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Recent studies have identified a Child Behavior Checklist profile that characterizes children with severe affective and behavioral dysregulation (CBCL-dysregulation profile, CBCL-DP). In two recent longitudinal studies the CBCL-DP in childhood was associated with heightened rates of comorbid psychiatric disorders, among them bipolar disorder, an increased risk for suicidality, and marked psychosocial impairment at young-adult follow-up. This is the first study outside the US that examines the longitudinal course of the CBCL-DP. Methods: We studied the diagnostic and functional trajectories and the predictive utility of the CBCL-DP in the Mannheim Study of Children at Risk, an epidemiological cohort study on the outcome of early risk factors from birth into adulthood. A total of 325 young adults (151 males, 174 females) participated in the 19-year assessment. Results: Young adults with a higher CBCL-DP score in childhood were at increased risk for substance use disorders, suicidality and poorer overall functioning at age 19, even after adjustment for parental education, family income, impairment and psychiatric disorders at baseline. Childhood dysregulation was not related to bipolar disorder in young adulthood. The CBCL-DP was neither a precursor of a specific pattern of comorbidity nor of comorbidity in general. Conclusions: Children with high CBCL-DP values are at risk for later severe, psychiatric symptomatology. The different developmental trajectories suggest that the CBCL-DP is not simply an early manifestation of a single disease process but might rather be an early developmental risk marker of a persisting deficit of self-regulation of affect and behavior.
Psychotherapeutic interventions require empirical as well as scientific assessment. Specifically, the proven efficacy of psychotherapy for children and adolescents is essential. Thus, studies examining treatment efficacy and meta- analyses are necessary to compare effect sizes of individual therapeutic interventions between treatment groups and waiting control groups. Assessment of 138 primary studies from 1993-2009 documented the efficacy of psychotherapy for children and adolescents. Furthermore, behavioural therapy outperformed non-behavioural interventions, as 90 % of behavioural interventions showed larger effect sizes compared to non-behavioural psychotherapy. Analysis of moderator variables demonstrated an improved treatment efficacy for individual therapy, inclusion of the family, treatment of internalised disorders, and in clinical samples. Stability of psychotherapeutic treatment effects over time was demonstrated.
Neurofeedback treatment has been demonstrated to reduce inattention, impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder (ADHD). However, previous studies did not adequately control confounding variables or did not employ a randomized reinforcer-controlled design. This study addresses those methodological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD: EEG neurofeedback (NF) aiming at theta/beta ratio reduction and EMG biofeedback (BF) aiming at forehead muscle relaxation. Thirty-five children with ADHD (26 boys, 9 girls; 6-14 years old) were randomly assigned to either the therapy group (NF; n = 18) or the control group (BF; n = 17). Treatment for both groups consisted of 30 sessions. Pre- and post-treatment assessment consisted of psychophysiological measures, behavioural rating scales completed by parents and teachers, as well as psychometric measures. Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups, respectively. Parents reported significant reductions in primary ADHD symptoms, and inattention improvements in the NF group were higher compared to the control intervention (BF, dcorr = -.94). NF training also improved attention and reaction times on the psychometric measures. The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests. However, regarding hyperactivity and impulsivity symptoms, the results imply that non-specific factors, such as behavioural contingencies, self-efficacy, structured learning environment and feed-forward processes, may also contribute to the positive behavioural effects induced by neurofeedback training.
Parameters of a formal working-memory model were estimated for verbal and spatial memory updating of children. The model proposes interference though feature overwriting and through confusion of whole elements as the primary cause of working-memory capacity limits. We tested 2 age groups each containing 1 group of normal intelligence and 1 deficit group. For young children the deficit was developmental dyslexia; for older children it was a general learning difficulty. The interference model predicts less interference through overwriting but more through confusion of whole elements for the dyslexic children than for their age-matched controls. Older children exhibited less interference through confusion of whole elements and a higher processing rate than young children, but general learning difficulty was associated with slower processing than in the age-matched control group. Furthermore, the difference between verbal and spatial updating mapped onto several meaningful dissociations of model parameters.
Objective: We investigated in a high-risk sample the differential impact of biological and psychosocial risk factors on antisocial behaviour pathways. Method: One hundred and thirty-eight boys and 155 girls born at differing degrees of obstetric and psychosocial risk were examined from birth until adolescence. Childhood temperament was assessed by a highly-structured parent-interview and standardized behavioural observations, adolescent temperament was measured by self-report. Neurodevelopmental variables were assessed by age-specific developmental tests. Emotional and behaviour problems were measured at the ages of 8 and 15 by the Achenbach scales. Results: In both genders, psychosocial adversity and early self-control temperament were strongly associated with early-onset persistent (EOP) antisocial behaviour. Psychosocial adversity and more severe externalizing problems differentiated the EOP from childhood-limited (CL) pathway. In girls, adolescent-onset (AO) antisocial behaviour was strongly associated with novelty seeking at 15 years. Conclusion: Our findings emphasize the need for early support and intervention in psychosocially disadvantaged families.
