Kenneth D Gadow

Stony Brook University, Stony Brook, New York, United States

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Publications (152)510.37 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Although psychiatric symptom severity and impairment are overlapping but nevertheless distinct illness parameters, little research has examined whether variables found to be associated with the severity are also correlated with symptom-induced impairment. Parents and teachers completed ratings of symptom-induced impairment for DSM-IV-referenced syndromes, and parents completed a background questionnaire for a consecutively referred sample of primarily male (81 %) 6-to-12 year olds with autism spectrum disorder (ASD) (N = 221). Some clinical correlates (e.g., IQ < 70, maternal level of education, pregnancy complications, current use of psychotropic medication, season of birth) were associated with impairment for several disorders, whereas others were correlated with only a few syndromes (e.g., gender, co-morbid medical conditions) or were not related to impairment in any disorder (e.g., family psychopathology). There was little convergence in findings for parents' versus teachers' ratings. Some clinical correlates (e.g., season of birth, current psychotropic medication, maternal education) were unique predictors of three or more disorders. Pregnancy complications were uniquely associated with social anxiety and schizoid personality symptom-induced impairment. IQ was a unique predictor of schizophrenia, ASD, oppositional defiant disorder symptom-induced impairment. Children whose mothers had relatively fewer years of education had greater odds for symptom-induced impairment in social anxiety, depression, aggression, and mania and greater number of impairing conditions. Season of birth was the most robust correlate of symptom-induced impairment as rated by teachers but not by parents. Children born in fall evidenced higher rates of co-occurring psychiatric and ASD symptom-induced impairment and total number of impairing conditions. Many variables previously linked with symptom severity are also correlated with impairment.
    Journal of Abnormal Child Psychology 02/2015; DOI:10.1007/s10802-015-9979-9 · 3.09 Impact Factor
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    ABSTRACT: Objective In this study, we aimed to expand on our prior research into the relative efficacy of combining parent training, stimulant medication and placebo (Basic) versus parent training, stimulant, and risperidone (Augmented) therapy by examining treatment effects for attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms and peer aggression, symptom-induced—impairment, and informant discrepancy. Method Children (6-12 years; N=168) with severe physical aggression, ADHD, and co-occurring ODD/CD received an open trial of parent training and stimulant medication for 3 weeks. Participants failing to show optimal clinical response were randomly assigned to Basic or Augmented therapy for an additional 6 weeks. Results Compared with Basic therapy, children receiving Augmented therapy experienced greater reduction in parent-rated ODD severity (p=.02, Cohen’s d=0.27) and peer aggression (p=.02, Cohen’s d=0.32), but not ADHD or CD symptoms. Fewer children receiving Augmented (16%) than Basic (40%) therapy were rated by their parents as impaired by ODD symptoms at Week 9/endpoint (p=.008). Teacher ratings indicated greater reduction in ADHD severity (p=.02, Cohen’s d =0.61) with Augmented therapy, but not for ODD or CD symptoms or peer aggression. Although both interventions were associated with marked symptom reduction, a relatively large percentage of children were rated impaired for at least one targeted disorder at Week 9/endpoint by parents (Basic 47%; Augmented 27%) and teachers (Basic 48%; Augmented 38%). Conclusion Augmented was superior to Basic therapy in reducing severity of ADHD and ODD symptoms, peer aggression, and symptom-induced impairment, but clinical improvement was generally context-specific, and effect sizes ranged from small to moderate. identifier: NCT00796302 Clinical trial registration information--Treatment of Severe Childhood Aggression (The TOSCA Study); http://; NCT00796302.
