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Objective: Although a certain level of motor activity is considered to be typical in preschoolers, in the most severe cases it interferes with the child's social and academic development. Valid assessment procedure of children's motor activity is therefore a very important issue. The current study aims to validate the Triaxial Accelerometry for Preschoolers (3AAP), a method using the measurement of children's wrist acceleration as a way to estimate their motor activity. Method: Data were collected from a community sample of 226 preschoolers and from a sample of 32 preschoolers clinically referred for externalizing behavior concerns. The participants' motor activity was assessed using a triaxial accelerometer (a sensor worn on the wrist) in three different conditions of assessment, i.e. at school, in a lab session and during a computerized task administration. Results: The 3AAP variables, i.e. the peak, the mean level, the intra-individual variability, and the median of motor activity as well as the percentage of time spent in the lower range and conversely in the higher range of motor activity, were highly intercorrelated and normally distributed. They were significantly correlated with externalizing behavior-related scales from the CBCL, the SDQ and the UCG, and low correlations were reported with internalizing behavior-related scales from the same instruments. Test-retest correlations after a 10-week interval were moderate to high. Significant differences were displayed between the three conditions of assessment as well as between referred and normally-developing preschoolers. Conclusion: The 3AAP scores are good candidates for an objective, low-cost and reliable measurement of preschoolers' motor activity that could be helpful both for research and clinical purposes.

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Background For decades, researchers have been searching for objective laboratory markers to measure and define attention deficit and hyperactivity disorder. However, in clinical practice, the most commonly used tools are still psychological scales, which are neither objective nor laboratory-based. This reliance on scales may stem from the fact that they are currently the only available method in this field for collecting daily-life data, and such data plays an irreplaceable role in defining mental disorders. Fortunately, wearable devices now offer the possibility of collecting objective daily-life data. In our study, we aim to monitor children’s activity synchrony (AcSyn) and activity volume (AcVo) using accelerometers in a school setting to examine the correlation between these daily-life markers and the symptoms related to attention deficit and hyperactivity disorder. Methods This study included an entire class of children of 1st grade (n = 39). Children were required to wear the accelerometer on their wrist to record their activities during school time for 3 weeks using 1-second epoch, based on which we calculated AcSyn and AcVo, and conducted correlation analysis with Attention Deficit and Hyperactivity Disorder Rating Scale. Results In-class AcSyn was significantly correlated with teacher-reported inattention score (r=-0·480, P = 0·001), but not hyperactivity/impulsivity score. In-class/recess AcVo is significantly related to parent-reported hyperactivity/impulsivity score (r = 0·448-0·482, P ≤ 0·002), but not inattention score. Conclusions AcSyn and AcVo are potential markers to measure children’s attention/hyperactivity/impulsivity performance in daily-life. Moreover, when combined with event labels and analyzed on micro or macro time scales, AcSyn and AcVo have the potential to provide profound insights.
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To examine the usefulness of temporal measures of motor activity during psychometric assessment on two different assessment days, 1 week apart with a scope to help the early identification of hyperactivity. Actigraph measures at the ankle and the waist were compared on the first and the second days of psychometric assessment in a total of 169 children (93 children in ADHD group; 76 children in Non-ADHD group) aged 3 years and 4 years. There was a significant interaction effect between group and time on the activity level at the waist. Although the activity level of the waist in the children with ADHD did not significantly differ between Day 1 and Day 2, the activity level of the children without ADHD declined significantly from Day 1 to 2. A total of 70% of children were correctly classified into ADHD or Non-ADHD groups based only on Day 2 waist activity data. The temporal consistency of hyperactivity in young children with ADHD during psychometric assessment is confirmed, indicating that objective measures of motor activity at the waist over different days of psychometric assessment can provide additional information for the stability of hyperactivity.
