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Anxiety Disorders in Persons with Developmental Disabilities: Empirically Informed Diagnosis and Treatment

Reviews Literature on Anxiety Disorders in DD Population with Practical Take-Home Messages for the Clinician

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Abstract

Anxiety disorders are common in individuals with developmental disabilities (DDs), although they may not be diagnosed and treated as often as they are in patients without DDs. Patients with mental retardation, autism, and other pervasive developmental disorders may exhibit comorbid anxiety disorders, such as generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), phobias, and other anxiety symptoms at much higher rates than in the general population, but identification of these comorbid anxiety disorders may be made more difficult by the presence of the DD and concurrent difficulties with communication, other behavior problems, the lack of standardized assessments specific to diagnosing patients with DDs and psychiatric comorbidities, and the need for greater collateral sources of assessment information. In addition, systematic study of the treatment of anxiety in patients with DD is limited to a relatively small number of empirical studies done specifically in these patients along with case reports and theoretical reviews on the extension and modification of more well-studied treatments used for anxiety in patients without DDs. The present article reviews the literature on the prevalence, features, assessment and diagnosis of anxiety disorders in individuals with DDs, and also reviews empirical studies of pharmacological and psychological treatment of patients with comorbid anxiety and DD and summarizes the findings. Recommendations are made to guide treatment and further research in this area.

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References

  1. Stavrakaki C, Lunsky Y, Bouras N, et al.: Depression, Anxiety and Adjustment Disorders in People with Intellectual Disabilities. Psychiatric and Behavioural Disorders in Intellectual and Developmental Disabilities, 2nd edn. New York, NY, US, Cambridge University Press, 2007

  2. Saulnier C, Volkmar F, Bouras N, et al.: Mental Health Problems in People with Autism and Related Disorders. Psychiatric and Behavioural Disorders in Intellectual and Developmental Disabilities, 2nd edn. New York, NY, US, Cambridge University Press, 2007

  3. Schlauch RC, Gordon KH, Schmidt NB, et al.: The Assessment, Diagnosis, and Treatment of Psychiatric Disorders in Individuals with a Dual Diagnosis: The Co-occurrence of Developmental Disorders and Psychiatric Disorders. Mental Health Care for People of Diverse Backgrounds. Abingdon, United Kingdom, Radcliffe Publishing, 2007

  4. Tantam D: Psychological disorder in adolescents and adults with Asperger syndrome. Autism 4(1):47–62, 2000. doi:10.1177/1362361300004001004

    Article  Google Scholar 

  5. Masi G, Favilla L, Mucci M: Generalized anxiety disorder in adolescents and young adults with mild mental retardation. Psychiatry 63(1):54–64, 2000

    PubMed  CAS  Google Scholar 

  6. Gillott A, Standen PJ: Levels of anxiety and sources of stress in adults with autism. Journal of Intellectual Disabilities: JOID 11(4):359–370, 2007. doi:10.1177/1744629507083585

    Article  PubMed  Google Scholar 

  7. de Bruin EI, Ferdinand RF, Meester S, et al.: High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders 37(5):877–886, 2007. doi:10.1007/s10803-006-0215-x

    Article  PubMed  Google Scholar 

  8. Ghaziuddin M: Mental Health Aspects of Autism and Asperger Syndrome. London, England, Jessica Kingsley Publishers, 2005

    Google Scholar 

  9. Weisbrot DM, Gadow KD, DeVincent CJ, et al.: The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology 15(3):477–496, 2005. doi:10.1089/cap.2005.15.477

    Article  PubMed  Google Scholar 

  10. Gillott A, Furniss F, Walter A: Anxiety in high-functioning children with autism. Autism: The International Journal of Research and Practice 5(3):277–286, 2001

    CAS  Google Scholar 

  11. Kim JA, Szatmari P, Bryson SE, et al.: The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism 4(2):117–132, 2000. doi:10.1177/1362361300004002002

