The reliability and validity of the psychiatric assessment of the child: II. Interview with the parent

Psychological problems of school-age German and Greek children: A cross-cultural study

This study investigated psychological problems of 466 Greek and 790 German non-referred, non-migrant children aged 6-11 years using the Child Behavior Checklist. Comparisons between the two countries on the total behaviour problem scores, the total number of positive codings, the externalizing and internalizing scales and the social competence scales revealed a number of cultural differences. Greek children displayed consistently higher problem scores and lower scores on social and activities competence scores than the German children with the one exception of school competence. These results are discussed in relation to different intercultural attitudes, meanings and expectations of parents on their children.

Social and emotional impact of faecal incontinence after surgery for anorectal abnormalities

A significant proportion of children with anorectal malformations have long term problems with faecal continence. The psychological consequences of this chronic disability was assessed in 160 children and adolescents. The prevalence of clinically significant emotional problems among the sample overall, as assessed by a diagnostic psychiatric interview (19%), parental assessment (27%), and child self report depressive scale (24%) was higher than expected relative to normative populations. With the exception of the young girls (6-11 years), the incontinent children and adolescents were not judged to be less well adjusted than those with good bowel control. Treatment for anorectal malformations appears to be associated with an increased risk for behavioural and social problems, but this was not related to the level of continence. Parental factors and gender were significantly associated with outcome. These children and families would benefit from psychological evaluation and support especially during early childhood.

A structured pictorial questionnaire to assess DSM-III-R-based diagnoses in children (6-11 years): development, validity, and reliability

This paper presents a structured pictorial instrument, the Dominic questionnaire, to assess mental disorders in 6- to 11-year-old children. Ninety-nine drawings represent situations corresponding to DSM-III-R based ADHD, CD, ODD, MDD, SAD, OAD, and SPh. However, cognitive limitation of 6- to 11-year-old children do not allow for time-related measurement. The instrument takes 15-20 min to administer. Reliability and validity of the Dominic questionnaire were studied in Parent DISC-2 positive and negative outpatient and general population samples and against clinical judgement. The pictorial approach provides acceptable test-retest reliability and the instrument makes standardized assessment possible for children as young as 6 years of age.

The Chartres Study: I. Prevalence of psychiatric disorders among French school-age children

A survey of child psychiatric disorders was conducted in a community sample of 2441 French school-aged children selected from 18 public and private schools; children attending special classes were oversampled. A two-stage survey design was used to identify disorders. Measures were the Child Behavior Checklist and the Rutter teacher scale for screening. The Isle of Wight parental interview was used in the second phase for 217 home interviews, along with the Children Global Assessment Scale as an index of impaired functioning. Response rates were excellent, and non-respondents in the screening phase were shown to have higher levels of psychopathology as gauged by their teacher scale scores. Several weights were used in the analysis to adjust for differential probabilities of selection and participation in each survey phase. The overall prevalence rate among 8-11-year-olds was estimated to be 12.4% (5.9% for more severe disorders), with roughly equal rates of disruptive and emotional disorders (6.5% and 5.9%). Prevalence was higher in boys (15.0%) than in girls (9.5%), owing to a threefold increase in their frequency of conduct disturbances. Rates of disturbance were twice as high among children with special educational needs, while no difference was found between private and public schools. The frequency of behavioural problems appeared to be similar in the urban and semi-rural subsamples.

Practitioner review: problems in children's peer relations: what can the clinician do?

This paper describes the assessment and treatment of children with peer relationship problems. The first part of the paper is organized around five topics: peer rejection, peer neglect, the absence of friendships, reputation in the peer group, and peer group affiliations. Next, a series of assessment methods is delineated, including peer, teacher, parent and self reports, as well as direct observational procedures. Finally, we suggest a number of treatment options, including social skills training, social cognitive interventions, and co-operative group interventions.

Informants, correlates and child disorders in a clinical population

This paper examines associations between informants, correlates and child disorders in a sample of 230 outpatients six to 14 years of age. K-SADS-E diagnoses and scores were studied according to informant, gender, age group, mental health of the parents, life events and parents' relationship. The results show that parents underreport their daughters' internalized disorders compared with reports of children and adolescents and that male children and adolescents underreport all types of disorders compared with the reports of their parents. Intra-informant correlations and differences between informants suggest an uneven influence according to informants of correlates on the report of child disorders.

