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

Association between dietary habits and emotional and behavioral problems in children: the mediating role of self-concept

Introduction

Increasing research has focused on the influence of diet on mental health and well-being. This study aimed to investigate dietary habits status and their associations with emotional and behavioral problems (EBPs) in pre-teen children, as well as explore the mediating effect of child self-concept in the associations between healthy dietary habits and EBPs.

Methods

A cross-sectional survey using stratified random sampling was conducted to recruit third-grade children and their caregivers. Dietary habits and self-concept were assessed with self-administrated questionnaires in children. Information on children's EBPs was collected through questionnaires completed by their caregivers. Multilevel logistic regression models were used to estimate the associations between dietary habits and self-concept and EBPs, respectively. The mediation analysis was employed to test the mediating role of self-concept in the association between dietary habits and EBPs.

Results

Of 1,126 caregiver-child dyads (Mean age of children: 9.53, 52.8% boys) included, only 37.4 and 54.2% of children met the healthy standard of milk/soy milk and fruit, respectively. Healthy fresh fruit (odds ratio [OR] = 0.57, 95% confidence intervals [CI] 0.40-0.78) and vegetables intake (OR = 0.54, 95% CI 0.38-0.76) were associated with a higher self-concept while frequent consumption of sweet foods (OR = 1.58, 95% CI 1.05-2.36) and street foods (OR = 1.61, 95% CI 1.14-2.28) were associated with a lower self-concept. Children who had unhealthy sugar-sweetened beverages intake were at an elevated risk of EBPs (OR = 1.41, 95% CI 1.03-1.95). Moreover, the relationship between healthy dietary habits and EBPs was mediated by self-concept (indirect effect β = -0.09, p < 0.001, total effect β = -0.13, p < 0.001), the proportion of mediation was 29%.

Conclusion

This study revealed that the dietary habits of pre-adolescents need improvement, and dietary habits of certain foods, such as fresh fruits and sugar-sweetened beverages, were significantly associated with child mental health. Furthermore, dietary practices were related to the reduced EBPs through an enhanced self-concept. The findings provide an evidence base for developing dietary improvement strategies for pre-adolescent children in families, schools, and other health service settings, thereby contributing to the United Nations' Sustainable Development Goals related to zero hunger and good health and well-being.

The perceived social support of parents having bipolar disorder impacts their children's mental health: a 10-year longitudinal study

BACKGROUND

The offspring of parents with bipolar disorder (OBD) are at higher risk of developing psychopathology than the offspring of parents with no affective disorder (control). In addition to genetic predisposition, childhood adversity and a stressful family environment are important risk factors for the OBD. Protective factors in parents, such as social support and coping strategies, may buffer the effects of stress on at-risk children. This study tested whether parents' social support and coping style attenuated the link between risk status (OBD vs. control) and psychopathology in offspring.

METHODS

During offspring's middle childhood, parents underwent a diagnostic interview and completed social support and coping style questionnaires. Sixty-nine OBD (39 female) and 69 control (29 female) offspring between ages 13 and 29 completed a diagnostic interview approximately 10 years later.

RESULTS

Parents' social support satisfaction moderated the link between offspring risk status and their development of substance use disorder (SUD) symptoms (F(1,131) = 5.90, p = .017). Parents' social network size moderated the link between offspring risk status and their development of anxiety and depression symptoms in an unexpected direction (F(1,131) = 5.07, p = .026). No effects of parents' coping style were found.

CONCLUSIONS

Among the OBD, having parents with greater social support satisfaction and, unexpectedly, a smaller social network buffered their development of SUD and depression and anxiety symptoms by early adulthood. Parents' social support may thus have a protective function for children in these high-risk families.

A systematic review of the psychosocial factors associated with pain in children with juvenile idiopathic arthritis

BACKGROUND

Pain is one of the most frequently reported experiences amongst children with Juvenile Idiopathic Arthritis (JIA); however, the management of JIA pain remains challenging. As pain is a multidimensional experience that is influenced by biological, psychological, and social factors, the key to effective pain management lies in understanding these complex relationships. The objective of this study is to systematically review the literature on psychosocial factors of children with JIA and their caregivers 1) associated with and 2) predictive of later JIA pain intensity, frequency, and sensitivity in children 0-17 years of age.