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Background Some studies report neurobehavioral symptoms in neonates exposed to serotonin reuptake inhibitors (SRIs) in utero. However, maternal psychiatric illness during the last trimester of pregnancy, as a confounding factor, has not always been assessed.AimsIn this prospective study we compared neurobehavioral complications among neonates who were born to euthymic women who either took or did not take an SRI during the last trimester of pregnancy.Study designExposed and unexposed infants were assessed for: 1) temperament as measured by the Neonatal Behavioral Assessment Scale (NBAS); 2) activity via Actiwatch electronic monitoring; 3) sleep state using trained observer ratings; and 4) perinatal complications through medical record review. T-tests, Fisher's exact tests, and analyses of covariance were used to assess the relationship between clinical and neurobehavioral factors and exposure status.Subjects67 infants (61 controls and 6 exposed to SRIs).Outcome measuresNeonatal Assessment Behavioral Scale, APGAR scores, infant sleep state (% sleep, % wakeful), startles and tremulousness, gestational age, birth weight, and head circumference.ResultsInfants exposed to SRIs in the third trimester had poorer motor development, lower 5-minute APGAR scores, and shorter mean gestational age as compared to unexposed infants.Conclusion Results of this study show differences in autonomic and gross motor activity between neonates who were or were not exposed to SRIs in utero after controlling for active maternal psychiatric illness. Future longitudinal work should compare longer term outcomes of exposed and unexposed infants of depressed mothers.
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This study assessed the diagnostic potential of the actigraph, the Continuous Performance Test, and the Matching Familiar Figures Test in diagnosing attention-deficit hyperactivity disorder (ADHD). Twenty boys previously diagnosed with ADHD and 52 controls were examined. By these measures the boys with ADHD were differentiated from the controls with sensitivity and specificity above 75%. We were able to classify ADHD into eight subtypes by combining the scores of the actigraph and the CPT: hyperactive-impulsive, hyperactive-inattentive, impulsive-inattentive, hyperactive, impulsive, inattentive, mixed, and unspecified type. These classifications may be useful in diagnosing ADHD.
Article
The purpose of this study was to explore whether childhood family environments moderated the relation between daily stress and daily biological outcomes (sleep, cortisol output) in healthy young adults. There were 87 participants, ages 19 to 25 who provided information on characteristics of their childhood family environment (conflict, parental warmth). For 1 week they completed a daily stress checklist via electronic diary, provided salivary cortisol samples 4 times a day, and wore an Actiwatch to measure sleep (minutes, efficiency). Data was analyzed using hierarchical linear modeling. Family risk significantly moderated the relation between daily number of stressors and sleep minutes (b = -12.10, p = .02), such that the more difficult one's childhood environment, the less sleep individuals got on days in which they experienced a greater number of stressors. Parental warmth moderated the relation between stress severity and cortisol output (b = -0.19, p = .04), such that the less parental warmth individuals received during childhood, the more cortisol they secreted on days that they experienced more severe stress. The childhood psychosocial environment may have long-term effects on biological responses to daily stress, creating vulnerability to disease in individuals from difficult childhoods.
Article
Symptoms of overactivity form part of the DSM-IV criteria for the combined or hyperactive-impulsive subtypes of attention-deficit/hyperactivity disorder (ADHD); yet little data exist that would quantify the nature of the overactivity component. We aimed to quantify the ability of four different measures of motion sensor data, taken from actigraphs, and the intraindividual variability (IIV) in these measures, to distinguish ADHD cases from controls. Furthermore, we aimed to investigate the degree of shared familial influences on these measures and the ADHD diagnosis. Receiver operating characteristic analysis and multivariate structural equation modeling were used on actigraph data collected during a cognitive testing session in a sample of 116 ADHD combined-type probands, 119 of their siblings, and 218 control siblings (age range 6-18 years). Three measures of actigraph data--the number of movements made, the magnitude of these movements, and the IIV in the magnitude of movement--yielded an area under the curve of up to 0.8, indicating an ability to distinguish between cases and controls. The latter two of these measures showed significant shared familial vulnerability with an ADHD diagnosis, with high ADHD-actigraph familial correlations. The actigraph data support the DSM-IV conceptualization of including overactivity as one of the core features within ADHD combined subtype. The magnitude of movements made, and the IIV of these movements, may be suitable candidates for future molecular genetic studies seeking to identify polymorphisms associated with the risk for ADHD. Further research should investigate if these findings generalize to a more naturalistic, homelike setting.