    Article  Google Scholar 

  12. White P, Chant D, Edwards N, et al.: Prevalence of intellectual disability and comorbid mental illness in an Australian community sample. The Australian and New Zealand Journal of Psychiatry 39(5):395–400, 2005. doi:10.1111/j.1440-1614.2005.01587.x

    Article  PubMed  Google Scholar 

  13. Gustafsson C, Sonnander K: Occurrence of mental health problems in Swedish samples of adults with intellectual disabilities. Social Psychiatry and Psychiatric Epidemiology 39(6):448–456, 2004. doi:10.1007/s00127-004-0774-0

    Article  PubMed  Google Scholar 

  14. Dekker MC, Koot HM: DSM-IV disorders in children with borderline to moderate intellectual disability. I: prevalence and impact. Journal of the American Academy of Child and Adolescent Psychiatry 42(8):915–922, 2003. doi:10.1097/01.CHI.0000046892.27264.1A

    Article  PubMed  Google Scholar 

  15. Emerson E: Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability. Journal of Intellectual Disability Research: JIDR 47:51–58, 2003. doi:10.1046/j.1365-2788.2003.00464.x

    Article  PubMed  CAS  Google Scholar 

  16. Reiss S, Levitan GW, Szyszko J: Emotional disturbance and mental retardation: diagnostic overshadowing. American Journal of Mental Deficiency 86(6):567–574, 1982

    PubMed  CAS  Google Scholar 

  17. Bailey NM, Andrews TM: Diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation (DC-LD) and the diagnosis of anxiety disorders: a review. Journal of Intellectual Disability Research: JIDR 47(1):50–61, 2003. doi:10.1046/j.1365-2788.47.s1.25.x

    Article  PubMed  Google Scholar 

  18. Mohr C, Costello H, Bouras N, et al.: Mental Health Assessment and Monitoring Tools for People with Intellectual Disabilities. Psychiatric and Behavioural Disorders in Intellectual and Developmental Disabilities, 2nd edn. New York, NY, US, Cambridge University Press, 2007

  19. Charlot L, Deutsch C, Hunt A, et al.: Validation of the mood and anxiety semi-structured (MASS) interview for patients with intellectual disabilities. Journal of Intellectual Disability Research: JIDR 51:821–834, 2007. doi:10.1111/j.1365-2788.2007.00972.x

    Article  PubMed  CAS  Google Scholar 

  20. Ramirez SZ, Lukenbill JF: Development of the fear survey for adults with mental retardation. Research in Developmental Disabilities 28(3):225–237, 2007. doi:10.1016/j.ridd.2006.01.001

    Article  PubMed  Google Scholar 

  21. Matson JL, Love SR: A comparison of parent-reported fear for autistic and nonhandicapped age-matched children and youth. Australia & New Zealand Journal of Developmental Disabilities 16(4):349–357, 1990

    Google Scholar 

  22. Li H, Morris RJ: Assessing fears and related anxieties in children and adolescents with learning disabilities or mild mental retardation. Research in Developmental Disabilities 28(5):445–457, 2007. doi:10.1016/j.ridd.2006.06.001

    Article  PubMed  Google Scholar 

  23. Esbensen AJ, Rojahn J, Aman MG, et al.: Reliability and validity of an assessment instrument for anxiety, depression, and mood among individuals with mental retardation. Journal of Autism and Developmental Disorders 33(6):617–629, 2003. doi:10.1023/B:JADD.0000005999.27178.55

    Article  PubMed  Google Scholar 

  24. Mindham J, Espie CA: Glasgow anxiety scale for people with an intellectual disability (GAS-ID): development and psychometric properties of a new measure for use with people with mild intellectual disability. Journal of Intellectual Disability Research: JIDR 47:22–30, 2003. doi:10.1046/j.1365-2788.2003.00457.x

    Article  PubMed  CAS  Google Scholar 

  25. Dekker MC, Nunn RJ, Einfeld SE, et al.: Assessing emotional and behavioral problems in children with intellectual disability: revisiting the factor structure of the developmental behavior checklist. Journal of Autism and Developmental Disorders 32(6):601–610, 2002. doi:10.1023/A:1021263216093

