A Cultural Analysis of Adolescent Psychopathology

Behavior problems of adolescents have increasingly come to be examined as psychopathology. A medical/psychological view conflicts with a cultural interpretive approach. Material in the literature that bears on this topic is reviewed and analyzed critically. The goal is to illustrate how the concept of culture has been used to enhance understanding of adolescent psychopathology. Pertinent studies rely on differing methods, procedures, and conceptualizations of culture and psychopathology itself Epidemiologists handle culture abstractly and in a static way as a type of independent variable, and psychopathology is operationalized in terms of discreet disorders. Other researchers handle culture more broadly as systems of meaning and tend to examine descriptive aspects of behavior that reflect problems of adjustment. Advantages and disadvantages of the differing approaches are discussed. The needforstudies that balance methodologic rigor with interpretive sensitivity is emphasized. Suggestionsfor enhancing cultural sensitivity are presented.

Adolescence, stress, and psychological well-being

The present study analyzes the mental-health consequences of stress in a sample of 1,038 adolescents (526 females and 512 males) from a Canadian prairie city. The study examined the relationship between perceived stress in family, school, and peer-group situations and four measures of psychological well-being, i.e., anxiety, depression, social dysfunction, and anergia. The moderator effects of locus of control orientation (mastery) on stress-outcome relationships were also examined, as were the sex differences in health and the perception of stress. All three sources of stress were found to be related to the four measures of mental health, with family stress having the strongest negative health impact. The health-protective role of locus of control was limited for the large part to the stresses emanating from school and peer groups. Substantial sex differences were found in the perception of family- and peer-related stresses as well as in levels of psychological distress. A tentative explanation of these differences was examined with reference to prevailing structural conditions and differences in locus of control orientation, with female adolescents showing greater externality. Implications of the results are drawn for the long-standing debate on the relative impact of stress and its sources on adolescents' psychosocial development and for a current controversy in adolescent theory between proponents of "classical" and proponents of "empirical" conceptions of adolescence.

Prevention of conduct disorder before and after school entry: Relating interventions to developmental findings

In this paper, both longitudinal and treatment studies relevant to conduct disorder (CD) are reviewed, and a developmental approach to its prevention is presented. Outcome studies for the treatment of CD and antisocial behavior are first reviewed to demonstrate that, although none have been entirely successful, many interventions have powerful effects on various symptoms that comprise the disorder, highly predictive antecedents, and risk factors. Second, the development of CD and the potency and interrelationship among antecedent and mediating variables is traced through the preschool and early elementary school years. Third, an attempt is made to synthesize the developmental and treatment research findings to suggest possible integrations of interventions that are promising for future preventive trials in the preschool and elementary school periods. It is concluded that, whereas before the entry to school preventive interventions targeted entirely in the family setting may prove successful, after the transition to school multisetting interventions will be essential. Finally, three examples of new and multisetting prevention trials are briefly described.

Conduct and affective disorders in developmental perspective: A systematic study of adolescent psychopathology

This study examined the relationship of psychiatric diagnoses to gender, IQ, and ego development level in an inpatient sample of 269 adolescents. It was found that adolescents with an affective disorder diagnosis, in contrast to those with a diagnosis of conduct or mixed affective-conduct disorder, were more likely to (a) be female, (b) have higher IQ scores, and (c) have higher ego development levels. No significant age differences were found between groups. Comparisons between the single diagnosis and mixed disorder groups indicated that the mixed disorder group is characterized by the most severe symptoms found in each of the pure affective and conduct disordered groups. A relationship between type of DSM-III diagnosis and ego development level in adolescence was demonstrated after controlling for the effects of age, gender, and IQ. These results are offered as an explication of the developmental dimensions inherent in DSM-III psychiatric diagnoses.

Psychological, contextual, and psychobiological interactions: A developmental perspective on conduct disorder

An understanding of the interactions among developmental psychobiological and psychological and contextual aspects of conduct disorder has the potential for contributing new insights on the etiology and stability of conduct problems. The purpose here is to present theoretical and methodological issues germane to integrating a psychophysiological theory of conduct disorder with psychological developmental perspectives. These issues are theoretical concerns germane to a developmental perspective on conduct disorder, stability and change in conduct disorder, and bidirectionality in biological and psychological influences on conduct disorder.

