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Background: We investigated the effectiveness of Nurse‐Family Partnership (NFP), a prenatal‐to‐age‐two‐years home‐visiting programme, in British Columbia (BC), Canada. Methods: For this randomised controlled trial, we recruited participants from 26 public health settings who were: <25 years, nulliparous, <28 weeks gestation and experiencing socioeconomic disadvantage. We randomly allocated participants (one‐to‐one; computer‐generated) to intervention (NFP plus existing services) or comparison (existing services) groups. Prespecified outcomes were prenatal substance exposure (reported previously); child injuries (primary), language, cognition and mental health (problem behaviour) by age two years; and subsequent pregnancies by 24 months postpartum. Research interviewers were masked. We used intention‐to‐treat analyses. (ClinicalTrials.gov, NCT01672060.) Results: From 2013 to 2016 we enrolled 739 participants (368 NFP, 371 comparison) who had 737 children. Counts for child injury healthcare encounters [rate per 1,000 person‐years or RPY] were similar for NFP (223 [RPY 316.17]) and comparison (223 [RPY 305.43]; rate difference 10.74, 95% CI ‐46.96, 68.44; rate ratio 1.03, 95% CI 0.78, 1.38). Maternal‐reported language scores (mean, M [SD]) were statistically significantly higher for NFP (313.46 [195.96]) than comparison (282.77 [188.15]; mean difference [MD] 31.33, 95% CI 0.96, 61.71). Maternal‐reported problem‐behaviour scores (M [SD]) were statistically significantly lower for NFP (52.18 [9.19]) than comparison (54.42 [9.02]; MD ‐2.19, 95% CI −3.62, −0.75). Subsequent pregnancy counts were similar (NFP 115 [RPY 230.69] and comparison 117 [RPY 227.29]; rate difference 3.40, 95% CI ‐55.54, 62.34; hazard ratio 1.01, 95% CI 0.79, 1.29). We observed no unanticipated adverse events. Conclusions: NFP did not reduce child injuries or subsequent maternal pregnancies but did improve maternal‐reported child language and mental health (problem behaviour) at age two years. Follow‐up of long‐term outcomes is warranted given that further benefits may emerge across childhood and adolescence. [ABSTRACT FROM AUTHOR]

Background: The standard approach for classifying child/youth psychiatric disorder as present or absent in epidemiological studies is lay‐administered structured, standardized diagnostic interviews (interviews) based on categorical taxonomies such as the DSM and ICD. Converting problem checklist scale scores (checklists) to binary classifications provides a simple, inexpensive alternative. Methods: Using assessments obtained from 737 parents, we determine if child/youth behavioral, attentional, and emotional disorder classifications based on checklists are equivalent psychometrically to interview classifications. We test this hypothesis by (1) comparing their test–retest reliabilities based on kappa (κ), (2) estimating their observed agreement at times 1 and 2, and (3) in structural equation models, comparing their strength of association with clinical status and reported use of prescription medication to treat disorder. A confidence interval approach is used to determine if parameter differences lie within the smallest effect size of interest set at ±0.125. Results: The test–retest reliabilities (κ) for interviews compared with checklists met criteria for statistical equivalence: behavioral,.67 and.70; attentional,.64 and.66; and emotional,.61 and.65. Observed agreement between the checklist and interviews on classifications of disorder at times 1 and 2 was, on average, κ =.61. On average, the β coefficients estimating associations with clinical status were.59 (interviews) and.63 (checklists); and with prescription medication use,.69 (interviews) and.71 (checklists). Behavioral and attentional disorders met criteria for statistical equivalence. Emotional disorder did not, although the coefficients were stronger numerically for the checklist. Conclusions: Classifications of child/youth psychiatric disorder from parent‐reported checklists and interviews are equivalent psychometrically. The practical advantages of checklists over interviews for classifying disorder (lower administration cost and respondent burden) are enhanced by their ability to measure disorder dimensionally. Checklists provide an option to interviews in epidemiological studies of common child/youth psychiatric disorders. [ABSTRACT FROM AUTHOR]