Aims: To investigate whether concurrent alcohol and tobacco use during early adolescence characterizes a subgroup that differs from users of one substance only regarding several risk factors for later substance use problems. Methods: Participants were from a prospective longitudinal cohort study of 384 children at risk for later psychopathology, with the majority being born with obstetric complications and psychosocial adversities. Assessments of adolescent drug consumption and related intrapersonal characteristics were obtained at age 15. Results: Compared to consumers of alcohol only, 15-year-olds drinking and smoking during the same time period (past 4 weeks) had significantly higher levels of consumption and more excessive use of alcohol, started drinking at an earlier age, had higher scores on the Fagerstrom Test for Nicotine Dependence, and more cannabis use. This group could be distinguished from users of alcohol only by higher novelty seeking and more positive alcohol effect expectancies. Compared to consumers of tobacco only, concurrent users reported higher nicotine dependence and more cannabis use. No significant differences were observed regarding frequency and age at initiation of tobacco use, tobacco-related sensitivity, self- efficacy and instrumentality as well as novelty seeking. Conclusions: Concurrent alcohol and tobacco use during early adolescence is associated with characteristics that are well known as risk factors for later alcohol use problems and dependence and that should be targeted by prevention programs.
Objective: To clarify the nature of the association between dopamine genes and smoking by examining whether genetic variability in components of the dopamine pathway could explain refined phenotypes in adolescent smoking progression. Method: Data are from an ongoing prospective study of the long-term outcome of early risk factors studied since birth. At age 15 years, 220 participants (108 males, 112 females) completed a self-report questionnaire measuring smoking behavior and were genotyped for five dopamine gene variants. Results: Smoking initiation was related to allelic variation in the dopamine D-4 receptor gene (DRD4), whereas smoking continuation and dependence showed association with the dopamine D-2 receptor gene (DRD2). Adolescents with the seven-repeat allele of the common DRD4 exon 3 polymorphism had rates of ever smoking that were significantly higher than in those with other genotypes. Once smoking started, carriers of the T allele of a single nucleotide polymorphism of DRD2 (rs4648317) reported higher rates of current smoking and scored higher on nicotine dependence than their allelic counterparts. Among current smokers, intention to quit was significantly lower in adolescents homozygous for the 10-repeat allele of the common dopamine transporter 3 untranslated region polymorphism. Conclusions: Our results provide preliminary evidence of genetic influences on different stages of smoking and suggest the importance of specific dopamine genes in smoking progression in adolescence.
Objective: Despite theoretical discrepancies between different concepts of temperament, some core dimensions are thought to be common to the various models. We compared temperamental traits derived from the New York Longitudinal Study (NYLS) model and the Cloninger dimensions in the developmental course and investigated the associations of temperament with sex as well as with obstetric risks or psychosocial risks present at birth. - Methods: Participants were 151 boys and 157 girls born at differing degrees of obstetric and psychosocial risk from a longitudinal study on a high-risk community sample. In infancy and childhood, NYLS-derived temperamental characteristics were assessed by a highly structured parent interview and standardized behavioral observations. At age 15 years, the Junior Temperament and Character Inventory/1218 was administered. - Results: Moderate correlations were found between Junior Temperament and Character Inventory scales in adolescence and NYLS-derived factors in childhood. The psychosocial risk load seemed to influence the expression of novelty seeking or corresponding NYLS-derived factors, whereas the obstetric risks did not contribute to variation in temperament. Our findings further support highly sex-specific gene x environment interactions on temperament in the developmental course. - Conclusion: The content of our NYLS-derived factors and the specific type of association across different temperament constructs fit into the increasing consensus regarding a small number of higher-order temperamental traits. (c) 2007 Elsevier Inc. All rights reserved.
Background: Recent animal and human studies indicate that the exposure to alcohol during early adolescence increases the risk for heavy alcohol use in response to stress. The purpose of this study was to examine whether this effect may be the consequence of a higher susceptibility to develop "drinking to cope" motives among early initiators. Methods: Data from 320 participants were collected as part of the Mannheim Study of Children at Risk, an ongoing epidemiological cohort study. Structured interviews at age 15 and 19 were used to assess age at first alcohol experience and drunkenness. The young adults completed questionnaires to obtain information about the occurrence of stressful life events during the past 4 years and current drinking habits. In addition, alcohol use under conditions of negative states was assessed with the Inventory of Drinking Situations. Results: The probability of young adults' alcohol use in situations characterized by unpleasant emotions was significantly increased the earlier they had initiated the use of alcohol, even when controlling for current drinking habits and stressful life events. Similar results were obtained for the age at first drunkenness. Conclusions: The findings strengthen the hypothesis that alcohol experiences during early adolescence facilitate drinking to regulate negative affect as an adverse coping strategy which may represent the starting point of a vicious circle comprising drinking to relieve stress and increased stress as a consequence of drinking.