METHODS

The Joanna Briggs Institute methodology for etiology and risk and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guided the conduct and reporting of this review. Terms related to pain and JIA were searched in English without date restrictions across various databases (PubMed, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Central Register of Controlled Trials) in September 2021. Two independent reviewers identified, extracted data from, and critically appraised the included studies. Conflicts were resolved via consensus.

RESULTS

Of the 9,929 unique studies identified, 61 were included in this review and reported on 516 associations. Results were heterogeneous, likely due to methodological differences and moderate study quality. Results identified predominantly significant associations between pain and primary and secondary appraisals (e.g., more child pain beliefs, lower parent/child self-efficacy, lower child social functioning), parent/child internalizing symptoms, and lower child well-being and health-related quality of life. Prognostically, studies had 1-to-60-month follow-up periods. Fewer beliefs of harm, disability, and no control were associated with lower pain at follow-up, whereas internalizing symptoms and lower well-being were predictive of higher pain at follow-up (bidirectional relationships were also identified).

CONCLUSIONS

Despite the heterogeneous results, this review highlights important associations between psychosocial factors and JIA pain. Clinically, this information supports an interdisciplinary approach to pain management, informs the role of psychosocial supports, and provides information to better optimize JIA pain assessments and interventions. It also identifies a need for high quality studies with larger samples and more complex and longitudinal analyses to understand factors that impact the pain experience in children with JIA.

TRIAL REGISTRATION

PROSPERO CRD42021266716.

Psychiatrie et épidémiologie

L’épidémiologie psychiatrique s’est beaucoup développée depuis trente ans. Après avoir rappelé les définitions et méthodes fondamentales en épidémiologie, nous décrivons des progrès accomplis en épidémiologie psychiatrique. Parmi eux, la définition des cas, les techniques d’identification des cas, et la recherche de facteurs de risque sont présentés ici. Pour les illustrer, certaines connaissances actuelles sur les facteurs de risque dans la schizophrénie et la dépression sont brièvement décrits. Ensuite, les travaux en psychiatrie de l’enfant sont brièvement présentés en insistant sur quelques difficultés spécifiques à la recherche en pédopsychiatrie. Finalement, après avoir fait le point de la situation française, quelques opinions communes qui freinent l’essor de la recherche épidémiologique sont passées en revue. Les conclusions soulignent la possibilité et la nécessité de développer cette approche multi-disciplinaire en psychiatrie.

The Child Psychiatric Patient Database System of the Chinese University of Hong Kong

An original child psychiatric patient database system developed in Hong Kong is reported. The system was developed mainly to meet the dilemma of the local working setting, namely heavy clinical and teaching commitments on the one hand and, on the other hand, the failure to make use of the massive and invaluable clinical materials for research purposes because there was no proper collection of data. The system was designed for routine clinical purposes with strong emphasis on practicability, and yet it also allows the systematic, comprehensive and prospective collection of clinical data. The first part of the system is a semistructured interview schedule which reflects the author’s usual style of interview, especially his preference for the family approach. Data are collected in two forms - a precoded and readily analyzable form, and a descriptive and non-coded form. The second part of the system is a computer program for converting the raw data to medical records. Some preliminary experience of using the system is also discussed. The system may easily be modified to suit different clinical styles and settings.

Anxiety in Depressed School Children

The purpose of this study was to investigate the relationship between anxiety and depression in school children. From a pool of 292 nineto eleven-year-old children, 23 depressed children (12 boys and 11 girls) were identified and compared to 23 ageand schoolmatched controls. Measures were based on parallel items from the self-rated Children's Depression Inventory (CDI), parent-rated Child Behaviour Checklist (CBCL) and Children's Behaviour Questionnaire for parents and teachers as compared to DSM-III symptomatology for Overanxious Disorder (OAD). Results suggest that depressed children are generally anxious but not identical to children suffering from OAD. Depressed girls were most likely to suffer from tension and somatic symptoms than depressed boys, who tend to be more generally anxious at this age.

