Karakter Child and Adolescent Psychiatry University Center

Nijmegen, Netherlands

Karakter Child and Adolescent Psychiatry University Center

Nijmegen, Netherlands
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Oosterling I.,Karakter Child and Adolescent Psychiatry University Center
Journal of child psychology and psychiatry, and allied disciplines | Year: 2010

The Social Communication Questionnaire (SCQ) is a screening instrument with established validity against the Autism Diagnostic Interview-Revised (ADI-R) in children aged 4 years and older. Indices of diagnostic accuracy have been shown to be strong in school-aged samples; however, relatively little is known about the performance of the SCQ in toddlers at risk of autism spectrum disorder (ASD). This study replicates and extends previous research by Corsello et al. (2007) in a comparatively large (N = 208), substantially younger (20-40 months) sample of children at high risk of ASD. The usefulness of the SCQ as a second-level screening instrument with different cut-off scores was evaluated in relation to IQ, age, and type of ASD diagnosis. The use of the SCQ as compared to the ADI-R was evaluated against clinical diagnosis, both alone and in combination with the ADOS. The SCQ with different cut-offs consistently showed an unsatisfactory balance between sensitivity and specificity in screening for ASD in high-risk toddlers, with only a few exceptions for specific age, IQ, or diagnostic groups. Even though the SCQ and ADI-R were highly correlated, diagnostic agreement with the best evidence clinical diagnosis was poor for both measures. The ADOS used alone consistently had the highest predictive value. For autism versus not-autism, the combined SCQ and ADOS performed as well as the ADOS alone and notably better than the combination ADI-R and ADOS. The SCQ is likely to result in a number of false-positive findings, particularly in children with autism symptomatology, and the balance between sensitivity and specificity is poor. The ADOS should be considered the most valid and reliable diagnostic instrument in these very young at-risk children. © 2010 The Authors. Journal of Child Psychology and Psychiatry © 2010 Association for Child and Adolescent Mental Health.


Van Dongen-Boomsma M.,Karakter Child and Adolescent Psychiatry University Center | Van Dongen-Boomsma M.,Radboud University Nijmegen | Vollebregt M.A.,Karakter Child and Adolescent Psychiatry University Center | Vollebregt M.A.,Radboud University Nijmegen | And 4 more authors.
Journal of Clinical Psychiatry | Year: 2013

Objective: A double-blind, randomized, placebocontrolled study was designed to assess the efficacy and safety of electroencephalographic (EEG) neurofeedback in children with attention-deficit/hyperactivity disorder (ADHD). The study started in August 2008 and ended in July 2012 and was conducted at Karakter Child and Adolescent Psychiatry University Centre in Nijmegen, The Netherlands. Method: Forty-one children (aged 8-15 years) with a DSM-IV-TR diagnosis of ADHD were randomly assigned to treatment with either EEG neurofeedback (n = 22) or placebo neurofeedback (n = 19) for 30 sessions, given as 2 sessions per week. The children were stratified by age, electrophysiologic state of arousal, and medication use. Everyone involved in the study, except the neurofeedback therapist and the principal investigator, was blinded to treatment assignment. The primary outcome was severity of ADHD symptoms on the ADHD Rating Scale IV, scored at baseline, during treatment, and at study end. Clinical improvement as measured by the Clinical Global Impressions-Improvement scale (CGI-I) was a secondary outcome. Results: While total ADHD symptoms improved over time in both groups (F1,39 = 26.56, P < .001), there was no significant treatment effect, ie, group × time interaction (F1,39 = 0.36, P = .554); the same was true for clinical improvement as measured by the CGI-I (P = .092). No clinically relevant side effects were observed. Among the children and their parents, guessing treatment assignment was not better than chance level (P = .224 for children, P = .643 for parents). Conclusion: EEG neurofeedback was not superior to placebo neurofeedback in improving ADHD symptoms in children with ADHD. © Copyright 2013 Physicians Postgraduate Press, Inc.


