Faculty Bibliography

BACKGROUND: The aim of this study was to assess the validity of diagnosing attention deficit/hyperactivity disorder (ADHD) in high IQ children and to further characterize the clinical features associated with their ADHD. METHODS: We operationalized giftedness/high IQ as having a full scale IQ >/=120. We identified 92 children with a high IQ who did not have ADHD and 49 children with a high IQ that met diagnostic criteria for ADHD who had participated in the Massachusetts General Hospital Longitudinal Family Studies of ADHD. RESULTS: Of our participants with ADHD and a high IQ, the majority (n = 35) met criteria for the Combined subtype. Relative to control participants, children with ADHD and high IQ had a higher prevalence rate of familial ADHD in first-degree relatives, repeated grades more often, had a poorer performance on the WISC-III Block Design, had more comorbid psychopathology, and had more functional impairments across a number of domains. CONCLUSIONS: Children with a high IQ and ADHD showed a pattern of familiality as well as cognitive, psychiatric and behavioral features consistent with the diagnosis of ADHD in children with average IQ. These data suggest that the diagnosis of ADHD is valid among high IQ children.

This study investigated predictive relations between preschoolers' (N=310) behavioral regulation and emergent literacy, vocabulary, and math skills. Behavioral regulation was assessed using a direct measure called the Head-to-Toes Task, which taps inhibitory control, attention, and working memory, and requires children to perform the opposite of what is instructed verbally. Hierarchical linear modeling (HLM) was utilized because children were nested in 54 classrooms at 2 geographical sites. Results revealed that behavioral regulation significantly and positively predicted fall and spring emergent literacy, vocabulary, and math skills on the Woodcock Johnson Tests of Achievement (all ps<.05). Moreover, growth in behavioral regulation predicted growth in emergent literacy, vocabulary, and math skills over the prekindergarten year (all ps<.05), after controlling for site, child gender, and other background variables. Discussion focuses on the role of behavioral regulation in early academic achievement and preparedness for kindergarten

Longitudinal analyses on normal versus impaired functioning across 7 domains were conducted in children who had experienced profound institutional deprivation up to the age of 42 months and were adopted from Romania into U.K. families. Comparisons were made with noninstitutionalized children adopted from Romania and with nondeprived within-U.K. adoptees placed before the age of 6 months. Specifically, the validity of the assessment, the degree of continuity and change in levels of functioning from 6 to 11 years, and the factors in the pre- and postadoption environment accounting for heterogeneity in outcome were examined. Pervasive impairment was significantly raised in children experiencing institutional deprivation for > or =6 months of life, with a minority within this group showing no impairment. There was no additional significant effect of duration of deprivation beyond the 6-month cutoff, and few other predictors explained outcome. The pattern of normality/impairment was mainly established by 6 years of age, with considerable continuity at the individual level between 6 and 11 years. The findings are discussed in terms of the possibility of a sensitive period for development

BACKGROUND: Anxiety disorders are often undetected and untreated in adolescents. This study evaluates the relative efficacy of a school-based, cognitive-behavioral intervention compared to an educational-supportive treatment for adolescents with social anxiety disorder. METHODS: Thirty-six students (30 females), ages 14 to 16, were randomized to a 12-week specific intervention, Skills for Social and Academic Success (SASS), or a credible attention control matched for structure and contact, conducted in school. RESULTS: Independent evaluations and adolescent self-reports indicated significant reduction in social anxiety for SASS compared to the control group. Parent reports of their children's social anxiety did not discriminate between treatments. In the specific intervention, 59%, compared to 0% in the control, no longer met criteria for social anxiety disorder following treatment. Superiority of the SASS intervention was maintained 6 months after treatment cessation. CONCLUSIONS: The study provides evidence that intervention for social anxiety disorder that emphasizes exposure and social skills is efficacious. Results indicate that clinical improvement is sustained for at least 6 months, and that, overall, adolescents with social anxiety disorder do not respond to non-specific treatment. This investigation has public health implications by demonstrating that effective interventions can be transported to nonclinical settings

OBJECTIVE: This study assessed the long-term effects of group behavioral treatment plus individual cognitive behavioral therapy (CBT) and/or fluoxetine in binge eating disorder (BED) patients. RESEARCH METHODS AND PROCEDURES: A total of 116 individuals were randomized to an initial five-month trial and were followed up over two years. Assessments, including binge frequency, weight, and self-report measures, were administered at pre-treatment, post-treatment, and approximately 6, 12, 18, and 24 months after initial treatment. RESULTS: Across treatment groups, there was overall improvement over 29 months in binge frequency and in binge abstinence. The odds of binge abstinence 2 years post-treatment were 1.373 times the odds of binge abstinence immediately post-treatment. There was no significant change in weight over the two-year period. Subjects who received individual CBT evidenced lower binge frequency over the two-year follow-up period than patients who had not received individual CBT. Similarly, CBT was associated with increased rates of binge abstinence. There were no main effects of treatment assignment on weight over the two-year follow-up period. There was a significant advantage for fluoxetine assignment over the two-year follow-up period on depressive symptoms. DISCUSSION: The major significance of the study rests in its examination of the long-term effects of standardized interventions for BED. Our findings provide support for the ideas that short-term treatment may confer long-term benefit and that not all treatments are equivalent in the benefits they confer

Across a range of mammalian species, early developmental variations in fear-related behaviors constrain patterns of anxious behavior throughout life. Individual differences in anxiety among rodents and non-human primates have been shown to reflect early-life influences of genes and the environment on brain circuitry. However, in humans, the manner in which genes and the environment developmentally shape individual differences in anxiety and associated brain circuitry remains poorly specified. The current review presents a conceptual framework that facilitates clinical research examining developmental influences on brain circuitry and anxiety. Research using threat-exposure paradigms might most directly integrate basic and clinical perspectives on pediatric anxiety.