Objective: To examine prospectively whether early parental child-rearing behavior is a predictor of cardiometabolic outcome in young adulthood when other potential risk factors are controlled. Metabolic factors associated with increased risk for cardiovascular disease have been found to vary, depending on lifestyle as well as genetic predisposition. Moreover, there is evidence suggesting that environmental conditions, such as stress in pre- and postnatal life, may have a sustained impact on an individual's metabolic risk profile. Methods: Participants were drawn from a prospective, epidemiological, cohort study followed up from birth into young adulthood. Parent interviews and behavioral observations at the age of 3 months were conducted to assess child-rearing practices and mother-infant interaction in the home setting and in the laboratory. In 279 participants, anthropometric characteristics, low-density lipoprotein and high-density lipoprotein cholesterol, apolipoproteins, and triglycerides were recorded at age 19 years. In addition, structured interviews were administered to the young adults to assess indicators of current lifestyle and education. Results: Adverse early-life interaction experiences were significantly associated with lower levels of high- density lipoprotein cholesterol and apolipoprotein A1 in young adulthood. Current lifestyle variables and level of education did not account for this effect, although habitual smoking and alcohol consumption also contributed significantly to cardiometabolic outcomes. Conclusions: These findings suggest that early parental child-rearing behavior may predict health outcome in later life through its impact on metabolic parameters in adulthood.
To examine whether the dopamine receptor D4 gene (DRD4) exon III VNTR moderates the risk of infants with regulatory disorders for developing attention-deficit/hyperactivity disorder (ADHD) later in childhood. In a prospective longitudinal study of children at risk for later psychopathology, 300 participants were assessed for regulatory problems in infancy, DRD4 genotype, and ADHD symptoms and diagnoses from childhood to adolescence. To examine a potential moderating effect on ADHD measures, linear and logistic regressions were computed. Models were fit for the main effects of the DRD4 genotype (presence or absence of the 7r allele) and regulatory problems (presence or absence), with the addition of the interaction term. All models were controlled for sex, family adversity, and obstetric risk status. In children without the DRD4-7r allele, a history of regulatory problems in infancy was unrelated to later ADHD. But in children with regulatory problems in infancy, the additional presence of the DRD4-7r allele increased the risk for ADHD in childhood. The DRD4 genotype seems to moderate the association between regulatory problems in infancy and later ADHD. A replication study is needed before further conclusions can be drawn, however.
Is a specific disorder of arithmetic skills as common as reading/spelling disorder?Background: Referring to the prevalence rates of learning disorders in the research literature, the numbers of mathematics disorder and reading/ spelling disorder are often reported to be identical. However, the correlation between intelligence level and reading/ spelling skills is much weaker than between intelligence and arithmetic skills. If the same definition criterion is applied to both disorders, a lower prevalence rate for mathematics disorder should be expected. Objective: Are there differences in the prevalence estimates for learning disorders depending on the definition criterion? Method: A large representative sample of German students (N = 1970) was used to review the hypothesis. Results: Depending on the definition criterion, we could show a prevalence range of mathematics disorder between 0.1% and 8.1% in the same sample. Using the same definition criterion for both learning disorders, there are two to three times as many students with reading/spelling disorder than those with mathematics disorder. Discussion: Whenever children with reading/spelling disorder are compared to children with mathematics disorder, the same definition criterion has to be applied.
Es werden Befunde aus einer prospektiven Laengsschnittstudie praesentiert, in der 321 Probanden im Alter von 8, 13, 18 und 25 Jahren untersucht werden konnten; ihre Dunkelfelddelinquenz wurde mit 18 und 25 Jahren erfasst. Wir suchten nach Assoziationen zur Delinquenzentwicklung und erwarteten Unterschiede zwischen auf das Jugendalter beschraenkter gegenueber ins fruehe Erwachsenenalter fortgesetzter sowie spaet, d.h. nach dem Alter von 18 Jahren, beginnender Delinquenz. Wir fanden gemeinsame Risikofaktoren und fuer die drei Verlaufstypen spezifische Risikokonstellationen, die eher im Jugendalter als in der Kindheit identifiziert wurden. Widrige familiaere Bedingungen, Entwicklungsverzoegerungen und psychische Stoerungen scheinen mit Delinquenz als eher persistentem Verhalten assoziiert.
