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Background It is unknown how much variation in adult mental health problems is associated with differences between societal/cultural groups, over and above differences between individuals. Methods To test these relative contributions, a consortium of indigenous researchers collected Adult Self-Report (ASR) ratings from 16 906 18- to 59-year-olds in 28 societies that represented seven culture clusters identified in the Global Leadership and Organizational Behavioral Effectiveness study (e.g. Confucian, Anglo). The ASR is scored on 17 problem scales, plus a personal strengths scale. Hierarchical linear modeling estimated variance accounted for by individual differences (including measurement error), society, and culture cluster. Multi-level analyses of covariance tested age and gender effects. Results Across the 17 problem scales, the variance accounted for by individual differences ranged from 80.3% for DSM-oriented anxiety problems to 95.2% for DSM-oriented avoidant personality (mean = 90.7%); by society: 3.2% for DSM-oriented somatic problems to 8.0% for DSM-oriented anxiety problems (mean = 6.3%); and by culture cluster: 0.0% for DSM-oriented avoidant personality to 11.6% for DSM-oriented anxiety problems (mean = 3.0%). For strengths, individual differences accounted for 80.8% of variance, societal differences 10.5%, and cultural differences 8.7%. Age and gender had very small effects. Conclusions Overall, adults' self-ratings of mental health problems and strengths were associated much more with individual differences than societal/cultural differences, although this varied across scales. These findings support cross-cultural use of standardized measures to assess mental health problems, but urge caution in assessment of personal strengths.

Green environments are associated with improved child brain development and mental health. We study cross-sectionally the association of the availability of greenspace at home and school with obsessive-compulsive behaviors (OCB) in primary schoolchildren. Greenspace and tree cover surrounding home and school of 378 children aged 9 to 10 in Barcelona (Spain) were characterized using satellite-based indices [Normalized Difference Vegetation Index (NDVI), Modified Soil Adjusted Vegetation Index (MSAVI), Vegetation Continuous Field (VCF)] across buffers of 100, 300, and 500 m, and distance to the nearest green space. OCB was assessed with the Spence Children’s Anxiety Scale-Parent version. Linear and mixed effects models showed that greenspace at school, but not at home, was significantly related to a reduction in OCB across buffers, with benefits for girls and also children with graduate parents. Higher greenspace around the school might be associated with less obsessive-compulsive behavior in primary schoolchildren, especially in girls and those with higher socioeconomic status.

Background and Objectives From a gene-by-environment perspective, parenting in interaction with the polymorphism in the Monoamine oxidase A (MAOA) gene (MAOA-uVNTR) might also be associated with increased callous-unemotional traits (CU) in preschoolers. MAOA-uVNTR results in differential enzyme activity, so that high-activity alleles (MAOA-H) are linked to reduced dopamine, serotonin, and norepinephrine availability in comparison to low-activity allele (MAOA-L). As MAOA-uVNTR has been previously described to moderate the relationship between childhood parental maltreatment and aggressive and antisocial behavior, it may also play a role in CU traits etiology. Methods Data was collected through questionnaires answered by parents and teachers. MAOA-uVNTR was genotyped in 368 Caucasian children from a community sample (51.9% male). Multiple linear regression analyses were conducted to analyze the interaction effect of MAOA genotypes and both positive parenting and punitive parenting practices on CU traits at two different periods (3 and 5 years old) and separately by sex. Results No significant interactions were found for boys. Among girls, a significant interaction effect was found for MAOA-LL carriers, who showed higher CU traits at age 5 when exposed to higher punitive or positive parenting at age 3. Conclusions Our study provides the first evidence for significant MAOA × early parenting effects on CU traits in preschoolers, specifically among female MAOA-LL carriers. This suggests that the MAOA-LL genotype for girls is associated with higher sensitivity to both positive and punitive parenting in girls, so that MAOA-LL emerges as a genotype that confers higher vulnerability to parental influences.

This study ascertains how the proposed subtypes and specifiers of oppositional defiant disorder (ODD) based on irritability and prosocial emotions co-develop and describes the clinical characteristics of the resultant classes. A sample of 488 community children was followed up from ages 3 to 12 years and assessed with categorical and dimensional measures answered by parents and teachers. Latent class growth analysis for three parallel processes [defiant/headstrong, irritability, and limited prosocial emotions (LPE)] identified a 4-class model with adequate entropy (.912) and posterior probabilities of class membership (≥ .921). Class 1 (n = 38, 7.9%) was made up of children with defiant/headstrong with chronic irritability and LPE. Class 2 (n = 128, 26.3%) was comprised of children with defiant/headstrong with chronic irritability and typical prosocial emotions. Class 3 (n = 101, 20.7%) clustered children with LPE without defiant/headstrong and without irritability. Class 4 (n = 220, 45.1%) included children with the lowest scores in all the processes. The classes were distinguishable and showed different clinical characteristics through development. These findings support the validity of ICD-11 ODD subtypes based on chronic irritability and may help to guide clinicians' decision-making regarding treating oppositionality in children.

This longitudinal study aims to provide meaningful cutoff scores for total score of the teacher-rated Inventory of Callous-Unemotional Traits (ICU) from the preschool age until early adolescence, separately by age and sex. The ICU cutoff scores were determined by using low/high trajectories of oppositional defiant problems (ODP) and conduct problems in a Spanish community sample of 620 children that were followed up between the ages of 3 and 13. Receiver operating characteristic (ROC) curves with the two trajectories as criteria and ICU total score at each age as a predictor were estimated by sex separately, and the area under the ROC curve (AUC) was obtained. Average ICU cutoff scores of 26 for boys and 22 for girls were found to be of moderate utility for the prediction of high trajectories of each of ODP and conduct problems. They identified cases with an average sensitivity of 66% and specificity of 70% for boys and an average sensitivity of 69% and specificity of 72% for girls. The obtained cutoff scores might help clinical practitioners in their decision-making process when identifying low and high-risk groups of children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

This longitudinal study aims to define the developmental trajectories of social cognition (SC) in a community sample (N = 378) assessed from preschool (3 years old) to preadolescence (12 years old). Parents and teachers reported on a SC measure at ages 5, 10, and 12. We tested the existence of different trajectories and whether they discriminated outcomes in early adolescence. The data were collected from different sources, the children, the parents, and teachers, by means of different methods. Using Growth Mixture Modeling (GMM), we identified three distinct social cognition trajectories: persistently mild difficulties reported by parents and teachers (7.9% of the children), stable low problems reported by parents and increased difficulties reported by teachers (10.5% of the sample), and stable low problems reported by both informants for most of the participants (81.5%). Comparison of the psychological outcomes between classes using regression models showed that the two trajectories including children with any level of problems differ from the normative one as regards their association with psychological problems, daily functioning, and variables, such as aggressive behavior and callousness. The two non-normative trajectories also differ from each other in terms of the personal characteristics of the adolescents included in them. Adolescents in the increasing problematic class in the school have a tougher and more problematic style of social relating, while children with persistent and non-context-dependent difficulties are more anxious. These results might help to better detect and design specific interventions for children with deficits in SC that might respond to different personal characteristics leading to different outcomes.

