Table Of ContentBiological Child Psychiatry
Advances in Biological Psychiatry
Vol. 24
Series Editors
D. Ebert Freiburg
K.P. Ebmeier Oxford
W.F. Gattaz São Paulo
W.P. Kaschka Ulm
Biological Child Psychiatry
Recent Trends and Developments
Volume Editors
T. Banaschewski Mannheim
L.A. Rohde Porto Alegre
8 figures and 13 tables, 2008
Basel · Freiburg · Paris · London · New York ·
Bangalore · Bangkok · Singapore · Tokyo · Sydney
Prof. Dr. Dr. Tobias Banaschewski
Prof. Dr. Luis Augusto Rohde
Department of Child and Adolescent
Child and Adolescent Psychiatric Division
Psychiatry and Psychotherapy
Hospital de Clinicas de Porto Alegre
Central Institute of Mental Health
Rua Ramiro Barcelos, 2350
PO Box 12 21 20
Porto Alegre, RS 90035–003 (Brazil)
DE-68072 Mannheim (Germany)
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Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel
ISSN 0378–7354
ISBN 978–3–8055–8482–1
Library of Congress Cataloging-in-Publication Data
Biological child psychiatry : recent trends and developments / volume
editors, T. Banaschewski, L.A. Rohde.
p. ; cm. – (Advances in biological psychiatry, ISSN 0378-7354 ; v.
24)
Includes bibliographical references and index.
ISBN 978-3-8055-8482-1 (hard cover : alk. paper)
1. Biological child psychiatry.
I. Banaschewski, Tobias.
II. Rohde, L. A.
(Luis Augusto)
III. Series.
[DNLM:
1. Mental Disorders–physiopathology.
2. Adolescent.
3. Child.
4. Psychophysiology. W1 AD44 v.24 2008 / WS 350 B615 2008]
RJ486.5.B56 2008
618.92�89–dc22
2007049800
Contents
VII Preface
1 Attention-Deficit/Hyperactivity Disorder
Coghill, D. (Dundee); Rohde, L.A. (Porto Alegre); Banaschewski, T. (Mannheim)
21 Autism
Moura, P.J. (São Paulo/New Haven, Conn.); Lombroso, P.J. (New Haven, Conn.);
Mercadante, M.T. (São Paulo)
39 Brain Model for Pediatric Bipolar Disorder
Pavuluri, M.N.; Bogarapu, S. (Chicago, Ill.)
53 Neurobiology of Depression in Childhood and Adolescence
Bark, C.; Resch, F. (Heidelberg)
67 The Neurobiological Basis of Anxiety in Children and Adolescents
Grados, M.A. (Baltimore, Md.)
82 Obsessive-Compulsive Disorder in Childhood
Rosário, M.C.; Alvarenga, P.; Mathis, M.A. (São Paulo);
Leckman, J. (New Haven, Conn.)
95 Neurobiological Background of Tic Disorders
Roessner, V.; Rothenberger, A. (Goettingen)
118 Schizophrenia in Children and Adolescents
Remschmidt, H. (Marburg)
138 Eating Disorders
Fleitlich-Bilyk, B. (São Paulo); Lock, J. (Stanford, Calif.)
153 Conduct Disorder
Popma, A. (Amsterdam); Vermeiren, R. (Leiden)
166 Substance Use Disorders in Adolescence
Szobot, C.M. (Porto Alegre); Bukstein, O. (Pittsburgh, Pa.)
VI
Contents
181 Molecular Genetics in Child Psychiatry
Stringaris, A.K.; Asherson, P. (London)
195 Recent Developments in Neuropsychological Models of
Childhood Psychiatric Disorders
Willcutt, E.G. (Boulder, Colo.); Sonuga-Barke, E.J.S. (Southampton/New York, N.Y./
London/Ghent); Nigg, J.T. (East Lansing, Mich.); Sergeant, J.A. (Amsterdam)
227 Electrophysiology in Child Psychiatric Disorders
Banaschewski, T. (Mannheim); Brandeis, D. (Zürich)
238 Neuroimaging in Child Psychiatry
Durston, S. (Utrecht)
250 Author Index
251 Subject Index
Section Title
Preface
Several epidemiological studies have documented that mental health disorders are
extremely prevalent in children and adolescents with rates varying from 10 to 20%
depending on whether the evaluation of impairment is part of the assessment [1, 2]. In
addition, data from longitudinal studies and retrospective investigations in adulthood
have demonstrated that a substantial proportion of psychiatric diagnoses identified in
adults have their roots in childhood and adolescence [3, 4]. Moreover, several reports
in the literature have also documented the substantial amount of burden that child
mental health problems impose on children, their families and society in general [5].
