Download (CBCL) AND THE CONNER`S PARENT RATING SCALE

CAREGIVER SCREENING FOR FASD USING THE
CHILD BEHAVIOR CHECKLIST (CBCL) AND THE
CONNER’S PARENT RATING SCALE (CPRS)
ELLEN FANTUS, JOANNE ROVET, KELLY NASH, RACHEL
GREENBAUM,DONNA SORBARA, IRENA NULMAN, GIDEON KOREN
The Hospital for Sick Children, Toronto
Rationale
• Cognitive problems extensively studied in
children with FASD
• Behavioral sequelae less well studied in children
with FASD
• FASD associated with high risk of mental health
problems in adults
• Children with FASD often misdiagnosed with
Attention Deficit Hyperactivity Disorder (ADHD)
• Therefore need to identify full spectrum of
behavioural disorders in children with FASD
Rationale (cont’d)
• Caregiver questionnaires provide useful
information on behavioural characteristics
of children with disorders
• Several studies using caregiver
questionnaires with FASD have provided
inconsistent results
Past Studies
•
•
•
•
Steinhausen et al (1993)
– CBCL to FAS adolescents
– Elevated scores on hyperactivity and anxiety but not aggression or
delinquency scales
Roebuck et al (1999)
– Personality Inventory for Children (PIC) to FAS/ARND and control
children
– Elevated scores on scales of delinquency, psychosis, emotional lability,
social withdrawal, and social problems
Mattson et al (2000)
– CBCL to FAS/ARND children
– Elevated scores on aggression, delinquency, social, thought, and
attention problems
Greenbaum et al (2004; Greenbaum, 1999)
– CBCL to FASD and matched control children
– FASD higher incidence of clinically elevated externalizing behaviour
problems with clinically elevated scores on attention, thought
processing, social functioning, delinquency, and aggression scales
Motherisk Follow-up Clinic
• Founded in 1996
• Over 200 children (aged 3-17) with known
and suspected alcohol exposure have
received a comprehensive
neuropsychological and medical
evaluation
• FASD diagnosis provided when indicated
• Ongoing data base of results to identify
behavioural phenotype in FASD
Early Results
• Preliminary data analysis on children
assessed from November 1998 to
September 2002 revealed significant
findings on 2 caregiver questionnaires
• On CBCL, most children showed clinical
elevations on attention problems,
delinquency, and aggression scales
• On CPRS, most children met criteria for
DSM-IV diagnosis for ADHD
OBJECTIVES
• To compare FASD with ADHD
• To compare and contrast results from
CBCL and CPRS
• To identify the behavioural phenotype in
FASD
• To determine utility of these questionnaires
in telehealth diagnosis
DESIGN
• Matched pairs analysis of ARND and
ADHD on CBCL and CPRS
TEST MEASURES
TEST MEASURES
Participants
• CBCL
– 48 ARND/ADHD pairs
matched for age and
sex
– 7-11 years of age
– ADHD from 3 studies
in Rovet lab in same
time period
• Conners
– 35 ARND/ADHD pairs
matched for age, sex,
and socioeconomic
status (SES)
– 7-11 years of age
– ADHD from 2 studies
in Rovet lab in same
time period
CBCL Broad Band Scale Scores
75
p<.05
T-Score
70
p<.001
65
60
55
50
Internalizing
Externalizing
ARND (n=29)
Total Problems
ADHD (n=30)