Background Four explanations for the concurrent and prospective associations between temperament and psychopathology in children have been suggested: predisposition, complication/scar, common cause/continuity, and pathoplasty/exacerbation. Because the confounding effects of common causes have not been ruled out in prior work, the support for the various explanations is uncertain. Methods Screen-stratified community samples of 4-year olds in Trondheim, Norway (n = 1,042), and 3-year olds in Barcelona, Spain (n = 622), were assessed biennially for symptoms of attention-deficit/hyperactivity (ADHD), oppositional defiant (ODD), conduct (CD), anxiety, and depressive disorders through interviewer-based psychiatric interviews across four waves of data collection. The parents completed child temperament ratings. The data were analyzed with random and fixed effects regression adjusted for all time-invariant unmeasured confounders (e.g., genetics, common methods bias, item overlap). Results In both Norway and Spain and across ages, negative affect predisposed children to symptoms of all disorders except CD, low effortful control predisposed children to ADHD and ODD-symptoms, and surgency predisposed children to increased ADHD-symptoms. Complication effects were observed in the Spanish children for ADHD-symptoms, which increased surgency and diminished effortful control, and for ODD-symptoms, which decreased surgency. The common cause and pathoplasty/exacerbation explanations were not supported. Conclusions The present results are consistent with the view that temperament plays a causal role in the development of symptoms of psychiatric disorders in children. Because temperament is malleable, interventions targeting the affective, attentional, and behavioral regulatory components of temperament may reduce psychopathology in children. © 2017 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

The present study investigates reciprocal associations between positive parenting, parental monitoring, CU traits, and ODD in children assessed at age 3 and again at age 6. Data were collected from a sample of preschoolers (N = 419; 51.58 % female) through diagnostic interviews and questionnaires answered by parents and teachers. Structural equation modeling revealed a bidirectional relationship between poor monitoring and ODD, with poor monitoring at age 3 predicting ODD at age 6 (β = 0.11, p < 0.05), and ODD at age 3 predicting poor monitoring at age 6 (β = 0.10, p < 0.05). While poor monitoring at age 3 predicted CU traits at age 6 (β = 0.11, p < 0.05), CU traits at age 3 predicted positive parenting (β = 0.09, p < 0.05) and ODD (β = 0.13, p < 0.05) at age 6. Results have important implications for early targeted parenting interventions for CU traits and ODD. Keywords

Maternal internalizing symptoms have been linked with child internalizing symptoms, but paternal internalizing difficulties have received little attention. Our aims were to prospectively analyse the simultaneous effect of maternal and paternal internalizing symptoms on child internalizing difficulties, examining gender differences, and to verify the mediating effect of parenting practices and child irritability. The sample included 470 families assessed at child ages 3, 6, 8, and 11. Multi-group structural equation modelling was performed with Mplus8.2. Complete equivalence was found between boys and girls for all paths. Maternal internalizing symptoms at age 3 had an indirect effect on child internalizing symptoms at age 11, via irritability at age 8. Paternal internalizing symptoms at age 3 were not associated with any of the variables under study. Maternal internalizing symptoms and child irritability are targets for intervention in order to prevent child internalizing difficulties.

This work tackles the measurement invariance of the social cognition construct when different observers, age and participant's age are considered. This is a prior question that needs to be answered before attributing discrepancies in information coming from diverse sources just to the varying behavior occurring across setting, and mainly interpret the discrepancies as indicative of cross-contextual variability. The article also studies the link between discrepancies and source-specific information and the validity of that information to predict several outcomes. The measurement invariance across sex, time and informant of a social cognition measure applied to children's parents and teachers was longitudinally tested in a Spanish general population sample, at ages 5 (N = 581) and 10 (N = 438). Full or partial metric and scalar equivalence were found across sex and over time within informants. Partial scalar invariance was not obtained across informants. Latent class analysis identified 2 classes of difficulties in social cognition for both informants at both ages: low social cognition and high social cognition. Comparison of classes resulting predicting outcomes yielded differential predictions due not only to varying context but also to a different concept of social cognition across informants. In general, significant differences between raters were informant dependent. We conclude that it is important to consider both teachers' and parents' observations to fully understand the construct of social cognition.

Spanish children were locked down for 72 days due to COVID-19, causing severe disruption to their normal life. The threat posed by COVID-19 continues and clinicians, administrators, and families need to know the life conditions associated with more psychological problems to modify them and minimize their effect on mental health. The goal was to study the life conditions of adolescents during lockdown and their association with psychological problems. A total of 226 parents of 117 girls and 109 boys (mean age: 13.9, Standard deviation: 0.28) from the community that were participants in a longitudinal study answered an online questionnaire about life conditions during lockdown and the Strengths and Difficulties Questionnaire (SDQ). Stepwise regression analyses controlling by previous reports of SDQ were performed. Conduct, peer, prosocial, and total problems scores increased after lockdown. After adjusting for previous measures of psychopathology, worse adolescents&rsquo, mental health during COVID-19 lockdown was associated with unhealthy activities, worsening of the relationships with others, and dysfunctional parenting style. It seems important to mitigate psychological stress in a situation of isolation due to a state of emergency by keeping the adolescent active and maintaining their daily habits and routines in a non-conflictive atmosphere and give support to parents.