Epidemiology of behavioural and emotional problems of primary schoolchildren in Greece

The behavioural and emotional problems and the competencies of non-referred children in Athens were studied by administering Achenbach's Child Behavior Checklist to the parents of 466 children aged 6-11 years. In comparison to other countries, relatively high scores were obtained on both the internalizing (mean 15.1 for boys and 13.3 for girls) and externalizing scales (16.4 and 18.6), and relatively low scores on the competence scales. Cut-offs for the indication of high risk of behavioural problems suggested by USA data were exceeded by 36% of boys and 39% of girls on the total behaviour scale; appropriate cut-offs (90th percentiles) for use in Greece were re-computed for all scales. Parents' responses to individual behaviour items were analysed in relation to the child's age and sex and the family's socio-economic status. Results are discussed in relation to cultural factors.

Pathways of problem behaviors from childhood to adolescence

OBJECTIVE

the purpose of this study was to determine the 6-year longitudinal course of psychiatric disorders in children from the general population commencing at age 4 to 11 years.

METHOD

three groups of children were selected on the basis of Child Behavior Checklist ratings obtained at 2-year intervals: "persisters," "decreasers," and "increasers." Selected subjects and their parents were clinically interviewed, and DSM-III-R diagnoses were derived.

RESULTS

the majority of children whose overall level of psychopathology persisted over time obtained lifetime DSM-III-R diagnoses classified as externalizing: attention-deficit hyperactivity disorder, oppositional disorder, or conduct disorder. The majority of children whose overall level of psychopathology decreased obtained lifetime DSM-III-R diagnoses classified as internalizing: anxiety disorders, major depression, or dysthymic disorder. Children with initial Child Behavior Checklist scores in the normal range whose problem scores increased received lifetime diagnoses that were neither predominantly externalizing or internalizing.

CONCLUSIONS

this study showed that the majority of initially disordered children with the poorest outcome showed aggressive or antisocial behaviors, whereas disordered children whose functioning improved had problems reflecting fearful, inhibited, or depressive behavior. The findings also showed that retrospective information on the course of children's problem behaviors should be regarded with caution.

The effect of family counselling on the mental health of 10-11-year-old children in low- and high-risk families: a longitudinal approach

This study investigated the effect of family counselling on the child's mental health in low- and high-risk families. The material consisted of 160 families with a baby born in 1975-76. First, the families were classified with a weighted risk index into low- and high-risk families. Eighty of the families attended a five-year-long family counselling program. The results of a ten year follow-up study showed that both the initial family risk and the counselling made a statistically significant contribution to the 10-11-year-old child's mental health. The counselling had a positive effect both in low- and high-risk families.

Structured interviews for assessing children

Structured interviews provide a valuable means of obtaining and quantifying information about the mental status of children. This review indicates that children can reliably self-report and that the information they provide can concur with the opinion of adults knowledgeable about them. However, considerably more research is warranted before it may be assumed that these interviews are adequately reliable and valid. In general, it appears that the task of documenting the psychometric soundness of these interviews has not been taken seriously, as if content validity were sufficient. For example, except for the CAS and the DISC, there has been little effort to study contrast group validity (i.e. whether the interview even differentiates "known groups"). More specifically, review of the reliability and validity data relevant to DSM-III-R diagnoses provides support for the CAS, DICA, ISC and K-SADS, with the validity data for the DICA being weaker than for the others. One limitation of these data for the DICA, ISC and K-SADS is that the diagnoses were clinician-generated, rather than algorithm-generated. Unfortunately the processes for generating clinical diagnoses were not specified, except for criterion reference to DSM-III-R. The findings for the DISC and the DISC-R are notably weak. There is no evidence for DISC reliability, except for adolescents, and the validity studies have demonstrated only weak relationships. There has been limited study of the psychometric properties of symptom scales. In fact, for two interviews (i.e. DICA and ISC), there are no data available. Reliability for the DISC scales is adequate only for adolescents. Psychometric data have been generated for the CAS and the K-SADS, with considerably more studies conducted with the CAS. The relative paucity of interest in scale scores is striking given that they provide a continuous variable which can indicate extent of symptoms. Other measures of mental status, besides presence/absence of diagnosis, will become increasingly important as research in child psychopathology progresses toward more sophisticated studies (i.e. treatment effects, risk factors). These interviews are labor intensive and costly to the researcher as well as time-consuming and tedious for the children and parents. Given this commitment, researchers should invest in developing other ways of exploiting the richness of the data generated. An example is the CAS "content" scales, which generate scores reflecting on the child's functioning in various areas (e.g. school, friends, family). As the evolution of these interviews continues, it will be important to remain attentive to the developmental limitations of children.(ABSTRACT TRUNCATED AT 400 WORDS)

