Attention-Deficit and Disruptive Behavior Disorders
- Attention-Deficit Hyperactivity Disorder: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/
- Conduct disorder: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001917/
- Oppositional Defiant Disorder: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002504/
Chronis-Tuscano, A., Molina, B. G., Pelham, W. E., Applegate, B., Dahlke, A., Overmyer, M., & Lahey, B. B. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 67(10), 1044-1051. doi:10.1001/archgenpsychiatry.2010.127
Context: Major depression and dysthymia in adolescence are associated with substantial disability, need for mental health services, and risk for recurrence. Concrete suicidal ideation and attempts during adolescence are particularly associated with significant distress, morbidity, and risk for completed suicide. Objectives: To test the hypothesis that young children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for depression and suicidal ideation and attempts during adolescence and to identify early predictors of which young children with ADHD are at greatest risk. Design: Prospective follow-up study. Setting: Chicago, Illinois, and Pittsburgh, Pennsylvania. Patients: A cohort of 125 children who met DSM-IV criteria for ADHD at 4 to 6 years of age and 123 demographically matched comparison children without ADHD were prospectively followed up in 7 structured diagnostic assessments of depression and suicidal behavior in assessment years 6 through 14, spanning 9 through 18 years of age. Main Outcome Measures: DSM-IV criteria for depressive disorders and suicidal behavior. Results: Children with ADHD at 4 to 6 years of age were at greatly increased risk for meeting DSM-IV criteria for major depression or dysthymia (hazard ratio,4.32) and for attempting suicide (hazard ratio,3.60) through the age of 18 years relative to comparison children. There were marked variations in risk for these outcomes among children with ADHD, however. Within the ADHD group, children with each subtype of ADHD were at risk but for different adverse outcomes. Girls were at greater risk for depression and suicide attempts. Maternal depression and concurrent child emotional and behavior problems at 4 to 6 years of age predicted depression and suicidal behavior. Conclusions: All subtypes of ADHD in young children robustly predict adolescent depression and/or suicide attempts 5 to 13 years later. Furthermore, female sex, maternal depression, and concurrent symptoms at 4 to 6 years of age predict which children with ADHD are at greatest risk for these adverse outcomes. Identifying high-risk young children with ADHD sets the stage for early prevention trials to reduce risk for later depression and suicidal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Impey, M. M., & Heun, R. R. (2011). P03-447 - Suicidality in ADHD: A review. European Psychiatry, 26, 1617. doi:10.1016/S0924-9338(11)73321-1
Introduction: Both Attention Deficit Hyperactivity Disorder (ADHD) and suicidal behaviour are common psychiatric conditions with significant social and emotional morbidity. Although completed suicide in ADHD has been assessed in a previous meta-analysis, other domains of suicidal behaviour such as attempts and ideation have been documented only in individual studies. This review provides a summary of these studies in order to examine the relationship between attention deficit and risk to self. Method: Electronic and manual literature search of MEDLINE, EMBASE and PSYCHINFO, using a range of search terms around suicidality, attention-deficit and hyperactivity. Articles included both those looking at diagnosis of ADHD in suicidal populations, and those looking at suicidality in pre-diagnosed ADHD populations. Results: Wide variation was seen in all dimensions, with the main determining factor being co-morbid diagnoses. Suicidal populations: In populations completing suicide, ADHD was present in 4 to 25.9%. In suicide attempt and ideation populations, 1.6 to 65% and 10.5–31.8% respectively had ADHD. Attention deficit disorders were diagnosed more frequently in suicidal males than females. Age and location differences were not consistent across groups. ADHD populations: In those with diagnosed ADHD, 9.1–70% had attempted suicide and 15.8–66.3% described suicidal ideation. Higher rates were seen in prison inmates and drug dependent subjects. Discussion: Although there is a positive relationship between ADHD and risk to self, the magnitude can vary greatly between different populations. Further research on larger samples is necessary to firmly establish this. The process of risk assessment in ADHD needs to take into account the possibility of intentional self-injury and provide management strategies. [Copyright &y& Elsevier]
Manor, I. I., Gutnik, I. I., Ben-Dor, D. H., Apter, A. A., Sever, J. J., Tyano, S. S., & ... Zalsman, G. G. (2010). Possible association between attention deficit hyperactivity disorder and attempted suicide in adolescents – A pilot study. European Psychiatry, 25(3), 146-150. doi:10.1016/j.eurpsy.2009.06.001