Background: A better understanding of factors contributing to the observed variability in estimates of test–retest reliability in published studies on standardized diagnostic interviews (SDI) is needed. The objectives of this systematic review and meta‐analysis were to estimate the pooled test–retest reliability for parent and youth assessments of seven common disorders, and to examine sources of between‐study heterogeneity in reliability. Methods: Following a systematic review of the literature, multilevel random effects meta‐analyses were used to analyse 202 reliability estimates (Cohen's kappa = ҡ) from 31 eligible studies and 5,369 assessments of 3,344 children and youth. Results: Pooled reliability was moderate at ҡ = .58 (CI 95% 0.53–0.63) and between‐study heterogeneity was substantial (Q = 2,063 (df = 201), p < .001 and I2 = 79%). In subgroup analysis, reliability varied across informants for specific types of psychiatric disorder (ҡ = .53–.69 for parent vs. ҡ = .39–.68 for youth) with estimates significantly higher for parents on attention deficit hyperactivity disorder, oppositional defiant disorder and the broad groupings of externalizing and any disorder. Reliability was also significantly higher in studies with indicators of poor or fair study methodology quality (sample size <50, retest interval <7 days). Conclusions: Our findings raise important questions about the meaningfulness of published evidence on the test–retest reliability of SDIs and the usefulness of these tools in both clinical and research contexts. Potential remedies include the introduction of standardized study and reporting requirements for reliability studies, and exploration of other approaches to assessing and classifying child and adolescent psychiatric disorder. [ABSTRACT FROM AUTHOR]

Background: Individuals born extremely preterm are exposed to significant perinatal stresses that are associated with an increased risk of psychopathology. However, a paucity of longitudinal studies has prevented the empirical examination of long‐term, dynamic effects of perinatal adversity on mental health. Here, internalizing and externalizing problems from adolescence through adulthood were compared in individuals born at extremely low birth weight (ELBW; <1,000 g) and normal birth weight (NBW; >2,500 g). Methods: Internalizing and externalizing data were collected over 20 years in three waves, during adolescence, young adulthood, and adulthood. Growth models were used to compare longitudinal trajectories in a geographically based sample of 151 ELBW survivors and 137 NBW control participants born between 1977 and 1982 matched for age, sex, and socioeconomic status at age 8. Results: After adjusting for sex, socioeconomic and immigrant status, and family functioning, ELBW survivors failed to show the normative, age‐related decline in internalizing problems over time relative to their NBW peers (β = .21; p < .01). Both groups exhibited small declines in externalizing problems over the same period. Self‐esteem (but not physical health, IQ, or maternal mood) partially mediated the association between ELBW status and internalizing problems. Conclusions: Extremely low birth weight survivors experienced a blunting of the expected improvement in depression and anxiety from adolescence to adulthood. These findings suggest that altered physiological regulatory systems supporting emotional and cognitive processing may contribute to the maintenance of internalizing problems in this population. Read the full article at doi: 10.1111/jcpp.12971 [ABSTRACT FROM AUTHOR]

Background: Preterm birth is associated with an increased risk of depression and anxiety, but it is not known if this is due to greater exposure to risk, or if perinatal adversity amplifies the impact of traditional risk factors. This study sought to determine if exposure to perinatal adversity modifies associations between traditional risk and resilience factors and depression and anxiety in adulthood. Methods: A sample of 142 extremely low‐birth‐weight (ELBW < 1,000 g) survivors and 133 sociodemographically matched normal birth weight (NBW) control participants was followed longitudinally to 22–26 years of age. Separate postnatal risk and resilience scales were created using eight risk and seven resilience factors, respectively. Depression and anxiety were assessed using the internalizing scale of the Young Adult Self‐Report (YASR). This scale was also dichotomized at the 90th percentile to define clinically significant psychopathology. Results: While the average number of risk exposures did not differ between groups, ELBW survivors were more susceptible to risk than NBW control participants. For the ELBW group, each additional risk factor resulted in a 2‐point increase in internalizing scores, and two and a half times the odds of clinically significant internalizing symptoms (OR = 2.47, 95% CI = 1.63, 3.76). The protective effect of resiliency factors was also blunted among ELBW survivors. Conclusions: Extremely low‐birth‐weight survivors may be more sensitive to traditional risk factors for psychopathology and less protected by resiliency factors. Intervention strategies aimed at preventing or reducing exposure to traditional childhood risk factors for psychopathology may reduce the burden of mental illness in adult survivors of prematurity. [ABSTRACT FROM AUTHOR]