Validating Screening Tool in Malayalam for Mental Disorders

OBJECTIVES

Valid screening tools are needed to identify Indian children and adolescents with mental health problems, both for clinical or research purposes. The present study validated the Strengths and Difficulties Questionnaire (SDQ) in Malayalam across different informants and sub-scales.

METHODS

A sample of 150 children and adolescents seen in a psychiatric clinic for children in Kerala, India was compared to a community sample of 1984 children from six surrounding urban and rural districts. Children in clinic and community samples were screened with the parent-report SDQ; those over 11 y completed the self-report SDQ. The community sample was also screened with the teacher-report SDQ and the clinical sample received formal diagnoses from a child psychiatrist blind to SDQ scores. The discriminative validity of the SDQ was investigated using Receiver Operator Characteristic (ROC) curves and by assessing Area Under the Curve (AUC).

RESULTS

The SDQ discriminated reliably between clinical and community samples for the SDQ total score and its subscales. Within the clinic sample, 49 % of patients qualified for more than one broad diagnostic grouping. The SDQ discriminated between diagnostic categories in the clinic sample, but did so most effectively for conduct disorders. Based on the cut-offs that generated the highest combined value of sensitivity and specificity, the estimated rate of psychiatric disorder in the community sample was 13.6 % (parent-report) and 7.3 % (self-report).

CONCLUSIONS

The SDQ is a useful screening tool for child and adolescent mental disorders for Malayalam speakers in Kerala, India.

A Review of Child and Adolescent Diagnostic Interviews for Clinical Practitioners

The publication of the DSM-5 poses a challenge for many interview instruments due to the changes for many of the diagnoses. Six of the more widely used and studied interview instruments (structured and semistructured) were reviewed with a focus on usefulness for the practicing clinician and researcher. Use of these types of assessment procedures can facilitate the accuracy of diagnoses given by potentially reducing clinician bias. Each interview instrument varied in its strengths and characteristics related to amount of flexibility associated with administration of items; breadth of coverage of diagnoses based on DSM-IV; time required for administration; presence of screening items or modular format; and psychometric support for its reliability and validity, as well as amount of training required for use, and costs associated with acquiring and learning the format. Recommendations were made regarding the utilization of different instruments for specific diagnostic questions along with future recommendations for enhancing the format and utility of these instruments, especially in relation to the publication of the DSM-5.

An overview of studies on psychological well-being in children born following assisted reproductive technologies

Over the course of the past 35 years, assisted reproductive technologies (ARTs) have been increasingly used worldwide, while debates on their safety have been generated. Birth defects and imprinting disorders were reported in previous research. Thus, the psychological development of children born following ARTs has become a major concern nowadays. This review gives a systematic view of psychological well-being of children conceived by different types of ART, including in vitro fertilization, intracytoplasmic sperm injection (ICSI), preimplantation genetic diagnosis/screening, and in vitro maturation. The previous studies are analyzed in three sections: (1) cognitive, motor, and language developments, (2) behavior problems and socio-emotional development, and (3) parent-child relationship. We conclude that although the majority of the studies on cognitive, motor, and language developments reported comparable achievements in the ART group vs. the naturally conceived group, lower intelligence quotient (IQ) scores, worse visual-motor ability or locomotor development, and delayed receptive language competence were found in the ART group. The results on the socio-emotional development were reassuring. As for the behavior problems, a higher prevalence of behavior problems existed in ART children; moreover, ICSI children were found to be at a higher risk of autism than the general population. Meanwhile, ART parents tended to have positive parental attitudes and be more protective of their children. Some suggestions for further research are also given in this review.

A 15 month follow-up study of children admitted to a child psychiatric inpatient unit

Objectives: This study focused on measuring symptomatology and self-esteem in children admitted to an inpatient child psychiatric unit.

Method: Twenty-six children consecutively admitted to a child psychiatric unit were assessed using the Rutter Parent Interview, the Birleson Depression Scale and the Harter Self Perception Profile for Children. Children were followed up at three and 15 months post-discharge and the same measures administered.