Background The Affective Reactivity Index (ARI) is a brief instrument originally designed as a self- and parent report. However, the view of teachers, who can observe social situations that may give rise to irritability, is relevant. The goal is to provide the measurement qualities of the ARI score as reported by teachers. Method Children formed part of a longitudinal study on behavior problems in Barcelona (Spain) and they were assessed when they were 7 (N = 471) and 11 years old (N = 454) with questionnaires about psychopathology, anger and aggressive behavior, and a diagnostic interview answered by the parents, youths and teachers. Confirmatory factor analysis, measurement invariance, reliability and validity were studied for the ARI answered by teachers. Results The 6-item, 1-factor model fitted well. Almost full metric invariance and partial scalar invariance was obtained across sex and over age. The ARI scores largely converged with other teacher-reported measures of anger and irritability, and with other measures of psychopathology, aggressive behavior, and callous-unemotional traits at a medium level. The associations with parent's measures were medium to low, and very low for child self-reported measures. The ARI scores significantly differentiated children with and without psychopathology and functional impairment, both cross-sectionally and longitudinally. Limitations Only one child self-report measure of irritability included. Limited internal consistency of some scale scores. Findings are mostly generalizable to Spanish children. Conclusions ARI could be a suitable instrument for measuring irritability as reported by teachers. The teacher's view can be useful when planning treatment by helping to identify treatment targets.

Irritability is a transdiagnostic symptom in oppositional defiant disorder, depression, and anxiety, all highly comorbid disorders but with unknown simultaneous evolution. The aim was to obtain the developmental trajectories of simultaneous irritability and oppositional, depression, and anxiety problems from preschool age to early adolescence. A sample of 493 community children was followed up annually from ages 3–11 years and assessed using categorical and dimensional measures answered by parents and teachers. Latent Class Growth Analysis for four parallel processes was used to identify distinct groups of individual trajectories for irritability and oppositional, depression, and anxiety problems. Outcomes at ages 11 and 12 were compared among trajectories using regression models and multiple comparisons. A 3-class model showed the highest entropy (0.961) and adequate posterior probabilities of class membership (≥0.969). Class 1 (n = 331, 67.1%) was made up of children with stable low scores in all the variables; class 2 (n = 55, 11.2%) of children with high depression, anxiety, and irritability and above the mean stable profiles for oppositional problems; and class 3 (n = 107, 21.7%) of children with medium-high increasing irritability and oppositional problems and on the mean depression and anxiety. The classes with symptomatology and irritability (2 and 3) clearly differed from class 1 (low) at baseline and in outcomes. The course of irritability and oppositional, depression, and anxiety problems from ages 3–11 years differed qualitatively and quantitatively across subgroups of children. The 3 classes identified may help to guide clinicians’ decision-making regarding treating irritability and its comorbid disorders.

Becoming an effective front-line nurse manager is a complex and dynamic process, particularly when nurses progress to these roles within their own unit when multifaceted interpersonal factors may feature. This article reports on a project referred to as, ‘Coaching and Rounding' in the neonatal intensive care unit of the Women's Hospital in Qatar. This project integrated leadership coaching activities with staff rounding on nurses they supervised using a structured framework. This project was designed to equip front-line nurse leaders with enhanced skills and techniques to promote a framework for developing relational leadership styles. Evaluation involved the charge nurses and staff under their supervision. Results suggested that there was improved supervisor-supervisee relationships, increased motivation and more frequent constructive feedback. The challenges to sustain these initial gains are the focus of ongoing initiatives.

Objective: ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children. Method: To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children ( n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls ( n = 19) and healthy peers ( n = 30). Results: We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients ( n = 21) from healthy controls ( n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children ( n = 11) from clinical controls ( n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90). Conclusion: In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in children.

There is increasing interest in describing different variants and subtypes that characterize the heterogeneity of behavior problems with the aim of supporting early detection and prevention, as well as facilitating research into etiological differences. This work examines the course of co-occurrence of callous-unemotional traits (CU), anxiety (ANX) and oppositionality (ODD-s) levels in a longitudinal community sample. A sample of 622 3-year-old preschoolers, followed up until age 7, was assessed annually with dimensional measures of callous-unemotional traits, oppositional defiant disorder and anxiety and related psychological constructs answered by parents, teachers and performed by children. Growth-Mixture-Modeling yielded six trajectories (null 58.9%, ANX-increasing 4.9%, CU + ANX + ODD 2.4%, CU + ODD-decreasing 8.1%, ODD-increasing 16.4%, and ANX-decreasing 9.2%) that represent the variants previously described with older subjects. The specifier ODD “with limited prosocial emotion” (CU + ODD decreasing and increasing) showed deficits in executive functioning, attention, aggressive behavior and social cognition in comparison with null trajectory. The secondary variant showed a more severe clinical picture and presented more difficulties in executive functioning, worse environmental characteristics, and worse outcomes at age 7. It is possible to identify the heterogeneity of disruptive behavior problems from preschool age. The identification of homogeneous groups in this category of disorders may help to design more suitable treatments with specific components for specific difficulties, and to progress in the etiological research of each class.

Background There is debate about whether the difficulties that children with different degrees of oppositionality (ODD) and callous–unemotional traits (CU) have in processing emotions are global or specific. The aim of this study is to identify difficulties in recognizing emotion (happiness, anger, sadness and fear) through a go/no-go task in children with different levels of ODD and CU traits. Method A total of 320 8-year-old children were assessed through questionnaires filled out by teachers about oppositional defiant symptoms and CU traits and were then distributed into four groups: LowCU–HighODD, HighCU–LowODD, HighCU–HighODD and a comparison group (LowCU–LowODD). Results The analyses of variance comparing the 4 groups showed that the two groups with high ODD were less accurate than the control group in recognizing the emotion when the stimuli expressed happiness, fear or neutral emotion. The HighCU–HighODD group differed in the quality of the response (correct/wrong responses) but not in the reaction time in relation to the comparison group. The LowCU–HighODD group was faster to respond to emotions than the comparison group. Implications The results show that the deficit in emotion processing is not restricted to specific distressing emotions such as fear or sadness, but they point to a global impairment in emotion processing in children scoring high in the constructs studied. The results also suggest that the difficulties that children with combined CU traits and oppositional conduct problems have in processing emotions are more of an emotional rather than an attentional nature.