Background: Maximizing measurement accuracy is an important aim in child development assessment and research. Parents are essential informants in the diagnostic process, and past research suggests that certain parental characteristics may influence how they report information about their children. This has not been studied in autism spectrum disorders (ASD) to date. We aimed, therefore, to investigate the possible effect that maternal depression might have on a mother's reports of her child's ASD behaviors. Using structural equation modeling, we disaggregated shared from unique variation in the association between latent variable measures of maternal depression and ASD behaviors. Methods: Data were obtained from a study of preschoolers aged 2-4 newly diagnosed with ASD ( n = 214). Information from a parent questionnaire, a semi-structured parent interview, and a semi-structured observational assessment was used to develop a latent variable measure of child ASD behaviors. Mothers reported on their own depression symptoms. We first modeled the covariance between maternal depression and child ASD behavior. Then, to quantify unique variation, we added covariance terms between maternal depression and the residual variation associated with the individual measures of child ASD behaviors. Results: The model demonstrated excellent fit to the underlying data. Maternal self-report of depression symptoms exhibited a significant association with the unique variance of the questionnaire report but not with the latent variable measure of child ASD behavior. A gradient pattern of association was demonstrated between maternal depression and the unique variance of the ASD measures: most strongly for the maternal questionnaire report, more weakly for the maternal semi-structured interview, and to a trivial extent for the observational interview. Conclusions: Parental depression may influence reporting of ASD behaviors in preschoolers. Shared method effects may also contribute to bias. This finding highlights the importance of obtaining multimethod reports of child ASD symptoms. [ABSTRACT FROM AUTHOR]

Background: Although structured interviews are assumed to be scientifically superior to checklists for measuring youth psychopathology, few studies have tested this hypothesis. Interviews place a much greater burden on respondents, making it critical to determine their added value when quantifying psychiatric symptoms. Methods: Confirmatory factor analysis was used to compare interviews and checklists in community ( N = 251) and clinically referred ( N = 406) samples of youth aged 5 to 17 years. We examined the associations between mother-reported externalizing symptoms assessed by interview versus checklist against (a) teacher-reported externalizing symptoms, and (b) child’s gender, academic performance, single- versus two-parent family, and family income. Models in which associations were estimated freely were contrasted to models in which the interview and the checklist were constrained to have equal associations with the variables. Finding these models fit comparably would suggest no difference between interviews and checklists. Results: In the community sample, both the constrained and unconstrained models provided comparable fit to the data, suggesting no marked differences between interviews and checklists. In the clinical sample, associations with the interview were generally stronger. Reducing the number of items on the interview to match those on the 6-item checklist eliminated these differences, suggesting that the increased reliability of the interview scales, afforded by additional items, enhanced their quantification of psychopathology. Conclusions: Consistent with previous studies, interviews were not notably superior to checklists for the measurement of externalizing symptoms. When only a few items are used, small performance differences between checklists and interviews may be due to scale length. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to chart the developmental trajectories of high-functioning children with autism spectrum disorders (ASD) from early childhood to adolescence using the presence and absence of structural language impairment (StrLI) as a way of differentiating autism from Asperger syndrome (AS). Method: Sixty-four high-functioning children with ASD were ascertained at 4–6 years of age from several different regional diagnostic and treatment centers. At 6–8 years of age, the ADI-R and the Test of Oral Language Development were used to define an autism group (those with StrLI at 6–8 years of age) and an AS group (those without StrLI). Growth curve analysis was then used to chart the developmental trajectories of these children on measures of autistic symptoms, and adaptive skills in communication, daily living and socialization. Results: Differentiating the ASD group in terms of the presence/absence of StrLI provided a better explanation of the variation in growth curves than not differentiating high-functioning ASD children. The two groups had similar developmental trajectories but the group without StrLI (the AS group) was functioning better and had fewer autistic symptoms than the group with StrLI (the autism group) on all measures across time. The differences in outcome could not be explained by non-verbal IQ or change in early language skills. Conclusion: Distinguishing between autism and Asperger syndrome based on the presence or absence of StrLI appears to be a clinically useful way of classifying ASD sub-types. [ABSTRACT FROM AUTHOR]