Results: A stay in the unit was linked with a significant reduction in overall symptomatology and this was particularly so for emotional-type symptoms at both follow-up points and for hyperactive-inattentive symptoms at 15-month follow-up. The unit did not appear to be successful at reducing conduct symptoms at either followup. Nor did self-esteem change significantly following an inpatient episode. Children with depressive symptoms especially appeared to benefit both in the short- and longterm and this benefit extended to self-esteem.

Conclusions: When analysing the benefits of an inpatient admission it is crucial to consider outcome and therefore efficacy on a long-term basis. Efficacy needs to take into account longer-term outcomes. The impact of an inpatient episode on a child's psychosocial adjustment will for some children take time. These ‘sleeper effects’ need further study.

Examining the genetic and environmental influences on self-control and delinquency: results from a genetically informative analysis of sibling pairs

The Child and Young Adult Supplement of the National Longitudinal Survey of Youth (CNLSY) has been used extensively within criminology. A significant amount of criminological research, for example, has explored various issues related to the correlates, causes, and consequences associated with levels of self-control and delinquent involvement. The overwhelming majority of these CNLSY studies, however, have not accounted for the potential effects of genetic factors on these two widely studied criminological variables and thus the findings generated from previous empirical work may be inaccurate due to genetic confounding. The current study partially addresses this possibility by analyzing a sample of kinship pairs nested within the CNLSY. Analyses of these data revealed that genetic factors accounted for between 51% and 92% of the variance in levels of self-control and between 30% and 41% of the variance in delinquency. We discuss the implications of these results for interpreting findings from the large body of existing research using the CNLSY.

An Integrative, Multilevel, and Transdisciplinary Research Approach to Challenges of Work, Family, and Health

Recognizing a need for rigorous, experimental research to support the efforts of workplaces and policymakers in improving the health and wellbeing of employees and their families, the National Institutes of Health and the Centers for Disease Control and Prevention formed the Work, Family & Health Network (WFHN). The WFHN is implementing an innovative multisite study with a rigorous experimental design (adaptive randomization, control groups), comprehensive multilevel measures, a novel and theoretically based intervention targeting the psychosocial work environment, and translational activities. This paper describes challenges and benefits of designing a multilevel and transdisciplinary research network that includes an effectiveness study to assess intervention effects on employees, families, and managers; a daily diary study to examine effects on family functioning and daily stress; a process study to understand intervention implementation; and translational research to understand and inform diffusion of innovation. Challenges were both conceptual and logistical, spanning all aspects of study design and implementation. In dealing with these challenges, however, the WFHN developed innovative, transdisciplinary, multi-method approaches to conducting workplace research that will benefit both the research and business communities.

Early menarcheal age and risk for later depressive symptomatology: the role of childhood depressive symptoms

Previous research has investigated the relationship between pubertal timing and depression in girls, with most results suggesting that earlier menarche predicts more depression in adolescence. However, few studies have controlled for the potentially confounding effects of childhood depressive symptoms. The current study uses a prospective, longitudinal sample of 1,185 girls (47.8 % Caucasian) to examine the relationships between pubertal timing, childhood depressive symptoms, and adolescent depressive symptomatology. Using multiple linear regression analyses, our results suggest that higher levels of childhood depressive symptoms and earlier menarche have independent effects on adolescent depressive symptoms. Surprisingly, childhood depressive symptomatology predicted later age of menarche, although the magnitude of this effect was small. Taken together, the results suggest that early childhood depressive symptoms and early menarche represent independent pathways to later depressive symptoms.

Association of maternal and paternal IQ with offspring conduct, emotional, and attention problem scores. Transgenerational evidence from the 1958 British Birth Cohort Study

CONTEXT

Individuals with lower IQ scores have an increased risk of psychological disorders, mental health problems, and suicide; similarly, children with low IQ scores are more likely to have behavioral, emotional, and anxiety disorders. However, little is known about the effect of parental IQ on the mental health outcomes of their children.

OBJECTIVE

To determine whether maternal and paternal IQ scores are associated with offspring conduct, emotional, and attention scores.

DESIGN

Cohort study.

SETTING

General population.

PARTICIPANTS

Members of the 1958 National Child Development Study and their offspring were studied. Of 2984 parent-offspring pairs with nonadopted children 4 years or older, 2202 pairs had complete data regarding all variables of interest and were included in the analyses.