    Journal of the American Academy of Child & Adolescent Psychiatry 09/2014; 53(9). DOI:10.1016/j.jaac.2014.05.008 · 6.35 Impact Factor
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    ABSTRACT: Our aim was to characterize the association of 2 functional single nucleotide polymorphisms (rs6311 and rs6314) in the serotonin 2A receptor gene (HTR2A) with severity of depression symptoms in children with autism spectrum disorder. These polymorphisms have been shown to be associated with depression symptom severity and response to selective serotonin reuptake inhibitor drugs in adults with diagnosed depressive disorder.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2014; 27(2):107-16. DOI:10.1097/WNN.0000000000000028 · 1.09 Impact Factor
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    ABSTRACT: The aim of the present study was to evaluate the association of dopaminergic gene variants with emotion dysregulation (EMD) and attention-deficit/hyperactivity disorder (ADHD) symptoms in children with autism spectrum disorder (ASD). Three dopamine transporter gene (SLC6A3/DAT1) polymorphisms (intron8 5/6 VNTR, 3'-UTR 9/10 VNTR, rs27072 in the 3'-UTR) and one dopamine D2 receptor gene (DRD2) variant (rs2283265) were selected for genotyping based on à priori evidence of regulatory activity or, in the case of DAT1 9/10 VNTR, commonly reported associations with ADHD. A sample of 110 children with ASD was assessed with a rigorously validated DSM-IV-referenced rating scale. Global EMD severity (parents' ratings) was associated with DAT1 intron8 (ηp(2)=.063) and rs2283265 (ηp(2)=.044). Findings for DAT1 intron8 were also significant for two EMD subscales, generalized anxiety (ηp(2)=.065) and depression (ηp(2)=.059), and for DRD2 rs2283265, depression (ηp(2)=.053). DRD2 rs2283265 was associated with teachers' global ratings of ADHD (ηp(2)=.052). DAT1 intron8 was associated with parent-rated hyperactivity (ηp(2)=.045) and both DAT1 9/10 VNTR (ηp(2)=.105) and DRD2 rs2283265 (ηp(2)=.069) were associated with teacher-rated inattention. These findings suggest that dopaminergic gene polymorphisms may modulate EMD and ADHD symptoms in children with ASD but require replication with larger independent samples.
    Research in developmental disabilities 04/2014; 35(7):1658-1665. DOI:10.1016/j.ridd.2014.04.007 · 4.41 Impact Factor
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    ABSTRACT: Although combination pharmacotherapy is common in child and adolescent psychiatry, there has been little research evaluating it. The value of adding risperidone to concurrent psychostimulant and parent training (PT) in behavior management for children with severe aggression was tested. One hundred sixty-eight children 6 to 12 years old (mean age 8.89 ± 2.01 years) with severe physical aggression were randomized to a 9-week trial of PT, stimulant (STIM), and placebo (Basic treatment; n = 84) or PT, STIM, and risperidone (Augmented treatment; n = 84). All had diagnoses of attention-deficit/hyperactivity disorder and oppositional-defiant disorder (n = 124) or conduct disorder (n = 44). Children received psychostimulant (usually Osmotic Release Oral System methylphenidate) for 3 weeks, titrated for optimal effect, while parents received PT. If there was room for improvement at the end of week 3, placebo or risperidone was added. Assessments included parent ratings on the Nisonger Child Behavior Rating Form (Disruptive-Total subscale was the primary outcome) and Antisocial Behavior Scale; blinded clinicians rated change on the Clinical Global Impressions scale. Compared with Basic treatment (PT + STIM [44.8 ± 14.6 mg/day] + placebo [1.88 mg/day ± 0.72]), Augmented treatment (PT + STIM [46.1 ± 16.8 mg/day] + risperidone [1.65 mg/day ± 0.75]) showed statistically significant improvement on the Nisonger Child Behavior Rating Form Disruptive-Total subscale (treatment-by-time interaction, p = .0016), the Nisonger Child Behavior Rating Form Social Competence subscale (p = .0049), and Antisocial Behavior Scale Reactive Aggression subscale (p = .01). Clinical Global Impressions scores were substantially improved for the 2 groups but did not discriminate between treatments (Clinical Global Impressions-Improvement score ≤2, 70% for Basic treatment versus 79% for Augmented treatment). Prolactin elevations and gastrointestinal upset occurred more with Augmented treatment; other adverse events differed modestly from Basic treatment; weight gain in the Augmented treatment group was minor. Risperidone provided moderate but variable improvement in aggressive and other seriously disruptive child behaviors when added to PT and optimized stimulant treatment. Clinical trial registration information-Treatment of Severe Childhood Aggression (The TOSCA Study), URL:, unique identifier: NCT00796302.