Recent evidence suggests that heterogeneity in the age at onset could explain the inconsistent findings of association studies relating the dopamine transporter (DAT1) gene with alcohol and nicotine consumption. The aim of this study was to examine interactions between two DAT1 polymorphisms and different initiation ages with regard to alcohol and tobacco consumption levels and dependence. Two hundred and ninety-one young adults (135 males, 156 females) participating in the Mannheim Study of Children at Risk were genotyped for the 40-bp variable number of tandem repeats (VNTR) and rs27072 polymorphisms of DAT1. Age at initiation was assessed at age 15 and 19 years. Information about current alcohol and tobacco consumption was obtained at age 19 years using self-report measures and structured interviews. Results suggest that age at onset of intensive consumption moderated the association of the DAT1 gene with early adult substance use and dependence, revealing a DAT1 effect only among individuals homozygous for the 10r allele of the 40-bp VNTR who had started daily smoking or being intoxicated early in life. Equally, carriers of the T allele of the rs27072 polymorphism reporting an early age at first intoxication showed higher current alcohol consumption at age 19 years. In contrast, no interaction between rs27072 and the age at first cigarette with regard to later smoking was observed. These findings provide evidence that the DAT1 gene interacts with an early heavy or regular drug exposure of the maturing adolescent brain to predict substance (ab)use in young adulthood. Further studies are required to confirm these findings.
In a high-risk community sample, we examined the role of regulative temperament and emotionality as well as the extent of gender specificity in the development of externalizing problems. 151 boys and 157 girls born at differing degrees of obstetric and psychosocial risk were followed from birth into adolescence. In infancy and childhood, NYLS- derived temperamental characteristics were assessed by a highly structured parent interview and standardized behavioral observations. At age 15 years, externalizing problems were measured by the Child Behavior Checklist. As revealed by multiple linear regression and logistic regression, low regulative abilities predicted adolescent behavioral and attentional problems over and above obstetric and psychosocial risks. Gender specificity was found in the strength of the association rather than in the kind with a stronger long-term prediction from infant and toddler temperament in girls. Compared to regulative abilities, temperament factors describing aspects of mood and fear/withdrawal versus approach tendencies played a minor role in the development of externalizing problems. Findings are discussed in terms of gender-specific risk factors and possible differential developmental trajectories to subtypes of disruptive behavior.
Background: Evidence from animal studies supports a role for serotonin transporter gene promoter polymorphism (5-HTTLPR) gene-environment interaction (G X E) in the development of excessive alcohol intake. Few studies in humans have been conducted on this topic, yielding inconsistent results. The present study aims to further explore G x E between 5-HTTLPR and exposure to psychosocial adversity on alcohol consumption in a high-risk community sample of young adults. Methods: Data were collected as part of the Mannheim Study of Children at Risk, an ongoing epidemiological cohort study following the outcome of early risk factors from birth into young adulthood. At age 19 years, 309 participants (142 male participants, 167 female participants) were genotyped for the biallelic and triallelic 5-HTTLPR and were administered a 45-day alcohol timeline follow-back interview, providing measures of the total number of drinks and the number of binge drinking days. Psychosocial adversity was assessed at birth (family adversity) and at age 19 (negative life events). Results: In contrast to various previous reports, a significant G x E emerged, indicating that, when exposed to high psychosocial adversity, individuals with the LL genotype of 5-HTTLPR exhibited more hazardous drinking than those carrying the S allele or those without exposure to adversity. This effect, which was confined to male participants, held both for different classifications of 5-HTTLPR and different types of adversity. Conclusions: One explanation for the discrepant results might be heterogeneity in alcohol phenotypes. While the L allele relates more strongly to early-onset alcoholism, the S allele may be linked more closely to alcohol use associated with anxiety and depression.
Previous research examining gene-environment interaction (G x E) with regard to vulnerability to depression and anxiety has yielded conflicting results. The present study was designed to further investigate G x F between 5-HTTLPR and exposure to environmental adversity, using different phenotypic and genotypic characterizations as well as different types of adversity within a prospective study design. Data were available from an ongoing epidemiological cohort Study following the outcome of early risk factors from birth to adulthood. At age 19 yr, 309 participants (142 males, 167 females) were characterized on measures of depression and anxiety through interview and questionnaire (DSM-IV diagnosis, Beck Depression Inventory, Harm Avoidance). Environmental adversity was assessed at birth (family adversity), and at age 19 yr (stressful life events). Bi- and tri-allelic 5-HTTLPR genotypes were obtained from genomic DNA. Results indicated that depression and anxiety in 19-yr-olds were strongly associated with both family adversity and stressful life events. Individuals with the LL genotype of 5-HTTLPR who were exposed to high family adversity displayed significantly higher rates of depressive or anxiety disorders and had more depressive symptoms than those without either condition. This G x E replicates recent findings from an epidemiological cohort study of adolescents but is in contrast to many previous reports suggesting an interaction with the S allele. No evidence for G x E was obtained with regard to current stressful life events and trait anxiety. One possible source for the conflicting findings might be attributed to heterogeneity in depression phenotypes and environmental adversity.