Cognitive effects of mild head injury in children and adolescents

A comprehensive review of recent neuropsychological studies of mild head injury (MHI) involving children and adolescents is presented. The seminal work of Rutter and his colleagues is reviewed. An alternative conceptualization of MHI as proposed by various researchers is elaborated and further research investigating the cognitive sequelae of MHI is reviewed. MHI is discussed within the context of development and information processing models. Finally, the sequelae of MHI are reviewed with respect to academic functioning. Methodological problems inherent in studies of MHI are identified and discussed. The studies reviewed here support the conclusion that both the cognitive and emotional consequences of MHI should receive serious evaluation.

Young women's antisocial behavior and the later emotional and behavioral health of their children

OBJECTIVES

Antisocial and criminal behavior are increasing among US youth, especially among females. Thus, questions arise concerning whether youthful female deviant behavior eventually will have negative behavioral and emotional consequences for the later children of these women.

METHODS

Associations between the severity of early female antisocial behavior (including both drug-related and non-drug related offenses) and the later behavioral and emotional health of the children of these women were examined among 1425 mother-child pairs of the National Longitudinal Survey of Youth.

RESULTS

Multiple linear regression procedures indicated a significant positive relationship between the severity of the mothers' early non-drug-related offenses and the later severity of the children's scores on the Antisocial, Hyperactive, Anxious/Depressed, Headstrong, Peer Conflict/Social Withdrawal, Immature Dependency, and Total Problem subscales of the Behavior Problem Index.

CONCLUSIONS

This study demonstrated an association between the antisocial behavior of female youth and the later behavioral and emotional problems of the children of these women. Future research needs to determine the mechanisms underlying the intergenerational transmission of these types of problems so that effective preventive and therapeutic public health practices may be designed and implemented.

Assessment of child psychopathology: relationships between different methods, different informants and clinical judgment of severity

The purpose of this study was to assess the relationships between information on children's problem behavior obtained by different methods (rating scales and clinical interviews) and from different sources (adolescent, parents and teacher). From a sample of 132 14-year-old international adoptees and their parents, information was obtained via the Child Behavior Checklist (CBCL), the Youth Self-Report and the Teacher's Report Form, the Child Assessment Schedule, and the Graham and Rutter Parent Interview. Agreement between the CBCL and the clinical judgment of the severity of psychopathology was substantial. Assessment procedures providing data on the adolescents' functioning derived from different sources revealed less agreement than those derived from the same informant. Agreement was higher for externalizing than for internalizing behaviors. Data from different sources made unique contributions to clinicians' judgments of the severity of psychopathology.

Marital disharmony and children's behaviour problems: aspects of a poor marriage that affect children adversely

The aim of this study was to investigate the elements of the parental marital relationship which put children at risk for behavioural and emotional problems. Data from 119 families from the general population with a child aged between 9 and 12 years were analysed for the present study. The relationship between children's emotional and behavioural problems and overt parental conflict, covert tension between parents and discrepancy on child-rearing practices was assessed. Overt parental conflict was found to relate most strongly to children's emotional and behavioural problems using mothers', fathers' and children's accounts of the children's symptoms and after controlling for other aspects of marital disharmony. Aspects of the parent-child relationship were hypothesized as mediating variables in the relationship between parental conflict and children's emotional and behavioural problems, but the data did not support this hypothesis.