Abstract: Objective: Both adolescent suicide and attention deficit hyperactivity disorder (ADHD) are troubling phenomena with high comorbidity, including impulsivity, depression and personality disorders (PD). Studies on the association between these two phenomena are relatively rare. This pilot study''s aim was to estimate the rate of ADHD in adolescents attempting suicide. Method: Subjects constituted consecutive admissions to the psychiatric emergency room (ER) who were admitted as a result of attempting suicide. Assessment included the use of the Kiddie-SADS, Strengths and Difficulties Questionnaire (SDQ) and the Conners’ Rating Scale (CRS). Those diagnosed as suffering from ADHD were assessed by a standardized Continuous Performance Test (Test of Variables of Attention [TOVA]) that included methylphenidate (MPH) challenge. Twenty-three (23) adolescents completed the study. M:F ratio was 5:18, respectively. Results: Of the 23 participants who completed the study, 65% were diagnosed with ADHD, 43.5% with depression and 39% with clusterB PD. ADD/ADHD ratio was 66%:34%. Only five of the patients were formerly diagnosed as ADHD, only three had been medicated and 14 out of 15 adolescents responded well to MPH challenge. Conclusion: These preliminary results suggest a significant association between ADHD and suicidal behavior in adolescents. Further study is needed to establish this association and assess the causality. [Copyright &y& Elsevier]
Murphy, K., Barkley, R., & Bush, T. (2002). Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational, and clinical history. Journal of Nervous & Mental Disease, 190(3), 147-157. Retrieved from EBSCOhost.
The present study sought to examine subtype differences in comorbidity and in antisocial, educational, and treatment histories among young adults (ages 17-27) with attention deficit hyperactivity disorder (ADHD). Comparisons were made between ADHD Combined Type (ADHD-C; N = 60) and Predominantly Inattentive Type (ADHD-I; N = 36) relative to each other and to a community control group of 64 adults. Both ADHD groups had significantly less education, were less likely to have graduated from college, and were more likely to have received special educational placement in high school. Both groups also presented with a greater likelihood of dysthymia, alcohol dependence/abuse, cannabis dependence/abuse, and learning disorders, as well as greater psychological distress on all scales of the SCL-90-R than the control group. Both ADHD groups were more likely to have received psychiatric medication and other mental health services than control adults. In comparison with ADHD-I, adults with ADHD-C differed in only a few respects. The C-type adults were more likely to have oppositional defiant disorder, to experience interpersonal hostility and paranoia, to have attempted suicide, and to have been arrested than the ADHD-I adults. These results are generally consistent with previous studies of ADHD in children, extend these findings to adults with ADHD, and suggest that the greater impulsivity associated with the ADHD-C subtype may predispose toward greater antisocial behavior and its consequences than does ADHD-I type in adults.
Ng, S., Ran, M., & Chan, C. (2010). Factors related to suicidal ideation among adolescents in Hong Kong. Illness, Crisis, & Loss, 18(4), 341-354. doi:10.2190/IL.18.4.d
The study investigated the relations among suicidal ideation, general mental health status (domains: depression, lack of confidence and uselessness; measured by the shorter General Health Questionnaire [GHQ]), and psychosocial difficulties and strengths with 2638 secondary school students in Hong Kong. A cross-sectional survey using self-report questionnaires was carried out. Suicidal ideation was assessed by four relevant items on GHQ. Overall prevalence of suicidal ideation was revealed to be 14.6%, with 1.9% at severe level. Binary logistic regression indicated that factors associated with increased level of suicidal ideation were being female, lack of confidence, conduct disorder, and emotional symptoms. Factors associated with lowered level of suicidal ideation were spirituality, tranquility, resilience, and being in senior grades. The prevalence of suicidal ideation revealed in this study is lower than findings of other local studies which included nonschool participants. This seems to confirm the overemphasis of academic achievements in Chinese culture. Similar to Western studies, being female appeared to be a risk factor in the current study, but showed a relatively lower odds ratio (1.67, versus over 2 in Western studies). Suicidal ideation among male Chinese adolescents appeared to be more prevalent than we used to believe. Apart from addressing risk factors and psychopathology, the findings of the current study point to the desirability of also addressing the spiritual and meaning domains in suicide prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Nock, M. K. (2009). Suicidal Behavior Among Adolescents: Correlates, Confounds, and (the Search for) Causal Mechanisms. Journal of the American Academy of Child & Adolescent Psychiatry, 48(3), 237-239. doi:10.1097/CHI.0b013e318196b944
The article identifies the factors triggering the suicidal behavior among adolescents in the U.S. Results of a survey conducted on the behavior of adolescents in the nation reveal that suicide is the third leading cause of death among children and adolescents in the nation. Analysis on the possible factors that trigger suicide can be attributed to genetics, psychology and social relations. Potential factors that trigger suicide include bullying and victimization during childhood, conduct disorder and major depression.