Gender and the development of conduct disorder

A discussion of gender and conduct disorder must first answer the basic questions of whether or not there are any differences in prevalence, symptoms, and correlates of conduct disorder by sex. Several epidemiologic studies have found no difference in the prevalence of conduct disorder in adolescence by sex. Correlates of conduct disorder in girls are similar to those in boys (including aggression and internalizing disorders), once base rates of the correlates are accounted for. A major problem in studying conduct disorder in girls is the lack of appropriate criteria; theDiagnostic and Statistical Manual(3rd ed., rev.) criteria are not appropriate for girls. A case is made for sex-specific criteria for conduct disorder that take into account known differences in male and female childhood cultures and base-rate differences in aggression and criminality. Until basic issues of diagnosis and prevalence are resolved, other issues such as risk factors and developmental pathways cannot be successfully addressed.

Psychiatric disorders and MND in non-handicapped preterm children. Prevalence and stability from school age into adolescence

In preterm children (N = 66) without major physical and/or mental handicaps the prevalence of psychiatric disorders and minor neurological dysfunction (MND) was assessed at school age (8-10 years). In adolescence (15-17 years) 43 children were reassessed. The study sample was drawn from a cohort of non-handicapped preterm children (N = 218) hospitalised in a Neonatal Intensive Care Unit because of serious neonatal complications. The findings in the preterm group were compared with two control groups (N = 20 and N = 20) matched for age and sex ratio. The association between psychiatric disorders on the one hand and group status (preterm versus control), MND, IQ and family adversity on the other was explored. At both ages the preterm children exhibited more psychiatric disorders and MND than controls. The very preterm and/or very low birth weight children contributed to the differential psychopathological findings between the preterm and control groups. Besides preterm birth, the prevalence of psychiatric disorders was positively associated with MND and negatively associated with VIQ and family adversity. In the preterm group there was a shift from school age into adolescence into a predominance of anxious and depressive disorders. No significant changes with age were found with respect to the prevalence of MND and psychiatric disorders. Thus, very preterm and/or very low birth weight children are at increased risk of persistent psychiatric disorders, especially anxious and depressive disorders. In preterm children the development of psychopathology seems to be mediated by MND, decreased verbal abilities and family adversity.

Resilience to adult psychopathology following childhood maltreatment: evidence from a community sample

OBJECTIVE

Child abuse is an important risk for adult psychiatric morbidity. However, not all maltreated children experience mental health problems as adults. The aims of the present study were to address the extent of resilience to adult psychopathology in a representative community sample, and to explore predictors of a good prognosis.

METHODS

Data are drawn from a follow-up of the Isle of Wight study, an epidemiological sample assessed in adolescence and at midlife. Ratings of psychiatric disorder, peer relationships and family functioning were made in adolescence; adult assessments included a lifetime psychiatric history, personality and social functioning assessments, and retrospective reports of childhood sexual and physical abuse.

RESULTS

Ten percent of individuals reported repeated or severe physical or sexual abuse in childhood. Prospective measures revealed increased rates of adolescent psychiatric disorders in this group. Rates of adult psychopathology were also high. A substantial minority of abused individuals reported no mental health problems in adult life. Resilience of this kind was related to perceived parental care, adolescent peer relationships, the quality of adult love relationships, and personality style.

CONCLUSION

Good quality relationships across childhood, adolescence and adulthood appear especially important for adult psychological well being in the context of childhood abuse.

Is there an epidemic of child or adolescent depression?

BACKGROUND

Both the professional and the general media have recently published concerns about an 'epidemic' of child and adolescent depression. Reasons for this concern include (1) increases in antidepressant prescriptions, (2) retrospective recall by successive birth cohorts of adults, (3) rising adolescent suicide rates until 1990, and (4) evidence of an increase in emotional problems across three cohorts of British adolescents.

METHODS

Epidemiologic studies of children born between 1965 and 1996 were reviewed and a meta-analysis conducted of all studies that used structured diagnostic interviews to make formal diagnoses of depression on representative population samples of participants up to age 18. The effect of year of birth on prevalence was estimated, controlling for age, sex, sample size, taxonomy (e.g., DSM vs. ICD), measurement instrument, and time-frame of the interview (current, 3 months, 6 months, 12 months).

