Biological 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) Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents® PubMed/MEDLINE Disclaimer. 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Box, CH–4009 Basel (Switzerland) www.karger.com 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].