Child Neurodevelopmental and Behavioural Problems are Intercorrelated and Dimensionally Distributed in the General Population

The Autism – Tics, AD/HD, and other Comorbidities inventory (A-TAC) is a comprehensive interview for evaluating problems related to autism spectrum disorders (ASD), tic disorders, attention-deficit/hyperactivity disorder (AD/HD), and common comorbid conditions in children and adolescents. A-TAC telephone interviews were administered to parents of 2,957 children aged nine- or twelve-years, representing one in each twin pair included in the populationbased Child and Adolescent Twin Study in Sweden (CATSS). A total of 16.4% were screen-positive for one or several of the targeted disorder, 1.3% for ASD and 5.6% for AD/HD. All types of problems were more common among boys, with the exception of those related to “eating habits”. They were all dimensionally/continuously distributed, highly inter-correlated, and overlapped across types. They aggregated in three basic factors corresponding to externalizing/disruptiveness, socio-communicative problems, and compulsiveness. Population-based data on problems in children thus challenge current categorical diagnostic definitions, calling for dimensional and complementary models of problem descriptions

On the validity of neurodevelopmental disorders

Abstract Introduction: Validity is important at different levels in psychiatry. Valid structured instruments are important aids in screening and diagnostics, in both research and clinical practice. An aim of the diagnostic procedure is to yield valid diagnoses. Ultimately, the validity of structured instruments (non-empirical) and clinical diagnoses depends on the validity of the diagnostic classification system and its constructs. Aims and methods: (1) To validate the Autism – Tics, ADHD, and other Comorbidities inventory (A-TAC), developed for screening in large-scale studies, against clinical diagnoses and an established screening instrument (Child Behavior Checklist [CBCL]). (2) To determine prevalence rates and distributions of neurodevelopmental problems (NDPs) and general psychiatric problems as well as patterns of co-occurrence in a general population sample according to the A-TAC. (3) To qualitatively explore patients’ own experiences of being diagnosed with ADHD as an adult in an attempt to validate the diagnosis from a patient perspective. Results: The A-TAC showed excellent inter-rater reliability (ICC ≥0.97). ICCs for test-retest reliability were 0.77-0.97 for most modules. AUCs were around 0.90 for autism spectrum disorders (ASDs) and ADHD, and 0.71-0.84 for the other NDPs. Optimal cut-offs gave sensitivity around 0.90 and specificity around 0.75 for ASDs and ADHD. Cohen’s κ was > 0.60 for ASDs and ADHD. Sensitivity and Cohen’s κ were lower for the other NDPs. The A-TAC had moderate convergent validity with the CBCL on subscales that tended to target the same areas, but provided a more detailed and specific assessment of ASDs and related NDPs. Problems were continuously distributed and highly inter-correlated across types. There was a complex intra- and inter-individual variation of experiences of being diagnosed with ADHD, focused on diagnosis, identity, and life, but positive experiences were dominant. All but one interviewee expressed important positive consequences of being diagnosed. About half of them acknowledged negative aspects, but none regretted going through the neuropsychiatric evaluation. Conclusions: The results support the reliability and validity of the A-TAC in identifying ASDs, ADHD, and common comorbid NDPs. From a patient perspective, an ADHD diagnosis brings major benefits compared to the undiagnosed situation. Knowledge of an individual’s experiences is important for professionals as they can affect well-being and interfere with different treatments. Negative experiences especially might need to be addressed in the treatment work. Using the patient’s perspective may help validate psychiatric diagnoses, and is consistent with the idea of incorporating consequences into the concept of validity

Experienced consequences of being diagnosed with ADHD as an adult - a qualitative study.

Despite increasing knowledge of attention deficit hyperactivity disorder (ADHD) across the life span, there is still little research on adults' own experiences of being diagnosed with ADHD. The aim of the present study was to explore and describe patients' experiences and perceptions of being diagnosed with ADHD in adulthood. The study can be seen as an attempt to validate the diagnosis from a patient perspective

The Autism-Tics, AD/HD and other Comorbidities (A-TAC) telephone interview: Convergence with the Child Behavior Checklist (CBCL).