Cultural differences in family communication about Duchenne muscular dystrophy

This study compared the patterns of communication and use of professional support systems of Irish and American families with sons with Duchenne muscular dystrophy (DMD). Structured interviews were used with the parents of 34 Irish boys and 21 American boys attending the muscular dystrophy services of Central Remedial Clinic, Dublin, and Children's Hospital, Boston. A matched control group was interviewed in each culture to compare use of professional support systems. Difficulties in communicating about DMD with their spouses and with their affected sons were reported by significantly more Irish parents than by their American counterparts. More Irish parents had never spoken about DMD with their affected sons. American DMD families reported significantly more contact with professional support systems than did the Irish families. Factors which may contribute to these cultural differences are discussed.

The measurement of adolescent adaptive processes in the clinical interview

A study is described measuring the clinical usefulness of Adolescent Adaptive Process Scales. These processes are measured in three groups of adolescents in which psychopathology is also measured using a standardized psychiatric interview. Inter-rater reliability is calculated between two raters and mean score comparisons are made between the groups using the t-test method. In the study a higher inter-rater reliability and some preliminary evidence of construct validity are found for these scales. The findings indicate that these scales could constitute a useful clinical tool in psychotherapy, research and teaching. They also provide scope for future work in the field.

A symptom self-report measure for preschool children

The Preschool Symptom Self-Report (PRESS) is a pictorial instrument designed to facilitate the self-report of depressive symptoms by preschool children. It was tested with a sample of 84 Head Start children and their parents and teachers. A parent-teacher version of the instrument correlated with other measures designed for adult rating of children's depression about as well as those measures correlate with one another. It showed high reliability upon retesting by a different examiner within 24 hours. The instrument also showed high internal consistency, which implies that the children responded to items based upon their meaning rather than upon irrelevant characteristics. The retest reliability of the instrument did not depend upon the child's mental age. The children's self-reports showed no relation to adults' ratings of the children's symptoms; this result is consistent with some findings with older children.

Problem behavior in international adoptees: III. Diagnosis of child psychiatric disorders

This study is a clinical extension of two previous epidemiological studies on problem behavior in international adoptees. In depth pictures were obtained by clinical interviews of 132 14-year-old international adoptees and their parents. Children were selected on the basis of previously obtained Child Behavior Checklist (CBCL) scores. Clinical severity ratings and DSM-III-R diagnoses were obtained. The correlations of r = 0.63 and r = 0.45 between clinical severity ratings and CBCL problem and competence scores, respectively, indicated that the results from the authors' extensive epidemiological survey and the clinical evaluation, which took place more than 10 months later, converged. The results showed that the CBCL may be used in epidemiological studies to obtain an estimate of the prevalence of psychiatric disorders in children. The 28% prevalence rate of psychiatric disorders in this sample of 14-year-old international adoptees (22% rate for girls, 36% for boys) was somewhat higher than for general population samples reported in comparable studies. Conduct disorders were elevated in the sample. The behavior of disordered adopted children was characterized by antisocial behaviors, poor relationships, and problems of affect.

Parent-child agreement on symptoms assessed via a clinical research interview for children: the Child Assessment Schedule (CAS)

This study examined the relationship between symptom type and parent-child agreement, as reflected in symptom scores on a structured diagnostic interview, the Child Assessment Schedule (CAS). Forty-eight psychiatric inpatients (mean age 10 years) were administered the CAS. Their mothers were interviewed independently with the parent form. The average time between interviews was 12 days. High parent-child agreement was found for conduct/behavioral problems and moderate agreement for affective symptoms. Parents reported more conduct-related problems; children reported more anxiety and somatic symptoms and more family problems. The pattern of parent-child differences was the same as observed for other interviews.

Epidemiology and course of psychiatric disorders in school-age children--results of a longitudinal study

In an epidemiological longitudinal study, 356 out of 399 8-yr old children were re-examined at age 13. Prevalence rates for psychiatric disorders of about 16% remained constant during adolescence. The course of emotional disorders proved very promising, while that of conduct disorders was extremely unfavorable. Remission of psychiatric disorders was also influenced by an improved psychosocial environment within the family. Development of disorders in initially healthy children was related to prior learning disabilities and stressful life events. More effective approaches in the treatment of conduct disorders as well as early detection of detrimental familial conditions and learning disabilities are called for.

