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Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Predictive validity of the Conners' Teacher Rating Scale-Revised (CTRS-R) was evaluated against a semi-structured clinical teacher interview in school children referred for diagnostic assessment of attention-deficit hyperactivity disorder (ADHD). We hypothesized that extreme scale values would increase diagnostic certainty and that classification errors would be associated with comorbid conditions.Method: Children (n = 1038), aged 6 to 12 years, were screened using the CTRS-R and their teachers were interviewed. Three levels of T scores on the 3 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) subscales of the CTRS-R were compared with DSM-IV symptom thresholds by interview. Where subscale scores and interviews showed highest agreement, presence of comorbid disruptive behavioural disorders, reading disability, language impairment, and low IQ were investigated for children classified correctly, compared with incorrectly.Results: T scores of 60 and above on all CTRS-R DSM-IV subscales offered high sensitivity, from 91% to 94%. Only on subscales M (hyperactive-impulsive) and N (total) did T scores of less than 60 offer posttest probabilities of less than 10%, confirming that a child does not reach diagnostic threshold by interview. T scores of 80 and more offered high specificity, from 88% to 93%, but did not provide high posttest probabilities that children reach diagnostic criteria. Classification errors were associated with more language impairment among false positives than true positives on the M (18.9%, compared with 11.3%, P = 0.04) and N (19.0%, compared with 9.5%, P = 0.023) subscales, and more reading disabilities among false positives than among true positives on the N subscale (35.2%, compared with 21.6%, P = 0.009).Conclusions: The ability of the CTRS-R to predict whether clinically referred children reach DSM-IV criteria for ADHD at school is limited. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To describe the properties of a semistructured research interview of parents designed to evaluate attention-deficit hyperactivity disorder (ADHD) and related psychopathology.Method: We examined interrater reliability in 48 videotaped interviews randomly selected from a large clinic sample. We examined convergence of the Parent Interview for Child Symptoms (PICS) and Conners' Parent Rating Scale (CPRS) scores in 594 clinic-referred cases and 26 control subjects, comparing the groups generated by cross-tabulation on measures of intelligence, academic achievement, and inhibitory control.Results: Intraclass correlation coefficients for symptom scores of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) were excellent. We found good reliability for diagnoses of ADHD (e = 0.73) and CD (kappa = 0.73) and excellent reliability for the diagnosis of ODD (kappa = 0.80). Two-thirds of cases were classified similarly on the PICS and the CPRS. Greater impairment in inhibitory control was observed in cases identified as ADHD by the PICS, compared with those identified by the CPRS-ADHD index.Conclusions: The PICS displays good reliability and validity, indicating that a balance between clinical applicability and reliability can be achieved in the development of clinical research instruments. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To determine the prevalence of obsessive--compulsive behaviours (OCB) in a clinical sample of children with attention-deficit hyperactivity disorder (ADHD) and to compare ADHD children (with and without OCB) with respect to clinical and cognitive characteristics and risk factors.Method: We compared ADHD children (n = 134) with and without OCB, and we compared all ADHD children with a group of normal control subjects (n = 26) on various clinical, cognitive, and inhibitory control measures; neurobiological and psychosocial risk factors; and family histories of psychiatric illness.Results: Clinically significant OCB was identified in 11.2% (15/134) of children with ADHD. Comorbid OCB was associated with significantly increased perfectionism, improved teacher ratings of inattention, and a decreased likelihood of having a first-degree relative with ADHD. Comorbid ADHD and OCB may also be associated with increased oppositional behaviour at home and better inhibitory control, though these differences were not statistically significant.Conclusions: Comorbid OCB is common in clinically referred children with ADHD and is associated with increased impairment relative to ADHD alone. Further, children with ADHD and OCB may develop symptoms as the result of different genetic and environmental risk factors, compared with children with ADHD only. [ABSTRACT FROM AUTHOR]