The objective was to obtain developmental trajectories combining callous-unemotional traits and the number of stressful life-events between ages 3 and 9 years and to ascertain their association with the polymorphism rs53576 at the Oxytocin Receptor gene (OXTR). A total of 377 children were assessed yearly from ages 3 to 9 years. Latent class growth analysis for parallel processes was used to identify distinct trajectories for callous-unemotional traits (assessed using the Inventory of Callous-Unemotional Traits, ICU) and number of stressful life-events, and then the influence of being an A allele carrier on class membership was included with OXTR genotypes as a binary time-invariant predictor, following a 3-step approach. A 3-class model showed the highest entropy (.859) and adequate posterior probabilities of class membership (≥.884). Class 1 (n = 226, 59.9%) included children with low and stable ICU scores and low and descending stressful life-events; class 2 (n = 127, 33.7%) included children with high and ascending ICU scores and low and slightly descending stressful life-events; and class 3 (n = 24, 6.4%) included children with persistently high profiles both for ICU scores and stressful life-events. Carrying an A allele (genotypes GA/AA) increased the odds of pertaining to class 3 (high and persistent ICU scores and stressful life-events) as opposed to class 2 (OR = 4.27, p = 0.034) or class 1 (OR = 3.81, p = 0.042). The results suggest the importance of considering callous-unemotional traits and stressful life-events in conjunction. In addition, the genetic variability of OXTR (rs53576) may help to understand individual differences in early development.

Previous studies have shown that there are several significant early-life risk factors associated with childhood overweight. However, research has mainly focused on school-aged children. The aim of this study is to identify risk factors in early life for overweight in a community sample of Spanish preschoolers. A sample of 622 three-year-olds was monitored until the age of 5, and their height and weight were registered annually. Overweight status was defined by World Health Organization standards. A large set of risk factors including sociodemographic variables, family structure, pregnancy, birth, postnatal period, school and neighborhood were measured through semi-structured interviews. Stepwise logistic regressions created predictive models with the best predictors of overweight for each age group. This is the first longitudinal study to examine a large set of risk factors among Spanish preschoolers. Several potential early risk factors in preschool children were associated with later overweight: high birth weight, ethnicity, excess screen time, low attention span, maternal smoking during pregnancy, inconsistent discipline, fewer rules, corporal punishment and parents psychopathology. Among them, the most powerful factor was high birth-weight (odds ratio = 1.89 at age 3, 1.87 at age 4, and 2.35 at age 5), underlining the importance of weight monitoring from postpartum and routine screening for overweight in children who have high birth weight. With the increasing prevalence of overweight in children at early ages, understanding the determinants for overweight risk becomes crucial for public health professionals and policy-makers in order to implement effective prevention and intervention programs Diferentes estudios han mostrado una asociación clara en­tre determinados factores de riesgo en edad temprana y so­brepeso en la infancia. Sin embargo, hasta ahora la inves­tigación solo se ha centrado en niños en edad escolar. El objetivo de este estudio es el de examinar en niños prees­colares los factores de riesgo para el sobrepeso en una muestra comunitaria de niños españoles. En el presente es­tudio se seleccionó una muestra de 622 niños de 3 años de edad a los que se siguió anualmente hasta los 5 años. El peso y la talla fueron registrados anualmente y el sobre­peso fue definido siguiendo los criterios definidos por la Organización Mundial de la Salud. A través de una entre­vista semi-estructurada, se analizaron diversos factores de riesgo tales como estructura familiar, embarazo, parto, pe­ríodo post-natal, escuela y vecindario. Las regresiones lo­gísticas múltiples permitieron crear modelos predictivos que seleccionaron los mejores predictores de sobrepeso para cada grupo de edad. El presente estudio es el primer estudio longitudinal en examinar diferentes factores de riesgo para el sobrepeso en niños españoles con edad preescolar. Diferentes factores de riesgo están asociados a un posterior sobrepeso: mayor peso al nacer, etnia, uso ex­cesivo de pantallas, capacidad de atención baja, madre fu­madora durante el embarazo, disciplina inconsistente, cas­tigo físico y psicopatología parental. De entre ellos, el fac­tor más importante fue: mayor peso al nacer (razón de pro­babilidades = 1.89 a los 3 años, 1.87 a los 4 años y 2.35 a los 5 años), subrayando la importancia de monitorizar el peso del niño desde el post-parto y realizar cribados ruti­narios de sobrepeso en aquellos niños que nacieron con un peso elevado. La prevalencia cada vez mayor de sobrepeso en niños cada vez más pequeños hace que la comprensión e identificación de los factores de riesgo relacionados con el sobrepeso sea crucial para que los profesionales públi­cos de salud y los responsables políticos implementen pro­gramas de prevención e intervención efectivos

To study the prevalence of subthreshold oppositional defiant disorder (ST ODD)—less than 4 symptoms, but nonetheless an impairing form of oppositional defiant disorder (ODD)—its coexistence with other homotypic externalizing and heterotypical internalizing problems in children and associated impairment, as well as the long-term effect of this condition. A population-based sample of 622 preschoolers (5.0% boys) was followed up from preschool to preadolescence. Parents were interviewed when the children were 3, 6 and 9 years old with the Diagnostic Interview for Preschoolers/Children and Adolescents versions following DSM-5 and the children’s functioning was assessed by trained clinicians. ST ODD diagnosis is highly prevalent (19.4–25.5%), highly comorbid [homo- (1.9–18.4%) and heterotypical (5.8–23.7%)], resulting in functional impairment across child development in a similar way for both genders. ST is also a risk factor condition that predicts the presence of psychological problems and impairment in childhood and preadolescence from preschool age. A broader clinical assessment and intervention similar to that provided full syndrome cases is needed for children presenting subthreshold forms of ODD.

IntroductionSchool victimization by peers is an important social problem with serious short- and long-term consequences poorly studied at preschool ages, which can lead to school bullying without timely intervention. Longitudinal data was used to determine the prevalence of warning signs of preschool peer victimization and its individual and family risk factors.MethodsData was obtained from 577 community preschoolers. School victimization was measured using the Strengths and Difficulties Questionnaire (SDQ) administered to parents and teachers of children at ages 4 and 5. Risk factors for the child (demographics, conduct and emotional problems, aggressiveness) and the family (maternal problems during pregnancy and early development, parenting styles, adaptive functioning and parents' problems) were previously recorded at 3 years old.ResultsCombined information from parents and teachers showed that 4.2% of preschoolers presented warning signs of victimization at ages 4 and 5. Low socioeconomic status, poor emotional control, early problems making friends and low level of parenting education in social norms at age 3 predicted later victimization at ages 4 and 5 (AUC = .78).ConclusionPeer victimization affects a considerable percentage of preschoolers. Early detection may help to reduce the risk of escalation.