MAIN OUTCOME MEASURES

Offspring conduct, emotional, and attention scores based on the Behavioral Problems Index for children aged 4 to 6 years or the Rutter A scale for children and adolescents 7 years and older.

RESULTS

Little evidence was observed of any association of parental IQ with conduct or emotional problems in children aged 4 to 6 years. However, among children and adolescents 7 years or older, strong evidence was observed from age- and sex-adjusted models to support a decrease in conduct, emotional, and attention problems in those whose parents had higher IQ scores. These associations were linear across the full IQ range. Individual adjustments for socioeconomic status and the child's own IQ had limited effect. However, adjustments for Home Observation for Measurement of the Environment scores and parental malaise attenuated associations with the mother's IQ but had little effect on associations with the father's IQ (scores were available for only 1 parent for each child or adolescent). Strong associations were no longer evident in models that simultaneously adjusted for all 4 potential mediating variables.

CONCLUSIONS

Children whose parents score poorly on IQ tests may have an increased risk of conduct, emotional, and attention problems. The home environment, parental malaise, and the child's own IQ may have a role in explaining these associations.

Assessing the psychometric properties and the perceived usefulness of the BasisRaadsOnderzoek (BARO) as a first-line screening instrument for juvenile offenders

BACKGROUND

The aim of this study is to investigate the psychometric properties and the perceived usefulness of the BARO (Dutch: BAsisRaadsOnderzoek; Protection Board Preliminary Examination of Juvenile Suspects). The BARO is a first-line screening instrument for the identification of psychiatric disorders, adverse environmental factors, and levels of (dys)function in adolescent offenders (age 12 to 18), to be used by social workers of the Child Protection Board (CPB) following a police arrest.

METHOD

CPB workers administered the BARO to 295 juvenile offenders (91% boys, 9% girls). A subgroup of 66 offenders (89% boys, 11% girls) underwent an elaborate diagnostic assessment by forensic psychologists and psychiatrists. Using these assessments the most relevant psychometric properties of the BARO were studied. The perceived usefulness was studied using questionnaires to be filled in by the CPB social workers.

RESULTS

The internal consistency of the instrument was sufficient to good, the concurrent validity of the CPB social workers applying the BARO and the forensic experts carrying out the comprehensive diagnostic assessment was strong, the discriminatory value of the instrument was moderate to strong, and the perceived usefulness of the instrument was evaluated as good to very good by the majority of the CPB workers.

DISCUSSION

The BARO has sufficient to good psychometric properties including moderate to strong discriminatory value and is considered a good screening instrument by the CPB social workers. In conclusion, the BARO seems to be a very promising first-line screening instrument to identify psychiatric and psychosocial problems in young offenders.

Psychiatric outcome of localized head injury in children

Previous studies have shown a high prevalence of psychiatric disturbance in children with brain injury. Studies on localized lesions have suggested that injury to the young organism carries a better prognosis for recovery of function than injury at a later age. The present study was designed to investigate these phenomena systematically. A representative sample of children (n = 98) who had been hospitalized for treatment of a compound depressed fracture, associated with a dural tear and visible damage to the underlying cortex, was identified from the records of neurosurgical units throughout the United Kingdom. The children were aged between 3 months and 12 years at the time of injury and between 5 and 15 years at the time of examination. The interval between injury and examination varied but the sample was designed to include only children who had been injured at least two years before examination. The children were examined neurologically and psychometrically, a detailed account of their current psychiatric state was obtained from one or both parents, and their mental state was assessed in a standard psychiatric examination. Preliminary data are presented which relate psychiatric, educational and intellectual status at the time of examination to site and severity of injury, age at injury, and to a number of psychosocial variables.

A developmental framework for distinguishing disruptive behavior from normative misbehavior in preschool children

BACKGROUND

Attaining a developmentally sensitive nosology for preschool disruptive behavior requires characterization of the features that distinguish it from the normative misbehavior of this developmental period. We hypothesize that quality of behavior and its pervasiveness across contexts are critical dimensions for clinical discrimination in young children and propose that structured diagnostic observation provides a systematic method for their identification. We use the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) to examine whether: (a) observed quality and pervasiveness of behavior distinguishes preschoolers with clinically concerning disruptive behavior from typically developing preschoolers, and (b) observed pattern of clinically salient behavior predicts impairment above and beyond maternal report of behavioral frequency.

