Association between autism symptoms and functioning in children with ADHD

OBJECTIVE: To examine the association between autism spectrum disorder (ASD) symptoms and (a) social functioning, (b) mental health, (c) quality of life and (d) sleep in children with and without attention-deficit hyperactivity disorder (ADHD).

METHODS: Participants were 6-10-year-old children with ADHD (N=164) and without ADHD (N=198). ADHD was assessed via community-based screening (wave 1) and case confirmation using the Diagnostic Interview Schedule for Children IV (DISC-IV) (wave 2). ASD symptoms were identified using the Social Communication Questionnaire (SCQ). Outcome measures were social functioning (Strengths and Difficulties Questionnaire (SDQ)), mental health (DISC-IV, SDQ), quality of life (QoL, Pediatric Quality of Life Inventory 4.0) and sleep problem severity.

RESULTS: Greater ASD symptoms were associated with more parent and teacher-reported peer problems and emotional and conduct problems. For every SD increase in SCQ scores, internalising (OR 1.8, 95% CI 1.3 to 2.6, p=0.001) and externalising disorders (OR 1.5, 95% CI 1.1 to 2.1, p=0.02) increased, QoL decreased by 6.7 units (p<0.001), and moderate/severe sleep problems increased (OR 1.5, 95% CI 1.0 to 2.2, p=0.04). Most findings held in analyses adjusting for socio-demographic factors, ADHD symptom severity and comorbidities (when not the outcome), with the exception of externalising disorders and sleep problems.

CONCLUSIONS: ASD symptoms are associated with poorer functioning in children with ADHD. It is important to identify and potentially manage ASD symptoms in children with ADHD given that they exacerbate functional impairments in this already vulnerable group.

Factors associated with accidental injuries in children with ADHD-combined type: more than a motor problem?

OBJECTIVE: We explored the relationship between accidental injuries, motor impairment, and co-occurring autism spectrum disorder (ASD) symptoms in children with ADHD-combined type (ADHD-CT).

METHOD: Participants were 32 male children diagnosed with ADHD-CT and 23 typically developing male children (7-12 years, full scale IQ [FSIQ] > 80). Parents completed a customized questionnaire on the occurrence of accidental injuries (e.g., bruises, cuts) their child experienced in the past 12 months. Motor proficiency was assessed using the Movement ABC-2 (MABC-2). Parents rated motor, ADHD-CT, ASD, and anxiety symptoms.

RESULTS: Children with ADHD-CT had significantly increased parent-reported accidental injuries compared with typically developing children. Among children with ADHD-CT, Spearman's rho rank correlations revealed no association between increased accidental injuries and MABC-2 score, but significant associations with increased hyperactivity/impulsivity, ASD, and anxiety symptoms.

CONCLUSION: Although these findings require validation, they suggest a need for further research investigating the contribution of co-occurring ASD and anxiety symptoms to accidental injuries in children with ADHD-CT.

Developmental brain trajectories in children with ADHD and controls: a longitudinal neuroimaging study

BACKGROUND: The symptom profile and neuropsychological functioning of individuals with Attention Deficit/Hyperactivity Disorder (ADHD), change as they enter adolescence. It is unclear whether variation in brain structure and function parallels these changes, and also whether deviations from typical brain development trajectories are associated with differential outcomes. This paper describes the Neuroimaging of the Children's Attention Project (NICAP), a comprehensive longitudinal multimodal neuroimaging study. Primary aims are to determine how brain structure and function change with age in ADHD, and whether different trajectories of brain development are associated with variations in outcomes including diagnostic persistence, and academic, cognitive, social and mental health outcomes.

METHODS/DESIGN: NICAP is a multimodal neuroimaging study in a community-based cohort of children with and without ADHD. Approximately 100 children with ADHD and 100 typically developing controls will be scanned at a mean age of 10 years (range; 9-11years) and will be re-scanned at two 18-month intervals (ages 11.5 and 13 years respectively). Assessments include a structured diagnostic interview, parent and teacher questionnaires, direct child cognitive/executive functioning assessment and magnetic resonance imaging (MRI). MRI acquisition techniques, collected at a single site, have been selected to provide optimized information concerning structural and functional brain development.

DISCUSSION: This study will allow us to address the primary aims by describing the neurobiological development of ADHD and elucidating brain features associated with differential clinical/behavioral outcomes. NICAP data will also be explored to assess the impact of sex, ADHD presentation, ADHD severity, comorbidities and medication use on brain development trajectories. Establishing which brain regions are associated with differential clinical outcomes, may allow us to improve predictions about the course of ADHD.

Understanding hoarding symptoms in children with comorbid ADHD

This thesis explored the nature of hoarding symptoms in children and adolescents with comorbid ADHD. It was concluded that a correlated liabilities model may be useful in understanding the comorbidity between hoarding symptoms and ADHD, including shared executive functioning difficulties, emotion dysregulation, neurological and genetic vulnerability.