    Journal of the American Academy of Child and Adolescent Psychiatry 01/2014; 53(1):47-60.e1. DOI:10.1016/j.jaac.2013.09.022 · 6.97 Impact Factor
  • 2013 International Meeting for Autism Research; 05/2013
  • Aaron J Kaat, Kenneth D Gadow, Luc Lecavalier
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    ABSTRACT: The general aim of this study was to examine the relation of psychiatric symptom-induced impairment with other common parameters of mental health in children with autism spectrum disorder (ASD). Prevalence rates are used to illustrate the implications of different criteria for caseness. Parents/teachers completed DSM-IV-referenced rating scales for 6-12 year old children with ASD (N = 115), the majority of whom were boys (86 %). Most children were rated by parents (81 %) or teachers (86 %) as being socially or academically impaired by symptoms of at least one psychiatric disorder. The most common impairing conditions (parent/teacher) were attention-deficit/hyperactivity disorder (67 %/71 %), oppositional defiant disorder (35 %/33 %), and anxiety disorder (47 %/34 %), and the combined rates based on either informant were generally much higher. Agreement between symptom cutoff and impairment cutoff was acceptable for most disorders. A larger percentage of youth were impaired by psychiatric symptoms than met symptom cutoff criteria, and the discrepancy between impairment cutoff and clinical cutoff (impairment cutoff plus symptom cutoff) was even greater. Impairment was moderately to highly correlated with both number and severity of symptoms. Parents' and teachers' ratings indicated little agreement as to whether a child was impaired. Findings for youth with ASD were similar to non ASD child psychiatry outpatient referrals, but clearly different in several ways from comparable studies of community-based samples.
    Journal of Abnormal Child Psychology 04/2013; 41(6). DOI:10.1007/s10802-013-9739-7 · 3.09 Impact Factor
  • Kenneth D Gadow, Aaron J Kaat, Luc Lecavalier
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    ABSTRACT: OBJECTIVE: To examine the relation of caregiver ratings of psychiatric symptom-induced impairment with number and severity of symptoms and informant agreement in consecutive child psychiatry outpatient referrals. METHODS: Parents and teachers completed a broadband DSM-IV-referenced rating scale with disorder-specific impairment for 636 youth (6-18 years). Illness parameters included impairment, number and severity of symptoms, and their combination (symptom + impairment) as well as categorical (cut-off) and dimensional scoring. RESULTS: Agreement between impairment and other illness parameters showed considerable variation as a function of type of parameter, disorder, and informant, but to lesser extent age and gender. Many youth who met impairment cut-off for specific disorders did not meet symptom cut-off. Conversely, most youth who met symptom cut-off were impaired. Symptom cut-off evidenced greater convergence with impairment cut-off than combined symptom + impairment cut-offs. Severity of impairment was moderately to highly correlated with number and severity of symptoms. Parents' and teachers' ratings indicated little disorder-specific agreement about youth who met impairment cut-off, symptom cut-off, or combined symptom + impairment cut-off. Therefore, sole reliance on one informant greatly underestimates the pervasiveness of impairment. CONCLUSION: Findings are consistent with the notion that each illness parameter represents a unique conceptual construct, which has important clinical and research implications.