Schizophrenia patients with the deficit syndrome (DS) may represent a homogeneous subgroup. To increase the practicability of diagnosing the DS, Kirkpatrick et al. [Kirkpatrick, B., Buchanan, RW., Breier, A. Carpenter, WT., 1993. Case identification and stability of the deficit syndrome of schizophrenia. Psychiatry Res. 47, 47-56.] proposed the use of a 'proxy' case identification tool using standardized symptom ratings instead of the Schedule for the Deficit Syndrome (SDS) which requires an independent clinical assessment. The Proxy for the Deficit Syndrome (PDS) is based on the extraction of symptoms that are essentially equivalent or overlap substantially with the restricted affect and diminished emotional range on the SDS. Kirkpatrick et al. [Kirkpatrick, B., Buchanan, RW., Breier, A. Carpenter, WT., 1993. Case identification and stability of the deficit syndrome of schizophrenia. Psychiatry Res. 47, 47-56.] reported good sensitivity and specificity in a comparison of SDS and PDS assessments among 100 chronic schizophrenia outpatients. The present investigation involves the comparison of the deficit syndrome as assessed by the 'gold standard' Schedule for the Deficit Syndrome with the ratings of the same symptoms embodied in the 'proxy instrument' the PANSS, within the same group of 156 inpatients. Forty-four patients were assessed by the SDS to have the deficit syndrome. Patients with and without the DS, as defined by the SDS, did not differ for age, education, age at illness onset and duration of illness. The two main 'proxy' measures PDS1 and PDS2 discriminated across the SDS groups. The direct dichotomous comparison of the actual SDS and the 'proxy' derived PDS groups demonstrated good specificity (78.6% and 79.5%) and moderate to very good sensitivity (61.4% and 86.4%) and there was a moderately low rate of false positive cases (21.4% and 20.5%). For the two main 'proxy' measures (PDS1 and PDS2) kappas were .38 and .59, representing poor to good agreement. In our sample of rigorously diagnosed schizophrenia inpatients, the use of a 'proxy' case identification tool for the deficit syndrome would appear to be a viable alternative in identifying a subgroup of schizophrenia patients with the deficit syndrome when the use of the actual SDS is not feasible. Further study is indicated before the PDS as extracted from the PANSS can be used in lieu of the SDS for identifying patients with this syndrome

Childhood aggression has both biological and environmental underpinnings. However, the manner in which these factors interact to influence various types of aggression remains an important area of study. The current study examined the degree to which biological risk and psychosocial adversity, both alone and in combination, are associated with childhood aggression. Linear regression procedures were used to assess the extent to which biological risk status (low vs. high serotonergic responsivity, as measured by prolactin response to fenfluramine), magnitude of psychosocial risk, and the interaction of these factors predicted parent and teacher ratings of aggression and delinquency. After accounting for the independent contribution of biological and psychosocial risk, the interaction of biological and psychosocial risk was significantly associated with parent-rated aggression and marginally related to parent-rated delinquency. In contrast, no such interaction was observed for teacher-rated aggression. Findings suggest that individuals at biological risk for aggression may be particularly vulnerable to the impact of psychosocial adversity.

BACKGROUND: This multicenter, randomized, fixed-dose, double-blind, placebo-controlled study evaluated efficacy of extended-release dexmethylphenidate (d-MPH-ER) in adults with attention-deficit/hyperactivity disorder (ADHD). METHODS: Randomized adults with ADHD (n = 221) received once-daily d-MPH-ER 20 mg, 30 mg, or 40 mg or placebo for 5 weeks. The primary efficacy variable was change from baseline to final visit in DSM-IV ADHD Rating Scale (ADHD-RS) total score. Secondary efficacy parameters included the proportion of patients with improvement >/=30% in ADHD-RS total score and final scores on Clinical Global Impressions-Improvement (CGI-I) scale. RESULTS: Of 218 evaluable patients, 184 completed the study. All d-MPH-ER doses were significantly superior to placebo in improving ADHD-RS total scores. Placebo scores improved by 7.9; d-MPH-ER, 20 mg, improved by 13.7 (p = .006); d-MPH-ER, 30 mg, improved by 13.4 (p = .012); and d-MPH-ER, 40 mg, improved by 16.9 (p < .001). Overall distribution of CGI-I ratings at final visit was significantly better with each d-MPH-ER dosage than with placebo. There were no unexpected safety or tolerability concerns, based on experience with racemic methylphenidate (MPH) in adults and dexmethylphenidate (d-MPH) in children. CONCLUSIONS: Once-daily d-MPH-ER at 20 mg, 30 mg, or 40 mg is a safe and effective treatment for adults with ADHD