Soo-Churl, C., Jae-Won, K., Hyun-Jung, C., Boong-Nyun, K., Min-Sup, S., Jong-Ha, L., & Eun-Hui, K. (2008). Associations between symptoms of attention deficit hyperactivity disorder, depression, and suicide in Korean female adolescents. Depression & Anxiety (1091-4269), 25(11), E142-E146. doi:10.1002/da.20399
The objective of this study was to examine the associations between symptoms of attention-deficit/hyperactivity disorder (ADHD), depression, and suicide in Korean female adolescents. It was hypothesized that the relationship between ADHD symptoms and suicidal ideation would be mediated by the level of depressive symptoms. Seven hundred and eighty-eight high school girls completed the Conners/Wells Adolescent Self-Report Scale: Short Form, Children's Depression Inventory, and Reynolds Suicidal Ideation Questionnaire. Path analyses were conducted using the statistical program, AMOS version 4.0, to determine the best fitting model. The conduct, cognitive, and hyperactivity problems of the ADHD symptoms in each domain were associated positively with the depressive symptoms, with the depressive symptoms being associated with suicidal ideation. This initially proposed model represented an acceptable fit to the data (root mean square error of approximation, RMSEA=0.077; normed fit index, NFI=0.998; non-NFI, NNFI=0.990; comparative fit index, CFI=0.998). The inclusion of a direct path from the conduct problems of ADHD symptoms to suicidal ideation significantly improved the model fit (RMSEA=0, NFI=1, NNFI=1, CFI=1). The results of our study suggest that depressive symptoms partially mediate the relationship between ADHD symptoms and suicidal ideation, and that the conduct problems of ADHD symptoms are associated with suicidal ideation both directly and indirectly via the depressive symptoms in Korean female adolescents. Depression and Anxiety, 2008. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]
Wyman, P. A., Gaudieri, P. A., Schmeelk-Cone, K., Cross, W., Brown, C., Sworts, L., & ... Nathan, J. (2009). Emotional Triggers and Psychopathology Associated with Suicidal Ideation in Urban Children with Elevated Aggressive-Disruptive Behavior. Journal of Abnormal Child Psychology, 37(7), 917-928. doi:10.1007/s10802-009-9330-4
8.6% suicidal ideation (SI) was found among 349 urban 6–9 year olds in the top tercile of aggressive-disruptive behavior. SI was associated with more self-reported depression, ODD, conduct problems, and ADHD symptoms (ES 0.70–0.97) and 3.5–5 times more clinically significant symptoms. Parents rated more symptoms in older children associated with SI compared to parents of similar age children without SI, including greater somatic and behavior problems in 8–9 year olds with SI. Parent atings did not differentiate SI and non-SI in 6–7 year olds. SI frequently co-occurred with thoughts about death. Children described anger, dysphoria and interpersonal conflict as motivators/triggers for SI and worries about safety/health as motivator/triggers for thoughts about death, suggesting that problems managing emotionally challenging situations are a specific factor in initiating SI. Universal and indicated interventions for children to strengthen emotional self-regulation and behavioral control are recommended to complement the current emphasis on suicide prevention among adolescents. [ABSTRACT FROM AUTHOR]