Background Child abuse is a health and social problem, and few screening instruments are available for the detection of risk in primary health care. The aim was to develop a screening instrument to be used by professionals in the public health care sector, thus enabling the detection of infants and toddlers at risk of emotional and physical abuse and neglect, and to provide evidence for the feasibility of the instrument in Cyprus, Greece and Spain. Method A total of 50 health professionals from paediatric public health-care centres in the three countries were involved in a three-step process for guiding the development of the screening tool and its application. Results A nine-item screening tool, consisting of items assessing relational emotional abuse, physical abuse and other risk factors, was developed. The screening tool was applied on a total of 219 families with 0 to 3-year-old children attending public health centres in the three countries. Clinicians reported that they agreed on the inclusion of the questions (86.4–100%) and that they found the questions to be useful for the clinical evaluation of the family (63.2–100%). Conclusion The screening tool shows considerable face validity and was reported feasible by an international set of clinicians.

The goal of the study was to examine the affective-cognitive components of Theory of Mind (ToM), in a community sample of 538 preschoolers, and more specifically in a subsample of 40 children diagnosed with ODD. The relationship between affective and cognitive ToM and some ODD clinical characteristics was examined. Children were assessed with structured diagnostic interviews and dimensional measures of psychopathology, impairment and unemotional traits. A measure based on eye-gaze was used to assess ToM. Mixed analysis of variance compared the mean cognitive versus affective scale scores and the between-subjects factor ODD. The association between ToM-scores and clinical measures was assessed through correlation models. Execution and reaction time to emotional and cognitive components of ToM tasks are different at age 5 in normally developing children. Oppositional Defiant children had slower response time when performing the affective mentalizing condition than children without the disorder. The correlation matrix between ToM-scores and clinical measures showed specific associations depending on the impaired ToM aspect and the psychological domain. Results may have clinical implications for the prevention and management of ODD.

The study examined whether the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised Edition (DC: 0-3R; ZERO TO THREE, 2005) Parent-Infant Relationship Global Assessment Scale (PIR-GAS) is applicable to six European countries and contributes to the identification of caregiver-infant/toddler dyads with abusive relationship patterns. The sample consisted of 115 dyads with children's ages ranging from 1 to 47 months. Sixty-four dyads were recruited from community settings without known violence problems, and 51 dyads were recruited from clinical settings and already had been identified with violence problems or as being at risk for violence problems. To classify the dyads on the PIR-GAS categories, caregiver-child interactions were video-recorded and coded with observational scales appropriate for child age. To test whether the PIR-GAS allows for reliable identification of dyads with abusive relationship patterns, PIR-GAS ratings were compared with scores on the the International Society for the Prevention of Child Abuse and Neglect's (ISPCAN) Child Abuse Screening Tool-Parental Version (ICAST-P; D.K. Runyan et al., ), a questionnaire measuring abusive parental disciplinary practices. It was found that PIR-GAS ratings differentiated between the general and the clinical sample, and the dyads with abusive patterns of relationship were identified by both the PIR-GAS and the ICAST-P. Interrater reliability for the PIR-GAS ranged from moderate to excellent. The value of a broader use of tools such as the DC: 0-3R to promote early identification of families at risk for infant and toddler abuse and neglect is discussed.

Reinforcement Sensitivity Theory has been applied to childhood psychopathology and the development of different types of personality in recent years. Few studies have reported evidence of the reliability/validity of specific measures based on this theory. The aim of this study was to assess the psychometric properties of the measures obtained through the Spanish version of the Sensitivity to Punishment and Sensitivity to Reward Questionnaire for Children (SPSRQ-C) in a community sample of N = 478 children aged 6. Confirmatory Factor Analysis showed that the three-factor model was the best solution with indexes of moderate to good fit. Resulting factors were F1 sensitivity-to-punishment, F2 impulsivity/fun-seeking and drive and F3 reward-responsivity. High correlations were achieved between empirical SPSRQ-C factors and external measures: a) F1 largely correlated with anxiety–depression and internalizing problems, shyness and negative affectivity; b) F2 was strongly related to externalizing problems (attention-aggressive), activity level and surgency; and c) F3 achieved the highest correlations with externalizing problems. These results highlight the validity of the SPSRQ-C measures to be used with young children from the general population. Availability of accurate measures of response to punishment and reward is especially valuable in educational and therapeutic plans that include discipline and incentives as contingencies

Hostile Attributional Bias (HAB) has been related to conduct problems. The common and unique associations between the different dimensions of Oppositional Defiant Disorder (ODD) symptoms, specific components of HAB, sex and types of aggression (overt and relational) in a community sample of 491 7-year-old children are investigated.Teachers rated the children's ODD symptoms and aggression and the children self-reported about HAB. Multiple linear regressions showed that ODD dimensions were directly associated with both types of aggression.Boys were more overtly aggressive and girls more relational. Emotional distress was directly associated with relational aggression. The relational component of HAB uniquely moderated the influence of the oppositional dimension on relational aggressive behaviour.The assessment of social cognition variables is necessary to approach specific interventions in the presence of ODD symptoms, as this may help to identify a subset of children prone to aggressive reactions.

This study traces the developmental course of irritability symptoms in oppositional defiant disorder (ODD) from ages 3–5 and examines the psychopathological outcomes of the different trajectories at age 6. Method. A sample of 622 3-year-old preschoolers (311 were boys), followed up until age 6, was assessed yearly with a semi-structured diagnostic interview with parents and at age 6 with questionnaires answered by parents, teachers and children. Results. Growth-Mixture-Modeling yielded five trajectories of irritability levels for the whole sample (high-persistent 3.5 %, decreasing 3.8 %, increasing 2.6 %, low-persistent 44.1 % and null 46.0 %). Among the children who presented with ODD during preschool age, three trajectories of irritability symptoms resulted (high-persistent 31.9 %, decreasing 34.9 % and increasing 33.2 %). Null, low-persistent and decreasing irritability courses in the sample as a whole gave very similar discriminative capacity for children’s psychopathological state at age 6, while the increasing and high-persistent categories involved poorer clinical outcomes than the null course. For ODD children, the high-persistent and increasing trajectories of irritability predicted disruptive behavior disorders, comorbidity, high level of functional impairment, internalizing and externalizing problems and low anger control at age 6. Conclusions. Irritability identifies a subset of ODD children at high risk of poorer longitudinal psychopathological and functional outcomes. It might be clinically relevant to identify this subset of ODD children with a high number of irritability symptoms throughout development with a view to preventing comorbid and future adverse longitudinal outcomes.