    Journal of Child Psychology and Psychiatry 04/2013; DOI:10.1111/jcpp.12077 · 5.42 Impact Factor
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    ABSTRACT: PurposeSymptoms of depression are common in children and adolescents with an autism spectrum disorder (ASD), but information about underlying developmental factors is limited. Depression is often linked to aspects of emotional functioning such as coping strategies, but in children with ASD difficulties with social interactions are also a likely contributor to depressive symptoms.MethodologyWe examined several aspects of emotional coping (approach, avoidant, maladaptive) and social functioning (victimization, negative friendship interactions) and their relation to depression symptoms in children with ASD (N = 63) and typically developing (TD) peers (N = 57). Children completed a battery of self-report questionnaires.ResultsLess approach and avoidant, but more maladaptive coping strategies, and poor social functioning were uniquely associated with more symptoms of depression in children with ASD. Only less approach and more maladaptive coping were uniquely associated with depression severity in TD boys.Conclusions Unlike TD boys, boys with ASD who report using avoidant strategies to deal with stressful situations report fewer symptoms of depression, suggesting that this may be an adaptive emotion regulation strategy. However, understanding the role of over-arousal in this process, inferences about long-term effects of this strategy, its causality and direction of effects will require additional research.
    Research in Autism Spectrum Disorders 04/2013; 7(4):549–556. DOI:10.1016/j.rasd.2013.01.002 · 2.96 Impact Factor
  • Kenneth D Gadow
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    ABSTRACT: This study examines relations between the severity of specific symptoms of schizophrenia spectrum disorder (SSD) and severity of the three defining symptom domains of autism spectrum disorder (ASD) in children with ASD (N=147) and child psychiatry outpatient referrals (Controls; N=339). Participants were subdivided into four groups depending on ASD status (±) and whether they met symptom criteria for attention-deficit/hyperactivity disorder (±ADHD). Their mothers and teachers evaluated them with a DSM-IV-referenced rating scale. Correlations between schizoid personality symptoms and ASD social skills deficits were moderate to large, and this was true for children with ASD and Controls, regardless of ADHD status, and for mother's and teachers' ratings. Conversely, severity of hallucinations, delusions, and disorganized thinking were minimally correlated with ASD severity with the exception of Controls with ADHD. The disorganized behavior and negative symptoms of schizophrenia evidenced the strongest pattern of associations with ASD symptoms, and this was particularly true for children with co-morbid ADHD (±ASD, all three ASD symptom dimensions), and for teachers' ratings of all four groups. Nevertheless, there was considerable variability in relations for specific symptoms across informants and groups. Correlations between SSD symptom severity and IQ were generally low, particularly among the ASD Only group and for all teacher-rated symptoms. Associations between ASD and SSD symptoms were often dimension-specific, and this was particularly evident in children without ADHD (±ASD; mothers' ratings). Findings were interpreted as supporting the deconstruction of complex clinical phenotypes as a means of better understanding interrelations among psychiatric syndromes.
    Research in developmental disabilities 04/2013; 34(4):1289-99. DOI:10.1016/j.ridd.2013.01.011 · 4.41 Impact Factor
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    ABSTRACT: This study explores the manifestation and measurement of anxiety symptoms in 415 children with ASDs on a 20-item, parent-rated, DSM-IV referenced anxiety scale. In both high and low-functioning children (IQ above vs. below 70), commonly endorsed items assessed restlessness, tension and sleep difficulties. Items requiring verbal expression of worry by the child were rarely endorsed. Higher anxiety was associated with functional language, IQ above 70 and higher scores on several other behavioral measures. Four underlying factors emerged: Generalized Anxiety, Separation Anxiety, Social Anxiety and Over-arousal. Our findings extend our understanding of anxiety across IQ in ASD and provide guidance for improving anxiety outcome measurement.