    Article  PubMed  Google Scholar 

  26. Balboni G, Battagliese G, Pedrabissi L: The psychopathology inventory for mentally retarded adults: factor structure and comparisons between subjects with or without dual diagnosis. Research in Developmental Disabilities 21(4):311–321, 2000. doi:10.1016/S0891-4222(00)00044-5

    Article  PubMed  CAS  Google Scholar 

  27. Masi G, Brovedani P, Mucci M, et al.: Assessment of anxiety and depression in adolescents with mental retardation. Child Psychiatry and Human Development 32(3):227–237, 2002. doi:10.1023/A:1017908823046

    Article  PubMed  Google Scholar 

  28. Aman MG, Watson JE, Singh NN, et al.: Psychometric and demographic characteristics of the psychopathology instrument for mentally retarded adults. Psychopharmacology Bulletin 22(4):1072–1076, 1986

    PubMed  CAS  Google Scholar 

  29. Prosser H, Moss S, Costello H, et al.: Reliability and validity of the Mini PAS-ADD for assessing psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research: JIDR 42 (Pt 4):264–272, 1998. doi:10.1046/j.1365-2788.1998.00146.x

    Article  PubMed  Google Scholar 

  30. Moss S, Ibbotson B, Prosser H, et al.: Validity of the PAS-ADD for detecting psychiatric symptoms in adults with learning disability (mental retardation). Social Psychiatry and Psychiatric Epidemiology 32(6):344–354, 1997. doi:10.1007/BF00805440

    Article  PubMed  CAS  Google Scholar 

  31. Muris P, Steerneman P, Merckelbach H, et al.: Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders 12(4):387–393, 1998. doi:10.1016/S0887-6185(98)00022-X

    Article  PubMed  CAS  Google Scholar 

  32. Gadow KD, DeVincent CJ, Pomeroy J, et al.: Psychiatric symptoms in preschool children with PDD and clinic and comparison samples. Journal of Autism and Developmental Disorders 34(4):379–393, 2004. doi:10.1023/B:JADD.0000037415.21458.93

    Article  PubMed  Google Scholar 

  33. McDougle CJ, Kresch LE, Goodman WK, et al.: A case-controlled study of repetitive thoughts and behavior in adults with autistic disorder and obsessive-compulsive disorder. The American Journal of Psychiatry 152(5):772–777, 1995

    PubMed  CAS  Google Scholar 

  34. Pine DS, Shapiro T, Jensen PS, et al.: A Developmental Evolutionary Perspective on Two Anxiety Disorders. Toward A New Diagnostic System for Child Psychopathology: Moving Beyond the DSM. New York, NY, US, Guilford Press, 2006

  35. Jacobs LM: Dysregulation of autonomic nervous system activity associated with anxiety in children with multiple complex developmental disorder. Dissertation Abstracts International: Section B: The Sciences and Engineering, vol 66. US, ProQuest Information & Learning, 2006

  36. Palkovitz RJ, Wiesenfeld AR: Differential autonomic responses of autistic and normal children. Journal of Autism and Developmental Disorders 10(3):347–360, 1980. doi:10.1007/BF02408294

    Article  PubMed  CAS  Google Scholar 

  37. James AL, Barry RJ: Cardiovascular and electrodermal responses to simple stimuli in autistic, retarded and normal children. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology 1(2):179–193, 1984

    CAS  Google Scholar 

  38. Stevens S, Gruzelier J: Electrodermal activity to auditory stimuli in autistic, retarded, and normal children. Journal of Autism and Developmental Disorders 14(3):245–260, 1984. doi:10.1007/BF02409577

    Article  PubMed  CAS  Google Scholar 

  39. Romanczyk RG, Gillis JM, Baron MG, et al.: Autism and the Physiology of Stress and Anxiety. Stress and Coping in Autism. New York, NY, US, Oxford University Press, 2006

  40. Zahn TP, Rumsey JM, Van Kammen DP: Autonomic nervous system activity in autistic, schizophrenic, and normal men: effects of stimulus significance. Journal of Abnormal Psychology 96(2):135–144, 1987. doi:10.1037/0021-843X.96.2.135