Individual differences in children's suggestibility : a comparison between intellectually disabled and mainstream samples

This study examined whether age, gender, intelligence, communication ability and shyness predict intellectually disabled children’s susceptibility to an interviewer’s misleading suggestions. Further, the study examined whether the relative influence of these factors differs between intellectually disabled and mainstream samples. Participants included 75 children with mild and borderline intellectual disabilities (aged 77–158 months) and 83 mainstream children (aged 68–152 months). All children were individually administered the Yield and Shift subscales of the Gudjonsson Suggestibility Scale (Form 2) as well as standardised measures of IQ, shyness and communication ability. For the intellectually disabled children, multiple regression analyses revealed that age, IQ and communication inversely predicted Yield suggestibility, however, none of the factors predicted Shift suggestibility. For the mainstream children, age made a significant independent contribution to both Yield and Shift suggestibility, while IQ was a significant predictor of Shift suggestibility. When comparing the relative impact of these factors across the samples, age had a significantly greater impact on mainstream (compared with intellectually disabled) children’s Shift suggestibility, while IQ had a significantly greater influence on intellectually disabled (compared with mainstream) children’s Yield scores. These findings highlight the limited generalisability of previous findings involving mainstream children’s suggestibility to intellectually disabled samples.

Subjective quality of life and self-esteem in children: the role of primary and secondary control in coping with everyday stress

Two major predictors of subjective quality oflife (SQOL) in adults are known to beself-esteem and a sense of primary control.Moreover, secondary control is known to be animportant defence strategy when primary controlfails. This study aimed to determine whetherthese relationships also apply to children. Asample of 66 children aged from 5 to 12 yearswere compared on their use of primary andsecondary control and on their ratings of SQOLand self-esteem. SQOL was measured using theComprehensive Quality of Life Scale,self-esteem by using the CoopersmithSelf-Esteem Inventory, and primary andsecondary control were measured by codingchildren's responses to three short video clipsof children in stressful situations. It wasfound that younger children use more primarycontrol and less secondary control than olderchildren. However, five year olds were foundcapable of producing secondary controlstrategies. Contrary to expectation, primaryand secondary control did not predict eitherself-esteem or SQOL. However, self-esteempredicted SQOL as expected and no sexdifferences were found. These findingsemphasise important differences from the adultliterature and the reasons for this arediscussed.

Re Alex: adolescent gender identity disorder and the family court of Australia

'People with gender identity disorder live with a conviction that their physical anatomy is incompatible with their true gender role. They have an overwhelming desire to live and function in the opposite biological sex' . The manifestation of the disorder in children and adolescents is dominated by secrecy, confusion and shame. The purpose of this article is to promote discussion amongst the legal fraternity of the difficult issues confronting the Family Court of Australia when asked to make decisions with life-altering ramifications for the young and vulnerable.

Role of peer support and emotional expression on posttraumatic stress disorder in student paramedics

This exploratory study contrasted and tested the predictive value of the reverse buffering hypothesis of social support and the information processing model of posttraumatic stress disorder (PTSD) in an investigation of trauma-related symptomatology (TRS) in a single sample of 42 student paramedics. Participants completed several anonymous self-report measures of PTSD symptomatology, peer social support, and attitude toward emotional expression. Regression-based path analyses did not support either theory of PTSD in this population. A path model of PTSD in student paramedics was subsequently developed, indicating that a direct relationship exists between duty-related trauma exposure, dysfunctional peer social support, and students' negative attitudes toward emotional expression. This new model accounted for 30% of the variance in student paramedics' TRS.

Trends in children`s physical activity and weight status in high and low socio-economic status areas of Melbourne, Victoria, 1985-2001

Objective:
To examine trends in active transport to and from school, in school sport and physical education (PE), and in weight status among children from high and low socio-economic status (SES) areas in Melbourne, Victoria, between 1985 and 2001.

Methods:
Cross-sectional survey data and measured height and weight from 1985 (n=557) and 2001 (n=926) were compared for children aged between 9–13 years within high and low SES areas.

Results:
From 1985 to 2001, the frequency of walking to or from school declined (4.38±4.3 vs. 3.61 ± 3.8 trips/wk, p<0.001), cycling to or from school also declined (1.22±2.9 vs. 0.36±1.5 trips/wk, p<0.001), and the frequency of PE lessons declined (1.64±1.1 vs. 1.18±0.9 lessons/wk, p<0.001). However, the frequency of school sport increased (0.9±1.22 vs. 1.24±0.8 sessions/wk, p<0.001). In 1985, 11.7% of children were overweight or obese compared with 28.7% in 2001 (p<0.001). Apart from walking to school and school sport, there were greater relative declines in cycling to school and PE, and increases in overweight and obesity among children attending schools in low SES areas compared with those attending schools in high SES areas.

Conclusions:
Declines in active school transport and PE have occurred at the same time as increases in overweight and obesity among Australian children.

Implications:
Promoting active school transport and maintaining school sport and PE should be important public health priorities in Australia. Current inequities in school sport and PE and in prevalence of overweight and obesity by area-level SES also need to be addressed.