    Journal of Autism and Developmental Disorders 02/2013; DOI:10.1007/s10803-013-1775-1 · 3.06 Impact Factor
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    ABSTRACT: Objective: To compare the results of categorically based versus dimensionally based scoring algorithms for a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV)-referenced teacher rating scale for assessing ADHD and commonly co-occurring conditions and to determine their relative agreement with ratings of symptom-induced impairment. Method: Teachers completed Child and Adolescent Symptom Inventory-4R (CASI-4R) ratings for 1,092 youth (ages 6-18 years) referred to a child and adolescent psychiatry outpatient service. Caseness was determined according to DSM-IV symptom count (categorical model) and T-score (dimensional model) criteria. Results: Agreement between symptom count and T-score cutoffs was generally good (kappa ≥ 0.61) for ADHD-Inattentive, ADHD-Hyperactive-Impulsive, ADHD-Combined (except adolescent females), Oppositional Defiant Disorder, and Conduct Disorder, but this was not the case for anxiety and depressive disorders where only 15% of kappas were good. Agreement of impairment cutoff with T-score and symptom count cutoffs ranged from poor to good. Conclusion: In general, although in many cases CASI-4R categorical and dimensional scoring algorithms generated similar results, there was considerable variability across disorders, age groups, scoring method, and in some cases, gender. Moreover, symptom counts and T-scores are not a proxy for assessing impairment suggesting that each scoring strategy likely provides unique information for clinical decision-making. (J. of Att. Dis. 2013; XX(X) 1-XX).
    Journal of Attention Disorders 02/2013; DOI:10.1177/1087054712475083 · 2.40 Impact Factor
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    ABSTRACT: Background: Obtaining accurate estimates of mental health problems among youth perinatally infected with HIV (PHIV) helps clinicians develop targeted interventions but requires enrollment and retention of representative youth into research studies. Methods: The study design for IMPAACT P1055, a US-based, multisite prospective study of psychiatric symptoms among PHIV youth and uninfected controls aged 6 to 17 years old, is described. Participants were compared with nonparticipants by demographic characteristics and reasons were summarized for study refusal. Adjusted logistic regression models were used to evaluate the association of psychiatric symptoms and other factors with loss to follow-up (LTFU). Results: Among 2281 youth screened between 2005 and 2006 at 29 IMPAACT research sites, 580 (25%) refused to participate, primarily because of time constraints. Among 1162 eligible youth approached, 582 (50%) enrolled (323 PHIV and 259 Control), with higher participation rates for Hispanic youth. Retention at 2 years was significantly higher for PHIV than Controls (84% vs 77%, P = 0.03). In logistic regression models adjusting for sociodemographic characteristics and HIV status, youth with any self-assessed psychiatric condition had higher odds of LTFU compared with those with no disorder (adjusted odds ratio = 1.56, 95% confidence interval: 1.00 to 2.43). Among PHIV youth, those with any psychiatric condition had 3-fold higher odds of LTFU (adjusted odds ratio = 3.11, 95% confidence interval: 1.61 to 6.01). Conclusions: Enrollment and retention of PHIV youth into mental health research studies is challenging for those with psychiatric conditions and may lead to underestimated risks for mental health problems. Creative approaches for engaging HIV-infected youth and their families are required for ensuring representative study populations.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2013; 63(3):401-409. DOI:10.1097/QAI.0b013e318293ad53 · 4.39 Impact Factor
  • Source