Background: This study describes the development of the Brief Child and Family Phone Interview (BCFPI) – a computer-assisted telephone interview which adapts the revised Ontario Child Health Study’s (OCHS-R) parent, teacher, and youth self-report scales for administration as intake screening and treatment outcome measures in children’s mental health services. It focuses on the factor structure of the BCFPI’s hypothesized parent-reported child mental health scales describing attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and major depression (MDD). Methods: Data for the analysis come from an OCHS-R measurement study that included two groups of children and adolescents selected from the same urban area: a general population sample ( n = 1,712) and a clinic-referred sample ( n = 1,512); and a third sample that was enlisted in a province-wide implementation study of clinic-referred 6- to 18-year-olds ( n = 56,825). We used confirmatory factor analysis to assess the factor structure of the BCFPI scales in different populations and to test measurement equivalence across selected groups. Results: Despite the strong constraints imposed on the measurement models, estimates of model fit across the three samples were comparable in magnitude and approached the cut-offs suggested for the GFI and CFI (>.9) and RMSEA (<.05). Measurement equivalence was demonstrated between the OCHS-R clinic and provincial implementation samples. Within the implementation sample, the factor structure of the BCFPI scales was equivalent for boys versus girls and for 6- to 12- versus 13- to 18-year-olds. A companion paper examines the test–retest reliability, sensitivity, specificity, and validity of these BCFPI scales when used for screening. Conclusion: This project supports the feasibility and acceptability of a computer-assisted telephone interview for assessing emotional-behavioral problems of children and adolescents referred to children’s mental health services. [ABSTRACT FROM AUTHOR]

Background: This study examines the use of the Brief Child and Family Phone Interview (BCFPI) to screen for childhood psychiatric disorder based on Diagnostic Interview Schedule for Children Version IV (DISC-IV) classifications of attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety (SAD), generalized anxiety (GAD) and major depression (MDD). Methods: Data for analysis come from a sample of 399 children and adolescents aged 5–17 years old referred to child mental health outpatient services in three Ontario cities. Mothers were administered the BCFPI on three occasions: baseline, 2 and 13 months; and the DISC-IV on two occasions: 1 and 12 months. Results: Based on kappa, test–retest reliability for disorders classified by the BCFPI exceeded .50 for all conditions except MDD (.45). In receiver operating characteristic (ROC) analysis, area-under-the-curve (AUC) estimates for BCFPI scale score associations with DISC-IV classifications of disorder exceeded .80 for CD, ODD, ADHD and SAD; and were lower for GAD (.76) and MDD (.75). In stratified analyses, there were no statistically significant differences in AUC estimates for boys versus girls and 5 to 11 versus 12 to 17-year-olds. Conclusions: Classifications of childhood disorder derived from the BCFPI provided a reasonable approximation to disorders classified by the DISC-IV administered by lay interviewers. [ABSTRACT FROM AUTHOR]