Nonsuicidal self-injury (NSSI) usually starts during adolescence and is associated with an array of psychological and psychiatric symptoms and future suicide attempts. The aim of this study is to determine prospective predictors, mediators and moderators of NSSI in adolescent community samples in order to target prevention and treatment strategies. Two team members searched online databases independently. Thirty-nine studies were included in the review. Several variables were seen to prospectively predict NSSI: female gender, family-related variables, peer victimisation, depression, previous NSSI and self-concept. Few studies analysed mediators and moderators. Low self-concept was highlighted as a relevant moderator in the relationship between intra/interpersonal variables and NSSI. Implications of these findings are discussed. The considerable heterogeneity between studies posed a limitation to determine robust predictors of NSSI. Further prospective studies using standardised measures of predictors and outcomes are needed to ascertain the most at risk individuals and develop prevention strategies.

We provide the first validation data on the Spanish version of the Brief Problem Monitor-Parent form (BPM-P), a recently developed abbreviated version of the 120-item Child Behavior Checklist for Ages 6 to 18 (CBCL/6-18) in young schoolchildren. Parents of a community sample of 521 children aged 6-8 answered the CBCL/6-18 yearly, and the 19 BPM-P items were examined; parents also provided different measures of psychopathology. Confirmatory factor analysis of the expected 3-factor model (attention, externalizing, and internalizing) showed adequate fit (root mean square error of approximation, RMSEA ≤ .057), and measurement invariance across sex and age was observed. Internal consistency for the derived scores was satisfactory (ω ≥ .83). Concurrent validity with the equivalent scale scores of the original full CBCL/6-18 (r ≥ .84) and convergent validity with parents' ratings of the Strengths and Difficulties Questionnaire scores (r ≥ .52) were good. BPM-P scores at age 7 showed good predictive accuracy for discriminating the use of mental health services (OR ≥ 1.12), functional impairment (B ≤ -1.25), and the presence of the corresponding disorders diagnosed with an independent clinical interview, both cross-sectionally at age 7 and longitudinally at age 8 (OR ≥ 1.24). The BPM-P provides reliable and valid scores as a very brief follow-up and screening tool for assessing behavioral and emotional problems in young schoolchildren. (PsycINFO Database Record

Executive functioning in 3-year-old preschoolers with attention-deficit hyperactivity disorder (ADHD), oppositional-defiant disorder (ODD), comorbid ADHD+ODD, and children without any of these conditions (control group) was examined. A community sample including 622 children was diagnosed using a diagnostic interview following DSM-IV criteria, and assessed using the Behavior Rating Inventory of Executive Function Preschool version (BRIEF-P) and the Kiddie-Conners' Continuous Performance Test. The children diagnosed with ADHD showed the poorest executive function (EF) profile in comparison with controls, and were closely followed up in this respect by the comorbid ADHD+ODD children. The ADHD and comorbid groups presented similar executive difficulties. The ODD group obtained mean scores statistically equal to those of controls in EF. These findings suggest that, in preschoolers, executive functioning deficits assessed with a performance-based measure or with behavioural descriptions are specific to children with ADHD, in comparison with those with ODD. This study contributes knowledge about EFs in two prevalent and comorbid disorders in preschool children, ADHD and ODD, knowledge that can help our understanding of specific deficits and the design of specific early intervention initiatives.

Altres ajuts: PSI2009-07542, PSI2012-32695 This study provides data on the usefulness of the Spanish version of the Social and Communication Disorders Checklist (SCDC; Skuse et al., 1997), in terms of the validity and reliability of derived scores. Data were obtained from parents' interviews and parents' and teachers' questionnaires that measured different psychological variables from a community sample of 579 (291 boys and 288 girls), 5-year-old children. These children were tested to assess their intellectual capacity. Confirmatory factor analyses yield a one-dimensional structure invariant across sex within each informant (parents or teachers), with negligible latent mean differences between boys and girls for both informants (parents-teachers). The internal consistency was satisfactory (alpha values ≥ .85 for teacher version and ≥ .75 for parent version). SCDC scores correlated with specific scales related to developmental problems, aggressive behavior, executive functioning, and uncaring behavior toward others. SCDC scores were unrelated to intelligence quotient, whereas SCDC scores were associated with the presence of disruptive disorders, measured with diagnostic interview. Results provide evidence on reliability and validity of SCDC scores, which is potentially a useful measure for the study of social cognition and its relationship with preschool adjustment

Psychological maltreatment (PM) is an extremely heterogeneous phenomenon that includes several subtypes. The aim of this work is to explore whether the accumulation of different subtypes of PM has a greater impact on the child’s psychopathology and functional impairment. One hundred and sixty-eight children and adolescents aged between 4 and 17 whose mothers had been exposed to intimate partner violence (IPV) participated. Psychopathology was assessed through a rating scale and a diagnostic interview. Polynomial contrasts by means of Generalized Estimated Equations explored linear and quadratic trends. The greater the number of PM subtypes suffered by children, the greater the adverse effects in psychopathology and functioning. When a child suffers four PM subtypes, the number of DSM disorders is, on average, twice as high compared with children who are suffering only one PM subtype. Linear trends were mainly found in internalizing problems. The importance of accurately assessing characteristics and severity of PM, and design efficient programs of prevention and treatment, is highlighted.

