who had never been treated with lithium. Thyroxine (T4), the thyroid hormone binding index (THBI) , the free T4 index (FT4I), triiodothyronine (T3), and thyroid stimulating hormone (TSH) levels were all essentially normal. Only four subjects had any thyroid values outside of laboratory cutoffs. While these subjects had T3 values that were slightly above 195 ng/dL , all four had low TSH values and no clinical symptoms . There was a negative correlation for most thyroid values with age, which has been well described in the pediatric endocrine literature . Also, there were modest effects of comorbid major depressive disorders on several thyroid measures, but none for other comorbid diagnoses. There were no gender effects. While there were modest associations of stimulant trials on several thyroid parameters, no associations were found with other medication trials. This study failed to identify any association berween thyroid abnormalities and ADHD. Not a single subject in this study had a clinically significant abnormal thyroid parameter. In spite of the high rate of ADHD in GRTH patients, this study failed to identify a link berween thyroid abnormalities and ADHD in non-GTRH patients.
J.
Are Perinatal Complications Relevant to the Manifestation ofAttention-Deficit Disorder? S. Milberger, M.S., J. Biederman , M.D.; S. Sprich-Buckminster, B.A.; S. V Faraone, Ph.D.; B. Krifcher Lehman, B.A. This study evaluates the role of pregnancy, delivery, and infancy complications (PDICs) in the etiology of attention deficit disorder (ADD). We address issuesof comorbidity and familiality by formulating and testing multiple hypotheses. Subjects were 6- to 17-year-old boys with DSM-III ADD (N = 73), psychiatric (N = 26) and normal (N = 26) controls and their relatives. Information on PDICs was obtained from the mothers in a standardized manner blind to the proband's clinical status. Using odds ratio analyses, an association was found berweenAD D and PDICs that was strongest for the comorbid and nonfamilial subtypes. In contrast, non-comorbid and familial ADD subgroups differed less from normal controls in the risk for PDICs. The increased risk for PDICs in nonfamilial ADD children and the lack of evidence for increased risk among familial ADD patients suggests that PDICs may represent nongenetic etiological mechanisms in this disorder, especially for children who have comorbid disorders. Do Children Aged 9 to 11 Understand Questions from the DISC-2? J. J. Breton, M.D., L. Bergeron, M.Sc.; J. P. Valla, M.D. A research study was designed to assess the relevance of using the Diagnostic Interview Schedule for Children (DISC2) with 9- to l l-year-old children in a province-wide child mental health survey in Quebec (QCMHS). Two studies were realized, with French-speaking and English-speaking children. Each study was completed for the following diagnoses evaluated in the QCMHS: simple phobia, separation anxiety disorder, overanxious disorder and generalized anxiety disorder, major depressive disorder and dysthymia, attention-deficit hyperactivity disorder, oppositional defiant disorder and conduct disorder. Two hundred forty Englishspeaking subjects berween 9 and 11 years old were recruited from four elementary schools in the Montreal area. Every child was interviewed about the meaning of each question . Sixty DISC-2 interviews were completed. Two experienced child psychiatrists separately evaluated the children's answers. The agreement was approximately 65% to 70% for the questions taken as a whole, and 80% for the time concepts in the interview. Overall, 45% of the questions were understood. However, only 25% of the questions in which time concepts were required were understood. There was some improvement in understanding as children got older, and girls performed slightly better than boys. Shorter questions were significantly better understood than longer ones. Regression analysis was performed for each DISC-2 diagnosis. The dependent variable was the mean percentage of questions understood . The significant independent variable in the regression analysis models were age, repeated grade, location of the school, sex, and siblings.
AM . ACAD. CHILD ADOL ESC. PSYCHIATRY, 33:6, JULY/AUGUST 199 4
919