Thus, understanding child psychiatric disorders is a priority in the worldwide mental
health agenda based on its prevalence, continuity into adulthood and impact.
Throughout the last decades, several different frameworks have influenced the
field of child psychiatry. In the past, the field was strongly based on psychodynamic
and social concepts [6]. In the last two decades, an enormous amount of data has
emerged in areas such as neuroimaging, molecular genetics, neuropsychology, and
neurophysiology, helping to better understand the biological basis of the majority of
child mental disorders. Thus, we have moved from attributing the causes of severe
child mental disorders like autism primarily to problematic mother-infant relation-
ships to an era in which huge genome-wide scanning studies and longitudinal gene-
environmental investigations are beginning to reveal the complex interplay of nature
and nurture in normal development and in the etiology of child mental disorders [7].
Advances in biological child psychiatry may ultimately facilitate our understanding of
how environmentally and psychosocially mediated risk processes operate on the
developing brain and also increase our knowledge of the developmental trajectories
that occur across the life course [8].
In this exciting context, the authors of this book wrote their chapters. They are
among the world’s leading experts, both researchers and clinicians, in the area of
VIII
Rohde � Banaschewski
biological child psychiatry. While some contributors focused exclusively on recent
biological aspects of specific disorders, others preferred a more comprehensive
approach describing some clinical aspects too. However, independent of the approach
chosen, the reader will always find the most recent advances in neurobiological
research on each of the disorders addressed in this book.
During the rapid development of child psychiatry in the last decade, investigators
have also paid special attention to the impact of cross-cultural issues on the develop-
ment and/or modulation of phenotype or course of child mental disorders [9]. This is
another interesting aspect of this book, since the team of authors came from very
diverse cultural backgrounds and, whenever possible, we tried to have authors from
different cultures address specific disorders.
Finally, a very relevant issue is related to what is called ‘translation research’. In
other words, how very sophisticated basic laboratory findings translate into clinical
practice [10]. Although the focus of this volume is on child biological psychiatry, the
authors tried to present findings in an integrative context helping readers to establish
the needed connections with the real clinical world.
For all the reasons mentioned above, we are confident that this book will be valu-
able to all practitioners and researchers both in child and adolescent mental health
services and developmental and clinical neuroscience who are interested in deepen-
ing their knowledge of the recent advances in the underlying biological bases of major
child and adolescent mental health disorders.
Luis Augusto Rohde, Porto Alegre
Tobias Banaschewski, Mannheim
References
1
Belfer ML, Saxena S: WHO Child Atlas Project.
Lancet 2006;367:551–552.
2
Fleitlich-Bilyk B, Goodman R: Prevalence of child
and adolescent psychiatric disorders in southeast
Brazil. J Am Acad Child Adolesc Psychiatry 2004;43:
727–734.
3
Kessler RC, Berglund P, Demler O, Jin R,
Merikangas KR, Walters EE: Lifetime prevalence
and age-of-onset distributions of DSM-IV disorders
in the National Comorbidity Survey Replication.
Arch Gen Psychiatry 2005;62:593–602.
4
Kim-Cohen J, Caspi A, Moffitt TE, Harrington H,
Milne BJ, Poulton R: Prior juvenile diagnoses in
adults with mental disorder: developmental follow-
back of a prospective-longitudinal cohort. Arch Gen
Psychiatry 2003;60:709–717.
5
Prince M, Patel V, Saxena S, Maj M, Maselko J,
Phillips MR, Rahman A: No health without mental
health. Lancet 2007;370:859–877.
6
Eisenberg L: The past 50 years of child and adoles-
cent psychiatry: a personal memoir. J Am Acad
Child Adolesc Psychiatry 2001;40:743–748.
7
Caspi A, Moffitt T: Gene-environment interactions
in psychiatry: joining forces with neuroscience. Nat
Rev Neurosci 2006;7:583–590.
8
Rutter M: Categories, dimensions, and the mental
health of children and adolescents. Ann NY Acad
Sci 2003;1008:11–21.
9
Rohde LA, Szobot C, Polanczyk G, Schmitz M,
Martins S, Tramontina S: Attention-deficit/hyper-
activity disorder in a diverse culture: do research
and clinical findings support the notion of a cultural
construct for the disorder? Biol Psychiatry 2005;57:
1436–1441.
10
Porges SW: Asserting the role of biobehavioral
sciences into translational research: the behavioral
neurobiological revolution. Dev Psychopathol 2006;
18:923–933.