The present study aimed to clarify the functional role of genes in the dopamine and serotonin systems by examining whether polymorphisms in these genes are related to adolescent externalizing behavior either alone or in interaction with each other. Participants were selected from an ongoing prospective study of the outcome of early risk factors. At age 15 years, 298 adolescents (144 males, 154 females) completed the Youth Self Report, 296 primary caregivers the Child Behavior Checklist and 253 teachers the Teacher Report Form. DNA was genotyped for the DRD4 exon III VNTR and the 5-HTTLPR polymorphisms. Results revealed that individuals with the DRD4 7r allele reported significantly more externalizing behavior than carriers of other variants. In addition, a significant interaction emerged, indicating that adolescents carrying two copies of the 5-HTTLPR short allele and the DRD4 7r variant scored highest on aggressive and/or delinquent behavior compared to other genotypes. This result suggests an effect of 5-HTTLPR on externalizing behavior in the presence of DRD4 7r but no effect in its absence.
This prospective longitudinal study of a representative community sample of children and adolescents (N = 269) examined the long-term course and predictive power of psychiatric symptoms in childhood/adolescence for diagnostic outcome (ICD-10) 18 years later at adult age. At both cross-sectional assessments, baseline (1980-1984) and the 18-year follow-up (2001-2004), psychiatric symptoms were assessed using the 'Standardized Psychiatric Interview' (Goldberg et al. in Br J Prev Soc Med 24:18-23, 1970). At follow-up, study participants were reassessed with the standardized M-CIDI (Wittchen and Pfister in Manual und Durchfuhrungsbeschreibung des DIA-X-M-CIDI, Swets and Zeitlinger, Frankfurt, 1997) interview. The participation rate at 18-year follow-up was 82% of those alive. The frequency of clinically relevant depressive symptoms and symptoms of anxiety or phobia was considerably higher when the participants were younger (baseline assessment at childhood, adolescent age) as compared to their scores in adult age. Increased levels of somatic symptoms, fatigue, irritability, sleep disturbances, depression, anxiety and worry as well as phobic symptoms in childhood/adolescence were related to a higher risk of suffering from a psychiatric disorder in adulthood. Depressive symptoms predicted both mood disorders and substance use disorders in adulthood. Phobias predicted later anxiety disorders. These data spanning almost two decades add significant information to the existing literature on the course of mental disorders in the community during the transition from adolescence to adulthood.
There is ample evidence that the early initiation of alcohol use is a risk factor for the development of later alcohol-related problems. The purpose of the current study was to examine whether this association can be explained by indicators of a common underlying susceptibility or whether age at drinking onset may be considered as an independent predictor of later drinking behavior, suggesting a potential causal relationship. Participants were drawn from a prospective cohort study of the long-term outcomes of early risk factors followed up from birth onwards. Structured interviews were administered to 304 participants to assess age at first drink and current drinking behavior. Data on risk factors, including early family adversity, parental alcohol use, childhood psychopathology and stressful life events, were repeatedly collected during childhood using standardized parent interviews. In addition, information on genotype was considered. Results confirmed previous work demonstrating that hazardous alcohol consumption is related to early-adolescent drinking onset. A younger age of first drink was significantly predicted by 5-HTTLPR genotype and the degree of preceding externalizing symptoms, and both factors were related to increased consumption or harmful alcohol use at age 19. However, even after controlling for these potential explanatory factors, earlier age at drinking onset remained a strong predictor of heavy alcohol consumption in young adulthood. The present longitudinal study adds to the current literature indicating that the early onset - adult hazardous drinking association cannot solely be attributed to shared genetic and psychopathologic risk factors as examined in this study.
Context: Recent evidence suggests that gene X environment interactions could explain the inconsistent findings of association studies relating the dopamine transporter (DAT1) gene with attention-deficit/hyperactivity disorder (ADHD). 1bjective: To examine whether psychosocial adversity moderated the effect of genetic variation in DAT1 on ADHD symptoms in. adolescents from a high-risk community sample. Design: Prospective cohort study. Setting: Data were taken from the Mannheim Study of Children at Risk, an ongoing longitudinal study of the long-term outcomes of early risk factors followed up from birth on. Participants: Three hundred five adolescents (146 boys, 159 girls) participated in a follow-up assessment at age 15 years. Main Outcome Measures: Measures of ADHD symptoms according to DSM-IV were obtained using standardized structural interviews with adolescents and their parents. Psychosocial adversity was determined according to an "enriched" family adversity index as proposed by Rutter and Quinton. DNA was genotyped for the common DAT1 40-base pair (bp) variable number of tandem repeats (VNTR) polymorphism in the 3' untranslated region; 3 previously described single nucleotide polymorphisms in exon 15, intron 9, and exon 9; and a novel 30-bp VNTR polymorphism in intron 8. Results: Adolescents homozygous for the 10-repeat allele of the 40-bp VNTR polymorphism who grew up in greater psychosocial adversity exhibited significantly more inattention and hyperactivity-impulsivity than adolescents with other genotypes or who lived in less adverse family conditions (significant interaction, P=.013-017). This gene X environment interaction was also observed in individuals homozygous for the 6-repeat allele of the 30-bp VNTR polymorphism and the haplotype comprising both markers. Conclusions: These findings provide initial evidence that environmental risks as described by the Rutter Family Adversity Index moderate the impact of the DAT1 gene on ADHD symptoms, suggesting a DAT1 effect only in those individuals exposed to psychosocial adversity.