Parenting practices should be assessed and taken into account at an early age, since it is well documented that they are strongly related to children's development. This study provides data on the psychometric properties of a Spanish version of the Alabama Parenting Questionnaire for Preschool children (APQ-Pr). A community sample of 622 (310 boys and 312 girls) 3 year-old children and their parents, participated in the study. Data were obtained from parents' reports and correspond to a semi-structured diagnostic interview and self-report questionnaires evaluating parenting and children's psychological states. Confirmatory factor analysis supported a three-factor solution: positive parenting, inconsistent parenting and punitive parenting. These scales scores showed moderate to good internal consistence (omega values ranged from .54 to .86). Inconsistent parenting scores achieved the strongest associations with external measures of psychopathology, especially for externalizing and conduct problems, as well as for functional impairment, the poorest associations being for the positive parenting scores. Results support the validity of the Spanish APQ-Pr, which is potentially a useful measure for the study of parenting practices regarding preschool children and their relation to conduct problems.

This study examined the mediator role of mothers’ mental health in the relationship among maternal childhood abuse (CA), intimate partner violence (IPV), and offspring’s psychopathology, and explored whether mediational pathways were moderated by children’s sex. Participants were 327 Spanish outpatient children, 8 to 17 years old, and their mothers. Mothers’ global psychological distress and depressive symptoms mediated the associations between mothers’ violence history and children’s externalizing problems. However, only depressive symptoms fully mediated these relationships. Children’s sex did not have a moderating role in adjusted paths. Mothers’ depressive symptoms are an important mechanism by which maternal violence experiences could affect externalizing problems in Spanish children.

Background: The aim of the study is to identify the main factors related to comorbid oppositional defiant disorder (ODD) and anxiety disorders (AD), for preschoolers, and to assess the moderating role of the children's sex. Design: The initial sample of 622 children was assessed longitudinally at the ages of 3 and 5 years by means of questionnaires and a diagnostic interview. At baseline, there were 310 boys (49.8%), most participants were of Caucasian-white ethnicity (554, 89.1%), 398 children attended to public school (64.0%) and families socioeconomic status was 64.3% medium-high, 14.1% medium and 20.5% medium-low or low levels. Methods: For the analysis, children diagnosed with ODD and/or AD were selected: n=103 at 3 years old (44 ODD, 42 AD and 17 ODD+AD) and n=106 at 5 years old (31 ODD, 60 AD and 15 ODD+AD). Results: High levels of the child's negative affectivity and the mother's aggressive behavior (versus AD), and high scores in the father's psychopathology measurements (versus ODD) are related to the presence of comorbid ODD+AD at the age of 3. High scores in the child's approach-positive anticipation, fears (only in boys, in girls the reverse effect occurred) compared to ODD and AD independently and aggressive behavior (versus AD), and low scores for smiling and laughter (versus ODD only and AD only) are predictive of comorbidity at the age of 5. Conclusions: Temperament traits may be a common factor in explaining longitudinal ODD+AD comorbidity.

Objective Oppositional defiant disorder (ODD) is a common disorder in preschool children. Evidence indicates that maternal and paternal psychopathology, particularly aggressive behavior and anxious and depressed symptoms, contributes to the development of this disorder. The latest research also suggests that ODD symptoms may exacerbate the mental health problems of parents. Our aim was to establish the existence of a reciprocal association between paternal and maternal psychopathology (aggression, depression, and anxiety) and child ODD at ages 3 and 8, using a longitudinal design in a community sample of preschoolers. Method The sample included 331 children evaluated at ages 3 and 8 through questionnaires and a semistructured diagnostic interview with parents. Parents also informed about their own psychopathology. Results At 3 years of age, higher levels of ODD symptoms in girls were concurrently associated with maternal anxious and depressed symptoms and paternal aggressive behavior, and higher levels of ODD symptoms in boys were concurrently associated with maternal aggressive behavior. Longitudinally, for boys, higher levels of maternal anxious and depressed symptoms at child age 3 predicted increases in ODD symptoms from 3 to 8 years of age. In addition, higher levels of ODD symptoms in boys aged 3–8 years predicted increases in fathers’ anxious and depressive symptoms. Conclusion Children with ODD should be evaluated and treated promptly, but efforts should be extended to their parents. Mothers’ and fathers’ mental health must be explored because the psychopathologies of children and parents reciprocally affect each other.

Oppositional Defiant Disorder (ODD) is among the most prevalent disorders in preschoolers. It has been linked to temperament, since characteristics such as elevated surgency and negative affect, as well as low levels of effortful control, contribute to the development of this disorder. Evidence also indicates that parental psychopathology can accentuate temperamental traits. Our aim was to assess whether the levels of psychopathology of mothers and fathers acts as a moderator of the relationship between temperament and ODD symptoms in preschoolers, both cross-sectionally at ages 3, 4 and 5, and longitudinally between ages 3 and 5. The sample included 550 children evaluated at ages 3, 4 and 5 through questionnaires and a semi-structured diagnostic interview with parents. Parents also answered a questionnaire about their own psychopathology. The results indicated that negative affect and effortful control are associated with higher levels of ODD symptoms in preschoolers. At child age 5, higher levels of paternal depression and anxiety increased the effect of low effortful control on ODD. High levels of negative affect and low levels of effortful control at age 3 were statistical predictors of ODD levels at age 5, and this relationship was also moderated by paternal anxiety and depression. The results have important clinical implications for the proper orientation of interventions, suggesting that interventions should integrate the paternal caregiver in the treatment.

Background: To test the factor structure of oppositional defiant disorder (ODD) symptoms and to study the relationships between the proposed dimensions and external variables in a community sample of preschool children. Method: A sample of 1,341 3-year-old preschoolers was randomly selected and screened for a double-phase design. In total, 622 families were assessed with a diagnostic semi-structured interview and questionnaires on psychopathology, temperament and executive functioning completed by parents and teachers. Results: Using categorical and dimensional symptoms of ODD it was possible to confirm, cross-informant and cross-method, distinct dimensions for defining the structure of ODD: one made up of irritable and headstrong and the other of negative affect, oppositional behaviour and antagonistic behaviour. Specific associations with DSM-IV disorders were found, and irritable was associated with anxiety disorders, whereas headstrong was associated with disruptive disorders, including aggressive and non-aggressive CD symptoms. Also, negative affect was associated with anxiety disorders and non-aggressive CD symptoms, oppositional behaviour with disruptive disorders and aggressive CD symptoms, and antagonistic behaviours with disruptive disorders and, in boys, with mood disorders. The dimensions correlated with specific scales of psychopathology, temperament and executive functioning. Conclusions: Oppositional defiant disorder is a heterogeneous disorder from preschool age. Different dimensions, with moderate to acceptable reliability and convergent and discriminant validity with other psychological constructs, can be identified early in life. Language: en