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    ABSTRACT: BACKGROUND: The aims of the present study were to examine the association between a common serotonin transporter gene (SLC6A4) polymorphism 5-HTTLPR/rs25531 with severity of attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) symptoms. METHODS: Mothers and teachers completed a validated DSM-IV-referenced rating scale for ADHD and ASD symptoms in 118 children with ASD. RESULTS: Analyses indicated that children with at least one copy of the S or L(G) allele obtained significantly more severe maternal ratings of hyperactivity (p=0.001; ηp(2)=0.097) and impulsivity (p=0.027; ηp(2)=0.044) but not inattention (p=0.061; ηp(2)=0.032), controlling for ASD severity, than children homozygous for the L(A) allele. Conversely, mothers' ratings indicated that children with L(A)/L(A) genotype had more severe ASD social deficits than S+or L(G) allele carriers (p=0.003; ηp(2)=0.081), controlling for ADHD symptom severity. Teachers' ratings though consistent with mothers' ratings of hyperactivity and social deficits were marginally significant (p=0.07/p=0.09). There was some evidence that the magnitude of parent-teacher agreement regarding symptom severity varied as a function of the child's genotype. CONCLUSION: The 5-HTTLPR/rs25531 polymorphism or its correlates may modulate severity of ADHD and ASD symptoms in children with ASD, but in different ways. These tentative, hypothesis-generating findings require replication with larger independent samples.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 10/2012; 40. DOI:10.1016/j.pnpbp.2012.10.019 · 4.03 Impact Factor
  • Kenneth D Gadow
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    ABSTRACT: This study compared the differential severity of specific symptoms of schizophrenia spectrum disorder (SSD) in children with autism spectrum disorder (ASD) and child psychiatry outpatient referrals (controls). Each group was further subdivided into subgroups with and without co-occurring attention-deficit/hyperactivity disorder (ADHD). Children with ASD (n = 147) and controls (n = 335) were evaluated with parent and teacher versions of a psychometrically established DSM-IV-referenced rating scale. The two ASD groups (with and without ADHD) had a larger number of more severe SSD symptoms than their respective control groups (with and without ADHD), extending the observation of an association between ASD and SSD to subgroups with and without co-occurring ADHD. The ASD groups exhibited more severe schizoid personality symptoms than controls, but findings for schizophrenia symptoms were mixed. The ASD + ADHD group generally had more severe disorganized thought, disorganized behavior, and negative schizophrenia symptoms than controls (with and without ADHD); nevertheless, findings varied according to ADHD status (present versus absent), individual symptom (symptom specificity), and informant (informant specificity). Ratings of hallucinations and delusions indicated mild severity and few group differences. Negative symptoms such as inappropriate emotional reactions evidenced considerable group divergence. Findings provide additional support for an interrelation between ASD and SSD symptoms and the differential influence of neurobehavioral syndromes on co-occurring symptom severity, underscore the multidimensionality of SSD in children with ASD, and suggest how symptom phenotypes may contribute to a better understanding of the etiology, nosology, and possibly clinical management.
    Journal of the American Academy of Child and Adolescent Psychiatry 10/2012; 51(10):1076-84. DOI:10.1016/j.jaac.2012.08.001 · 6.97 Impact Factor
  • Megan E. Tudor, Carla J. DeVincent, Kenneth D. Gadow
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    ABSTRACT: The current study examined the association between prenatal pregnancy complications (PPC) and childhood psychiatric symptoms in children with an autism spectrum disorder (ASD) and non-ASD children who were referred to a psychiatric clinic (Controls). Parents completed a DSM-IV-referenced rating scale and developmental history questionnaire. Participants were classified as having ≥1 PPC (+PPC) versus none (−PPC). Children with ASD were significantly more likely to have PPC than Controls. Intra-group comparisons demonstrated that children in the ASD + PPC group had more severe anxiety than ASD/−PPC group. The Control + PPC group obtained higher symptom ratings of inattention, hyperactivity, and oppositional behavior than Control/−PPC. Children in the ASD + PPC group were rated as having more severe anxiety and depression symptoms than Control + PPC. Dissimilar associations in ASD and non-ASD samples were found, suggesting divergent pathogenic processes in different clinical phenotypes.