Background: This study examines the longitudinal associations between adolescent tobacco and cannabis use and young adult functioning. Methods: Data for analysis come from the Ontario Child Health Study (OCHS), a prospective study of child health, psychiatric disorder and adolescent substance use in a general population sample that began in 1983, with follow-ups in 1987 and 2001. The sample for analysis includes 1,282 individuals who were between the ages of 12 and 16 years during the original OCHS in 1983 or the first follow-up in 1987 and returned for the 2001 follow-up. Results: Tobacco use in adolescence and continued use in adulthood is associated with increased risk for poorer functioning across multiple domains, including physical health and life satisfaction (.62 and .66 standard units lower, respectively), depression (Odds Ratio = 3.44), personal income ($7,281 less per year) and years of education (2.29 years lower). Cannabis use is associated with a reduced set of adverse outcomes and the magnitude of the effects is weaker. Conclusions: The long-term risks associated with adolescent tobacco and cannabis use speak to the importance of prevention and early intervention. [ABSTRACT FROM AUTHOR]

This study addressed four questions which parents of children with selective mutism (SM) frequently ask: (1) Is SM associated with anxiety or oppositional behavior? (2) Is SM associated with parenting and family dysfunction? (3) Will my child fail at school? and (4) Will my child make friends or be teased and bullied? In comparison to a sample of 52 community controls, 52 children with SM were more anxious, obsessive, and prone to somatic complaints. In contrast, children with SM were less oppositional and evidenced fewer attentional difficulties at school. We found no group differences in family structure, economic resources, family functioning, maternal mood difficulties, recreational activities, or social networks. While parents reported no differences in parenting strategies, children with SM were described as less cooperative in disciplinary situations. The academic (e.g., reading and math) and classroom cooperative skills of children with SM did not differ from controls. Parents and teachers reported that children with SM had significant deficits in social skills. Though teachers and parents rated children with SM as less socially assertive, neither teachers nor parents reported that children with SM were victimized more frequently by peers. [ABSTRACT FROM AUTHOR]

The use of DSM-IV based questionnaires in child psychopathology is on the increase. The internal construct validity of a DSM-IV based model of ADHD, CD, ODD, Generalised Anxiety, and Depression was investigated in 11 samples by confirmatory factor analysis. The factorial structure of these syndrome dimensions was supported by the data. However, the model did not meet absolute standards of good model fit. Two sources of error are discussed in detail: multidimensionality of syndrome scales, and the presence of many symptoms that are diagnostically ambiguous with regard to the targeted syndrome dimension. It is argued that measurement precision may be increased by more careful operationalisation of the symptoms in the questionnaire. Additional approaches towards improved conceptualisation of DSM-IV are briefly discussed. A sharper DSM-IV model may improve the accuracy of inferences based on scale scores and provide more precise research findings with regard to relations with variables external to the taxonomy. [ABSTRACT FROM AUTHOR]

This report describes the evaluation methodology of the Tri-Ministry Study-a school-based trial evaluating the effectiveness of three universal programs: (a) a classwide social skills program (SS), (b) a partner reading program (RE); and, (c) a combination of both (SS & RE), to reduce and prevent behavioural maladjustment among children in the primary division (up to grade 3) of Ontario schools. The trial was done between 1991 and 1995. Sixty schools in 11 boards of education took part and were assigned randomly to program(s) during the study. Contributing to the evaluation database are detailed follow-up assessments (observations, ratings, and standard tests) on 2439 children. Three-level growth trajectory models are used to evaluate program effects. The analysis presented for illustration in this report focuses on reading achievement measured by the Wide Range Achievement Test. A companion paper presents the results of the study and discusses important methodological and programmatic issues applicable to this and other prevention studies in the field. [ABSTRACT FROM AUTHOR]