Van Der Schaaf M.E.,Radboud University Nijmegen | Fallon S.J.,Radboud University Nijmegen | Ter Huurne N.,Radboud University Nijmegen | Buitelaar J.,Radboud University Nijmegen | And 2 more authors.
Neuropsychopharmacology | Year: 2013

Increased use of stimulant medication, such as methylphenidate, by healthy college students has raised questions about its cognitive-enhancing effects. Methylphenidate acts by increasing extracellular catecholamine levels and is generally accepted to remediate cognitive and reward deficits in patients with attention deficit hyperactivity disorder. However, the cognitive-enhancing effects of such 'smart drugs' in the healthy population are still unclear. Here, we investigated effects of methylphenidate (Ritalin, 20 mg) on reward and punishment learning in healthy students (N=19) in a within-subject, double-blind, placebo-controlled cross-over design. Results revealed that methylphenidate effects varied both as a function of task demands and as a function of baseline working memory capacity. Specifically, methylphenidate improved reward vs punishment learning in high-working memory subjects, whereas it impaired reward vs punishment learning in low-working memory subjects. These results contribute to our understanding of individual differences in the cognitive-enhancing effects of methylphenidate in the healthy population. Moreover, they highlight the importance of taking into account both inter- and intra-individual differences in dopaminergic drug research.


Harfterkamp M.,University of Groningen | Van De Loo-Neus G.,Karakter Child and Adolescent Psychiatry University Center | Minderaa R.B.,University of Groningen | Van Der Gaag R.-J.,Karakter Child and Adolescent Psychiatry University Center | And 6 more authors.
Journal of the American Academy of Child and Adolescent Psychiatry | Year: 2012

The efficacy of atomoxetine as treatment of symptoms of attention-deficit/hyperactivity disorder (ADHD) in patients with autism spectrum disorder (ASD) has not been established. In this study, 97 patients aged 6 to 17 years with ADHD and ASD were randomly assigned to double-blind treatment with 1.2 mg/kg/day atomoxetine or placebo for 8 weeks. The primary endpoint was the ADHD Rating Scale (ADHD-RS) score; secondary endpoints were the Clinical Global Impression of ADHD-Improvement (CGI-I) and the Conners Teacher Rating Scale-Revised: Short Form (CTRS-R:S) score. Baseline mean ADHD-RS scores for atomoxetine versus placebo were 40.7 and 38.6; after 8 weeks, mixed-effect model repeated-measure means were 31.6 (95% confidence interval 29.2-33.9) and 38.3 (36.0-40.6), respectively, with a difference in least square means of -6.7 (-10.0 to -3.4; p < .001). The CTRS-R:S Hyperactivity subscore also improved significantly for atomoxetine compared with placebo, but not the other CTRS-R:S subscores. However, there were not significantly more patients on atomoxetine (20.9%) who improved much, or very much according to the CGI-I, than on placebo (8.7%; p = 0.14). Adverse events (mostly nausea, decrease in appetite, fatigue, and early morning awakening) were reported in 81.3% of atomoxetine patients and 65.3% of placebo patients (p > .1). There were no serious adverse events. Atomoxetine moderately improved ADHD symptoms in patients with ASD and was generally well tolerated. Adverse events in this study were similar to those in other studies with ADHD patients without ASD. Clinical trial registration information--A Randomized Double-Blind Study of Atomoxetine Versus Placebo for ADHD Symptoms in Children with ASD; www.clinicaltrials.gov; NCT00380692. © 2012 American Academy of Child and Adolescent Psychiatry.


Naaijen J.,Donders Institute for Brain | Lythgoe D.J.,King's College London | Amiri H.,Donders Institute for Brain | Amiri H.,Radboud University Nijmegen | And 4 more authors.
Neuroscience and Biobehavioral Reviews | Year: 2015

Compulsivity and impulsivity are cross-disorder traits observed in autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). Aberrant fronto-striatal glutamatergic signalling is core to the understanding of compulsive and impulsive disorders. In this review, the glutamate (Glu) neurochemistry of fronto-striatal circuits in paediatric and adult ASD, ADHD and OCD, as described in 59 studies, is outlined from the perspective of proton magnetic resonance spectroscopy (1H MRS). Despite the methodological inconsistencies between studies, two observations stand out that form possible hypotheses for future studies. Firstly, a possible increase in Glx (combination of Glu, glutamine and GABA) in the striatum across ADHD, OCD and ASD. Secondly, an increased Glx signal in the anterior cingulate cortex in paediatric ASD and ADHD but a lower Glx signal in adult ASD and ADHD. This suggests neurodevelopmental changes in fronto-striatal glutamatergic circuits across the lifespan. Future studies should incorporate more homogeneous samples, perform MRS at field strengths of at least 3Tesla and provide much more precise and standardized information on methods to improve our understanding of fronto-striatal glutamatergic transmission in compulsive and impulsive syndromes. © 2015 Elsevier Ltd.