Article
Assessments of child psychopathology commonly rely on multiple informants, e.g., parents, teachers and children. Informants often disagree about the presence or absence of symptoms, reflecting reporter bias, situation-specific behaviour, or random variation in measurement. However, few studies have systematically tested how far correlates of child psychopathology differ between informants. Parents, teachers and children in the 1999 British Child and Adolescent Mental Health Survey (n = 4,525, ages 11-15 years) completed the Strengths and Difficulties Questionnaire. Multiple source regression models tested the extent to which child, family, school and neighbourhood characteristics were differentially associated with the three informants' reports. The 2004 British Child and Adolescent Mental Health Survey (n = 3,438, ages 11-15 years) was used for replication. Almost all significant correlates of child mental health were differentially related to parent, teacher and child ratings of adjustment. Parental distress, parent-rated family functioning, and child physical health problems were most strongly associated with parent ratings. Child ability and attainment, socio-economic factors, and school and neighbourhood disadvantage were more strongly associated with teacher and parent rated mental health than with children's own ratings. Gender differences in externalising problems were most pronounced for teacher ratings, and least so for child ratings; the opposite held true for emotional problems. Effect sizes for combined latent scores fell near the upper end of the range of effect sizes estimated for the three individual informants. Results showed good replication across the two samples. The study highlights that there is substantial variation across informants in the links between associated factors and child psychopathology.
Article
Sixty-four mothers and children, aged 24 to 54 months, were studied in three groups: a clinically-referred group of children with behavior problems, a clinic group with behavior problems and delayed development, and a matched comparison group. Mother-child dyads were seen in a session adapted from a problem-solving procedure and were scored on their approach to tasks, relationship, and separation-reunion behavior. Mothers reported on children's behavior using a Problem Behavior Checklist. Results showed that behavior of dyads varied as a function of problem group. Clinic mothers were less supportive and helpful in assisting their children than comparison group mothers. Clinic children had difficulty in relationships with their mothers but only delayed children had difficulty with the tasks. Children's behaviors reported on the Checklist tended to match their behavior as observed in the play session. Discriminant analysis predicted problem group for 93% of the dyads. Semistructured play assessment can be an easily used diagnostic tool for understanding the role of the relationship in children's problem behavior.
Article
A novel behavioural screening questionnaire, the Strengths and Difficulties Questionnaire (SDQ), was administered along with Rutter questionnaires to parents and teachers of 403 children drawn from dental and psychiatric clinics. Scores derived from the SDQ and Rutter questionnaires were highly correlated; parent-teacher correlations for the two sets of measures were comparable or favoured the SDQ. The two sets of measures did not differ in their ability to discriminate between psychiatric and dental clinic attenders. These preliminary findings suggest that the SDQ functions as well as the Rutter questionnaires while offering the following additional advantages: a focus on strengths as well as difficulties; better coverage of inattention, peer relationships, and prosocial behaviour; a shorter format; and a single form suitable for both parents and teachers, perhaps thereby increasing parent-teacher correlations.
Article
To compare subtypes of attention-deficit/hyperactivity disorder (ADHD) (predominantly inattentive and combined types) and a comparison group on an objective measure of activity level (actigraphy). Actigraphs were worn by 64 children (49 boys, 15 girls) during a full-day clinical diagnostic assessment; 20 subjects had a diagnosis of ADHD predominantly inattentive type, 22 had ADHD combined type, and 22 were non-ADHD controls. Mean actigraph scores were calculated for two 2-hour intervals, comprising, respectively, a psychometric evaluation in the morning and the completion of a speech and language assessment and research measures in the afternoon. There were no significant group differences in activity level in the morning session. During the afternoon session, children with ADHD were significantly more active than controls, but there were no differences between ADHD subtypes. These data partially support specifications in the DSM-IV regarding hyperactivity in ADHD; however, they also indicate that situational and/or temporal factors may affect the degree to which hyperactivity is expressed. Furthermore, the findings contradict specifications in the DSM-IV that suggest that children with ADHD combined type should be more hyperactive than children with ADHD predominantly inattentive type.
Article
To describe the psychometric properties of the Strengths and Difficulties Questionnaire (SDQ), a brief measure of the prosocial behavior and psychopathology of 3-16-year-olds that can be completed by parents, teachers, or youths. A nationwide epidemiological sample of 10,438 British 5-15-year-olds obtained SDQs from 96% of parents, 70% of teachers, and 91% of 11-15-year-olds. Blind to the SDQ findings, all subjects were also assigned DSM-IVdiagnoses based on a clinical review of detailed interview measures. The predicted five-factor structure (emotional, conduct, hyperactivity-inattention, peer, prosocial) was confirmed. Internalizing and externalizing scales were relatively "uncontaminated" by one another. Reliability was generally satisfactory, whether judged by internal consistency (mean Cronbach a: .73), cross-informant correlation (mean: 0.34), or retest stability after 4 to 6 months (mean: 0.62). SDQ scores above the 90th percentile predicted a substantially raised probability of independently diagnosed psychiatric disorders (mean odds ratio: 15.7 for parent scales, 15.2 for teacher scales, 6.2 for youth scales). The reliability and validity of the SDQ make it a useful brief measure of the adjustment and psychopathology of children and adolescents.