    Research in Autism Spectrum Disorders 10/2012; 6(4):1401–1405. DOI:10.1016/j.rasd.2012.06.001 · 2.96 Impact Factor
  • Source
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    ABSTRACT: Cross-sectional research indicates high rates of mental health concerns among youth with perinatal HIV infection (PHIV), but few studies have examined emerging psychiatric symptoms over time. Youth with PHIV and peer comparisons who were HIV-exposed but uninfected or living in households with HIV-infected family members (HIV-affected) and primary caregivers participated in a prospective, multisite, longitudinal cohort study. Groups were compared for differences in the incidence of emerging psychiatric symptoms during 2 years of follow-up and for differences in psychotropic drug therapy. Logistic regression models were used to evaluate the association of emerging symptoms with HIV status and psychosocial risk factors. Of 573 youth with study entry assessments, 92% attended at least 1 annual follow-up visit (PHIV: 296; comparisons: 229). A substantial percentage of youth who did not meet symptom criteria for a psychiatric disorder at study entry did so during follow-up (PHIV = 36%; comparisons = 42%). In addition, those who met criteria at study entry often met criteria during follow-up (PHIV = 41%; comparisons = 43%). Asymptomatic youth with PHIV were significantly more likely to receive psychotropic medication during follow-up than comparisons. Youth with greater HIV disease severity (entry CD4% <25% vs 25% or more) had higher probability of depression symptoms (19% vs 8%, respectively). Many youth in families affected by HIV are at risk for development of psychiatric symptoms.
    Journal of developmental and behavioral pediatrics: JDBP 07/2012; 33(6):456-68. DOI:10.1097/DBP.0b013e31825b8482 · 2.12 Impact Factor
  • Kenneth D Gadow, Deborah A G Drabick
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    ABSTRACT: Examined autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD) symptoms in a clinically referred, non-ASD sample (N=1160; ages 6-18) with and without oppositional defiant disorder (ODD). Mothers and teachers completed DSM-IV-referenced symptom checklists. Youth with ODD were subdivided into angry/irritable symptom (AIS) or noncompliant symptom (NS) subtypes. Two different classification strategies were used: within-informant (source-specific) and between-informant (source-exclusive). For the source-specific strategy, youth were classified AIS, NS, or Control (C) according to mothers' and teachers' ratings separately. A second set of analyses focused on youth classified AIS according to mother or teacher report but not both (source-exclusive) versus both mother and teacher (cross-informant) AIS. Results indicated the mother-defined source-specific AIS groups generally evidenced the most severe ASD and SSD symptoms (AIS>NS>C), but this was more pronounced among younger youth. Teacher-defined source-specific ODD groups exhibited comparable levels of symptom severity (AIS, NS>C) with the exception of SSD (AIS>NS>C; younger youth). Source-exclusive AIS groups were clearly differentiated from each other, but there was little evidence of differential symptom severity in cross-informant versus source-exclusive AIS. These findings were largely dependent on the informant used to define the source-exclusive groups. AIS and NS groups differed in their associations with ASD and SSD symptoms. Informant discrepancy provides valuable information that can inform nosological and clinical concerns and has important implications for studies that use different strategies to configure clinical phenotypes.