Pruim R.H.R.,Donders Institute for Brain | Mennes M.,Donders Institute for Brain | Buitelaar J.K.,Donders Institute for Brain | Buitelaar J.K.,Karakter Child and Adolescent Psychiatry University Center | And 2 more authors.
NeuroImage | Year: 2015

We proposed ICA-AROMA as a strategy for the removal of motion-related artifacts from fMRI data (Pruim et al., 2015). ICA-AROMA automatically identifies and subsequently removes data-driven derived components that represent motion-related artifacts. Here we present an extensive evaluation of ICA-AROMA by comparing our strategy to a range of alternative strategies for motion-related artifact removal: (i) no secondary motion correction, (ii) extensive nuisance regression utilizing 6 or (iii) 24 realignment parameters, (iv) spike regression (Satterthwaite et al., 2013a), (v) motion scrubbing (Power et al., 2012), (vi) aCompCor (Behzadi et al., 2007; Muschelli et al., 2014), (vii) SOCK (Bhaganagarapu et al., 2013), and (viii) ICA-FIX (Griffanti et al., 2014; Salimi-Khorshidi et al., 2014), without re-training the classifier. Using three different functional connectivity analysis approaches and four different multi-subject resting-state fMRI datasets, we assessed all strategies regarding their potential to remove motion artifacts, ability to preserve signal of interest, and induced loss in temporal degrees of freedom (tDoF). Results demonstrated that ICA-AROMA, spike regression, scrubbing, and ICA-FIX similarly minimized the impact of motion on functional connectivity metrics. However, both ICA-AROMA and ICA-FIX resulted in significantly improved resting-state network reproducibility and decreased loss in tDoF compared to spike regression and scrubbing. In comparison to ICA-FIX, ICA-AROMA yielded improved preservation of signal of interest across all datasets. These results demonstrate that ICA-AROMA is an effective strategy for removing motion-related artifacts from rfMRI data. Our robust and generalizable strategy avoids the need for censoring fMRI data and reduces motion-induced signal variations in fMRI data, while preserving signal of interest and increasing the reproducibility of functional connectivity metrics. In addition, ICA-AROMA preserves the temporal non-artifactual time-series characteristics and limits the loss in tDoF, thereby increasing statistical power at both the subject- and the between-subject analysis level. © 2015 Elsevier Inc.


Pruim R.H.R.,Donders Institute for Brain | Mennes M.,Donders Institute for Brain | van Rooij D.,Donders Institute for Brain | van Rooij D.,University of Groningen | And 5 more authors.
NeuroImage | Year: 2015

Head motion during functional MRI (fMRI) scanning can induce spurious findings and/or harm detection of true effects. Solutions have been proposed, including deleting ('scrubbing') or regressing out ('spike regression') motion volumes from fMRI time-series. These strategies remove motion-induced signal variations at the cost of destroying the autocorrelation structure of the fMRI time-series and reducing temporal degrees of freedom. ICA-based fMRI denoising strategies overcome these drawbacks but typically require re-training of a classifier, needing manual labeling of derived components (e.g. ICA-FIX; Salimi-Khorshidi et al. (2014)). Here, we propose an ICA-based strategy for Automatic Removal of Motion Artifacts (ICA-AROMA) that uses a small (n = 4), but robust set of theoretically motivated temporal and spatial features. Our strategy does not require classifier re-training, retains the data's autocorrelation structure and largely preserves temporal degrees of freedom. We describe ICA-AROMA, its implementation, and initial validation. ICA-AROMA identified motion components with high accuracy and robustness as illustrated by leave-N-out cross-validation. We additionally validated ICA-AROMA in resting-state (100 participants) and task-based fMRI data (118 participants). Our approach removed (motion-related) spurious noise from both rfMRI and task-based fMRI data to larger extent than regression using 24 motion parameters or spike regression. Furthermore, ICA-AROMA increased sensitivity to group-level activation. Our results show that ICA-AROMA effectively reduces motion-induced signal variations in fMRI data, is applicable across datasets without requiring classifier re-training, and preserves the temporal characteristics of the fMRI data. © 2015 Elsevier Inc.