This report describes program effects of the Tri-Ministry Study-a school-based, longitudinal trial carried out over a 5-year period to assess the effectiveness of classwide social skills training (SS), partner reading (RE), and a combination of both (SS & RE) to reduce maladjustment among children in the primary division (up to grade 3) of Ontario schools. It also places these effects in the context of other school-based prevention studies and discusses them in view of important methodological and programmatic issues. The incremental effects attributable to the intervention programs were small and sporadic. There were statistically significant increases in prosocial behaviour observed in the playgrounds of intervention schools with no differentiation by program type. Furthermore, there was some evidence-a reduction in teacher and parent-rated externalising problems-that the combination of SS & RE and SS alone may have had modest beneficial effects. A review of nine other school-based studies, which evaluated universally delivered mental health prevention programs in general populations of students, revealed similar mixed results. There are both methodologic and programmatic issues implicated in the weak findings that have been reported to date. These issues need to be addressed to advance knowledge about the potential impact of mental-health prevention initiatives delivered universally through school-based programs. A companion paper gives the specific details on the programs, randomisation of schools, selection of subjects, measurements, and analysis. [ABSTRACT FROM AUTHOR]

This study uses information collected on two occasions from a probability sample of families with 8- to 12-year-old children ( N= 718) participating in a general population study in 1983 and follow-up in 1987. It focuses on the association between maternal depressive symptoms and emotional disorder in children and adolescents, taking into consideration the influences of informant rating errors, contextual variables (economic disadvantage and family dysfunction), and child gender. Covariance structure analysis revealed a strong association between maternal depressive symptoms in girls (β= .59 in 1983 and β= .39 in 1987) but not in boys. This association is independent of the impact of contextual variables and the treatment of teacher rating errors. Among adolescent boys, maternal depressive symptoms are correlated with mother rating errors, suggesting the possible presence of maternal bias. [ABSTRACT FROM AUTHOR]

This article examines relationships between psychiatric disorder, poor school performance, family dysfunction and law family income in a cohort of 8-12-year-olds and use of tobacco, marijuana and hard drugs 4 years later. Conduct disorder assessed by teachers predicted use of alcohol and hard drugs, while low family income and poor school performance predicted use of tobacco. Neither attention-deficit disorder nor emotional disorder was related lo adolescent substance use. Although behavioural deviance in childhood is associated with adolescent substance use, it has limited potential for identifying groups at risk in the general population for purposes of preventing substance use in later years. [ABSTRACT FROM AUTHOR]

This article describes the development and evaluation of the revised Ontario Child Health Study (OCHS) scales to measure conduct disorder, oppositional disorder, attention-deficit hyperactivity disorder, overanxious disorder, separation anxiety- and depression based on DSM-III-R symptom criteria. Problem checklist assessments were obtained from parents and teachers of children aged 6-16 and youths aged 12-16 drawn from: (1) a general population sample ( N= 1751); and (2) a mental health clinic sample ( N= 1027) in the tame industrialized, urban setting. Evaluation of the revised OCHS scales indicates that they possess adequate psychometric properties and provide an efficient means to obtain measurements of childhood psychiatric disorder, in general population studies, that correspond to DSM-III-R classification of disorder. [ABSTRACT FROM AUTHOR]

SUMMARY This paper puts forward suggestions for assessing the suitability of existing measures of emotional and behavioral disorders of childhood for use in general populations. Specific attention is focused on the definition of emotional and behavioral disorder, measurement approaches and guidelines for choosing which disorders to study. The measurement criteria under review include acceptability, applicability, procedural adequacy, reliability and validity. These criteria are applied to seven instruments previously described as suitable for epidemiological and clinical research. Among these instruments, the ones developed by Rutter, Achenbach and Quay best meet the criteria and show the most promise of being useful in general populations. Among research priorities for the future, the foremost should include the specification of rules of evidence for establishing the validity of new measures of emotional and behavioral disorder. [ABSTRACT FROM AUTHOR]