Objective: To compare telephone interview screening for child psychiatric/neuropsychiatric disorders using the inventory of Autism-Tics, Attention deficit/hyperactivity disorder (AD/HD) and other Comorbidities (A-TAC) with results from the Child Behavior Checklist (CBCL). Background: The A-TAC is a parent telephone interview focusing on autism spectrum disorders (ASDs) and co-existing problems, developed for lay interviewers. Subjects and methods: A-TAC telephone interviews and CBCL questionnaires were obtained from parents of 106 Swedish twin pairs aged 9 and 12 years. Results: Correlations between A-TAC modules and CBCL scales aimed at measuring similar concepts were generally significant albeit modest, with correlation coefficients ranging from 0.30 through 0.55. Conclusion: The A-TAC has convergent validity with the CBCL in several problem areas, but the A-TAC also provides more detailed and specific assessments of ASD symptoms and related neuropsychiatric problems

Psychological manifestations of celiac disease autoimmunity in young children

BACKGROUND AND OBJECTIVES: Psychological symptoms can be associated with celiac disease; abstract however, this association has not been studied prospectively in a pediatric cohort. We examined mother report of psychological functioning in children persistently positive for tissue transglutaminase autoantibodies (tTGA), defined as celiac disease autoimmunity (CDA), compared with children without CDA in a screening population of genetically at-risk children. We also investigated differences in psychological symptoms based on mothers' awareness of their child's CDA status. METHODS: The Environmental Determinants of Diabetes in the Young study followed 8676 children to identify triggers of type 1 diabetes and celiac disease. Children were tested for tTGA beginning at 2 years of age. The Achenbach Child Behavior Checklist assessed child psychological functioning at 3.5 and 4.5 years of age. RESULTS: At 3.5 years, 66 mothers unaware their child had CDA reported more child anxiety and depression, aggressive behavior, and sleep problems than 3651 mothers of children without CDA (all Ps ≤ .03). Unaware-CDA mothers also reported more child anxiety and depression, withdrawn behavior, aggressive behavior, and sleep problems than 440 mothers aware of their child's CDA status (all Ps ≤.04). At 4.5 years, there were no differences. CONCLUSIONS: In 3.5-year-old children, CDA is associated with increased reports of child depression and anxiety, aggressive behavior, and sleep problems when mothers are unaware of their child's CDA status. Mothers' knowledge of their child's CDA status is associated with fewer reports of psychological symptoms, suggesting that awareness of the child's tTGA test results affects reporting of symptoms

Complement gene variants in relation to autoantibodies to beta cell specific antigens and type 1 diabetes in the TEDDY Study

A total of 15 SNPs within complement genes and present on the ImmunoChip were analyzed in The Environmental Determinants of Diabetes in the Young (TEDDY) study. A total of 5474 subjects were followed from three months of age until islet autoimmunity (IA: n = 413) and the subsequent onset of type 1 diabetes (n = 115) for a median of 73 months (IQR 54-91). Three SNPs within ITGAM were nominally associated (p < 0.05) with IA: rs1143678 [Hazard ratio; HR 0.80; 95% CI 0.66-0.98; p = 0.032], rs1143683 [HR 0.80; 95% CI 0.65-0.98; p = 0.030] and rs4597342 [HR 1.16; 95% CI 1.01-1.32; p = 0.041]. When type 1 diabetes was the outcome, in DR3/4 subjects, there was nominal significance for two SNPs: rs17615 in CD21 [HR 1.52; 95% CI 1.05-2.20; p = 0.025] and rs4844573 in C4BPA [HR 0.63; 95% CI 0.43-0.92; p = 0.017]. Among DR4/4 subjects, rs2230199 in C3 was significantly associated [HR 3.20; 95% CI 1.75-5.85; p = 0.0002, uncorrected] a significance that withstood Bonferroni correction since it was less than 0.000833 (0.05/60) in the HLA-specific analyses. SNPs within the complement genes may contribute to IA, the first step to type 1 diabetes, with at least one SNP in C3 significantly associated with clinically diagnosed type 1 diabetes