Banaschewski T, Rohde LA (eds): Biological Child Psychiatry. Recent Trends and Developments.
Adv Biol Psychiatry. Basel, Karger, 2008, vol 24, pp 1–20
Attention-Deficit/Hyperactivity
Disorder
David Coghilla � Luis Augusto Rohdeb �
Tobias Banaschewskic
aUniversity of Dundee, Section of Psychiatry, Division of Pathology and Neuroscience,
Ninewells Hospital and Medical School, Dundee, UK; bADHD Outpatient Program,
Child and Adolescent Psychiatric Division, Hospital de Clinicas de Porto Alegre,
Federal University of Rio Grande do Sul, Porto Alegre, Brazil; cDepartment of
Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health,
Mannheim, Germany
Abstract
Objectives: To describe the main aspects of attention-deficit/hyperactivity disorder (ADHD), including
the epidemiology, etiology, neurobiology, clinical features, comorbidities, diagnosis, outcome and treat-
ment. Sources of Data: We performed a comprehensive, selective (nonsystematic) review of the litera-
ture on ADHD. Summary of the Findings: ADHD is highly prevalent in children and adolescents, has a
clear neurobiological basis and an easily detectable set of cohesive symptoms, is associated with impair-
ments in different areas of functioning, and treatment is very efficacious, including the use of medication
in most the cases.
Copyright © 2008 S. Karger AG, Basel
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental
disorders affecting children and adolescents. The core ADHD symptoms are perva-
sive and impairing inattention, hyperactivity, and/or impulsivity. Due to its signifi-
cant prevalence during the lifespan and associated impairments, the disorder is
considered a major health problem [1].
This chapter addresses recent research findings on different aspects of ADHD that
might translate into relevant clinical issues. Thus, an extensive review of the abundant
literature on ADHD is beyond the scope of this chapter.
2
Coghill � Rohde � Banaschewski
Epidemiology
Epidemiological studies have contributed to the understanding of the worldwide dis-
tribution of ADHD and to an accurate planning of services for affected children.
However, disparate prevalence rates can be found around the world. Thus, rates as
low as 0.9% to as high as 20% can be found in epidemiological studies addressing
ADHD [2].
Three recent systematic reviews on this subject have been published in a tentative
to provide a ‘true’ prevalence rate, and to explain the reasons for the variability in
results across studies [3–5]. The prevalence rate estimated by these reviews is com-
monly between 5 and 10%.
In a comprehensive systematic review on ADHD prevalence during childhood and
adolescence conducted by Polanczyk et al. [4], an estimated pooled prevalence for the
disorder was provided. In addition, meta-regression analyses were performed to eval-
uate the role of methodological characteristics on the variability of results. After a
broad review and a rigorous analysis of papers, 102 studies comprising 171,756 sub-
jects from all world regions were included. The aggregated prevalence of ADHD
based on all studies was 5.29% (95% CI 5.01–5.56). The pooled prevalence for chil-
dren and adolescents were 6.48% (95% CI 4.62–8.35) and 2.74% (95% CI 2.04–3.45),
respectively. Furthermore, adjusting for methodological issues, estimates from North
America and Europe were not significantly different. Differences between studies
regarding the diagnostic criteria used (DSM-III, DSM-III-R, DSM-IV or ICD-10),
source of information (best-estimate procedure, parents, ‘and rule’, ‘or rule’, teachers,
or subjects), and requirement or not of impairment for the diagnosis were associated
with significant variability of results.
Studies in children consistently suggest that the ADHD prevalence is higher in
boys than in girls. The male/female ratio varies from 3:1 to 9:1, depending on the ori-
gin of the sample ascertainment [2]. In the systematic review and meta-regression
mentioned above, the pooled ADHD prevalence for boys was 2.45 times higher than
the one detected for girls (only non-referred samples were included). The prevalence
among girls seems to be higher in community samples than in clinical samples, prob-
ably because there is a barrier to diagnosis and treatment referral for females.
The impact of ethnic and socioeconomic issues on the prevalence rates of ADHD
has been much less investigated. In the study by Polanczyk et al. [4], a significantly
different pooled ADHD prevalence estimate was detected for both African and
Middle-East studies when compared to either North American or European esti-
mates. However, this finding might be related to the small number of studies con-
ducted in the first two world regions making their estimates less reliable. In a study by
Angold et al. [6], the authors did not detect significantly different ADHD prevalence
rates in African-American (2.1%) and white (3.2%) youths. Regarding the impact of
poverty on the prevalence of ADHD, several studies also did not detect significant
effects of income [7, 8].