Epidemiological studies have reported elevated rates of legal drug consumption among adolescents in Germany. The aim of this study was to ascertain patterns and parameters of smoking and drinking in early-users as well as to examine possible determinants of risky patterns of use. Participants were from a longitudinal study of a birth cohort of 384 children at risk. Assessments of adolescent drug consumption as well as of individual and social determinants were obtained at age 15. Adolescents drinking and smoking during the same period (past four weeks) were characterized by more excessive and impulsive consumption and by higher rates of cannabis use. No specific determinants of concurrent use could be found. These findings suggest that adolescents displaying early concurrent tobacco and alcohol use may be at higher risk for substance use problems and should be targeted by prevention programs.
Objectives: Are there any differences (organic, psychosocial, psychopathological, cognitive or educational, respectively differences in the motor or neurological development) between infants who later on at the age of 8 years suffer from a hyperactive disorder and those who later on at the same age are undisturbed? Are there specific harbingers for hyperactive disorders in the group concerned? Methods: With regard to their developmental risk load at the age of 3 months, 26 primary school children with hyperactive disorders were compared with 241 healthy children, 25 children with emotional disturbances, and 30 children with socially disruptive behaviour, all of the same age. Results: Identified as the most important predictors for the onset of hyperactive disorders were a reduced birth weight, the mother's origin from a shattered family, early contact impairments on the part of the child, and the mother's neglect of the infant. Conclusions: Altogether, however, the prediction of later hyperactivity in primary school children on the basis of salient features in the infant children remains unsatisfactory and unspecific.
Objective To demonstrate that children homozygous for the 10-repeat allele of the common dopamine transporter (DAT1) polymorphism who were exposed to maternal prenatal smoke exhibited significantly higher hyperactivity-impulsivity than children without these environmental or genetic risks. Study design We performed a prospective longitudinal study from birth into early adulthood monitoring the long-term outcome of early risk factors. Maternal prenatal smoking was determined during a standardized interview with the mother when the child was 3 months old. At age 15 years, 305 adolescents participated in genotyping for the DAT1 40 base pair variable number of tandem repeats polymorphism and assessment of inattention, hyperactivity-impulsivity, and oppositional defiant/conduct disorder symptoms with die Kiddie- Sads-Present and Lifetime Version. Results There was no bivariate association between DAT1 genotype, prenatal smoke exposure and symptoms of attention deficit hyperactivity disorder. However, a significant interaction between DAT1 genotype and prenatal smoke exposure emerged (P =.012), indicating that males with prenatal smoke exposure who were homozygous for the DAT1 10r allele had higher hyperactivity-impulsivity than males from all other groups. In females, no significant main effects of DAT1 genotype or prenatal smoke exposure or interaction effects on any symptoms were evident (all P >.25). Conclusions This study provides further evidence for the multifactorial nature of attention deficit hyperactivity disorder and the importance of studying both genetic and environmental factors and their interaction.
Verhaltensdiagnostik
(2008)
Unter Verhaltensdiagnostik versteht man ein Buendel diagnostischer Instrumente, die darauf abzielen, die aenderungsmoeglichkeiten von Problemverhalten zu eruieren. Verhaltensdiagnostik ist das klassische diagnostische Vorgehen der Verhaltenstherapie. Ausgehend von einer Analyse des Problemverhaltens und der Bedingungen seines Auftretens werden durch verschiedene Techniken Hinweise zu seiner Genese und seiner Aufrechterhaltung erwartet. Vertreter der Verhaltensdiagnostik sehen sie als Alternative und im Gegensatz zur klassischen Eigenschaftsdiagnostik (Reinecker-Hecht & Baumann, 1998), zu der die Ergebnisse aus psychologischen Testverfahren zur Erfassung von Intelligenzleistungen und Persoenlichkeitsmerkmalen ebenso zaehlen wie die Diagnostischen Klassifikationssysteme (z.B. ICD-10 oder DSM- IV)à.