RESULTS

Twenty-six studies were identified, generating close to 60,000 observations on children born between 1965 and 1996 who had received at least one structured psychiatric interview capable of making a formal diagnosis of depression. Rates of depression showed no effect of year of birth. There was little effect of taxonomy, measurement instrument, or time-frame of interview. The overall prevalence estimates were: under 13, 2.8% (standard error (SE) .5%); 13-18 5.6% (SE .3%); 13-18 girls: 5.9% (SE .3%); 13-18 boys: 4.6% (SE .3%).

CONCLUSIONS

When concurrent assessment rather than retrospective recall is used, there is no evidence for an increased prevalence of child or adolescent depression over the past 30 years. Public perception of an 'epidemic' may arise from heightened awareness of a disorder that was long under-diagnosed by clinicians.

Neurogenetic interactions and aberrant behavioral co-morbidity of attention deficit hyperactivity disorder (ADHD): dispelling myths

Background

Attention Deficit Hyperactivity Disorder, commonly referred to as ADHD, is a common, complex, predominately genetic but highly treatable disorder, which in its more severe form has such a profound effect on brain function that every aspect of the life of an affected individual may be permanently compromised. Despite the broad base of scientific investigation over the past 50 years supporting this statement, there are still many misconceptions about ADHD. These include believing the disorder does not exist, that all children have symptoms of ADHD, that if it does exist it is grossly over-diagnosed and over-treated, and that the treatment is dangerous and leads to a propensity to drug addiction. Since most misconceptions contain elements of truth, where does the reality lie?

Results

We have reviewed the literature to evaluate some of the claims and counter-claims. The evidence suggests that ADHD is primarily a polygenic disorder involving at least 50 genes, including those encoding enzymes of neurotransmitter metabolism, neurotransmitter transporters and receptors. Because of its polygenic nature, ADHD is often accompanied by other behavioral abnormalities. It is present in adults as well as children, but in itself it does not necessarily impair function in adult life; associated disorders, however, may do so. A range of treatment options is reviewed and the mechanisms responsible for the efficacy of standard drug treatments are considered.

Conclusion

The genes so far implicated in ADHD account for only part of the total picture. Identification of the remaining genes and characterization of their interactions is likely to establish ADHD firmly as a biological disorder and to lead to better methods of diagnosis and treatment.

Genetic and environmental mechanisms underlying stability and change in problem behaviors at ages 3, 7, 10, and 12

Maternal ratings on internalizing (INT) and externalizing (EXT) behaviors were collected in a large, population-based longitudinal sample. The numbers of participating twin pairs at ages 3, 7, 10, and 12 were 5,602, 5,115, 2,956, and 1,481, respectively. Stability in both behaviors was accounted for by genetic and shared environmental influences. The genetic contribution to stability (INT: 43%; EXT: 60%) resulted from the fact that a subset of genes expressed at an earlier age was still active at the next time point. A common set of shared environmental factors operated at all ages (INT: 47%; EXT: 34%). The modest contribution of nonshared environmental factors (INT: 10%; EXT: 6%) could not be captured by a simple model. Significant age-specific influences were found for all components, indicating that genetic and environmental factors also contributed to changes in problem behavior.

Epidemiologie psychischer Störungen im Kindes- und Jugendalter:

Zusammenfassung. In der vorliegenden Arbeit wird ein Überblick über den aktuellen Wissensstand zur Entwicklungsepidemiologie psychischer Störungen des Kindes- und Jugendalters gegeben. Der Median der Periodenprävalenzraten der wichtigsten Studien betrug 18%, wobei ca. ¾ der Prävalenzraten zwischen 15 und 22% lagen. Damit sind psychische Störungen bei Kindern und Jugendlichen in etwa gleich häufig wie bei Erwachsenen. Als häufigste Störungen zeigten sich Angststörungen mit einer durchschnittlichen Prävalenz von 10,4%, gefolgt von dissozialen Störungen mit 7,5%. Es ergaben sich konsistent hohe Persistenzraten der Störungen von ungefähr 50%, wobei dissoziale Störungen die ungünstigsten Verläufe aufwiesen. Die häufigsten komorbiden Störungen waren dissoziale Störungen bei Vorliegen einer hyperkinetischen Störung und Angststörungen bei Vorliegen einer depressiven Störung. Bis zum Alter von 13 Jahren wurden durchgehend höhere Gesamtprävalenzen psychischer Störungen bei Jungen gefunden, wogegen im Zuge der Adoleszenz eine Angleichung der Raten erfolgte. Bei Jungen zeigten sich höhere Raten externalisierender Störungen, während Mädchen höhere Raten von Eßstörungen und psychosomatischen Störungen aufwiesen. Ein differenziertes Bild zeigte sich für internalisierende Störungen. Während depressive Störungen ab dem späten Jugendalter doppelt so häufig beim weiblichen Geschlecht vorkamen, traten diese im Schulalter häufiger bei Jungen auf. Die Befundlage zeigt, dass verstärkte Forschungsbemühungen zur Prävention und Intervention im Kindes- und Jugendalter dringend erforderlich sind.

The prospective relation between dimensions of anxiety and the initiation of adolescent alcohol use

Examined the relation between early anxiety symptomatology (generalized and separation) and initiation of alcohol use 4 years later in an epidemiological sample of 936 children (45% girls), assessed at ages 9, 11, and 13, while controlling for the effects of depression. Although earlier overall anxiety symptomatology was unrelated to later onset of drinking, children with early symptoms of generalized anxiety were found to be at increased risk for initiation of alcohol use, whereas children with early symptoms of separation anxiety were at decreased risk. The magnitude of these relations was equally strong for boys and girls. In addition, early depressive symptomatology was associated with increased risk for initiation of alcohol use in adolescence. Results indicate that it is important to consider specific dimensions of anxiety symptomatology when attempting to identify those individuals at risk for early initiation of alcohol use.

Prävalenz, Komorbidität und Geschlechtsunterschiede psychischer Störungen vom Grundschul- bis ins frühe Erwachsenenalter

Zusammenfassung. Theoretischer Hintergrund: Die Mannheimer Kurpfalzerhebung wurde entwickelt, um Daten über die Prävalenz, die Entstehung und den Verlauf psychischer Störungen von der Kindheit bis ins Erwachsenenalter bereitszustellen. Fragestellung: Untersuchung alters- und geschlechtsspezifischer 6-Monats- und Lebenszeit-Prävalenzraten psychischer Störungen und Untersuchung von Komorbidität und Funktionsbeeinträchtigungen in verschiedenen Lebensbereichen. Methode: 321 (80 %) Teilnehmer einer im Alter von 8, 13 und 18 Jahren untersuchten Stichprobe nahmen in Alter von 25 Jahren an einem 4. Interview zur Erfassung von psychischen Störungen und Funktionsbeeinträchtigungen teil. Ergebnisse: Die 6-Monatsprävalenz psychischer Störungen im Alter von 25 Jahren betrug 18,4 %. Männer wiesen höhere Raten von dissozialen Störungen und Störungen durch Substanzgebrauch auf, wohingegen Frauen höhere Raten von affektiven und psychosomatischen Störungen zeigten. Die Komorbiditätsrate betrug 45 %. Längsschnittliche Vergleiche zeigten deutlich, daß sich die Störungsraten geschlechtsspezifisch im Entwicklungsverlauf verändern. Schlußfolgerungen: Die vorliegende Studie leistet einen wichtigen Beitrag zur Aufklärung geschlechtsspezifischer Veränderungen der Raten psychischer Störungen im Entwicklungsverlauf, indem sie die Forschungslücke zwischen Jugendalter und Erwachsenenalter schließt.

Social phobia and the persistence of conduct problems

Recent epidemiological studies suggest that both social anxiety and attention deficit hyperactivity disorder (ADHD) in childhood might predict levels of delinquent behavior in adolescence. The current study prospectively examines the influence of social phobia and ADHD symptom scale scores on the correlation in conduct disorder symptom scale scores over time. An epidemiologically selected sample of 776 young people living in Upstate New York received DSM-based psychiatric assessments in 1983, 1985, and 1992 using structured interviews. Correlations among conduct disorder scales over time were examined as a function of social phobia and ADHD ratings. Individuals with low scores on social phobia scales or high scores on ADHD scales exhibited the highest correlation in conduct disorder symptom scales over time. There was also a suggestion that low scores on social phobia scales predicted later risk for conduct disorder. Low scores on social phobia symptom scales or high scores on ADHD scales predict stronger across-time correlations in conduct disorder symptom scales. Various cognitive or biological factors might account for these moderating effects on conduct problems.