METHODS

Participants are a behaviorally heterogeneous sample of preschoolers (N = 327). Diagnostic methods developed for clinical assessment of preschoolers were used to classify children as (a) Non-Disruptive, (b) Sub-Clinical, or (c) Disruptive. Child behavior was coded based on interactions with parent and examiner during the DB-DOS.

RESULTS

Quality and pervasiveness of observed behaviors during the DB-DOS significantly distinguished the three behavioral groups. Discriminative utility varied depending on the comparison. With few exceptions, clinically concerning patterns on the DB-DOS added significant incremental utility in predicting impairment.

CONCLUSIONS

Observed patterns of clinically salient behavior show promise for advancing developmentally-informed characterization of disruptive behavior within the preschool period.

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.

The psychological sequelae of thermal injury on children and adolescents: Part 1

The psychological effects of thermal injury and children and their mothers were investigated in a three-part study; Part 1 is concerned with group comparisons regarding the psychological effects of thermal injury on children; Part 2 with aspects of the thermally injured group and Part 3 with psychological effects on their mothers. A total of 44 thermally injured (aged 11-16 years) injured 3-14 years previously, were matched according to age, sex, burn percentage and site of injury. In-depth interviewing and questionnaire responses on measures of psychological disturbance indicated that thermally injured children were differentiated in terms of psychopathology from matched Fracture Controls and Normal Controls. Such differences embraced many aspects of social and recreational functioning, and group differences emphasised depression, anxiety (particularly situational anxiety) and anti-social disorder as being particularly prominent in the thermally injured group. Therapeutic approaches are briefly discussed.

The psychological effects of sex, age at burn, stage of adolescence, intelligence, position and degree of burn in thermally injured adolescents: Part 2

A total of 44 thermally injured children (22 boys and 22 girls), currently aged 11-16 years old, who had been injured 3-14 years previously, stratified by age, sex, degree of burn (1-9%, 10-19%, 20%+) and position of burn (those whose burns included the face and those not burned facially) were selected from a sample pool of 394 previously hospitalized cases. Extent of psychological disturbance experienced by thermally injured adolescents and their mothers indicated that significant effects were evident regarding the sex of the child, age at the time of burn, stage of adolescence, intelligence and by the position and degree of burn.

'Needs expressed' and 'offers of care': an observational study of mothers with somatisation disorder and their children

BACKGROUND

The abnormal illness behaviours characterising somatisation disorder may be learnt responses acquired through exposure to parental illness and health anxiety in childhood. In this observational STUDY WE EXPLORE THIS HYPOTHESIS BY EXAMINING PATTERNS OF INTERACTION IN MOTHERS AND THEIR SCHOOL AGE CHILDREN.

METHOD

A sample of 136 mother and child pairs in 3 groups (42 mothers with somatisation disorder, 44 organically ill mothers and 50 healthy mothers) completed a battery of self-report and interview measures. Their interaction in semi-structured play tasks and a meal was videotaped and later analysed for the presence of 'needs' and 'offers of care' by researchers who were blind to maternal group membership.

RESULTS

During play, a greater proportion of the children of somatising mothers expressed 'health and safety' needs than did children of other mothers. In contrast, during a meal, these children expressed fewer needs of all types. Children of somatising mothers were more likely than other children to ignore their mothers' offers of care. The somatising mothers expressed more health and safety needs during the meal than did other mothers and were generally less responsive to all needs expressed by their children.

CONCLUSIONS

Our study suggests that mothers with somatisation disorder and their children interact differently than other mother-child pairs. This finding supports the theory for environmental influences in the development of this disorder.

