Diminished 5‐HT functioning in CBCL pediatric bipolar disorder‐profiled ADHD patients versus normal ADHD: susceptibility to rapid tryptophan depletion influences reaction time performance

Zepf, Florian Daniel; Wöckel, Lars; Poustka, Fritz; Holtmann, Martin

doi:10.1002/hup.934

Cited by 46 publications

(46 citation statements)

References 38 publications

(44 reference statements)

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“…The diagnostic value of the CBCL-DP has been discussed in recent years. Previous studies have revealed evidence of high heritability [4,7,8], longitudinal stability [8], stability across ages [4,5,9] and neurobiological basis [10,11]. In addition, there is a growing consensus that the CBCL-DP phenotype should be considered an indicator of poor self-regulation, overall psychopathology, symptom severity, exposure to psychosocial adversity and functional impairment [12,13,14,15,16,17], as well as a heritable trait that increases susceptibility for later psychopathology and impairment [5,17,18].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Correlates of Psychopathology in Children and Adolescents Evaluated with the Strengths and Difficulties Questionnaire Dysregulation Profile in a Clinical Setting

Carballo

Serrano-Drozdowskyj²,

Nieto³

et al. 2014

Psychopathology

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Background: The clinical presentation of children and adolescents referred to mental health services is frequently complicated by comorbid and severe affective and behavioral dysregulation. This dysregulation phenotype seems to be an indicator of overall psychopathology, symptom severity and functional impairment. Currently, this phenotype is assessed by the Child Behavior Checklist. However, the widely used Strengths and Difficulties Questionnaire (SDQ) has been recently validated to screen the Dysregulation Profile (SDQ-DP) in clinical settings. The objective of this study was to determine the prevalence and demographic, psychosocial and clinical correlates of the SDQ-DP phenotype in a Spanish clinical sample. Sampling and Methods: In a clinical sample of 623 consecutively referred children and adolescents (4-17 years old), we compared clinical and sociodemographic correlates between subjects who met the SDQ-DP criteria (DP) and those who did not (NO_DP). Sociodemographic data, parent-rated SDQ, Children's Global Assessment Scale, Clinical Global Impression, family Apgar scale and clinical diagnoses were collected by experienced child and adolescent psychiatrists. Results: Overall in our sample, 175 subjects (28.1%) met the SDQ-DP criteria (DP group). Compared with the NO_DP group, the DP subjects had significantly higher scores on internalizing and externalizing psychopathology, problems with peers and overall problems as well as significantly lower scores on prosocial behavior. Clinical diagnoses assigned revealed that DP subjects showed significantly greater psychiatric comorbidity. DP subjects also showed significantly worse family functioning and increased symptom severity and significantly lower scores on psychosocial functioning. Conclusions: A high prevalence of children and adolescents with the dysregulated profile, assessed by the SDQ-DP, was found in our clinical setting. The SDQ-DP may serve as an index of overall psychological severity and functional impairment. In addition, it may indicate family dysfunction. Further research is needed to validate the clinical value of SDQ-DP by examining longitudinal stability, heritability, adult outcome, risk factors and diagnostic correlates.

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Section: Introductionmentioning

confidence: 99%

Prevalence and Correlates of Psychopathology in Children and Adolescents Evaluated with the Strengths and Difficulties Questionnaire Dysregulation Profile in a Clinical Setting

Carballo

Serrano-Drozdowskyj²,

Nieto³

et al. 2014

Psychopathology

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“…Recent studies have examined the neurobiology underlying the behavioral phenotype captured by the CBCL-DP and presented evidence of genetic [7,11,16] , neurometabolic [17] and endocrinologic [18] characteristics of CBCL-DP.…”