    Research in developmental disabilities 07/2012; 33(4):1157-68. DOI:10.1016/j.ridd.2012.01.004 · 4.41 Impact Factor
  • A. J. Kaat, K. D. Gadow, L. Lecavalier
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    ABSTRACT: Background: To meet diagnostic criteria for most psychiatric disorders, the DSM-IV-TR requires that a certain number of symptoms be present and cause impairment in social, academic, or occupational functioning. Little research has been done on the relationship between psychiatric symptoms and impairment in children with Autism Spectrum Disorders (ASD). The Child and Adolescent Symptom Inventory (CASI-4R), a DSM-IV based symptom checklist, was recently revised to include impairment ratings for several major disorders. Objectives: The objective of this study was to examine the relationship between psychiatric symptoms and impairment in a large sample of clinically referred children with ASD. Specifically, the objective was to examine how many children screened positive for a disorder based on symptoms only, had significant impairment only, or had both positive screens and impairment. The following disorders were considered: Attention Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Generalized Anxiety Disorder (GAD), Social Phobia, Major Depressive Episode (MDE), and Dysthymia. Methods: Participants were consecutive referrals to a specialty clinic for autism and developmental disorders who met inclusion criteria for this study. Parents and teachers completed the CASI-4R. A positive screen on the CASI-4R occurs when the rater endorses the DSM-required number of symptoms for a disorder as occurring ‘often’ or ‘very often’. Parent-reported data were available for 104 children (88 boys, 16 girls) and teacher-reported data for 88 children (79 boys, 10 girls) with a mean age of 8.5 years (SD = 1.8) and FSIQ of 86 (SD= 22). Additional socio-demographic variables were also collected. Analyses were conducted on parent and teacher data separately. Results: Parents and teachers showed low but significant levels of agreement. The correlations between symptom severity scores and impairment scores varied from .49 (for CD) to .83 (for ODD) for parents and from .59 (for ADHD-HI) to .84 (for CD) for teachers. By parent-report, 84 children (81%) were impaired in at least one disorder. For teachers, 76 children (86%) were impaired. Rates of impairment varied significantly across disorders from 20% (for depressive disorders) to 67% (for ADHD). With the exception of parent-reported dysthymia and teacher-reported CD, more children showed impairment than met the symptom count requirements for a disorder. Just because children showed impairment did not mean that they met symptom count requirements. But for parents, children who met symptom count requirements usually also showed impairment. By teacher-report, not all children who met symptom count requirements were impaired. Conclusions: Many children with ASD present with psychiatric symptoms. Symptoms of other disorders are present and impairing in most children’s lives. Of the children who met symptom count requirements, most also met impairment requirements. However, a significant proportion of children failed to reach symptom count requirements, but showed impairment. These subthreshold cases warrant additional evaluation to ensure that all needs are appropriately addressed in treatment.
    2012 International Meeting for Autism Research; 05/2012
  • Kenneth D Gadow, Deborah A G Drabick
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    ABSTRACT: We examined differences in co-occurring psychological symptoms and background characteristics among clinically referred youth with oppositional defiant disorder (ODD) with and without anger/irritability symptoms (AIS) according to either parent or teacher (source-exclusive) and both informants (cross-informant), youth with noncompliant symptoms (NS) of ODD, and non-ODD clinic controls. Parents and teachers evaluated 1127 youth (ages 6-18) with a DSM-IV-referenced rating scale to assess ODD and co-occurring psychological symptoms. Parents also completed a background questionnaire (demographic, developmental, treatment, relationship, and academic characteristics) and teachers rated school functioning. Source-exclusive AIS groups were associated with different clinical features, and there was some evidence that cross-informant youth had more mental health concerns than source-exclusive groups. Findings varied to some extent among older (12-18 years) versus younger (6-11 years) youth. In general, the NS group (youth without AIS) was the most similar to clinic controls. AIS and NS are likely candidates for component phenotypes in ODD and continued research into their pathogenesis may have important implications for nosology, etiology, and intervention.
    Journal of Abnormal Child Psychology 05/2012; 40(7):1073-85. DOI:10.1007/s10802-012-9637-4 · 3.09 Impact Factor

Publication Stats

4k Citations
510.37 Total Impact Points


  • 1980–2014
    • Stony Brook University
      • • Department of Psychiatry and Behavioral Science
      • • Department of Neurology
      Stony Brook, New York, United States
  • 2012
    • St. Jude Children's Research Hospital
      Memphis, Tennessee, United States
  • 2005–2012
    • Stony Brook University Hospital
      Stony Brook, New York, United States
  • 1987–2012
    • State University of New York
      New York, New York, United States
  • 2010
    • Tulane University
      New Orleans, Louisiana, United States
  • 2004–2008
    • Temple University
      • Department of Psychology
      Philadelphia, PA, United States
  • 2002
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 1999
    • Harvard Medical School
      Boston, Massachusetts, United States