Article
This study focuses on a novel observational paradigm (SNAP) involving a rigged competitive card game (Murray, Woolgar, Cooper, & Hipwell, 2001) designed to expose children to the threat of losing. Recent work suggests that this paradigm is useful for assessing disruptive behaviour in young children (Hughes, Cutting, & Dunn, 2001). We report on a large study (involving 800 five-year-olds) that compares observational ratings of disruptive behaviour on the SNAP game with mother and teacher reports of externalising behaviour on the CBCL and TRF (Achenbach, 1991a, 1991b). To ensure independence of data, playmates were randomly assigned to two different sub-samples. The validity of this rigged game for examining individual differences in disruptive behaviour was supported (in both sub-samples) by modest but significant correlations with both mother and teacher ratings of externalising problems, and by significantly elevated SNAP ratings among children rated by mothers and teachers as showing extreme (> or = 95th%) levels of externalising problems, compared with the remaining majority of children. Significant gender differences in disruptive behaviour were found on all three measures: observational SNAP ratings and mother/teacher questionnaire ratings. Factors that may contribute to this gender difference are discussed. Our findings emphasise the importance of multi-method, multi-informant measures of disruptive behaviour, and suggest that the rigged card game used in this study is a valuable adjunct to more standard methods of rating disruptive behaviour.
Article
To evaluate the pharmacodynamic effects of an experimental (EXP) delivery of methylphenidate (MPH) in children with attention-deficit/hyperactivity disorder and to investigate the situational nature of effects in laboratory classroom and playground settings. A "sipping" study methodology was used to deliver a bolus followed by small but increasing MPH doses as the EXP regimen. A randomized, double-blind crossover design was used to compare the EXP regimen to a thrice-daily (TID) regimen and a placebo (PLA) regimen. Measures of efficacy were obtained from a Motionlogger actigraph to quantify activity and from the Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) rating scale to quantify two domains of behavior (attention and deportment). Compared with PLA, both EXP and TID delivery of MPH produced large, significant reductions in activity and inappropriate behavior in the classroom, but the two MPH regimens did not differ in onset or duration of effects across the day. The MPH effects were situationally dependent and were smaller for the playground than for the classroom settings. The findings of this "proof of concept" study support the efficacy of a continuous, ascending delivery of MPH. The situational effects of MPH provide support for the theory of selective effects of stimulants, dependent on the demands of the environment.
Article
This study examined (a) convergence between parents' and day care teachers' ratings of children's behavior problems, and (b) whether agreements and disagreements were associated with characteristics of the informant, context, or measures. Parents of 241, 2-4-year old children in day care centers serving low-income families completed measures of child behavior problems, parenting style, stress, depression, and self-efficacy. Teachers completed a measure of classroom behavior problems. There was a low correlation between parents' and teachers' ratings of child behavior (r=.17), and few children (2.5%) received high behavior problem scores from both parents and teachers. Cross-informant agreement on high behavior problem children was related to characteristics of the informants and home context. Implications for identifying children at risk are discussed.
Article
The aim of this study was to determine drug-dependent effects on attention and motor activity in children with attention-deficit/hyperactivity disorder (ADHD) in a double-blind methylphenidate (MPH) trial using both subjective behavior ratings and objective measures of function. In particular, we were interested in the relationship between changes of those subjective and objective measures. A total of 44 ADHD children with the combined subtype completed a randomized, double-blind, placebo-controlled, crossover trial with 2 doses of MPH (0.25; 0.5 mg/kg body weight) and placebo. In each condition, computerized attention tasks were performed, teacher-behavior ratings were obtained, and actigraph data were collected in both clinical and naturalistic settings. Trend tests revealed linear effects of MPH dose on actigraph data in the test session (p = 0.02) and at school (p = 0.001), as well as on sustained attention (p < 0.001), while inhibitory control showed a quadratic dose-response curve (p < 0.001). Multivariate regression analyses revealed that changes of both, hyperactive-impulsive symptoms (28%) and inattentive symptoms (23%) could be explained by objective changes of motor activity. Thus, for clinical practice, it should be taken into account that behavior ratings of ADHD symptoms seemed to be predominantly influenced by changes of motor activity.