The course of aggression in first-grade children with and without comorbid anxious symptoms

We studied the course of aggressive behavior in an epidemiologically defined sample of first graders with and without comorbid anxious symptoms. Our primary purpose in doing so was to understand whether the stability of aggression in young children was attenuated or strengthened in the presence of comorbid anxiety. Previous studies of older children and adolescents had produced equivocal findings in this regard. Data on anxious symptoms were obtained through an interview of the children, whereas aggressive behavior was assessed through the use of a teacher interview and peer nominations. Assessments were performed in the fall and spring of first grade. In contrast to children classified as aggressive alone in the fall of first grade, boys and girls classified as aggressive and anxious in the fall of first grade were significantly more likely to be classified as aggressive in the spring in terms of teacher ratings and/or peer nominations of aggression. Thus our findings suggest that the link between early and later aggression may be strengthened in the presence of comorbid anxious symptoms, rather than attenuated. Future studies are needed to identify the mechanisms by which the course of aggression is influenced by the presence of comorbid anxiety.

Pathways to a child mental health service

The mothers of 46 children who had been assessed by staff from a child mental health service were interviewed about the process by which they had come to be referred. The sequence of contacts with agencies was described and children coming via different pathways compared. Contacts with school teaching staff, and general practitioners were commonly part of the pathway, and health visitors were an important group of carers for younger children. When children had had contact with general practitioners and health visitors they were likely to be referred directly to the mental health service, but school staff had mostly sought help from other agencies.

Patterns of referral to child psychiatry in Hong Kong

The referral pattern by three major sources to the Child and Adolescent Psychiatric Unit of a university teaching hospital in Hong Kong is reviewed. In a health care system where primary health care is not properly developed, referral of children with psychiatric problems relies heavily on secondary health care professionals. Over a three year period, 37.8% of the new cases were referred by the other departments of the same hospital, while the Education Department and general practitioners each referred 17.4%. Overall, up to 80% of these children had definite psychiatric problems. Because the morbidities of these children often traverse physical, psychological, social, and educational dimensions, a close liaison with all the different professionals involved is vital.

Psychiatric disorders in Japanese secondary school children

Approximately 2000 ordinary secondary school children were investigated using screening methods such as the Rutter teacher's and parent's questionnaires and a diagnostic interview. The prevalence estimate was 16% for the 12-13-year-olds and 14% for the 14-15-year-old children. Disorders were identified in boys more often than in girls (boys: girls = 2.4:1, as the ratio of prevalence estimates). Emotional disorders were equally common in boys and girls. However, conduct disorders were found more frequently in boys (boys: girls = 7:1). Out of the children who were judged as having psychiatric disorders only one had received any professional help except from that given by teachers, regardless of severity.

Six-year stability of parent-reported problem behavior in an epidemiological sample

An epidemiological sample of 936 Dutch children originally aged 4-11 years was assessed at 2-year intervals over a 6-year period. Parents completed the Child Behavior Checklist (CBCL) on all four occasions. Stability coefficients computed for eight CBCL syndromes, Internalizing and Externalizing dimensions, and total problems revealed considerable long-term stability. There was no significant difference in the 6-year stability of internalizing vs. externalizing scores. This finding was at odds with reports of considerably lower stability of internalizing behavior, and was consistent with findings suggesting that the stability of internalizing problems should not be underestimated. The magnitude and specificity of the long-term stability of internalizing and externalizing scores lends support to the validity of these behavioral dimensions as tapped by the CBCL. No significant sex or age differences in the stability of problem behaviors were found.

