PSYCHOPATHOLOGY IN YOUNGSTERS WITH AUTISM SPECTRUM DISORDERS DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Andrea N Witwer, M.A. * * * * * The Ohio State University 2009 Dissertation Committee: Dr Luc Lecavalier, Adviser Dr. Michael G. Aman Dr. Mary Fristad Dr. David Hammer APPROVED BY __________________________ ADVISER GRADUATE PROGRAM IN PSYCHOLOGY ABSTRACT The primary purpose of this study was to examine the reliability and validity of the Children’s Interview for Psychiatric Syndromes-Parent Version (P-ChIPS). Reliability of the P-ChIPS was examined through interrater reliability (i.e., degree of agreement between raters) and internal consistency analyses. Concordant validity was explored by examining the agreement between the P-ChIPS and the Child and Adolescent Symptom Inventory (CASI). Convergent validity was examined by measuring the relationship between P-ChIPS-derived diagnoses and Nisonger Child Behavior Checklist (NCBRF) problem behavior and prosocial subscales. The impact of IQ, language, and age on these analyses were also examined. The second purpose of this study was to elucidate the clinical picture of psychiatric disorders in this population. This was done by examining the rates of symptoms and disorders, the presence of subsyndromal diagnoses, and behavioral equivalents. Parents of 61 children and adolescents (mean age 11.22± 3.80; range 6-17) with autism, Asperger’s disorder, and PDD-NOS were interviewed with the P-ChIPS and Autism Diagnostic Interview-Revised (ADI-R) and completed the CASI and NCBRF. The youngsters were administered the Stanford-Binet V IQ test. Interrater reliability kappa values were largely in the good to excellent range. Internal consistency values were good for ADHD, ODD, Social Phobia, Depression and Mania (.89-.86), but below acceptable values for Obsessions (.30) and Compulsions (.65). Concordance ii between the P-ChIPS and the CASI was fair (i.e., .41 < k < .57) for the majority of disorders. Percent overall agreement for most disorders was good with values at or above 70%, lending support to the concordant validity of the P-ChIPS. P-ChIPS derived diagnoses as a whole converged as expected with related NCBRF subscales. Subsyndromal analyses suggested that some modifications may be needed to diagnostic criteria cutoffs. Behavioral equivalent analyses were largely nonsignificant. The P- ChIPS appears to be appropriate for this population although some modifications may be necessary for those without language or IQ less than 70. iii Dedicated to my family. iv ACKNOWLEDGMENT I would like to thank the many people who have provided support throughout the completion of this dissertation. First, I would like to thank Dr Luc Lecavalier, my advisor, for his guidance throughout the development, implementation, and analysis of this study. He provided thoughtful feedback while also allowing me independence to complete the project the way I saw fit. I have learned an immeasurable amount from him throughout graduate school and for that I will always be grateful. I am grateful to my family for their love and unwavering support throughout this process and my graduate years. Without all of you this would not have been possible. I would also like to thank the many families who took time out of their hectic lives to participate in the study. Without them this project would not have been possible. This research was supported in part by a grant from the Ohio Department of Mental Health and the Ohio State University Alumni Grant for Graduate Research and Scholarship. v VITA October 29, 1978…………………………………………… Born Wadsworth, Ohio 2001…………………………………………………………B.S Psychology, Ohio State University 2001-2003…………………………………………………..Clinical Research Coordinator Ohio State University 2003-2004………………………………………………….. University Fellow, Ohio State University 2004-2005…………………………………………………...Graduate Teaching Associate Ohio State University 2005…………………………………………………………..M.A. Psychology, The Ohio State University 2005-2009…………………………………………………….Graduate Associate, Ohio State University PUBLICATIONS Aman, M.G., Arnold, L.E., Ramadan, Y, Witwer, A.N., & Lindsay, R., et al. (2005). Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Archives of General Psychiatry, 62, 1266-1274. Witwer, A. & Lecavalier, L. (2005). Treatment incidence and patterns in children and adolescents with autism spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 15, 671-681. Arnold, L.E., Aman, M.G., Cook, A.M., Witwer, A.N., Hall, K., Thompson, S., & Ramadan, Y. (2006). Atomoxetine for hyperactivity in autistic spectrum disorders: Placebo-controlled crossover pilot trial. Archives of General Psychiatry, 45, 1196- 205. vi Witwer, A.N. & Lecavalier, L. (2007). Autism screening tools: An evaluation of the Social Communication Questionnaire and the Developmental Behaviour Checklist- Autism Screening Algorithm. Journal of Intellectual & Developmental Disability, 32, 197-188. Witwer, A.N. & Lecavalier, L. (2007). A response to John Taffe’s commentary on an evaluation of the SCQ and DBC-ASA. Journal of Intellectual & Developmental Disability, 32, 189. Posey D.J., Aman M.G., McCracken J.T., Scahill L., Tierney E., Arnold L.E., Vitiello B., Chuang S.Z., Davies M., Ramadan Y., Witwer A., Swiezy N.B., Cronin P., Shah B., Carroll D.H., Young C., Wheeler C., & McDougle C.J. (2007). Positive effects of methylphenidate on inattention and hyperactivity in pervasive developmental disorders: An analysis of secondary measures. Biological Psychiatry, 61, 538-544. Witwer, A.N. & Lecavalier, L. (2008). Psychopathology in children with intellectual disability: Risk markers and correlates. Journal of Mental Health Research in Intellectual Disabilities, 1, 75–96. Witwer, A.N. & Lecavalier, L. (2008). Examining the validity of autism spectrum disorder subtypes. Journal of Autism and Developmental Disorders, 38, 1611-1624. Jahromi, L.B., Kasari, C.L., McCracken, J.T., Lee, L.S-Y., Aman, M.G., McDougle, C.J., Scahill, L., Tierney, E., Arnold, L.E., Vitiello, B., Ritz, L., Witwer, A., Kustan, E., Ghuman, J., & Posey, D. (2009). Positive effects of methylphenidate on social communication and self-regulation in children with pervasive developmental disorders and hyperactivity. Journal of Autism and Developmental Disorders, 39, 395–404. FIELDS OF STUDY Major Field: Psychology Specialization: Intellectual and Developmental Disabilities vii TABLE OF CONTENTS Page Abstract .................................................................................................................ii Acknowledgments.................................................................................................v Vita .......................................................................................................................vi List of Tables.........................................................................................................ix Chapters: 1. Introduction........................................................................................................1 2. Method ............................................................................................................20 3. Results.............................................................................................................31 4. Discussion........................................................................................................69 References ..........................................................................................................93 Appendices: Appendix A: Demographic Form……………………………………………………104 Appendix B: Consent Form………………………………………………………….108 Appendix C: Release of Information……………………………………………….112 Appendix D: Assent Form………………………………………………………...…114 viii LIST OF TABLES Table Page 1 Child and Informant characteristics………………………………..…………….25 2 Interrater agreement on the P-ChIPS (n=30)…………………………………….32 3 Interrater Agreement based on IQ………………………………………………..34 4 Interrater Agreement based on Age…………………………………………...…35 5 Internal Consistency of P-ChIPS items by diagnostic category (N=61)…….......36 6 Agreement between CASI and P-ChIPS (N=61)………..……………………....38 7 Impact of IQ on Agreement between CASI and P-ChIPS…………………….…39 8 Agreement between CASI and P-ChIPS based on language (N=61)…………....40 9 Agreement between the CASI and P-ChIPS Based on Age……………………..41 10 NCBRF Means and Standard Deviation by Diagnostic Categorization………....43 11 Correlations between NCBRF subscales and P-CHIPS symptom counts……….46 12 Rates of children meeting P-ChIPS diagnostic criteria (N=61)………………….47 13 Rates of children with ID and without ID meeting P-ChIPS diagnostic criteria (n=58)…………………………………………………………………………….48 14 Rates of those with and without language meeting P-ChIPS diagnostic criteria...49 15 Rates of those above and below 12 years of age meeting P-ChIPS diagnostic criteria………………………………………………………...………………….50 16 Frequency of ADHD Diagnoses and Symptoms Endorsed: Entire sample, by IQ, language, and age…………………………………………………….…………..53 ix 17 Frequency of ODD Diagnoses and Symptoms Endorsed: Entire sample, by IQ, language, and age………………………………………………..……………….55 18 Frequency of Conduct Diagnoses and Symptoms Endorsed: Entire sample, by IQ, language, and age………………………………………………...………………56 19 Frequency of Specific/Social Phobia Diagnoses and Symptoms Endorsed: Entire sample, by IQ, language, and age…………...……………………………57