Oppositional defiant disorder/conduct disorder co-occurrence increases the risk of Internet addiction in adolescents with attention-deficit hyperactivity disorder

Objectives The aims of this cross-sectional study were to assess the prevalence of Internet addiction (IA) in a clinical sample of adolescents with attention-deficit hyperactivity disorder (ADHD) and to detect the moderating effects of co-occurring oppositional defiant disorder/conduct disorder (ODD/CD) on the association between ADHD and IA. Methods The study group comprised 119 adolescent subjects who were consecutively referred to our outpatient clinic with a diagnosis of ADHD. The Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was completed by parents, and subjects were asked to complete the Internet Addiction Scale (IAS). Results The IAS results indicated that 63.9% of the participants (n = 76) fell into the IA group. Degree of IA was correlated with hyperactivity/impulsivity symptoms but not with inattention symptoms. As compared to the ADHD-only group (without comorbid ODD/CD), ADHD + ODD/CD subjects returned significantly higher scores on the IAS. Conclusions As adolescents with ADHD are at high risk of developing IA, early IA detection and intervention is of great importance for this group. In addition, adolescents with ADHD + ODD/CD may be more vulnerable to IA than those in the ADHD-only group and may need to be more carefully assessed for IA

Referral pattern and special interests in children and adolescents with Asperger syndrome: a Turkish referred sample

Objectives: To investigate the most frequent reasons for referral, the most common special interests, age at first referral to a mental health service, and the age of diagnosis in children and adolescents with Asperger syndrome living in Turkey

Psychiatric disorders in individuals with high-functioning autism and Asperger's disorder: Similarities and differences

Objectives. To investigate and compare the rate and type of psychiatric co-morbidity in individuals with diagnosis of high functioning autism (HFA) and Asperger's disorder (AS). Methods. This study includes 30 children and adolescents with diagnosis of HFA and 30 with diagnosis of AS. Diagnoses of HFA and AS were made using strict DSM-IV criteria. Psychiatric co-morbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL-T). Results. The rate of comorbid psychiatric disorders was very high in both groups (93.3% in HFA and 100% in AS). The most common disorder in both groups was attention deficit hyperactivity disorder. There was no statistically significant difference between groups in the rate of associated psychiatric disorders, except for major depressive disorder (P = 0.029) and ADHD-combined type (P = 0.030). The AS group displayed greater comorbidity with depressive disorders and ADHD-CT. Conclusion. From a clinical perspective, it could be concluded that both disorders involve a high risk for developing psychiatric disorders, with AS patients at greater risk for depression. From a nosological perspective, the substantial similarities in terms of psychiatric comorbidity may support the idea that both disorders are on the same spectrum and differs in some aspects

Case Report

ABS TRACT Asperger's disorder (AD) is a pervasive developmental disorder characterized by social impairment, restricted interests and repetitive behaviors. It is seldom that individuals with AD are referred to a psychiatry clinic only for their social and communication deficits. Quite often, the main reason for referral is the presence of other disabling symptoms, such as physical aggression and depression. Although diagnosed mainly in children, AD is increasingly being diagnosed for the first time in adulthood. Here, we present a 24-year-old patient with recurrent depression who was diagnosed as having AD for the first time in adulthood. This case is important to show the difficulty of diagnosing AD for the first time in adulthood and to show how a proper and effective treatment may be delayed if the underlying diagnosis of AD is missed for years. We wanted to emphasize the importance of developmental history and the usefulness of liaison with child and adolescent psychiatry in similar cases when the diagnosis is not clear. (Arc hi ves of Neu ropsy chi atry 2013; 50: 78-81) Key words: Asperger's disorder, adulthood, diagnosis, depression. Conflict of interest: The authors reported no conflict of interest related to this article. ÖZET Asperger Bozukluğu (AB), sosyal etkileşim bozukluğu, kısıtlı ilgi alanı ve davranışlarla karakterize yaygın gelişimsel bir bozukluktur. AB olan bireyler nadiren sadece sosyal ve iletişim zorlukları nedeniyle kliniğe başvururlar. Asıl başvuru sebebi sıklıkla, fiziksel agresyon ve depresyon gibi işlevselliği etkileyen diğer belirtilerin varlığıdır. AB tanısı genellikle çocukluk çağında konsa da, erişkin dönemde tanı konma sıklığının son yıllarda arttığı bildirilmektedir. Bu makalede tekrarlayıcı depresif atakları olan ve ilk olarak erişkin çağda AB tanısı konan bir olgu sunulmuştur. Olgumuz daha önce tanı almamış erişkin dönemi AB olgularında tanı koyma zorlukların dikkat çekmesi, altta yatan AB tanısının yıllarca atlandığında tam ve etkili bir tedavinin nasıl gecikebileceğini göstermesi açısından önemlidir. Bu olgu sunumu ile psikiyatri kliniklerine çeşitli belirtilerle başvuran bireylerden gelişim öyküsü alınmasının önemi ve tanı karmaşası yaşanan benzer olgularda çocuk ve ergen psikiyatri bölümüyle liyezonun yararlı olacağının vurgulaması amaçlanmıştır. (Nö rop si ki yat ri Ar fli vi 2013; 50: 78-81) Anah tar ke li me ler: Asperger Bozukluğu, erişkin çağ, tanı, depresyon Çıkar çatışması: Yazarlar bu makale ile ilgili olarak herhangi bir çıkar çatışması bildirmemişlerdir