Psychiatric morbidity in a Chinese primary school in Hong Kong

The psychiatric morbidity among 718 Chinese primary school children from a lower middle social class area in Hong Kong was studied, using a two-stage design. The screening procedures included two parts, a multi-component scale and a battery of probing questions. The screening procedures achieved an overall sensitivity of 75% and a specificity of 97%. The findings on prevalence were: (i) a total prevalence of all definite psychiatric cases of 16.3%; (ii) prevalence according to diagnostic categories: emotional disorder, 8.8%; conduct disorder, 2.0%; mixed disturbance of emotion and conduct, 3.0%; hyperkinetic syndrome, 1.0%; hyperkinetic conduct disorder, 1.0%; and Gilles de la Tourette's syndrome, 0.4%; (iii) boys 2.7 times more affected than girls; (iv) emotional disorder much more common than conduct disorder, even in boys; and (v) the prevalence of borderline cases was 19.5%. The mean duration of morbidity for all definite cases was 41.7 months. About half of all definite cases were seriously impaired in one or more areas of functioning and the other half moderately impaired. These results were compared with findings obtained from studies done in other countries.

Prediction of children's referral to mental health and special education services from earlier adjustment

The 4-year stability in problem behaviors assessed with the Child Behavior Checklist (CBCL), and their predictive validity with regard to poor outcome variables was studied in 1052 4-12-year old children from a general population sample. Irrespective of sex and age, the scores on the CBCL of some 44% of the children remained above the 90th percentile over the 4-year time interval. Externalizing problem behavior tended to show somewhat greater stability than internalizing problem behavior. High initial levels of both internalizing and externalizing problems, and persistence of problems were predictive of referral to mental health services. Referral to special education was higher for younger boys with high initial attention problems and school problems. Police contacts occurred more often in older boys with high initial aggression scores.

Ontario Child Health Study follow-up: evaluation of sample loss

This article presents an analysis of sample loss in a 4-year follow-up of children aged 4 to 12 who participated in the Ontario Child Health Study in 1983. Of the 1,617 children participating in the original Ontario Child Health Study, 1,172 (72.5%) were located and enlisted at follow-up in 1987. Based on wave-one assessments, nonparticipants at follow-up tended to have higher levels of psychopathology and family risk variables. Respondents were matched with nonparticipants and differentially weighted to compensate for selective loss. In comparing estimates based on actual (observed) and weighted responses in the follow-up sample, it was found that the effects of sample loss depended on the analytical focus. Evaluations of outcome of disorder and risk for disorder were not affected by sample loss. Evaluation of variables that predict persistence of disorder (prognosis) was affected by a bias toward the null.

Anxiety, inhibition, and conduct disorder in children: I. Relations to social impairment

Jeffrey A. Gray has proposed a model in which conduct disorder (CD) is viewed as the result of both excessive activity of a behavioral activation system that mediates appetitive and aggressive behavior and deficient activity of a behavioral inhibition system that mediates both anxiety and the inhibition of behavior in the presence of cues signalling impending punishment or frustration. The relation of anxiety to antisocial behavior was examined in 177 clinic-referred boys, aged 7 to 12 years, 68 of whom met DSM-III-R criteria for CD. As predicted by Gray's model, boys with CD and comorbid anxiety disorder were markedly less impaired than boys with CD alone.

Prevalence of psychological distress in Irish female adolescents

Some female adolescents (N = 132) attending two inner city Dublin schools completed the Youth Self Report Questionnaire (YSRQ). Of this group 15.4 per cent obtained a Total Problem Score in the clinical range. A higher proportion, 23 per cent, obtained a score in the clinical range on one or more problem subscales of the YSRQ. No one scored abnormally on the Social or Competence Scales. A number of interesting and thought provoking responses to individual questions were obtained. The possible clinical relevance of these findings and implications for future planning in schools are discussed.

Screening measures for detecting psychiatric disorders in Japanese secondary school children

Measurement characteristics of screening measures (Rutter's teachers' and parents' questionnaires) were explored with some Japanese secondary school children. The characteristics included stability, cut-off points, factor analyses and agreements between questionnaire diagnoses and interviewer's judgement concerning types of disorder. These measures were used in combination and checked in terms of measurement characteristics. Age trends in the obtained results were described using 12-13-yr-old and 14-15-yr-old children. Results suggested that the cut-offs were age-dependent, regardless of the questionnaire type.

