EBD Blog

One of the interesting areas of research developing these days centers around differences in people’s ability to interpret facial expressions. Some of the studies examine changes in people’s ability to read facial expressions of emotion after different brain surgeries. The most interesting to me are studies that examine whether children with disabilities read expressions differently than their non-disabled peers. The topic is active in studies of children with autism or ADHD.

Here’s the abstract of one study that indicates children with hyperactive-impulsive ADHD may not recognize expressions of anger and sadness as well as their peers. Of course, we’ll need additional studies to replicate and define the extent of the observed effect.

Recognition of emotional facial expressions in attention-deficit hyperactivity disorder.

Pediatr Neurol. 2006 Aug;35(2):93-7

Authors: Pelc K, Kornreich C, Foisy ML, Dan B

In ADHD, impaired interpersonal relationships have been documented. They have been hypothesized to be secondary to impairment of receptive nonverbal language. Recognition of emotional facial expressions is an important aspect of receptive nonverbal language, and it has been demonstrated to be central to organization of emotional and social behavior. This study investigated the identification of facial expression of four emotions (joy, anger, disgust, and sadness) in a group of 30 children aged 7-12 years who met the DSM-IV criteria for ADHD disorder of the predominantly hyperactive-impulsive type and have no comorbid mental retardation, specific learning difficulties, developmental coordination disorder, pervasive developmental disorders, conduct disorder, bipolar disorder, or substance abuse, and in 30 matched unimpaired control children. The test used includes 16 validated photographs depicting these emotions in varying intensities constructed by morphing. Children with ADHD exhibited a general deficit in decoding emotional facial expressions, with specific deficit in identifying anger and sadness. Self-rating of the task difficulty revealed lack of awareness of decoding errors in the ADHD group as compared with control subjects. Within the ADHD group, there was a significant correlation between interpersonal problems and emotional facial expression decoding impairment, which was more marked for anger expressions. These results suggest suboptimal nonverbal decoding abilities in ADHD that may have important implications for therapy.

Link to the PUBMED abstract. Links to Google Scholar searches on ADHD and autism and facial emotion expression.

On 6 October 2006, The US Centers for Disease Control announced a multi-site study of autism. To be called the Centers for Autism and Developmental Disabilities Research and Epidemiology (CADDRE) Network, the sites will be located at Kaiser Foundation Research Institute in California, Colorado Department of Public Health and Environment, Johns Hopkins University, University of North Carolina at Chapel Hill, and the University of Pennsylvania; the CDC itself will also participate in the study. The research will focus on thousands of young children and span the autistic spectrum.

In this five-year study, The National CADDRE Study: Child Development and Autism, a number of factors will be studied for their potential association with ASDs, including:

• infections or abnormal responses to infections in the child, mother or father
• genetic factors in the child, mother and father
• mother’s reproductive history
• abnormal hormone function in the child, mother or father
• gastrointestinal problems in the child
• family history of medical and developmental problems
• smoking, alcohol and drug use in pregnancy, and
• parent’s occupation and other socio-demographic factors.

Link to the CDC press release or linkto the CDC Web site about autism.

Writing in Wednesday Journal, Daniel J. Kill calls on citizens of his area to support efforts to secure adequate funding for mental health services. Mr. Kill, who is president and CEO of the Family Service & Mental Health Center of Oak Park and River Forest (IL, US), takes advantage of Mental Illness Awareness Week

As many as 10 percent of our children suffer from an emotional disturbance, and half of these children will drop out of school. There are more inmates in Illinois prisons with a mental illness than there are in all of the psychiatric hospitals in the state combined. As many as one quarter of Illinois residents are affected by a mental health issue in a given year. Mental illnesses do not discriminate by race, gender or ethnicity. All of us know someone who is suffering.

Link to Mr. Kill’s editorial. Link to the Web site for the Family Service & Mental Health Center of Oak Park & River Forest.

This is Mental Illness Awareness Week. It’s a great time to do something constructive to promote understanding of the problems that students with Emotional and Behavioral Disorders and their families experince. That National Alliance on Mental Illness, a leading proponent of providing help for individuals with EBD, is promoting this awareness week.

October 1-7, 2006

Since 1990, mental health advocates across the country have joined together during the first week of October to celebrate Mental Illness Awareness Week (MIAW).

What is Mental Illness Awareness Week?

Established in 1990 by Congress, the first week of October is designated as “Mental Illness Awareness Week” (MIAW) in recognition of NAMI’s efforts to raise mental illness awareness. “Bipolar Disorder Awareness Day” (BDAD) is held each year on the Thursday of MIAW to encourage further understanding and promote early intervention and treatment for this mental illness.

MIAW and BDAD are NAMI’s premiere public awareness and public education campaigns that link the organization nationally to the organization’s over 1100 local affiliates across the country.

Link to NAMI’s Web page about Mental Illness Awareness Week.

Over on Mentor Matters, Mrs. Ris has a good post on teachers reflecting about their teaching. She argues that some folks who might dismiss reflection as a popular bit of fluff in teaching—I’m among them—should look at reflection not as writing diary entries about cute incidents, but as serious examination of teaching practices that do and do not promote academic and social growth. It’s a good point. Link to Mrs. Ris’ post.

Sometimes I just don’t get it.

The following abstract (from PubMed) describes research on use of medications as a treatment for preschoolers with attention deficit hyperactivity disorder, disruptive behavior disorder, and posttraumatic stress disorder. I suspect that the article reports on prior interventions that have been tried in most of the cases described in the study, but I have to wonder whether those interventions were well-conceived and -executed. Afterall, preschoolers are little kids. Most all of them are very susceptible to differential reinforcement. Did anyone test a carefully implemented time-out program with these kids (and I don’t mean one of the bogus take-time-to-get-yourself-together practices that are often labeled “time out”)?

There are surely a few preschoolers who will not respond to effective behavior management practices, and for those children and their families we must turn to additional means of therapy. But, I hope professionals concerned with Emotional and Behavioral Disorders among young children are using well-documented behavior modification procedures as a much earlier line of therapy.

Prog Neuropsychopharmacol Biol Psychiatry. 2006 Sep 26; [Epub ahead of print] Related Articles, Links

Psychopharmacologic treatment of aggressive preschoolers: A chart review.

Staller JA.

Division of Child and Adolescent Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.

Very young children with severe aggression are a growing focus of care in child psychiatry. Notwithstanding diagnostic uncertainties in this age group, medication, not usually considered a first-line intervention, is becoming a treatment option for a growing number of clinicians in spite of a dearth of research in this area. This chart review assessed the patient characteristics, diagnoses and treatment responses of aggressive preschoolers who were treated in a university child psychiatry outpatient clinic from 2001-2004. The most common diagnoses were Attention Deficit Hyperactivity Disorder (ADHD), Disruptive Behavior Disorder and Posttraumatic Stress Disorder (PTSD). Medication was prescribed for a majority of the children with prominent aggression; atypical antipsychotics were prescribed with the greatest frequency, followed by stimulants and then alpha agonists-treatment response ratings indicated moderate to marked improved in a majority of the preschoolers who received one or a combination of these medications. Findings support the need for controlled trials of medication in preschoolers with severe aggression.