Article
The aim of this study was to examine the association between overweight and physical activity or sedentary time measured by accelerometry in rural boys and girls 7 to 19 years old. A cross-sectional study was conducted involving 130 girls and 99 boys in elementary, middle, and high school in rural Maryland. After weight, height, and body composition were measured, children wore an Actiwatch accelerometer for 6 days. Comparisons for activity counts were made between normal and overweight or at risk for overweight (at-risk/overweight) participants (>or=85th percentile of BMI). The associations between body composition and accelerometry-defined activity levels (sedentary, light, moderate, and vigorous) were analyzed by age group for boys and girls. Differences in total activity in counts per day or counts per minute were not observed between normal and at-risk/overweight boys or girls in all age groups. No associations between measures of body composition and time spent in an activity level were seen in boys. Fat mass and percentage fat were positively correlated to time spent in sedentary activity (range r = 0.42 to 0.54, all p < 0.01) for girls. In contrast, fat mass and percentage fat were negatively related to time spent in light activity (range, r = -0.40 to -0.51, p < 0.05) for girls. In girls, but not boys, greater body fat is associated with greater time spent being inactive, and lower levels of body fat are associated with more time spent in light activity. Physical activity interventions targeting inactive children in rural communities are warranted.
Article
Schulman and colleagues demonstrated that classroom activity level can be reduced in hyperactive boys using activity-level feedback and positive reinforcement. This article reports preliminary results using a device that combines modern beeper and actigraphy technology for the purpose of measuring, monitoring, and modifying motor excess in children with confirmed diagnoses of Attention Deficit Hyperactivity Disorder (ADHD). Nine boys ranging in age from 8 to 9 years with the ADHD Combined Type wore prototype BuzzBee feedback actigraphs during school periods and were reinforced for activity-level reductions in the context of a simple pre/post research design. The findings indicated that 7 of the 9 boys reduced their activity level from 20 to 47% of baseline levels while the activity levels of the two remaining boys increased from 2 to 7% of baseline levels. These changes were statistically significant and constitute a large effect.
Article
Attaining a developmentally sensitive nosology for preschool disruptive behavior requires characterization of the features that distinguish it from the normative misbehavior of this developmental period. We hypothesize that quality of behavior and its pervasiveness across contexts are critical dimensions for clinical discrimination in young children and propose that structured diagnostic observation provides a systematic method for their identification. We use the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) to examine whether: (a) observed quality and pervasiveness of behavior distinguishes preschoolers with clinically concerning disruptive behavior from typically developing preschoolers, and (b) observed pattern of clinically salient behavior predicts impairment above and beyond maternal report of behavioral frequency. Participants are a behaviorally heterogeneous sample of preschoolers (N = 327). Diagnostic methods developed for clinical assessment of preschoolers were used to classify children as (a) Non-Disruptive, (b) Sub-Clinical, or (c) Disruptive. Child behavior was coded based on interactions with parent and examiner during the DB-DOS. Quality and pervasiveness of observed behaviors during the DB-DOS significantly distinguished the three behavioral groups. Discriminative utility varied depending on the comparison. With few exceptions, clinically concerning patterns on the DB-DOS added significant incremental utility in predicting impairment. Observed patterns of clinically salient behavior show promise for advancing developmentally-informed characterization of disruptive behavior within the preschool period.
ASEBA preschool forms & profiles: An integrated system of multi-informant assessment
  • T M Achenbach
  • L Rescorla
Achenbach TM, Rescorla L (2000) ASEBA preschool forms & profiles: An integrated system of multi-informant assessment. Aseba.
Conners Rating Scales-Revised. The use of psychological testing for treatment planning and outcomes assessment
  • C K Conners
Conners CK (1999) Conners Rating Scales-Revised. The use of psychological testing for treatment planning and outcomes assessment (2nd edn.,). Lawrence Erlbaum Associates Publishers, Mahwah, NJ, Mahwah, NJ, US.