    Article  PubMed  CAS  Google Scholar 

  41. Delfos MF: A Strange World—Autism, Asperger’s Syndrome and PDD-NOS: A Guide for Parents, Partners, Professional Carers, and People with ASDs. London, England, Jessica Kingsley Publishers, 2005

    Google Scholar 

  42. Rumsey JM, Ernst M: Functional neuroimaging of autistic disorders. Mental Retardation and Developmental Disabilities Research Reviews 6(3):171–179, 2000. doi :10.1002/1098-2779(2000)6:3<171::AID-MRDD4>3.0.CO;2-N

    Article  PubMed  CAS  Google Scholar 

  43. LaBar KS, LeDoux JE, Moldin SO, et al.: Fear and Anxiety Pathways. Understanding Autism: From Basic Neuroscience to Treatment. Boca Raton, FL, US, CRC Press, 2006

  44. Rumsey JM, Rapoport JL, Sceery WS, et al.: Autistic Children as Adults: Psychiatric, Social, and Behavioral Outcomes. Annual Progress in Child Psychiatry and Child Development, 1986. Philadelphia, PA, US, Brunner/Mazel, 1987

  45. DeVincent CJ, Gadow KD, Delosh D, et al.: Sleep disturbance and its relation to DSM-IV psychiatric symptoms in preschool-age children with pervasive developmental disorder and community controls. Journal of Child Neurology 22(2):161–169, 2007. doi:10.1177/0883073807300310

    Article  PubMed  Google Scholar 

  46. Ryan R: Posttraumatic stress disorder in persons with developmental disabilities. Community Mental Health Journal 30(1):45–54, 1994. doi:10.1007/BF02188874

    Article  PubMed  CAS  Google Scholar 

  47. Kristensen H: Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder. Journal of the American Academy of Child and Adolescent Psychiatry 39(2):249–256, 2000. doi:10.1097/00004583-200002000-00026

    Article  PubMed  CAS  Google Scholar 

  48. Bastiaansen D, Koot HM, Ferdinand RF, et al.: Quality of life in children with psychiatric disorders: self-, parent, and clinician report. Journal of the American Academy of Child and Adolescent Psychiatry 43(2):221–230, 2004. doi:10.1097/00004583-200402000-00019

    Article  PubMed  Google Scholar 

  49. Franklin ME, March JS, Garcia A, et al.: Treating Obsessive-Compulsive Disorder in Children and Adolescents, in Psychological treatment of obsessive-compulsive disorder: fundamentals and beyond. Washington, DC, US, American Psychological Association, 2007

  50. Tsai L, Baron MG, Groden J, et al.: Diagnosis and Treatment of Anxiety Disorders in Individuals with Autism Spectrum Disorder. Stress and Coping in Autism. New York, NY, US, Oxford University Press, 2006

  51. Reinblatt SP, Riddle MA: The pharmacological management of childhood anxiety disorders: a review. Psychopharmacology 191(1):67–86, 2007. doi:10.1007/s00213-006-0644-4

    Article  PubMed  CAS  Google Scholar 

  52. Kolevzon A, Mathewson KA, Hollander E: Selective serotonin reuptake inhibitors in autism: a review of efficacy and tolerability. The Journal of Clinical Psychiatry 67(3):407–414, 2006

    Article  PubMed  CAS  Google Scholar 

  53. Findling RL, Steiner H, Weller EB: Use of antipsychotics in children and adolescents. The Journal of Clinical Psychiatry 66(7):29–40, 2005

    PubMed  CAS  Google Scholar 

  54. Antochi R, Stavrakaki C, Emery PC: Psychopharmacological treatments in persons with dual diagnosis of psychiatric disorders and developmental disabilities. Postgraduate Medical Journal 79(929):139–146, 2003. doi:10.1136/pmj.79.929.139

    Article  PubMed  CAS  Google Scholar 

  55. Kalachnik JE, Hanzel TE, Sevenich R, et al.: Benzodiazepine behavioral side effects: review and implications for individuals with mental retardation. American Journal of Mental Retardation: AJMR 107(5):376–410, 2002. doi :10.1352/0895-8017(2002)107<0376:BBSERA>2.0.CO;2

