- Email: [email protected]
Hyperactivity Disorder Trajectories in a Large Birth Cohort from a Developing Country
SYMPOSIA 7.3 – 8.1
not meet criteria for ADHD at any childhood assessment. In childhood, individuals with late-onset ADHD showed fewer behavior problems and higher IQ compared to the persistent group; at age 18, they exhibited comparable ADHD symptoms and impairment, as well as similarly elevated rates of mental health problems. Conclusions: The findings indicate that persistence of ADHD is driven by childhood ADHD severity and neuropsychological impairment. Furthermore, we identified heterogeneity in the adult ADHD population, which may call into question the conceptualization of adult ADHD as a childhood-onset neurodevelopmental disorder.
ADHD DIAG LONG Supported by the Medical Research Council (UKMRC Grant G1002190), the Economic and Social Research Council Grant RES-177-25-0013, the NIH National Institute of Child Health and Human Development Grant HD061298, and by the Jacobs Foundation http://dx.doi.org/10.1016/j.jaac.2016.07.160
7.3 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER TRAJECTORIES IN A LARGE BIRTH COHORT FROM A DEVELOPING COUNTRY Luis A. Rohde, MD, PhD, Department of Psychiatry, Federal University of Rio Grande do Sul, Rua Ramiro Barcellos 2350, Porto Alegre, 90035-003, Brazil Objectives: The goal of this study is to investigate ADHD trajectories in a population-based longitudinal study. Methods: Participants belonged to the 1993 Pelotas Birth Cohort Study, including 5,249 individuals born in Pelotas, Brazil, in 1993. They were followed up to age 18 and 19 years, with 81.3 percent retention. The ADHD status first was ascertained at age 11 years using a screening instrument (Hyperactivity Subscale of the Strength and Difficulties Questionnaire) calibrated for DSM-IV ADHD diagnosis based on clinical interviews with parents using the Development and Well-Being Assessment (DAWBA). At age 18–19 years, ADHD diagnosis was derived using DSM-5 criteria, with the exception of age of onset. We estimated the overlap between these groups assessed at ages 11 and 18–19 years, respectively, and the rates of markers of impairment in these two groups compared to subjects without ADHD. Results: We found ADHD prevalence rates of 8.9 percent in childhood and 12.2 percent in young adulthood (without using the age-of-onset criterion). Both groups had increased levels of impairment in adulthood, as measured by traffic accidents, criminal behavior, incarceration, suicide attempts, and comorbidities. However, only 17.2 percent of children with ADHD continued to have ADHD as young adults, and only 12.6 percent of young adults with ADHD had the disorder in childhood. Conclusions: Our findings do not support the premise that adult ADHD is necessarily a continuation of childhood ADHD.
ADHD DIAG LONG http://dx.doi.org/10.1016/j.jaac.2016.07.161
SYMPOSIUM 8 DISRUPTIVE MOOD DYSREGULATION DISORDER AND OTHER PSYCHOPATHOLOGY: PRESENT AND FUTURE Gabrielle A. Carlson, MD, Psychiatry, SUNY at Stony Brook, SUNY Stony Brook, Putnam Hall-South Campus, Stony Brook, NY 11794-8790; Rachel G. Klein, PhD Objectives: The goal of this session is to describe important comorbidities with disruptive mood dsyregulation disorder (DMDD) and longer-term implications of the disorder. Methods: This symposium brings together four presentations. The first two presentations explore questions about autism and ADHD and the
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
impact of treatment. The other two presentations describe short- and long-term outcomes of DMDD and irritability/dysregulation in community sample groups. Dr. Rachel Gittelman-Klein, well known for her longitudinal studies on ADHD and work with internalizing disorders, will be the discussant. Results: Dr. William Copeland will present on ASD and DMDD using a cohort of well-diagnosed children with autism. He reports rates of 20.1 percent of children who meet DMDD symptom criteria. Dr. James Waxmonsky will discuss the impact of symptoms of DMDD on the response to treatments for ADHD. DMDD symptoms were associated with elevated levels of externalizing behaviors and a partially reduced response to treatments for ADHD. Dr. Gabrielle A. Carlson explored symptoms of DMDD from age 6 to 12 years using data from the larger longitudinal Stony Brook Temperament Study (N ¼ 462). Through age 9, the diagnosis was remarkably unstable. Only 5 of 36 children continued to meet the criteria for DMDD. Child Behavior Checklist (CBCL) irritability was more stable. Dr. Robert Althoff re-examined data from the ZuidHolland sample group of 2,027 youth ages 4–18 years, who were followed every few years into adulthood, and used growth mixture modeling with the CBCL-Irritability Scale. Children with stable high levels of irritability had higher levels of DSM diagnoses of anxiety and mood disorders and, marginally, disruptive behavior disorders in adulthood, whereas those whose irritability worsened over time were more likely to have mood disorders only. Conclusions: DMDD, as well as irritability, does not appear to be either a stable or unified syndrome. Although it is clear in the combined internalizing/ externalizing dimension, as demonstrated by large sample groups within smaller sample groups that are likely to be more meaningful to the clinician, its meaning is less clear.