Chronicity of Challenging Behaviours in People with Severe Intellectual Disabilities and/or Autism: A Total Population Sample

The skills, social impairments and challenging behaviours of a total population of 166 children, with severe intellectual disabilities and/or autism, were assessed through interview with the main carers, when the children were under 15 years old (time 1). Twelve years later, 141 of these individuals were re-assessed, using the same measures (time 2). "Abnormal" behaviours tended to reduce with age and were associated with poorer language skills and poorer quality of social interaction. Individuals with most abnormal behaviours at time 1, tended to have most at time 2. Abnormal behaviour at time 2 was predicted by the presence of abnormal behaviour at time 1, poor expressive language at time 1, poor quality of social interaction at time 1 and a diagnosis of autism/autistic continuum at time 1.

Medical decision making: a selective review for child psychiatrists and psychologists

Physicians, including child and adolescent psychiatrists, show variability and inaccuracies in diagnosis and treatment of their patients and do not routinely implement evidenced-based medical and psychiatric treatments in the community. We believe that it is necessary to characterize the decision-making processes of child and adolescent psychiatrists using theories and methods from cognitive and social sciences in order to design effective interventions to improve practice and education. This paper selectively reviews the decision-making literature, including recent studies on naturalistic decision making, novice-expert differences, and the role of technology on decision making and cognition. We also provide examples from other areas of medicine and discuss their implications for child psychiatry.

Development and reliability of a pictorial mental disorders screen for young adolescents

OBJECTIVE

To report psychometric data from preliminary studies of the Adolescent Dominic (AD), a pictorial screen for the most frequent Axis I youth mental disorders.

METHODS

We created 113 picture items based on DSM-III-R diagnostic criteria and assessed them for comprehension (sample 1, n = 114; sample 2, n = 40) and reliability (sample 3, n = 128) in a group of adolescents aged 12 to 16 years living in the community. We used the kappa statistic to estimate test-retest reliability of symptoms, criteria and diagnoses, and intraclass correlation coefficients (ICCs) for symptom and criterion scores. We assessed internal consistency of symptom scores with the alpha coefficient.

RESULTS

For symptoms, 54.4% of kappas were higher than 0.60, while only 2% were poor. ICCs for symptom scores yielded higher values (0.81 to 0.89) than for criterion scores (0.51 to 0.86). Internal consistency of symptom scores ranged from 0.52 to 0.83. Kappas for diagnoses ranged from 0.52 to 0.76.

CONCLUSIONS

Symptom reliability compared favourably with data from other assessment interviews of youth mental disorders. Following these positive results, a computerized DSM-IV version of the AD has focused on the assessment of symptoms and is currently being tested for reliability and criterion validity.

Differential-Maternal Parenting Behavior: Estimating Within- and Between-Family Effects on Children

This study examined the impact of differential-maternal parenting behavior, evaluated as a family-level experience, on children's emotional-behavioral problems. Data come from 3 child development studies: 2,128 four- to sixteen-year-olds (Ontario Child Health Study), 7,392 four- to eleven-year-olds (National Longitudinal Study of Children and Youth), and 1,992 three- to fourteen-year-olds (National Longitudinal Study of Youth). In 2 of 3 studies, there was consistent evidence that differential-maternal parenting behavior had an adverse impact on all siblings as a group, over and above parenting directed at individual siblings. The strength of association was sensitive to the type of maternal parenting behavior, dimension of child maladjustment, and respondent perspective (stronger for hostile/negative parenting, child externalizing problems, and mother assessments of child emotional-behavioral problems).

Prevalence of child and adolescent psychiatric disorders in southeast Brazil

OBJECTIVE

To describe the prevalence of DSM-IV disorders and the pattern of comorbidity in a population-based sample of 7- to 14-year-old Brazilian schoolchildren.

METHOD

Random sampling of schools (stratified into private, public rural, and public urban) was followed by random sampling of pupils from school lists. In 2000-2001, a total of 1,251 children were assessed for DSM-IV diagnoses using the Development and Well-Being Assessment, a structured multiinformant assessment supplemented by verbatim reports reviewed by clinicians.

RESULTS

The response rate was 83%. The overall prevalence of DSM-IV disorders was 12.7% (95% confidence interval = 9.8%-15.5%), with 3.5% of children being assigned as not otherwise specified rather than operationalized diagnoses. The overall prevalence of psychiatric disorder was significantly higher than in a British study with the same measures and diagnostic procedures (12.7% versus 9.7%, p =.02).