Fragebogenverfahren haben in einer multimethodalen Diagnostik ihren festen Platz, obwohl ihre Grenzen stets beachtet werden muessen. Fragebogenverfahren stellen im diagnostischen Prozess eine einfache und oekonomische Variante der standardisierten Datenerhebung dar (Fombonne 1991). Mit ihrer Hilfe koennen kostenguenstig parallel Informationen zu identischen Problembereichen von verschiedenen Informanten (Lehrern, Eltern, Jugendlichen) eingeholt werden (Esser u. Wyschkon 2004). Ein isolierter Einsatz von Fragebogenverfahren birgt jedoch stets die Gefahr grober Fehler (Fisseni 1991, Merten 1999), somit sind individuelle Diagnosen, die allein auf Fragebogenverfahren beruhen, als im hohen Maße unzuverlaessig einzustufen (Esser et al. 2006). Als Vorauswahlverfahren sind Fragebogenverfahren dagegen durchaus nuetzlich (Merten 1999). Ihr Vorteil fuer Forschung und Praxis ist, dass sie "... leicht kommunizierbare, replizierbare, mathematisch zu verarbeitende Ergebnisse liefern" (S. 160). Mit Hilfe von Fragebogenverfahren kann z.B. oekonomisch erfasst werden, ob ueberhaupt eine psychische Stoerung vorliegt, die dann genauer untersucht werden kann (Poustka 1988). Fragebogenverfahren ergaenzen somit Interviewverfahren und machen deren Einsatz wirkungsvoller. Die klinische Diagnostik hat daher großen Bedarf an validierten Fragebogenverfahren, deren Zahl sich in den letzten 10 Jahren deutlich vergroeßert hat.
Enuresis
(2008)
Die meisten Kinder werden mit 2 bis 4 Jahren am Tage und in der Nacht trocken. Gemäß den klinisch- diagnostischen Leitlinien der ICD-10 (WHO 1993) spricht man von einer Enuresis, wenn es am Tag oder in der Nacht zu einem Entleeren der Blase in die Kleidung bzw. das Bett kommt, die relativ zum geistigen Entwicklungsstand der Person abnorm ist und nicht auf organische Ursachen zurückgeführt werden kann. Die Störungen der Blasenkontrolle dürfen nicht als Folge einer neurologischen Erkrankung, epileptischer Anfälle oder einer strukturellen Anomalie der ableitenden Harnwege auftreten. Gemäß den Forschungskriterien der ICD-10 (WHO 1994) muss das einnässende Kind nach seinem Lebens- und geistigen Alter mindestens 5 Jahre alt sein, um von einer nichtorganischen Enuresis (F 98.0) zu sprechen (in den klinisch-diagnostischen Leitlinien wird ein geistiger Entwicklungsstand gefordert, der mindestens dem eines Vierjährigen entspricht). Um die Diagnose zu erhalten, müssen Kinder unter 7 Jahren zumindest 2mal monatlich, 7-jährige oder ältere Kinder wenigstens einmal im Monat einnässen. Die Symptomdauer sollte mindestens 3 Monate betragen. In der Literatur wird synonym zum Begriff der "nichtorganischen Enuresis" häufig die Bezeichnung "funktionelle Enuresis" verwendet. Auch nach dem DSM-IV (Saß et al. 1996) sollten die Kinder für die Diagnose einer Enuresis (307.6) zumindest ein Entwicklungsalter von 5 Jahren aufweisen und die Symptomatik muss wenigstens seit 3 Monaten bestehen. Im Unterschied zur ICD-10 wird das Einnässen erst dann als klinisch bedeutsam beurteilt, wenn es mindestens 2mal wöchentlich auftritt. Ist dies nicht gegeben, kann die Diagnose dennoch gestellt werden, wenn durch das Einnässen klinisch bedeutsames Leiden hervorgerufen wird oder Beeintraechtigungen in sozialen, schulischen (beruflichen) oder anderen wichtigen Funktionsbereichen entstehen. Die Forderung eines 2mal wöchentlichen Einnässens erscheint deutlich zu streng, während das ein- bzw. 2malige Einnässen pro Monat ein sehr weiches Kriterium darstellt. V. Gontard (1998b) empfiehlt, Einnässen dann als klinisch bedeutsam einzuschätzen, wenn dies mindestens einmal wöchentlich auftritt.