    Article  PubMed  Google Scholar 

  56. Murphy TK, Bengtson MA, Tan JY, et al.: Selective serotonin reuptake inhibitors in the treatment of paediatric anxiety disorders: a review. International Clinical Psychopharmacology 15(2):S47–63, 2000

    PubMed  Google Scholar 

  57. King B, Bouras N, Holt G: Psychopharmacology in Intellectual Disabilities. Psychiatric and Behavioural Disorders in Intellectual and Developmental Disabilities, 2nd edn. New York, NY, US, Cambridge University Press, 2007

  58. Dagnan D, Bouras N, Holt G: Psychosocial Interventions for People with Intellectual Disabilities. Psychiatric and Behavioural Disorders in Intellectual and Developmental Disabilities, 2nd edn. New York, NY, US, Cambridge University Press, 2007

  59. Flament MF, Geller D, Irak M, et al.: Specificities of treatment in pediatric obsessive-compulsive disorder. CNS Spectrums 12(2 Suppl 3):43–58, 2007

    PubMed  Google Scholar 

  60. Namerow LB, Thomas P, Bostic JQ, et al.: Use of citalopram in pervasive developmental disorders. Journal of Developmental and Behavioral Pediatrics: JDBP 24(2):104–108, 2003

    PubMed  Google Scholar 

  61. Couturier JL, Nicolson R: A retrospective assessment of citalopram in children and adolescents with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology 12(3):243–248, 2002. doi:10.1089/104454602760386932

    Article  PubMed  Google Scholar 

  62. Posey DJ, Guenin KD, Kohn AE, et al.: A naturalistic open-label study of mirtazapine in autistic and other pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology 11(3):267–277, 2001. doi:10.1089/10445460152595586

    Article  PubMed  CAS  Google Scholar 

  63. Buitelaar JK, van der Gaag J, van der Hoeven J: Buspirone in the management of anxiety and irritability in children with pervasive developmental disorders: results of an open-label study. Journal of Clinical Psychiatry 59(2):56–59, 1998

    PubMed  CAS  Google Scholar 

  64. McDougle CJ, Price LH, Goodman WK: Fluvoxamine treatment of coincident autistic disorder and obsessive-compulsive disorder: a case report. Journal of Autism and Developmental Disorders 20(4):537–543, 1990. doi:10.1007/BF02216058

    Article  PubMed  CAS  Google Scholar 

  65. Fisman S, Steele M: Use of risperidone in pervasive developmental disorders: a case series. Journal of Child and Adolescent Psychopharmacology 6(3):177–190, 1996

    Article  PubMed  CAS  Google Scholar 

  66. Ratey JJ, Sovner R, Mikkelsen E, et al.: Buspirone therapy for maladaptive behavior and anxiety in developmentally disabled persons. The Journal of Clinical Psychiatry 50(10):382–384, 1989

    PubMed  CAS  Google Scholar 

  67. McDougle CJ, Holmes JP, Carlson DC, et al.: A double-blind, placebo-controlled study of risperidone in adults with autistic disorder and other pervasive developmental disorders. Archives of General Psychiatry 55(7):633–641, 1998. doi:10.1001/archpsyc.55.7.633

    Article  PubMed  CAS  Google Scholar 

  68. Ratey J, Sovner R, Parks A, et al.: Buspirone treatment of aggression and anxiety in mentally retarded patients: a multiple-baseline, placebo lead-in study. The Journal of Clinical Psychiatry 52(4):159–162, 1991

    PubMed  CAS  Google Scholar 

  69. Buitelaar JK, van der Gaag RJ, van der Hoeven J: Buspirone in the management of anxiety and irritability in children with pervasive developmental disorders: results of an open-label study. The Journal of Clinical Psychiatry 59(2):56–59, 1998