We undertook a systematic review of the literature on the long-term treatment of attention-deficit hyperactivity disorder (ADHD). We used systematic strategies to identify randomized treatment studies in which treatment was administered for 12 weeks or more. We included 14 studies involving 1379 subjects. Because of the limited number of high-quality studies and the heterogeneity of outcome measures, we did not perform meta-analysis. We rated 5 studies as adequate for methodological quality. Five studies followed children for more than 26 weeks. Pharmacologic interventions were studied more frequently than non-pharmacologic ones. Six studies permitted evaluation of the effects of combined drug and behavioural intervention. Twenty-five different outcomes were measured using 26 different tests. Stimulant medication appears to reduce ADHD (7 studies), dysfunctional social behaviour (6 studies), and internalizing symptoms (2 studies). Available studies provide little evidence for improved academic performance with stimulants (3 studies). Medications other than stimulants have not been studied extensively (3 studies). Only 1 study showed that combination therapy adds to the effects of medication. Rigorous treatment research among representative samples of ADHD individuals is needed. [ABSTRACT FROM AUTHOR]

Objective: This study examines the relationship between parents' knowledge of attention-deficit hyperactivity disorder (ADHD) and opinions of treatment and their impact on enrolment in and adherence to both pharmacological and nonpharmacological interventions for children with ADHD.Method: Participants in the study were the parents of 81 children who reached diagnostic criteria for ADHD and who were referred to a treatment study of ADHD involving stimulant medication and parent groups. The mothers completed a modified version of the ADHD Knowledge and Opinion Scale (AKOS) prior to receiving diagnostic feedback and prior to the families' decisions to participate in a 12-month randomized trial (medication [methylphenidate or placebo] and parent groups [training or support]). Treatment enrolment and adherence were monitored over the 12-month trial, and families who remained in the study at 12 months completed another modified AKOS.Results: A higher level of knowledge of ADHD was found to be related to more favourable opinions of parent groups but not of medication. Moreover, parents who were more knowledgeable about ADHD were more likely to enroll in both pharmacological and nonpharmacological treatments. Adherence to pharmacological and nonpharmacological treatments was not predicted by parental knowledge of ADHD or opinions of the treatment.Conclusion: Parents' knowledge of ADHD and opinions of treatments play a significant role in enrollment in treatments for their children with ADHD. Providing information to parents regarding ADHD prior to offering treatment modalities could have a favourable impact on treatment enrollment and hence treatment adherence. [ABSTRACT FROM AUTHOR]

Context: The Agency for Health Care Policy and Research charged the McMaster Evidence-based Practice Center with conducting a comprehensive systematic review of the literature on the treatment of attention-deficit hyperactivity disorder (ADHD), with input from various groups of stakeholders. One strategy used to avoid duplication of work included a critical appraisal of existing systematic reviews and metaanalyses.Objective: To identify and appraise published metaanalyses and systematic reviews on the treatment of ADHD and to produce an annotated bibliography.Data Sources: Medline, Cumulative Index in Nursing and Allied Health (CINAHL), Healthstar, Psycinfo, and Embase were searched to September 1998; the Cochrane Database (1998 issue 3), selected Internet sites, and the files of investigators were also reviewed.Study Selection: Review articles described as systematic reviews or metaanalyses or including a Methods section were identified independently by 3 reviewers.Data Extraction: Two reviewers extracted, by consensus, relevant information on the name, methodological quality, ADHD-related aspects (comorbid disorders, family characteristics) of those reviews; data on the population, study setting, interventions, and outcomes evaluated by the reviews were also retrieved.Results: Thirteen reviews, published from 1982 to 1998, were included. Eight included metaanalysis and 5 a qualitative review. Nonpharmacological treatments were mentioned in 6 reviews and combination therapies in 3. One review focused on the treatment of adults. Forty-seven drugs and 20 adverse effects were mentioned. Most reviews had major methodological flaws.Conclusions: Most published systematic reviews and metaanalyses on the treatment of ADHD have limited value for guiding clinical, policy, and research decisions. A rigorous, systematic review following established methodological criteria is warranted. [ABSTRACT FROM AUTHOR]

Editorial. Focuses on child and adolescent psychiatry in Canada. Integration of child psychopathology research and development in psycholinguistics; Use of clinical epidemiology tools in analyzing child psychopathology; Accounts on the prevalence of attention deficit hyperactivity disorder.

Editorial. Introduces articles in the special issue on child and adolescent psychiatry of the 'Canadian Journal of Psychiatry.' State of child psychiatry in Canada; Quality of research submitted to the journal; State of child psychiatry training in the country.

Editorial. Focuses on the development of the Multimodal Treatment (MTA) Study of Children With Attention-Deficit Hyperactivity Disorder (ADHD). Impact of the study on psychiatric practice; Introduction of several articles related to MTA study; Implications of the MTA results for the efficacy of behavioral interventions for children with ADHD.