Beijers R.,Radboud University Nijmegen | Buitelaar J.K.,Donders Institute for Brain | Buitelaar J.K.,Karakter Child and Adolescent Psychiatry University Center | de Weerth C.,Radboud University Nijmegen
European Child and Adolescent Psychiatry | Year: 2014

Accumulating evidence from preclinical and clinical studies indicates that maternal psychosocial stress and anxiety during pregnancy adversely affect child outcomes. However, knowledge on the possible mechanisms underlying these relations is limited. In the present paper, we review the most often proposed mechanism, namely that involving the HPA axis and cortisol, as well as other less well-studied but possibly relevant and complementary mechanisms. We present evidence for a role of the following mechanisms: compromised placental functioning, including the 11β-HSD2 enzyme, increased catecholamines, compromised maternal immune system and intestinal microbiota, and altered health behaviors including eating, sleep, and exercise. The roles of (epi)genetics, the postnatal environment and the fetus are also discussed. We conclude that maternal prenatal psychosocial stress is a complex phenomenon that affects maternal emotions, behavior and physiology in many ways, and may influence the physiology and functioning of the fetus through a network of different pathways. The review concludes with recommendations for future research that helps our understanding of the mechanisms by which maternal prenatal stress exerts its effect on the fetus. © 2014, Springer-Verlag Berlin Heidelberg.


Van de Loo-Neus G.H.H.,Karakter Child and Adolescent Psychiatry University Center | Rommelse N.,Karakter Child and Adolescent Psychiatry University Center | Rommelse N.,Radboud University Nijmegen | Buitelaar J.K.,Karakter Child and Adolescent Psychiatry University Center | Buitelaar J.K.,Radboud University Nijmegen
European Neuropsychopharmacology | Year: 2011

ADHD is a common neuropsychiatric disorder with a strong persistence over time. Medication is frequently used in the clinical management of ADHD. After response, medication is typically prescribed for months to years. It is unclear whether extended medication treatment provides long-term benefits and how long it should be continued. Furthermore, there is concern about the long-term safety of ADHD medication. The aim of this systematic review is to address these issues and provide recommendations about the decision to stop or not to stop ADHD medication. We performed a search in PubMed and focused on medication studies with a treatment longer than 12. weeks in subjects 6-18. years old.Extended placebo-controlled double-blind parallel studies are not available. Placebo-controlled discontinuation studies and prospective long-term observational treatment studies provide evidence that medication management leads to a substantial reduction of ADHD symptoms and less impairment of functioning for a period of about 2. years. There is limited and inconsistent evidence for long-term advantage of medication treatment beyond symptom control, such as improved social functioning, academic achievement, employment status and less adverse psychiatric outcome. In terms of safety, long-term effects of medication on growth, blood pressure and heart rate are limited and the occurrence of suicidal, psychotic and manic symptoms is rare. Animal data about neurotoxic effects of psycho stimulants cannot be directly extrapolated to humans.Therefore, clinical decisions about starting, continuing, and stopping of ADHD medication should be made on an individual basis. Medication free periods should be implemented at regular times to investigate the need for an ongoing benefit of medication. Unfounded assumptions about continuing benefit of medication use should be abandoned. Careful monitoring of side effects is necessary and must be able to detect early alarming signals. © 2011 Elsevier B.V. and ECNP.


Buitelaar J.,UMC St Radboud | Buitelaar J.,Karakter Child and Adolescent Psychiatry University Center | Medori R.,Laimer Str. 44
European Child and Adolescent Psychiatry | Year: 2010

Attention-deficit/hyperactivity disorder (ADHD), one of the most common neuropsychiatric conditions of childhood, often has a chronic course and persists into adulthood in many individuals. ADHD may have a clinically important impact on health-related quality of life in children, a significant impact on parents' emotional health and interfere with family activities/cohesion. To date, the main targets of ADHD treatment have focused on reducing the severity of symptoms during the school day and improving academic performance. However, the treatment of ADHD should reach beyond symptom control to address the issues of social competencies and improvement of health-related quality of life from the perspectives of individuals with ADHD and their families, to support them in reaching their full developmental potential. Methylphenidate (MPH) is recognised as the first-line choice of pharmacotherapy for ADHD in children and adolescents. This paper focuses on the importance and benefits to child development of ADHD symptom control beyond the school day only, i.e. extending into late afternoon and evening and uses the example of an extended-release MPH formulation (OROS® MPH) to demonstrate the potential benefits of active full day coverage (12 h) with a single daily dose. Concerns of long-term stimulant treatment are also discussed. © 2009 The Author(s).

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