Factors protecting children living in disharmonious homes: maternal reports

This study investigated factors which were protective to children living in disharmonious homes. The sample was drawn from a representative sample of children aged 9 to 12 who took part in a previous general population study. Semi-structured interviews with both parents were used to assess the quality of the parental marriage. Mothers provided information on children's emotional and behavioral problems and putative protective factors. Fifty-seven families were in the disharmonious marriage group and 62 were in the harmonious marriage group. Putative protective factors, hypothesized to be beneficial for children, were either an aspect of social support or related to children's activities. Data were analyzed using a two-way analysis of variance with parental marriage and the putative protective factor as main effects. A differentiation was made between protective factors which interacted with parental marriage and those that acted independently. Factors which interacted with the quality of parental marriage were children having a relationship with an adult outside the family, an activity for which they received much positive recognition, and good sibling relationships. The parent-child relationship was associated with children's disturbance in both harmonious and disharmonious homes.

The validity of the assessment of psychopathology in the psychoses

This paper reviews recent progress in the assessment of the psychopathology of psychosis and focuses upon a number of persistent limitations. In particular the over-emphasis upon reliability at the expense of validity is highlighted and the relationship between reliability and validity is reconsidered. A number of strategies aimed at improving the validity of psychopathological measures are outlined. Proposals to deploy such variables differently in research strategies and analyses are endorsed.

Autism diagnostic interview: a standardized investigator-based instrument

The development of a new standardized investigator-based interview for use in the differential diagnosis of pervasive developmental disorders is described, together with a diagnostic algorithm (using ICD-10 criteria) based on its use. Good interrater reliability for algorithm items was shown between four raters, two in Canada and two in the UK, who rated 32 videotaped interviews. The items also significantly discriminated between 16 autistic and 16 nonautistic mentally handicapped subjects. The algorithm based on ICD-10 identified all 16 autistic individuals and none of the 16 nonautistic subjects.

Adult personality functioning assessment (APFA). An investigator-based standardised interview

The development of an investigator-based standardised interview to assess patterns of specific and general social dysfunction is described. It covers six domains of functioning: work; love relationships; friendships; non-intimate social contacts; negotiations; and everyday coping. Inter-rater reliability was tested by three investigators rating 21 audiotaped interviews, and was shown to be high, with an intraclass correlation of 0.87 for the total score. The pattern of associations between specific and general social dysfunction was examined through determination of sensitivities and specificities and through LISREL modelling. The findings varied across social domains but it was concluded that the total APFA score provided a reasonable measure of general social dysfunction.

Coping with parental quarrels

Children's reactions to parental quarrels were investigated in a general population sample of children between 9 and 12 years old. One hundred and thirty-nine families participated in the study. Approximately half the children were living in disharmonious families and half were in harmonious families. Mothers and children were interviewed with semistructured interviews to determine how children responded to specific episodes of parental quarrelling. Seventy-one percent of children reported intervening in parental quarrels. A range of other coping strategies was identified: seeking contact with a sibling, confiding in friends, offering comfort to parents after a quarrel, self-blame, seeking information about quarrels, and perceiving beneficial aspects to parental quarrelling. The hypothesis was examined that certain coping strategies would be associated with lower levels of children's behavioral and emotional problems. Only a weak relationship was found between children's intervention in parental quarrels and emotional and behavioral problems. No other coping strategies were found to predict children's disturbance.

The Child Assessment Schedule: parent-child agreement and validity measures

Parents' and children's reports of behavioural-emotional problems in 116 children assessed by the Child Assessment Schedule developed by Hodges et al. (Journal of the American Academy of Child Psychiatry, 21, 468-473, 1982) and the Graham & Rutter Parent Interview (British Journal of Psychiatry, 114, 581-592, 1968), both semi-structured interviews, revealed relatively high agreement compared with studies using highly structured assessment procedures. The majority of disagreements could be attributed to higher parents' scores. Only fears were reported more often by children, especially by the better-functioning children, suggesting that children's reports of fears may be related to a higher level of adaptive functioning rather than a higher level of psychopathology. Although the child interview may be crucial to obtain information often not reported by parents such as fears and anxiety, it was found that information from the child contributed only little to overall clinical judgement based on information already available from the parents.