A significant percentage of children with disruptive behaviour disorders do not receive mental health assistance. Utilization is lowest among groups whose children are at greatest risk. To increase the availability, accessibility, and cost efficacy of parent training programs, this prospective randomized trial compared a large group community-based parent training program to a clinic-based individual parent training (FT) program. All families of junior kindergartners in the Hamilton public and separate school boards were sent a checklist regarding problems at home. Those returning questionnaires above the 90th percentile were block randomly assigned to: (1) a 12-week clinic-based individual parent training (Clinic/Individual), (2) a 12-week community-based large group parent training (Community/Group), or (3) a waiting list control condition. Immigrant families, those using English as a second language, and parents of children with severe behaviour problems were significantly more liklely to enrol in Community/Groups than Clinic/Individual FT. Parents in Community/Groups reported greater improvements in behaviour problems at home and better maintenance of these gains at 6-month follow-up. A cost analysis showed that, with groups of 18 families, Community/Groups are more than six times as cost effective as Clinic/Individual programs. [ABSTRACT FROM AUTHOR]

This paper examines the effects of a change in the wording of the Child Behavior Checklist (CBCL) instructions for the 0 category on the reported prevalence of behaviors among normal children by their parents. Convenience samples of parents were randomly allocated to complete CBCL items using either the standard instructions 'not true' or 'never or not true' to describe the 0 category. Adding the word 'never' to describe the 0 category decreased parents' use of that category and increased their use of the adjacent, 1, category. Implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

The objective of this paper is to report on the correlates of attention deficit disorder with hyperactivity (ADDH), the associated impairments of ADDH children, and to describe briefly their utilization of services. Our results suggest that household, family, parental, and developmental variables are associated with this disorder. However, children I red, rather than psychosocial, variables emerge as important if one controls for the presence of other disorders. Compared to children without any disorder, ADDH children art- also impaired in their relationships with others, their school performance, and competence in extra-curricular activities. ADDH children utilized mental health, social, and special education services more than non-ADDH children. Nevertheless, it was found that only a minority of ADDH children had received specialized mental health or social services in the past 6 months. [ABSTRACT FROM AUTHOR]

The objective of this paper is to present data from the Ontario Child Health Study on the prevalence of attention deficit disorder with hyperactivity (ADDH). The overall prevalence of ADDH was 9.0% in hoys and 3.3% in girls. There were no significant differences in the prevalence of ADDH by age or urban-rural status, but the disorder was significantly more common in boys than in twirls. The prevalence of various subtypes ADDH was also explored: attention deficit with and without hyperactivity, situational vs pervasive ADDH, and ADDH with and without other disorders. The clinical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder (ASD) is characterized by notable phenotypic heterogeneity, which is often viewed as an obstacle to the study of its etiology, diagnosis, treatment, and prognosis. On the basis of empirical evidence, instead of three binary categories, the upcoming edition of the DSM 5 will use two dimensions - social communication deficits (SCD) and fixated interests and repetitive behaviors (FIRB) - for the ASD diagnostic criteria. Building on this proposed DSM 5 model, it would be useful to consider whether empirical data on the SCD and FIRB dimensions can be used within the novel methodological framework of Factor Mixture Modeling (FMM) to stratify children with ASD into more homogeneous subgroups. Methods: The study sample consisted of 391 newly diagnosed children (mean age 38.3 months; 330 males) with ASD. To derive subgroups, data from the Autism Diagnostic Interview-Revised indexing SCD and FIRB were used in FMM; FMM allows the examination of continuous dimensions and latent classes (i.e., categories) using both factor analysis (FA) and latent class analysis (LCA) as part of a single analytic framework. Results: Competing LCA, FA, and FMM models were fit to the data. On the basis of a set of goodness-of-fit criteria, a 'two-factor/three-class' factor mixture model provided the overall best fit to the data. This model describes ASD using three subgroups/classes (Class 1: 34%, Class 2: 10%, Class 3: 56% of the sample) based on differential severity gradients on the SCD and FIRB symptom dimensions. In addition to having different symptom severity levels, children from these subgroups were diagnosed at different ages and were functioning at different adaptive, language, and cognitive levels. Conclusions: Study findings suggest that the two symptom dimensions of SCD and FIRB proposed for the DSM 5 can be used in FMM to stratify children with ASD empirically into three relatively homogeneous subgroups. [ABSTRACT FROM AUTHOR]