Objective: To assess the comorbidity of bipolar disorder (BPD) in children with ADHD and to study the psychopathological profile of ADHD children with and without mania. Method: A total of 100 children with ADHD were assessed with a semistructured diagnostic interview and questionnaires of mania, ADHD, and general psychopathology. Results: 8% of children met criteria for BPD and 6% for BPD–not specified. ADHD children with bipolar spectrum disorder had greater comorbidity with disruptive behavior disorders and scored higher on the Young Mania Rating Scales and on the Child Behavior Checklist (CBCL) Scales of rule-breaking behavior, externalizing problems, and total problems; however, significance on the CBCL Scales was lost when controlling for disruptive behavior disorders. Conclusion: BPD is frequently associated with ADHD; it has important implications for prognosis and choice of treatment. Differences on the CBCL Scales could be explained by the comorbidity with disruptive behavior disorders rather than by a specific manic profile.

The aim was to examine the potential mediating role of father's and mother's parenting styles in the association between parental psychopathology and antisocial behavior in children, and whether this pathway was moderated by child's sex. Participants included both parents and 338 Spanish outpatient children between 8 and 17 years (56.5% boys). Parenting style had a mediating effect on the studied relationships. Maternal psychopathology was positively associated with antisocial behavior in children, either directly or partially by parenting style, while paternal psychopathology was positively associated with offspring antisocial behavior only through the mediator role of parenting style. Child's sex did not moderate these relationships. Parenting style could be a target for prevention and intervention of antisocial behavior in the offspring of parents with mental health problems.

There is a need for reliable and well-validated diagnostic measures for studying psychopathology in preschool and young children. The goal is to study the psychometric properties of the Diagnostic Interview for Children and Adolescents for Parents of Preschool and Young Children (DICA-PPYC) in the general population. A sample of 852 Spanish school children, aged 3 to 7 years, were randomly selected and screened for a double phase design. A total of 251 families were interviewed with the DICA-PPYC and 244 participated in a test-retest design. Different measures of psychopathology and functional impairment were also administered. Test-retest agreement with a mean interval of 8.8 days ranged from excellent to slight (kappa from 1 to 0.39) for DSM-IV-TR and from good to fair (kappa from 0.77 to 0.49) for Research Diagnostic Criteria-Preschool Age diagnoses. Attenuation between test and retest was not significant for the prevalence of diagnoses, although it was significant for the number of externalising and total symptoms in the interview. The diagnoses converged moderately with the CBCL and Dominic scores. The presence of diagnoses in the DICA-PPYC significantly differentiated preschoolers and young children who had used mental health services, were more impaired, and presented more severe psychopathology measured by dimensional scales. The DICA-PPYC is a reliable and valid semi-structured interview schedule for preschool and young children, and can serve to advance the knowledge and mental health care of this population.

This work examines the moderator effect of sex and age on the relationship between different types of exposure to intimate partner violence (IPV) and child psychopathology and functional impairment. One hundred and sixty-six Spanish children aged 4 –17 years exposed to intimate partner violence were assessed using a diagnostic interview and other instruments for the measurement of psychopathology and functional impairment. Participants were classified in three groups according to the degree of exposure: witness (N = 77), involved (N = 63) and victim (N = 26). According to mothers’ self-reports and mother-child combined information, boy victims of IPV showed more mood disorders than involved or witness boys. There were no other moderator effects of either sex or age. The effect of exposure to intimate partner violence among children was not dependent, in general, on the child’s sex or age, and this has important implications for the assessment, treatment, and prevention of children’s exposure to IPV.

Objective Psychological maltreatment (PM) is the most prevalent form of child abuse, and is the core component of most of what is considered as child maltreatment. The aim of this work was to explore differential adverse outcomes of the different types of PM in the mental health and functioning of children living in homes in which they are exposed to intimate partner violence (IPV). Method Participants were 168 children, aged between 4 and 17, whose mothers experienced IPV. They were assessed using different measures of psychopathology and functioning: Diagnostic Interview for Children and Adolescents-IV, Child Behavior Checklists and Child and Adolescent Functioning Assessment Scale. Furthermore, IPV was assessed with the Schedule for Assessment of Intimate Partner Violence Exposure in Children and the Index of Spouse Abuse. Statistical analyses were carried out with regression models adjusted by means of Generalized Estimating Equations. Results Spurning was the PM subtype with the greatest global effect on the children, as it was significantly associated with internalizing and externalizing problems. Denying emotional responsiveness specifically increased the risk of internalizing psychopathology and impairment in the emotional area. Terrorizing was not significantly associated with a greater number of negative outcomes in children's psychopathology or functioning in this population. Implications The results suggest the importance of taking PM types into account in order to fully understand the problems of children exposed to IPV at home, and for the design of effective treatment and prevention programs.

Background: Diagnosing mania in children is difficult, due to the high comorbidity and symptom overlap with attention deficit/hyperactivity disorder (ADHD). The detection of manic symptoms in ADHD has important implications for prognosis and choice of treatment. Our objective was to study the utility of the Young Mania Rating Scale (YMRS) for discriminating mania in Spanish children with ADHD. Method: One hundred children and adolescents with ADHD between 8 and 17 years of age were evaluated with a structured diagnostic interview (Diagnostic Interview for Children and Adolescents-IV), the YMRS, the Parent-Young Mania Rating Scale (P-YMRS), the Child Mania Rating Scale-Parent Version (CMRS-P) and the Children’s Global Assessment Scale. Results: The YMRS showed a 1-dimensional structure with good internal consistency and test-retest reliability. The YMRS was associated with the P-YMRS and the CMRS-P. The scores obtained with the YMRS differentiated between ADHD with and without mania. The receiver operating characteristic curve analysis showed good diagnostic efficiency in differentiating mania in ADHD (area under the curve of 0.90). Conclusions: The Spanish version of the YMRS is a valid and reliable instrument for detecting and quantifying the symptoms of mania in children and adolescents with ADHD. The results provide further knowledge about the frequent association between ADHD and manic symptoms in children.