Annual Research Review: Conceptualising functional impairment in children and adolescents

Rapee, Ronald M.; Bögels, Susan M.; Sluis, C.M. van der; Craske, Michelle G.; Ollendick, Thomas H.

doi:10.1111/j.1469-7610.2011.02479.x

Cited by 97 publications

(101 citation statements)

References 72 publications

(136 reference statements)

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“…Clinical samples may be less suited for the investigation of gender differences, because girls with ADHD are referred for treatment less frequently than boys are (44). Thus, the effects of gender on impairment related to ADHD still seem somewhat ambiguous (44), and direct comparison across studies seems to be a problem, because gender effects will partly hinge on the referral source, the rater source, the ages of the children studied, and which functional domains were examined (45).…”

Section: Discussionmentioning

confidence: 99%

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

Bendiksen

Aase

Svensson

et al. 2013

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: We have limited knowledge of the impact of attention-deficit/hyperactivity disorder (ADHD) symptoms on the daily functioning of young preschool children. Objective: This study investigated the level of impairment related to symptoms of ADHD in different functional domains. It also addressed how impairment caused by ADHD was related to ADHD subtype, symptom load, gender, and the cooccurrence of oppositional defiant disorder, conduct disorder, or both. Method: Participating children (N = 807) who were 3.5 years old were recruited from a population-based sample included in The Norwegian Mother and Child Cohort Study. Children who scored above the 90th percentile for ADHD symptoms were included in the present sample. The assessment of the symptoms and functional impairment described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision, was based on parental ratings and the semi-structured psychiatric interview entitled "The Preschool Age Psychiatric Assessment." Results: Added burden and discord within family relationships were the areas that were most severely affected. All domain scores were strongly intercorrelated, and they were added to each child's total score. Children with symptoms of ADHD, inattentive type (mean [M], 3.5; standard deviation [SD], 3.4), or ADHD, hyperactive/impulsive type (M, 2.9; SD, 2.7), were significantly less impaired than children with symptoms of ADHD, combined type (M = 6.4; SD = 3.8; p < .001). Furthermore, co-occurring oppositional defiant disorder was associated with higher impairment scores (M, 6.1; SD, 4.3) than ADHD alone (M, 3.2; SD, 2.9; p < .001. About 30% of the variance of impairment score of ADHD was explained by symptoms of ADHD and co-occurring symptoms of oppositional defiant disorder and conduct disorder. Few gender differences were observed. Conclusion: Overall, these non-referred young children with clinical symptoms of ADHD were only modestly impaired. Impairment related to ADHD occurred mainly in the areas of family functioning, and it was associated with ADHD subtype and comorbidity. Still, it is important to assess the impact of ADHD symptoms and coexisting difficulties among preschoolers to identify children and families who are in need of early intervention efforts.

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Section: Discussionmentioning

confidence: 99%

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

Bendiksen

Aase

Svensson

et al. 2013

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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“…29 Predictors of functional impairment include experiencing anxiety with stressful situations, 30 and previous research has revealed the association between functional impairment and depression and mental health problems. [31][32][33] The purpose of this study was to empirically test whether siblings of children with disability have higher levels of functional impairment compared with a peer group of children with typically developing siblings.…”

Section: Resultsmentioning

confidence: 99%

“…Functional impairment is a key indicator for the need for mental health services 33 and, as such, early assessment and interventions to limit increasing severity and short-to long-term consequences need to be addressed. When time and attention are disproportionately spent on the child with disability, early signs of functional impairment problems in typically developing siblings may be overlooked or dismissed.…”

Section: Discussionmentioning

confidence: 99%

Assessing Functional Impairment in Siblings Living With Children With Disability

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Previous research on potential deleterious effects of typically developing children growing up in households with children with disability has produced mixed results. Research methods have been cited as a problem in many studies. WHAT THIS STUDY ADDS:This is the largest known empirical study comparing functional impairment in siblings living with a child with disability and siblings residing with children who are typically developing. This study also follows the trajectory of functional impairment across 2 measurement periods. abstract OBJECTIVE: The purpose of this study was to empirically test if siblings of children with disability had higher levels of parent-reported behavioral and emotional functional impairment compared with a peer group of siblings residing with only typically developing children. METHODS:This was a retrospective secondary analysis of data from the Medical Expenditure Panel Survey. We included only households with at least 2 children to ensure sibling relationships. Two groups of siblings were formed: 245 siblings resided in households with a child with disability and 6564 siblings resided in households with typically developing children. Parents responded to questions from the Columbia Impairment Scale to identify functional impairment in their children. RESULTS:On the basis of parent reports and after adjusting for sibling demographic characteristics and household background, siblings of children with disability were more likely than siblings residing with typically developing children to have problems with interpersonal relationships, psychopathological functioning, functioning at school, and use of leisure time (P , .05). The percentage of siblings of children with disability classified with significant functional impairment was 16.0% at the first measurement period and 24.2% at the second (P , .001). For siblings of typically developing children there was a smaller percentage increase from 9.5% to 10.3% (P , .001).CONCLUSIONS: Functional impairment is a key indicator for the need of mental health services and, as such, early assessment and interventions to limit increasing severity and short-to long-term consequences need to be addressed. Health care professionals need to consider a family-based health care approach for families raising children with disability. Pediatrics 2013;132:e476-e483 AUTHORS:

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“…Assuming such factors are not present, First then provides a & Thomas H. Ollendick tho@vt.edu set of decision trees and tables to help one determine the specific diagnoses that are present and which diagnosis is likely the primary one that should be targeted or prioritized for treatment. With this approach, the primary diagnosis is the one that the clinician determines to be most severe or impairing [5]. While guidelines recommended by First [4] are often utilized in clinical settings, there has been variability in how clinical research studies have defined the primary diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Primary Versus Secondary Diagnosis of Generalized Anxiety Disorder in Youth: Is the Distinction an Important One?

Ollendick

Jarrett

White

et al. 2015

Child Psychiatry Hum Dev

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Examine whether children with a primary diagnosis of generalized anxiety disorder (GAD) differ from children with a secondary diagnosis of GAD on clinician, parent, teacher, and youth-report measures. Based on consensus diagnoses, 64 youth referred to a general outpatient assessment clinic were categorized as having either a primary or secondary diagnosis of GAD. A semi-structured diagnostic interview was used to guide diagnostic decisions and assign primary versus secondary diagnostic status. We predicted that youth with a primary GAD diagnosis would present with greater anxiety symptomatology and symptom impairment on a variety of anxiety-related measures than youth with a secondary GAD diagnosis. Contrary to our hypotheses, no differences were found between those with primary versus secondary GAD diagnoses on measures of symptom severity and clinical impairment, comorbid diagnoses, or youth and teacher-report measures. Our findings have potential implications for the current practice of requiring primary anxiety diagnostic status as an inclusion criterion in clinical research and treatment outcome studies. Assuming our findings are confirmed in larger samples and with other anxiety disorders, future clinical trials and basic psychopathology research might not exclude youth based on absence of a particular anxiety disorder as the primary disorder but rather include individuals for whom that anxiety disorder is secondary as well.

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Annual Research Review: Conceptualising functional impairment in children and adolescents

Cited by 97 publications

References 72 publications

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

Assessing Functional Impairment in Siblings Living With Children With Disability

Primary Versus Secondary Diagnosis of Generalized Anxiety Disorder in Youth: Is the Distinction an Important One?

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