Epidemiologie des Alkoholkonsums im Jugendalter : Ergebnisse repräsentativer Bevölkerungsstudien
(2008)
Projektive Testverfahren
(2008)
Projektive Testverfahren folgen der Grundannahme, dass ein moeglichst vieldeutiges Testmaterial nach der Theorie der sozialen Wahrnehmung dazu fuehrt, dass die Persoenlichkeit des Probanden zum wichtigsten Faktor seines Testverhaltens wird. Projektive Testverfahren erfuellen im allgemeinen die Guetekriterien der klinischen Testtheorie nicht. Sie sind daher allenfalls als explorative Techniken vertretbar. Der Familie - in - Tieren Test soll Rueckschluesse auf die Familienstruktur aus der Sicht des Kindes geben. Einblicke in die Erlebniswelt des Kindes verspricht der Thematische Apperzeptionstest nach Murray. Auf die Familienbeziehungen zentriert ist der Familien- Beziehungs-Test von Howells und Lickorisch. Die Reaktionen der Versuchspersonen in frustrierenden Belastungssituationen versucht das einzige normierte projektive Testverfahren, der Rosenzweig Picture - Frustration - Test, zu objektivieren. Der Scenotest hat zum Ziel mit standardisiertem Spielmaterial Einblicke in die Erlebniswelt des Kindes zu gewinnen, die sich der direkten Befragung verschließen.
Entspannungsverfahren
(2008)
Objectives: The prospective longitudinal Mannheim Study of Children at Risk followed the development of children from the age of 2 years up to the age of 8 years. Are there differences between the developmental risk load in toddlers (psychopathology, cognition, motor or neurological development. and educational differences) who suffer from a hyperactive disorder at age 8 and that of undisturbed children of the same age? Are there specific harbingers of hyperkinetic disorders for the group concerned? Methods: In terms of their developmental risk load at the age of 2 years, 26 primary school children with hyperkinetic disorders were compared to 241 healthy primary school children, as well as to 25 children of the same age with emotional disturbances and 30 children of the same age with socially disruptive behavior. Results: A significant combination of predictors of later hyperkinetic disorders at primary school age proved to be increased fidgetiness and irritability, as well as a reduced language comprehension, at the age of two. Conclusions: The predictive value of symptoms in early childhood for later hyperkinetic disorder in children of primaryschool age is higher than that of symptoms assessed in infancy, which although expected is without relevant specificity.
Interaction between CRHR1 gene and stressful life events predicts adolescent heavy alcohol use
(2007)
Background: Recent animal research suggests that alterations in the corticotropin releasing hormone receptor 1 (CRHR1) may lead to heavy alcohol use following repeated stress. The aim of this study was to examine interactions between two haplotype-tagging single nucleotide polymorphisms (SNPs) covering the CRHR1 gene and adverse life events on heavy drinking in adolescents. Methods: Data were available from the Mannheim Study of Children at Risk, an ongoing cohort study of the long-term outcome of early risk factors followed since birth. At age 15 years, 280 participants (135 males, 145 females) completed a self-report questionnaire measuring alcohol use and were genotyped for two SNPs (rs242938, rs1876831) of CRHR1. Assessment of negative life events over the past three years was obtained by a standardized interview with the parents. Results: Adolescents homozygous for the C allele of rs1876831 drank higher maximum amounts of alcohol per occasion and had greater lifetime rates of heavy drinking in relation to negative life events than individuals carrying the T allele. No gene X environment interactions were found for regular drinking and between rs242938 and stressful life events. Conclusions: These findings provide first evidence in humans that the CRHR1 gene interacts with exposure to stressful life events to predict heavy alcohol use in adolescents.
Psychische Störungen bei Kindern und Jugendlichen : Häufigkeit, Versorgungslage und Prävention
(2007)
Dichte und Struktur von Lebensereignissen in Mannheim und Rostock in der Nachwendezeit 1989 - 1995
(1996)
Familiäre Determinanten seelischer Gesundheit und Krankheit im Generations- und Ost-West-Vergleich.
(1997)
Teilleistungsstörungen
(1997)
Ungeduldige Winzlinge und ihre Entwicklung : was schützt Frühgeborene vor Entwicklungsstörungen
(1997)
Die Entwicklung von Kindern, die in ihrer frühen Kindheit erhöhten Belastungen ausgesetzt waren, zeichnet sich durch eine grosse Variabilität aus. Welche Kinder besonders gefährdet sind und welchen es gelingt, Entwicklungsrisiken zu überwinden, wird anhand von Daten der Mannheimer Risikokinderstudie aufgezeigt. Dabei handelt es sich um eine prospektive Längsschnittstudie an einer Kohorte von 362 Kindern, die in ihrer Entwicklung von der Geburt bis ins Schulalter begleitet werden. Die Ergebnisse bis zum Alter von acht Jahren machen deutlich, dass die Entwicklungsprognose von sehr kleinen Frühgeborenen und von Kindern postnatal depressiver Mütter davon abhängt, wie die frühe Beziehung zwischen Mutter und Risikokind gelingt. Sie unterstreichen damit die besondere Bedeutung der frühen Mutter-Kind-Interaktion in der Entwicklung von Risikokindern.
Entwicklungspsychopathologie
(1998)