Tactile sensitivity of normal and autistic children

Many children with autistic spectrum disorders have unusual reactions to certain sensory stimuli. These reactions vary along a hyper- to hypo-responsivity continuum. For example, some children overreact to weak sensory input, but others do not respond negatively to even strong stimuli. It is typically assumed that this deviant responsivity is linked to sensitivity, although the particular stage of sensory processing affected is not known. Psychophysical vibrotactile thresholds of six male children (age: 8-12) who were diagnosed to have autistic spectrum disorders and six normal male children ( age: 7-11) were measured by using a two-alternative forced-choice task. The tactile stimuli were sinusoidal displacements and they were applied on the terminal phalanx of the left middle finger of each subject. By using a forward-masking paradigm, 40-and 250-Hz thresholds of the Pacinian tactile channel and 40-Hz threshold of the Non-Pacinian I tactile channel were determined. There was no significant difference between the thresholds of autistic and normal children, and the autistic children had the same detection and masking mechanisms as the normal children. The sensory responsivity of each subject was tested by clinical questionnaires, which showed again no difference between the two subject groups. Furthermore, no significant correlations could be found between the questionnaire data and the psychophysical thresholds. However, there was a high correlation between the data from the tactile and emotional subsets of the questionnaires. These results support the hypothesis that the hyper-and hypo-responsivity to touch, which is sometimes observed in autistic spectrum disorders, is not a perceptual sensory problem, but may probably be emotional in origin

Asperger's disorder and Williams syndrome: a case report

Williams syndrome (WS) is a genetic disorder caused by the hemizygous microdeletion in chromosome 7q11.23. It is characterized by dysmorphic face, cardiovascular disease, idiopathic hypercalcemia, mental retardation, and an uneven profile of cognitive-linguistic abilities and deficits. The presence of autistic features in individuals with WS is a controversial issue. While there are reports that describe them as overly friendly with excessive sociability and good empathic skills, some recent studies focus more on the qualitative impairment of their social abilities. Here, we report the clinical presentation and follow-up of an eight-year-old boy with WS and clear problems in his social interaction, non-verbal communication and circumscribed interests. To our knowledge, this is the first case report on the coexistence of WS and Asperger's disorder. It also differs from previous papers on the comorbidity of WS and autism spectrum disorders, by depicting a highly verbal, non-retarded child followed for seven years through adolescence

Prenatal androgens and autistic, attention deficit hyperactivity disorder, and disruptive behavior disorders traits

Objective: Androgen exposure is hypothesized to play a role in the development of autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and disruptive behavior disorders/DBDs (oppositional defiant disorder/ODD and conduct disorder/CD). The aim of this cross-sectional study was to investigate ASD, ADHD, and DBD (ODD and CD) traits in children and adolescents with congenital adrenal hyperplasia (CAH), a natural cause of prenatal androgen excess in females. Methods: Forty-five children and adolescents (27 girls, mean age 11.1 +/- 3; 18 boys, mean age 10.8 +/- 3.6) with CAH and their unaffected siblings (16 girls, mean age 11.4 +/- 3.9; 14 boys, mean age 12.6 +/- 4.2) were included in the study. Parents completed the Social Communication Questionnaire, to measure ASD symptoms; and the Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale to assess ADHD and DBD traits. Results: In this study, boys but not girls with CAH showed higher autistic traits. There was no significant difference between either girls or boys with CAH and their unaffected counterparts with respect to inattention or hyperactivity symptoms. Boys with CAH showed more ODD symptoms than the unaffected boys. There was a trend for boys to have more CD symptoms compared to unaffected boys. Conclusions: Our study does not support the hypothesis that prenatal androgen exposure is associated with ASD, ADHD or DBDs. Postnatal/circulating androgen levels, higher testosterone/cortisol ratio, lower basal cortisol or dysregulation in HPA axis might be related to higher autistic traits or increased DBDs symptoms found in boys with CAH. Further investigations with larger groups are needed to clarify these associations