Psychiatric disorder among boys with Duchenne muscular dystrophy

The prevalence of psychiatric disorder in 23 boys with Duchenne muscular dystrophy was assessed and compared to a matched control group. Dysthymic disorder and major depressive disorder occurred significantly more often among DMD boys than controls. Older boys with DMD were at greater risk of depressive disorder than younger boys. Possible aetiological factors and approaches to management are discussed.

Communication within families about Duchenne muscular dystrophy

An interview with parents of 23 boys with Duchenne muscular dystrophy (DMD) suggested that communication within families about the disorder presented difficulties for both parents and the boys. Spouses rarely discussed the condition and for many this was not a problem area but a way of coping by dealing only with the present. More problematic was the inability for parents and affected boys to communicate about the disorder. Lack of communication occasionally was responsible for carriers not being informed about the genetic nature of the disorder. Possible reasons for these patterns of communication are discussed and some approaches to helping families of boys with DMD are suggested.

Mental health in Dutch children: (II). The prevalence of psychiatric disorder and relationship between measures

This study concerns the second, more clinically oriented, part of our epidemiological project. The prevalence of child psychiatric disorders in random samples of 8- and 11-year-old children is assessed by using standardized parent- and child-interviews. The relationships between different measures of child psychopathology are determined. Furthermore, additional validity measures of the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) developed by Achenbach, are provided. Of the 153 8- and 11-year-old children selected through a two-stage sampling procedure, 116 (76%) children and their parents were intensively clinically assessed. The correlation between CBCL and direct child assessment is .42, whereas the correlation between the TRF and direct child assessment is .28. The correlation between TRF and CBCL is .26. The implications of the low correlation between raters who saw children is different situations are emphasized. The weight given to reports from different sources varies with the kind of problem the child exhibits. It is concluded that more research is needed to investigate the relative value of different types of data for different conditions. Seven percent of the 8- and 11-year-olds were judged severely disordered, whereas for 26% the clinicians judged the child to be moderately or severely disordered. The high prevalence rates found in our study compared with others is partly attributed to the arbitrary nature of clinical judgement. ANOVAs and discriminant function analysis were performed to obtain those CBCL items that showed the best discrimination between children who were clinically judged disordered and children from the normative comparison group. Many items found to be good discriminators of clinical status in this study were among the best discriminators of referral status in the earlier reported part of the study. A number of family and social factors were found to be associated with psychiatric disorder. These findings support those in other studies.

The nature and qualities of parenting provided by women raised in institutions

A repeated pattern of difficulties in parenting is often found in successive generations of the same families. That finding, together with a concern to identify potential adverse influences upon child behaviour and development, was the focus of this study into the parenting provided by women who were raised within institutions. Relationships with their 2- to 3-year-old infants were assessed using complementary interview and naturalistic observational techniques. Differences in parenting styles between the case and comparison groups were on the whole subtle. Ex-care women were relatively less sensitive to their children's cues and, in response to their demands and opposition, exercised control by confrontation rather than by circumvention.

Impact of whooping cough on patients and their families

The effects of whooping cough were studied in 21 children admitted to hospital with the disease and in their families. The illness caused considerable distress to both child and family. Parents suffered especially from fears for the life and health of their child and from serious loss of sleep. Two months after admission the child's behaviour was still disturbed, but in most cases the rest of the family had returned to normal. There was much misunderstanding and misinformation about whooping cough among both parents and doctors.

Psychiatric epidemiology in a sample of 1510 ten-year-old children--I. Prevalence

Prevalence estimates of psychiatric disorder in 10-yr-old rural Norwegian children were based on responses to symptom checklists for parents and teachers. The parents' index showed highest validity, and was used as a basis for prevalence estimates. Properties of the index were shown to be sample specific, and a validity test should consequently always be administered to representative subsamples in psychiatric epidemiological studies based on symptom checklists. Prevalence of functional problems of a primarily psychological nature was calculated by proportional extrapolations from the validity test results. The prevalence rate for the total sample was 5%, and corrected prevalence when emigrants were excluded was 4.6%.