DIAG DMDD LONG http://dx.doi.org/10.1016/j.jaac.2016.07.163
8.1 DISRUPTIVE MOOD DYSREGULATION DISORDER IN CHILDREN WITH AUTISM SPECTRUM DISORDER William E. Copeland, PhD, Psychiatry and Behavioral Sciences, Duke University Medical Center, 905 W. Main St., Brightleaf Square, Suite 22, Durham, NC 27701; Emily Simonoff; Argyris Stringaris, PhD Objectives: Few studies to date have observed DSM-5 diagnosis of disruptive mood dysregulation disorder (DMDD) in children with ASD, a group with significant emotional regulation problems. This study examines rates of DMDD in children with ASD, including individual criteria, clinical correlates, family characteristics, and impairments. Methods: Sampling used a two-stage stratified design to identify children born in 1990 and living in southeast England at risk for ASD. Gold standard research instruments were used in conjunction with expert clinical review to diagnose ASD (mean age ¼ 11.4 years; 78.8 percent male). DMDD and other psychiatric disorders were assessed with a structured diagnostic interview completed with a parent. The diagnosis of DMDD was made post hoc because its criteria overlapped entirely with those of ODD and depression. Results: Of the 112 children with ASD, as well as data from the Community Alternatives for People with Autism (CAPA), 20.1 percent (or 15 children) met full diagnostic criteria for DMDD. This compares to a prevalence of approximately 1 percent in community sample groups. In this sample group, 75.1 percent met criteria A and B, displaying severe temper outbursts, with 44.6 percent reporting such outbursts on more days than not (criterion C). Criterion D included 33.6 percent of the group who reported persistently negative moods between temper outbursts. The percentage of children with ASD, who met full criteria for DMDD, was limited by duration and crosscontext criteria, although this was less pronounced than seen in the community. Children with DMDD were more likely to be from families of low socioeconomic status, compared to other children with ASD, in which they displayed high levels of emotional and behavioral comorbidities (including
www.jaacap.org
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not meet criteria for ADHD at any childhood assessment. In childhood, individuals with late-onset ADHD showed fewer behavior problems and higher IQ compared to the persistent group; at age 18, they exhibited comparable ADHD symptoms and impairment, as well as similarly elevated rates of mental health problems. Conclusions: The findings indicate that persistence of ADHD is driven by childhood ADHD severity and neuropsychological impairment. Furthermore, we identified heterogeneity in the adult ADHD population, which may call into question the conceptualization of adult ADHD as a childhood-onset neurodevelopmental disorder.
ADHD DIAG LONG Supported by the Medical Research Council (UKMRC Grant G1002190), the Economic and Social Research Council Grant RES-177-25-0013, the NIH National Institute of Child Health and Human Development Grant HD061298, and by the Jacobs Foundation http://dx.doi.org/10.1016/j.jaac.2016.07.160
7.3 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER TRAJECTORIES IN A LARGE BIRTH COHORT FROM A DEVELOPING COUNTRY Luis A. Rohde, MD, PhD, Department of Psychiatry, Federal University of Rio Grande do Sul, Rua Ramiro Barcellos 2350, Porto Alegre, 90035-003, Brazil Objectives: The goal of this study is to investigate ADHD trajectories in a population-based longitudinal study. Methods: Participants belonged to the 1993 Pelotas Birth Cohort Study, including 5,249 individuals born in Pelotas, Brazil, in 1993. They were followed up to age 18 and 19 years, with 81.3 percent retention. The ADHD status first was ascertained at age 11 years using a screening instrument (Hyperactivity Subscale of the Strength and Difficulties Questionnaire) calibrated for DSM-IV ADHD diagnosis based on clinical interviews with parents using the Development and Well-Being Assessment (DAWBA). At age 18–19 years, ADHD diagnosis was derived using DSM-5 criteria, with the exception of age of onset. We estimated the overlap between these groups assessed at ages 11 and 18–19 years, respectively, and the rates of markers of impairment in these two groups compared to subjects without ADHD. Results: We found ADHD prevalence rates of 8.9 percent in childhood and 12.2 percent in young adulthood (without using the age-of-onset criterion). Both groups had increased levels of impairment in adulthood, as measured by traffic accidents, criminal behavior, incarceration, suicide attempts, and comorbidities. However, only 17.2 percent of children with ADHD continued to have ADHD as young adults, and only 12.6 percent of young adults with ADHD had the disorder in childhood. Conclusions: Our findings do not support the premise that adult ADHD is necessarily a continuation of childhood ADHD.