A longitudinal study of body image and strategies to lose weight and increase muscles in children

A longitudinal study was used to examine age differences in the role of body mass index (BMI) and sociocultural pressures in predicting changes in body image and strategies to both lose weight and increase muscles among 443 children aged between 8 and 12 years (207 boys, 236 girls) over a 16-month period. The strongest predictors of body image and these strategies were BMI, the media and mothers, and to a lesser extent fathers and best friends. Girls were focused on losing weight, whereas boys were focused on both increasing muscle and losing weight. Surprisingly, there was a reduction in strategies both to lose weight and increase muscles as children approached adolescence. The implications of these findings for preventative educational programs for boys and girls are discussed.

Parental concerns about childhood obesity and the strategies employed to prevent unhealthy weight gain in children.

Objectives: To describe parental concerns about their child’s weight, to determine the proportion of parents taking preventive action to avoid obesity in their children and the predictors of taking preventive action, and to describe the strategies adopted by parents.
Design: A cross-sectional survey was conducted. Children’s heights and weights were measured, and parents completed a questionnaire that included measures of their own weight status, perceptions of their child’s weight, concerns about their child’s current weight and future weight as an adolescent and adult, and the strategies used to prevent obesity.
Setting: The study was conducted in Melbourne, Australia.
Subjects: A total of 291 families of children aged 5–6 years and 919 families of children aged 10–12 years participated.
Results: Eighty-nine per cent of parents of overweight 5–6-year-olds and 63% of parents of overweight 10–12-year-olds were unaware their child was overweight. Seventy-one per cent of parents of overweight 5–6-year-olds and 43% of parents of overweight 10–12-year-olds were not concerned about their child’s current weight. Although 31% of parents of 5–6-year-olds and 43% of parents of 10–12-year-olds were taking action to prevent unhealthy weight gain in their children, less-educated parents were less likely to do so.
Conclusions: Public health programmes are required to raise parental recognition of childhood overweight and of related risk behaviours, and to provide parents with practical strategies to prevent unhealthy weight gain in their children.

Individual, social and home environment determinants of change in children's television viewing: the Switch-Play intervention

Understanding potential determinants of change in television (TV) viewing among children may enhance the effectiveness of programs targeting this behaviour. This study aimed to investigate the contribution of individual, social and home environment factors among 10-year-old Australian children to change in TV viewing over a 21-month period. A total of 164 children (49% boys) completed a 19-lesson (9-month) intervention program to reduce TV viewing time. Children completed self-administered surveys four times over 21 months (pre- and post-intervention, 6- and 12-month follow-up). Baseline factors associated with change in TV viewing during the intervention and follow-up periods were: ‘asking parents ≥once/week to switch off the TV and play with them’ (21.6 min/day more than those reporting <once/week, p = 0.007); being able to ‘watch just 1 h of TV per day’ (26.1 min/day less than those who could not, p = 0.010); ‘watching TV no matter what was on’ (36.6 min/day more than those who did not, p < 0.001); and ‘continuing to watch TV after their program was over’ (33.0 min/day more than those who did not, p = 0.006). With every unit increase in baseline frequency of TV viewing with family and friends, children spent on average 4.0 min/day more watching TV over the 21-month period (p = 0.047). Baseline number and placement of TVs at home did not predict change in children's TV viewing over the 21 months. Greater understanding of the family dynamics and circumstances, as well as the individual and social determinants of TV viewing, will be required if we are to develop effective strategies for reducing TV viewing in children.

Estimating the effects of energy imbalance on changes in body weight in children

BACKGROUND: Estimating changes in weight from changes in energy balance is important for predicting the effect of obesity prevention interventions. OBJECTIVE: The objective was to develop and validate an equation for predicting the mean weight of a population of children in response to a change in total energy intake (TEI) or total energy expenditure (TEE). DESIGN: In 963 children with a mean (+/-SD) age of 8.1 +/- 2.8 y (range: 4-18 y) and weight of 31.5 +/- 17.6 kg, TEE was measured by using doubly labeled water. Log weight (dependent variable) and log TEE (independent variable) were analyzed in a linear regression model with height, age, and sex as covariates. It was assumed that points of dynamic balance, called "settling points," occur for populations wherein energy is in balance (TEE = TEI), weight is stable (ignoring growth), and energy flux (EnFlux) equals TEE. RESULTS: TEE (or EnFlux) explained 74% of the variance in weight. The unstandardized regression coefficient was 0.45 (95% CI: 0.38, 0.51; R(2) = 0.86) after including covariates. Conversion into proportional changes (time(1) to time(2)) gave the equation (weight(2)/weight(1)) = (EnFlux(2)/EnFlux(1))(0.45). In 3 longitudinal studies (n = 212; mean follow-up of 3.4 y), the equation predicted the mean follow-up measured weight to within 0.5%. CONCLUSIONS: The relation of EnFlux with weight was positive, which implied that a high TEI (rather than low physical activity and low TEE) was the main determinant of high body weight. Two populations of children with a 10% difference in mean EnFlux would have a 4.5% difference in mean weight.