Cases with Elevated CBCL Broad-band Scales
100
Proportion of Cases in Group
90
(a) T-score > 63
p<.05
80
70
p<.005
60
50
40
30
20
10
0
Internalizing
Externalizing
Total
100
Proportion of Cases in Group
90
(b) T-score>70
80
P<.05
70
60
50
P<.05
40
30
20
10
0
ARND
ADHD
P<.10
CBCL Narrow-band Scale Scores
T Score (M n=50;SD=10)
75
70
65
p<.001
p<.01
p<.05
60
55
50
AnxDepr
WithdDepr
Somatic
SocialProb
ThoughtProb
ARND (n=48)
AttnProb
ADHD (n=48)
RuleBreaking Aggressive
Individual Items on Rule-Breaking Scale
p<.001
100
90
p<.05
80
p<.05
60
p<.001
50
40
30
20
10
ARND (n=48)
ADHD (n=48)
St
ea
ls
Sh
ow
O
ff
Ly
in
g
s
Im
pu
l
lt
N
oG
ui
ob
ed
D
is
C
ru
el
A
rg
ue
C
s
an
'tC
on
ce
n
R
es
tle
ss
0
A
ct
sY
ou
ng
Percent of Group
70
Proportion of Cases in
Group
Cases
with Elevated CBCL Narrow-band Scales
100
90
80
p<.01
p<.05
(a) T-score >63
70
60
50
40
p<.05
30
20
10
0
Proportion of Cases in
Group
AnxDepr
WithdDepr
Somatic
SocialProb
ThoughtProb
AttnProb
RuleBreaking
Aggressive
100
90
(b) T-score >70
80
70
60
p<.01
p<.10
RuleBreaking
Aggressive
50
40
p<.01
30
p<.05
20
10
0
AnxDepr
WithdDepr
Somatic
SocialProb
ThoughtProb
ARND (n=48)
ADHD (n=48)
AttnProb
Conner’s Parent Rating Scale (CPRS) Results
for ARND and ADHD Groups
75
T Score (Mn=50;SD=10)
p<.05
70
p<.05
p<.01
p<.05
65
p<.01
60
55
50
Oppos
CogProb
Hyperact
AnxShy
Perfec
SocProb Psychosom ADHDindex Restl/Imp
ARND (n=35)
ADHD (n=35)
EmotLab
Global
CPRS DSM-IV ADHD Scales
T Score (M=50;SD=10)
80
p<.05
75
70
65
60
55
50
Inattent
Hyper-Imp
ARND (n=35)
Total
ADHD (n=35)
CPRS Scales Involving
Significant Group Differences
T Score (Mn=50;SD=10)
75
70
p<.05
p<.05
p<.01
p<.05
65
p<.01
60
55
50
Oppositional
Hyperactive
Psychosomatic
ARND (n=35)
ADHD (n=35)
Emotional Lability
Global
Cases with Clinically Elevated (T>70)
CPRS Scores
70
p<.10
50
p<.10
p<.10
p<.01
40
30
20
10
ARND (n=35) ADHD (n=35)
al
Gl
ob
b
Em
ot
La
stl
/Im
p
Re
Di
nd
ex
m
ho
yc
Ps
AD
H
so
ro
b
cP
So
rfe
c
Pe
y
An
x
Sh
t
ra
c
pe
Hy
Co
gP
ro
b
os
0
Op
p
Percent of group
60
Summary of Findings
• FASD distinct from and more severely affected
than ADHD
• On CBCL, FASD have more externalizing
problems (rule breaking, social
problems,aggressive), whereas ADHD have
more somatic complaints and more internalizing
problems
• CBCL item analysis showed FASD highly likely
to be cruel, lack guilt, steal, lie, and act young
• On CPRS, FASD more oppositional,
hyperactive, impulsive, emotionally labile
whereas ADHD more psychosomatic and have
more internalizing problems
Conclusion
• Caregiver questionnaires can be used as a
screening tool to identify children with FASD
• Identification of high risk cases in remote
locations can lead to primary interventions
• Early intervention may circumvent secondary
disabilities in underserviced areas.
• Treatment programs to address their specific
needs
Future Directions
• Need to develop targeted treatment
programs to deal with their specific needs
within their community
• Need further research comparing with
other psychiatric populations e.g.,
ODD/CD
• Need to disentangle effects of alcohol from
genetic psychiatric susceptibility and
environmental factors