ADHD DIAG LONG http://dx.doi.org/10.1016/j.jaac.2016.07.161
SYMPOSIUM 8 DISRUPTIVE MOOD DYSREGULATION DISORDER AND OTHER PSYCHOPATHOLOGY: PRESENT AND FUTURE Gabrielle A. Carlson, MD, Psychiatry, SUNY at Stony Brook, SUNY Stony Brook, Putnam Hall-South Campus, Stony Brook, NY 11794-8790; Rachel G. Klein, PhD Objectives: The goal of this session is to describe important comorbidities with disruptive mood dsyregulation disorder (DMDD) and longer-term implications of the disorder. Methods: This symposium brings together four presentations. The first two presentations explore questions about autism and ADHD and the
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
impact of treatment. The other two presentations describe short- and long-term outcomes of DMDD and irritability/dysregulation in community sample groups. Dr. Rachel Gittelman-Klein, well known for her longitudinal studies on ADHD and work with internalizing disorders, will be the discussant. Results: Dr. William Copeland will present on ASD and DMDD using a cohort of well-diagnosed children with autism. He reports rates of 20.1 percent of children who meet DMDD symptom criteria. Dr. James Waxmonsky will discuss the impact of symptoms of DMDD on the response to treatments for ADHD. DMDD symptoms were associated with elevated levels of externalizing behaviors and a partially reduced response to treatments for ADHD. Dr. Gabrielle A. Carlson explored symptoms of DMDD from age 6 to 12 years using data from the larger longitudinal Stony Brook Temperament Study (N ¼ 462). Through age 9, the diagnosis was remarkably unstable. Only 5 of 36 children continued to meet the criteria for DMDD. Child Behavior Checklist (CBCL) irritability was more stable. Dr. Robert Althoff re-examined data from the ZuidHolland sample group of 2,027 youth ages 4–18 years, who were followed every few years into adulthood, and used growth mixture modeling with the CBCL-Irritability Scale. Children with stable high levels of irritability had higher levels of DSM diagnoses of anxiety and mood disorders and, marginally, disruptive behavior disorders in adulthood, whereas those whose irritability worsened over time were more likely to have mood disorders only. Conclusions: DMDD, as well as irritability, does not appear to be either a stable or unified syndrome. Although it is clear in the combined internalizing/ externalizing dimension, as demonstrated by large sample groups within smaller sample groups that are likely to be more meaningful to the clinician, its meaning is less clear.
DIAG DMDD LONG http://dx.doi.org/10.1016/j.jaac.2016.07.163
8.1 DISRUPTIVE MOOD DYSREGULATION DISORDER IN CHILDREN WITH AUTISM SPECTRUM DISORDER William E. Copeland, PhD, Psychiatry and Behavioral Sciences, Duke University Medical Center, 905 W. Main St., Brightleaf Square, Suite 22, Durham, NC 27701; Emily Simonoff; Argyris Stringaris, PhD Objectives: Few studies to date have observed DSM-5 diagnosis of disruptive mood dysregulation disorder (DMDD) in children with ASD, a group with significant emotional regulation problems. This study examines rates of DMDD in children with ASD, including individual criteria, clinical correlates, family characteristics, and impairments. Methods: Sampling used a two-stage stratified design to identify children born in 1990 and living in southeast England at risk for ASD. Gold standard research instruments were used in conjunction with expert clinical review to diagnose ASD (mean age ¼ 11.4 years; 78.8 percent male). DMDD and other psychiatric disorders were assessed with a structured diagnostic interview completed with a parent. The diagnosis of DMDD was made post hoc because its criteria overlapped entirely with those of ODD and depression. Results: Of the 112 children with ASD, as well as data from the Community Alternatives for People with Autism (CAPA), 20.1 percent (or 15 children) met full diagnostic criteria for DMDD. This compares to a prevalence of approximately 1 percent in community sample groups. In this sample group, 75.1 percent met criteria A and B, displaying severe temper outbursts, with 44.6 percent reporting such outbursts on more days than not (criterion C). Criterion D included 33.6 percent of the group who reported persistently negative moods between temper outbursts. The percentage of children with ASD, who met full criteria for DMDD, was limited by duration and crosscontext criteria, although this was less pronounced than seen in the community. Children with DMDD were more likely to be from families of low socioeconomic status, compared to other children with ASD, in which they displayed high levels of emotional and behavioral comorbidities (including
www.jaacap.org
S269