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confidence: 99%

Psychometric Validity of the Strengths and Difficulties Questionnaire-Dysregulation Profile

et al. 2010

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Background: In many severely mentally disordered children, the clinical presentation is complicated by comorbid affective and behavioral dysregulation. Recently, a highly heritable behavioral phenotype of simultaneous deviance on the anxious/depressed, attention problems, and aggressive behavior syndrome scales has been identified on the Child Behavior Checklist Dysregulation Profile (CBCL-DP). The aim of the present pilot study was to determine an equivalent to the CBCL-DP using the Strengths and Difficulties Questionnaire (SDQ). Sampling and Methods: We applied stepwise linear discriminant analyses and receiver operating characteristic (ROC) analysis to data from 543 consecutively referred children and adolescents, aged 5–17 years. The CBCL and the SDQ were completed by parents as part of the diagnostic routine. ICD-10 discharge diagnoses were established in consensus conferences. Results: A combination of five SDQ items (SDQ-Dysregulation Profile, SDQ-DP) yielded the best discrimination of children with and without CBCL-DP and classified 81.0% of the subjects correctly leading to an area under the curve of 0.93. The content of the five SDQ-DP items mirrors well the mixed behavioral phenotype of anxious-depressive, aggressive and attention problems captured by the CBCL-DP. SDQ-DP status was highly correlated with CBCL-DP status and was best defined by a SDQ-DP score ≧5. Conclusions: The psychometric properties of the SDQ-DP have been robustly tested and validated. Based on these results, clinicians may use the SDQ-DP as a useful and economical screening measure to improve the assessment, prevention, and treatment of severe dysregulation in childhood and adolescence. Future investigations should study the longitudinal stability, heritability, and genetic associations of this behavioral phenotype.

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“…First and foremost, apart from the double-blind within-subject repeated measures design it included a healthy control group that did not differ from the patients in education, IQ or age, which was not possible in previous research [34], [39], [40], [41]. Second, using the same behavioral paradigm as previous research with children and adolescents allows us to look at the behavioral data from a developmental viewpoint as part of an iterative approach that focuses on the neurobiological underpinnings of anger reactive aggression in ADHD.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Acute Tryptophan Depletion on Reactive Aggression in Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) and Healthy Controls

et al. 2012

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BackgroundThe neurotransmitter serotonin (5-HT) has been linked to the underlying neurobiology of aggressive behavior, particularly with evidence from studies in animals and humans. However, the underlying neurobiology of aggression remains unclear in the context of attention-deficit/hyperactivity disorder (ADHD), a disorder known to be associated with aggression and impulsivity. We investigated the effects of acute tryptophan depletion (ATD), and the resulting diminished central nervous serotonergic neurotransmission, on reactive aggression in healthy controls and adults with ADHD.Methodology/Principal FindingsTwenty male patients with ADHD and twenty healthy male controls were subjected to ATD with an amino acid (AA) beverage that lacked tryptophan (TRP, the physiological precursor of 5-HT) and a TRP-balanced AA beverage (BAL) in a double-blind, within-subject crossover-study over two study days. We assessed reactive aggression 3.25 hours after ATD/BAL intake using a point-subtraction aggression game (PSAG) in which participants played for points against a fictitious opponent. Point subtraction was taken as a measure for reactive aggression. Lowered rates of reactive aggression were found in the ADHD group under ATD after low provocation (LP), with controls showing the opposite effect. In patients with ADHD, trait-impulsivity was negatively correlated with the ATD effect on reactive aggression after LP. Statistical power was limited due to large standard deviations observed in the data on point subtraction, which may limit the use of this particular paradigm in adults with ADHD.Conclusions/SignificanceTogether with previous findings, the data provide preliminary evidence of an inverse association between trait-impulsivity and the ATD effect on reactive aggression after LP (as assessed by the PSAG) in patients with ADHD and that this relationship can be found in both adolescents and adults. Because of limited statistical power larger sample sizes are needed to find main effects of ATD/BAL administration on reactive aggression in adults with ADHD.

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Diminished 5‐HT functioning in CBCL pediatric bipolar disorder‐profiled ADHD patients versus normal ADHD: susceptibility to rapid tryptophan depletion influences reaction time performance

Abstract: The results suggest alterations in 5-HT functioning in CBCL-PBD-spectrum patients, and 'aggression' as a potential moderator variable to ADHD.

Cited by 46 publications

References 38 publications

Prevalence and Correlates of Psychopathology in Children and Adolescents Evaluated with the Strengths and Difficulties Questionnaire Dysregulation Profile in a Clinical Setting

Prevalence and Correlates of Psychopathology in Children and Adolescents Evaluated with the Strengths and Difficulties Questionnaire Dysregulation Profile in a Clinical Setting

Psychometric Validity of the Strengths and Difficulties Questionnaire-Dysregulation Profile

The Effects of Acute Tryptophan Depletion on Reactive Aggression in Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) and Healthy Controls

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