Ceresoli-Borroni Gianpiera, Liranso Tesfaye, Brittain Scott T, Connor Daniel F, Evans Christopher J, Findling Robert L, Hwang Steve, Fry Nicholas, Candler Shawn A, Robb Adelaide S, Saylor Keith E, Nasser Azmi, Schwabe Stefan
Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland.
Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut.
J Child Adolesc Psychopharmacol. 2019 Oct;29(8):599-607. doi: 10.1089/cap.2018.0089. Epub 2019 Jul 25.
Impulsive aggression (IA) is a maladaptive form of aggressive behavior that is an associated feature of neuropsychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD). As one of the most common forms of aggressive behavior, IA is a serious clinical concern. Recognition, monitoring, and management of IA symptoms are complicated by the lack of IA-specific psychometric instruments and evidence-based treatments. A recently developed electronic observer-reported outcome instrument has been validated in children for monitoring the frequency of 15 IA-related behaviors in the context of ADHD. This study seeks to first determine if the behaviors included in the pediatric IA diary are applicable to adolescents with ADHD, and second, compare the reliability of adolescent versus parent reporters. We evaluated the utility of the pediatric IA diary through concept elicitation and cognitive interviews with 17 pairs of parents and adolescents (aged 13-17 years) with IA and ADHD, supplemented with 15 new behaviors potentially applicable to adolescents. The behaviors most frequently reported by adolescents included arguing (93.8%), raising their voice/shouting/yelling (93.8%), hitting others (87.5%), slamming (87.5%), pushing/shoving (81.3%), breaking (75.0%), fighting (75.0%), throwing (75.0%), and cursing (68.8%). The behaviors most commonly reported by parents included raising their voice/shouting/yelling (94.1%), arguing (88.2%), being disrespectful/mean/rude (88.2%), slamming (88.2%), throwing (88.2%), cursing (82.4%), hitting others (82.4%), pushing/shoving (82.4%), breaking (76.5%), name-calling (76.5%), and threatening (70.6%). Of all commonly reported behaviors, only being "disrespectful/mean/rude" and "breaking" are not part of the pediatric IA diary, likely due to the imprecision of these terms. No significant usability issues were found for the IA diary device. These findings suggest that the 15-item pediatric IA diary should be applicable to adolescent populations to appropriately characterize IA behaviors in individuals with ADHD. Furthermore, this study indicated that parents may be more reliable reporters of IA behavior than adolescents.
冲动攻击行为（IA）是攻击性行为的一种适应不良形式，是神经精神疾病（包括注意力缺陷多动障碍（ADHD））的相关特征之一。作为攻击性行为最常见的形式之一，IA是一个严重的临床问题。由于缺乏IA特异性心理测量工具和循证治疗方法，IA症状的识别、监测和管理变得复杂。一种最近开发的电子观察者报告结局工具已在儿童中得到验证，用于监测ADHD背景下15种与IA相关行为的发生频率。本研究旨在首先确定儿童IA日记中包含的行为是否适用于患有ADHD的青少年，其次，比较青少年报告者与父母报告者的可靠性。我们通过对17对患有IA和ADHD的父母及青少年（年龄在13 - 17岁）进行概念引出和认知访谈，评估了儿童IA日记的效用，并补充了15种可能适用于青少年的新行为。青少年最常报告的行为包括争吵（93.8%）、提高音量/大喊/叫嚷（93.8%）、殴打他人（87.5%）、摔门（87.5%）、推搡（81.3%）、破坏（75.0%）、打架（75.0%）、投掷（75.0%）和咒骂（68.8%）。父母最常报告的行为包括提高音量/大喊/叫嚷（94.1%）、争吵（88.2%）、无礼/刻薄/粗鲁（88.2%）、摔门（88.2%）、投掷（88.2%）、咒骂（82.4%）、殴打他人（82.4%）、推搡（82.4%）、破坏（76.5%）、骂人（76.5%）和威胁（70.6%）。在所有常见报告的行为中，只有“无礼/刻薄/粗鲁”和“破坏”不属于儿童IA日记的内容，这可能是由于这些术语不够精确。未发现IA日记设备存在重大可用性问题。这些发现表明，15项的儿童IA日记应适用于青少年人群，以恰当描述ADHD患者个体的IA行为。此外，本研究表明，父母可能是比青少年更可靠的IA行为报告者。