    PubMed  CAS  Google Scholar 

  70. Suveg C, Roblek TL, Robin J, et al.: Parental involvement when conducting cognitive-behavioral therapy for children with anxiety disorders. Journal of Cognitive Psychotherapy 20(3):287–299, 2006. doi:10.1891/jcop.20.3.287

    Article  Google Scholar 

  71. Reaven J, Hepburn S: The parent’s role in the treatment of anxiety symptoms in children with high-functioning autism spectrum disorders. Mental Health Aspects of Developmental Disabilities 9(3):73–80, 2006

    Google Scholar 

  72. Bogacki DF, Newmark TS, Gogineni RR: Behavioral, psychosocial, and pharmacologic interventions in adults with developmental disabilities. Directions in Psychiatry 26(3):195–206, 2006

    Google Scholar 

  73. Dagnan D, Jahoda A: Cognitive-behavioural intervention for people with intellectual disability and anxiety disorders. Journal of Applied Research in Intellectual Disabilities 19(1):91–97, 2006. doi:10.1111/j.1468-3148.2005.00283.x

    Article  Google Scholar 

  74. Elder LM, Caterino LC, Chao J, et al.: The efficacy of social skills treatment for children with Asperger syndrome. Education & Treatment of Children 29(4):635–663, 2006

    Google Scholar 

  75. Davis TE, III, Kurtz PF, Gardner AW, et al.: Cognitive-behavioral treatment for specific phobias with a child demonstrating severe problem behavior and developmental delays. Research in Developmental Disabilities 28(6):546–558, 2007. doi:10.1016/j.ridd.2006.07.003

    Article  PubMed  Google Scholar 

  76. Suveg C, Comer JS, Furr JM, et al.: Adapting manualized CBT for a cognitively delayed child with multiple anxiety disorders. Clinical Case Studies 5(6):488–510, 2006. doi:10.1177/1534650106290371

    Article  Google Scholar 

  77. Lemmon VA, Mizes JS: Effectiveness of exposure therapy: a study of posttraumatic stress disorder and mental retardation. Cognitive and Behavioral Practice 9(4):317–323, 2002

    Article  Google Scholar 

  78. Lindsay WR, Baty FJ, Michie AM, et al.: A comparison of anxiety treatments with adults who have moderate and severe mental retardation. Research in Developmental Disabilities 10(2):129–140, 1989. doi:10.1016/0891-4222(89)90002-4

    Article  PubMed  CAS  Google Scholar 

  79. Hoelzley PD: Reciprocal inhibition in music therapy: a study involving wind instrument usage to attenuate fear, anxiety, and avoidance reactivity in a child with pervasive developmental disorder. Music Therapy 10(1):58–76, 1991

    Google Scholar 

  80. Ellis EM, Ala’i-Rosales SS, Glenn SS, et al.: The effects of graduated exposure, modeling, and contingent social attention on tolerance to skin care products with two children with autism. Research in Developmental Disabilities 27(6):585–598, 2006. doi:10.1016/j.ridd.2005.05.009

    Article  PubMed  Google Scholar 

  81. Lindsay WR, Fee M, Michie A, et al.: The effects of cue control relaxation on adults with severe mental retardation. Research in Developmental Disabilities 15(6):425–437, 1994. doi:10.1016/0891-4222(94)90027-2

    Article  PubMed  CAS  Google Scholar 

  82. Lindsay WR, Morrison FM: The effects of behavioural relaxation on cognitive performance in adults with severe intellectual disabilities. Journal of Intellectual Disability Research: JIDR 40 (Pt 4):285–290, 1996. doi:10.1111/j.1365-2788.1996.tb00632.x

    Article  PubMed  Google Scholar 

  83. Raven J, Hepburn S: Cognitive-behavioral treatment of obsessive compulsive disorder in a child with Asperger syndrome. Autism 7(2):145–164, 2003. doi:10.1177/1362361303007002003

    Article  Google Scholar 

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Davis, E., Saeed, S.A. & Antonacci, D.J. Anxiety Disorders in Persons with Developmental Disabilities: Empirically Informed Diagnosis and Treatment. Psychiatr Q 79, 249–263 (2008). https://doi.org/10.1007/s11126-008-9081-3

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