Four-year follow-up of an epidemiological sample

In this 4-year follow-up of behavioral/emotional problems in an epidemiological sample of 1,200 children originally aged 4 to 12 years assessed with the Achenbach Child Behavior Checklist (CBCL), high stability in the level of CBCL total problem scores was found. Stability of problem behavior was equally substantial for ages 4 to 12 and both sexes. Aggressive and other externalizing behaviors showed the highest stability. Even in children as young as 4 to 5 years, aggressive and attentional problems showed considerable stability. The results of the present study were informative with respect to methodology in indicating clearly that employing a mailing survey for obtaining parent reports on behavioral/emotional problems resulted in the selective exclusion of a group of especially problematic children who were recovered when parents were interviewed at home.

Conduct disorder in childhood and adolescence: an update

Conduct disorder is a diagnostic entity that has elicited controversy throughout the years. Classified as a psychiatric disorder of childhood and adolescence, the syndrome of conduct disorder recently was revised from four to three categories in the DSM-III-R (Revised). This article presents an overview of conduct disorders, including diagnostic criteria, epidemiology, etiology, treatment approaches and implications for nursing practice.

Psychiatric adjustment in children with chronic renal failure

Problems in psychiatric adjustment were found to be more common in children and adolescents with chronic renal failure (22 subjects on hospital haemodialysis and 22 with less severe renal failure) than in healthy matched controls. There was a trend towards more definite and marked psychological difficulties in patients with more severe renal condition. However, the less severely physically ill children tended to have increased difficulties in school adjustment and they reported more feelings of loneliness. The findings have implications on the management of children with chronic renal failure.

The relative value of screening instruments in adolescence

The phase of development that equips a child to become an adult is a period of transition. To date no instrument has become established as the routine screening measure for this age group in the same way as the Rutter B2 Scale has in children. During a major population study of adolescent functioning, the pupils drawn from four comprehensive schools were used to compare the validity of several screening measures in this age group. The results show that screen instruments tend to be behaviour specific and that antisocial and neurotic behaviour are relatively sex specific. The Rutter Malaise Inventory had the highest correlation with the psychiatrist's diagnosis of neurotic disorder, although the General Health Questionnaire also proved to be reasonably efficient. The antisocial subscale of the Rutter B2 Scale showed the best correlation with the psychiatrist's diagnosis of conduct disorder.

Factors which predict the persistence of aggressive conduct disorder

Fifty-three boys with aggressive conduct disorder were followed up 2 years after their original examination. Twenty-four (45%) no longer had the disorder and were classified as improved. A discriminant function analysis identified characteristics of the boys and their families which accurately predicted the outcome for 85% of the boys. Among the predictors of persisting conduct disorder were a variety of antisocial or aggressive symptoms, firesetting, early age of onset and family deviance.

The difficult adolescents who are referred to a psychiatric unit--II. Clinical features and response to treatment

The development of a new adolescent psychiatric unit for an urban area afforded the opportunity to study the range of cases that were referred. Using a special inventory that was developed and validated for the project distinct groups of youngsters were identified and their family characteristics studied. Of the conduct disordered group, a large proportion proved to be rather solitary and impulsive with a tendency towards outbursts of aggression. These adolescents and their families found least benefit from the family orientated approach of the unit. Of the remaining youngsters about 70 per cent showed symptomatic improvement, a rate which compares well with the findings from other outcome studies.

Health consequences of youth unemployment

The impact of unemployment on the physical and mental health of adolescents is one of the critical medical and social issues of our age. This paper reviews recent studies examining the link between youth unemployment and physical and mental ill-health. The evidence suggests that youth unemployment is associated with an increased vulnerability to psychiatric disorder. It is more firmly established that unemployment influences the course and prognosis of those with preexisting psychiatric disorders. Psychiatric disorder itself can also lead to reduced employability, particularly during periods of economic adversity. Fruitful areas of further study are identified.

The difficult adolescents who are referred to a psychiatric unit--I. Classification

The first 206 cases referred to an adolescent psychiatry unit were coded on a clinical inventory. This inventory proved to have acceptable inter-rater and test retest reliability, as well as quite a high degree of validity. Cluster analysis using Yule's similarity coefficient produced a series of near neighbours which, when combined with relevant history details produced four diagnostic groupings which seem to have clinical relevance to referrals to an adolescent psychiatric clinic. The importance of correct diagnosis in this age group is emphasized because of the part it plays in the search for more effective treatments of adolescent disorders.