Parental psychiatric disorder: effects on children

A 4-year prospective study was undertaken of the families of 137 newly referred English speaking psychiatric patients with children at home aged under 15 years. The group comprised a representative sample of such patients living in one inner London borough. Teacher questionnaires were obtained yearly for all children of school age in the families, and for age-, sex- and classroom-matched controls. Detailed standardized interviews were undertaken yearly with parent-patients and with their spouses. A comparison was also made with a control group of families in the general population with 10-year-old children. Patients' families differed in terms of a higher rate of psychiatric disorder in spouses and a much higher level of family discord. Both parental mental disorder and marital discord tended to persist over the 4-year period, but persistence of both was much more marked when the parent had a personality disorder. The children of psychiatric patients had an increased rate of persistent emotional/behavioural disturbance, which tended to involve disorders of conduct. The psychiatric risk to the children was greatest in the case of personality disorders associated with high levels of exposure to hostile behaviour. Boys showing temperamental risk features were most vulnerable to the ill-effects associated with parental mental disorder.

An evaluation of an inpatient psychiatric unit for children

The progress of 31 children admitted over a 2 year period to a regional child psychiatric inpatient unit was studied using questionnaires and interviews. The effectiveness of the children's treatment was evaluated using an interrupted time series design. Substantial and significant improvements were observed for both global levels of disorder and specific problems, and this effect appeared to be stable. These results confirm previous assertions on the efficacy of inpatient treatment.

Psychological and educational correlates of strabismus in school children

The results of a study investigating the relationship of psychiatric and cognitive disorder with strabismus and its treatment in primary school aged children are reported. Results suggest that children with strabismus have a higher prevalence of psychiatric disorder, particularly an emotional disorder or psychosis. Subjects also had an increased risk of having educational problems and of exhibiting difficulties with tasks involving visual perception. Variables related to the nature and treatment of the strabismus did not appear influential in the development of the psychiatric disorder. Family disruption was significantly associated with both the presence of strabismus and emotional and behavioural problems in the children reported by parents and teachers.

Predicting school performance of preschool children from parent reports

Parents of 391 preschool children ages 49 to 64 months completed a brief developmental inventory as part of a preschool screening program operated by an urban school district. The 28-item developmental inventory assessed adaptive behavior and language development. In addition, preschool children were administered the Minneapolis Preschool Screening Instrument. Teacher ratings of kindergarten performance the following year provided criterion data to validate the screening measures. Correlations with the overall teacher rating [the mean of nine ratings] were .40 for the adaptive behavior scale and .57 for the language scale. Validity figures for the developmental inventory were significantly higher for low SES than for high SES children, for older children [57 to 64 months] than for younger children [49 to 56 months], and for firstborn children than for younger siblings. No effects were found by sex. While a positive relationship between parent reports of developmental functioning and early school performance was clearly established, validity levels did not justify use of parent information as a sole source of preschool screening information.

Institutional rearing, parenting difficulties and marital support

A prospective follow-up study was undertaken of two groups of women first studied in the mid 1960s when they were children: 94 girls reared in institutions to which they had been admitted because of a breakdown in parenting, and 51 girls in a general population comparison group. Both groups were interviewed in detail when aged 21-27 years and home observations were undertaken for those with young children. The institution-reared women showed a markedly increased rate of poor psychosocial functioning and of severe parenting difficulties in adult life. However, the support of a non-deviant spouse and of good living conditions in adult life provided a powerful protective effect.

Children in lesbian and single-parent households: psychosexual and psychiatric appraisal

Thirty-seven school-age children reared in 27 lesbian households were compared with 38 school-age children reared in 27 heterosexual single-parent households, with respect to their psychosexual development and their emotions, behaviour and relationships. Systematic standardized interviews with the mothers and with the children, together with parent and teacher questionnaires, were used to make the psychosexual and psychiatric appraisal. The two groups did not differ in terms of their gender identity, sex role behaviour or sexual orientation. Also, they did not differ on most measures of emotions, behaviour and relationships--although there was some indication of more frequent psychiatric problems in the single-parent group. It was concluded that rearing in a lesbian household per se did not lead to atypical psychosexual development or constitute a psychiatric risk factor.