The relevance of the multiple criterion screen to an adolescent population

The 4th- and 5th-year pupils of four large comprehensive schools, which were broadly typical of the schools serving an urban population, were screened using a multiple criterion approach. The screen results were compared with those found in a younger population drawn from the same area, and a similar rate of efficiency was found. However, in the adolescent age group the screen was more accurate at detecting true negative cases (specificity) but less able to identify true positive cases (sensitivity). Overall, the multiple criterion screen proved more efficient than a variety of single screen criteria, and the findings also suggest that certain screen measures used in adolescence may be more effective at identifying disturbed girls while others are more effective at identifying disturbed boys. This confirms the principle that the choice of screening instruments must be made with reference to their proposed use.

Sex differences in minor psychiatric morbidity

This monograph is concerned with some epidemiological observations of minor psychiatric morbidity. Differences in rates of specific disorders have historically formed a crucial part of epidemiological enquiry. Sex differences in the prevalence of minor affective disorders have been demonstrated in studies of populations in treatment and in community populations, and have been variously ascribed to constitutional or environmental factors. A review of the literature exposes the methodological problems of measurement and study design, and the conflicting nature of the findings. Efforts have recently concentrated on establishing the social factors important in the aetiology of minor affective disorder without adequate exclusion of constitutional factors. The importance of life events, chronic social stress and inadequate social supports in the aetiology of minor affective disorder has been demonstrated, but the variance explained by such factors is small, reinforcing the view that constitutional factors of some kind are likely to be of importance. The evidence for a genetic contribution to minor affective disorder is tenuous, but there is circumstantial evidence that changes in gonadal hormones are linked to mood changes in women. Until further evidence is available this must remain a powerful possibility in the genesis of sex differences in minor affective disorder. This investigation used epidemiological methods to assess whether there is a sex difference in the constitutional vulnerability of the male and female phenotype to minor psychiatric morbidity. In order to minimize the effects of environment and of sex roles and stereotypes as far as possible, a sample of relatively homogeneous employed men and women (drawn from a population of executive officers in the Home Office) was studied. The data obtained from this population of men and women of similar age, education, occupation and social environment were compatible with the null hypothesis that there is no sex difference in the prevalence of minor psychiatric morbidity, or its outcome in such a homogeneous group. However, women did report significantly more somatic symptoms than men. The second hypothesis, that there is a substantial sex difference in the self-perception of illness, illness behaviour and sickness absence in individuals with minor psychiatric morbidity among a homogeneous group of men and women of similar age, education and occupation, and subject to similar levels of social stress and support, received only partial support from the findings of the study.(ABSTRACT TRUNCATED AT 400 WORDS)

Psychopathology and development: I. Childhood antecedents of adult psychiatric disorder

The childhood antecedents of psychiatric disorder in adult life are reviewed with regard to four groups of conditions that show sharply contrasting patterns of linkage between childhood and adult life. For emotional disorders the links are weak and the mechanisms largely unknown. About half of schizophrenic psychoses are preceded by non-psychotic abnormalities of behaviour in childhood; the processes involved are probably largely constitutional. Affective disorders only infrequently begin in childhood and the behavioural precursors of adult depression do not constitute a clearly recognisable pattern. However, adverse experiences in childhood may create a vulnerability to later depression. The child-adult linkages are strongest with conduct disturbance in childhood and adult personality disorder; the mechanisms in this continuity are probably both constitutional and environmental.

Psychological distress among Canadian adolescents

This paper examines a comprehensive set of data on the prevalence and correlates of psychological distress in a sample of 1038 adolescent students in a major urban area of a Canadian prairie province. About 27% of the students reported 6 or more symptoms of psychological distress on the GHQ-30. The frequency of symptoms varied with age, grade level and average marks, with sex being the most significant variation. 'Anxiety' and 'social dysfunction' were the most frequent symptom dimensions reported. More detailed analysis of possible predictors of mental health showed that the nature and quality of family life strongly affected adolescent mental health. Adolescents' positive evaluation of their school atmosphere and peer group life and their locus of control orientation also positively influenced their psychological well-being.