CONCLUSIONS

Approximately one in eight schoolchildren in the study area in the southeast of Brazil have psychiatric disorders involving a level of distress or social impairment likely to warrant treatment. The gulf between need and provision is currently vast.

Early television exposure and subsequent attentional problems in children

OBJECTIVE

Cross-sectional research has suggested that television viewing may be associated with decreased attention spans in children. However, longitudinal data of early television exposure and subsequent attentional problems have been lacking. The objective of this study was to test the hypothesis that early television exposure (at ages 1 and 3) is associated with attentional problems at age 7.

METHODS

We used the National Longitudinal Survey of Youth, a representative longitudinal data set. Our main outcome was the hyperactivity subscale of the Behavioral Problems Index determined on all participants at age 7. Children who were > or = 1.2 standard deviations above the mean were classified as having attentional problems. Our main predictor was hours of television watched daily at ages 1 and 3 years.

RESULTS

Data were available for 1278 children at age 1 and 1345 children at age 3. Ten percent of children had attentional problems at age 7. In a logistic regression model, hours of television viewed per day at both ages 1 and 3 was associated with attentional problems at age 7 (1.09 [1.03-1.15] and 1.09 [1.02-1.16]), respectively.

CONCLUSIONS

Early television exposure is associated with attentional problems at age 7. Efforts to limit television viewing in early childhood may be warranted, and additional research is needed.

Bullying: the consequences of interparental discord and child's self-concept

The objective of this research is to explore how the relationship between interparental discord and child's self-concept shapes participation in bullying behavior by elementary and middle-school children. The main finding is that child's self-concept mediates the effects of interparental discord on bullying behavior. Further, the results of the study support a symbolic interactionist view of child self-development, in which children internalize the environment provided by parents. This internalization gives way to self-concept, which guides behavior. This study adds to the growing body of literature that seeks to understand whether and how characteristics of children mediate the effects of parental attributes on behavioral outcomes. The proposed implications for the prevention of bullying include building children's self-concept, intervening in parental conflict, and involving the entire family system in the intervention process.

Early mother-infant interaction as a precursor to childhood social withdrawal

The relationship between early mother-infant interaction at three months of age, biological and psychosocial risks, and later social withdrawal was examined using a hierarchical logistic regression approach. A group of children (N = 20) who were stably socially withdrawn (4(1/2) and 8 years of age) and a control group of healthy children (N = 143) were formed. Variables were entered into the regression models in the following order: At first, biological and psychosocial risks and sex, followed by mother and child variables separately, while in a final regression model all of the variables were entered at once. The results show that child behaviors (smiling and gazing) as well as maternal behaviors (facial and motor responsiveness) significantly predict social withdrawal in middle childhood. Among the risks only biological risks significantly contribute to later child outcome. These results suggest that a dysfunctional interaction pattern between mother and infant may be a precursor of childhood social withdrawal.

Changes in social impairment for people with intellectual disabilities: a follow-up of the Camberwell cohort

The skills and social impairments of a total population of children with severe intellectual disabilities and/or autism from Camberwell, South London (Wing and Gould, 1978 and 1979), were assessed using the Handicaps, Behaviours and Skills schedule, and they were reassessed when they were adolescents and young adults (Shah, 1986). Changes in social impairment over time are presented here. As Shah (1986) had found with a smaller sample, social impairment remained relatively stable over time: on a simple "socially impaired" versus "sociable" dichotomous grouping, 93% did not change social group. Within the socially impaired group, there was a significant increase in impairment over time (i.e., people who were passive at Time 1, were aloof at Time 2). Implications of these results and predictions for a further follow-up study are discussed.

Enuresis and encopresis in a south Indian population of children

INTRODUCTION

Though bladder and bowel control are important developmental milestones in all cultures, the prevalence of enuresis and encopresis has rarely been studied in developing countries despite there being factors in these countries that could affect it. This study reports the prevalence and associations of enuresis and encopresis in children in Kerala, India.

METHOD

The parents of 1403 randomly selected 8-12-year-old children were interviewed. The prevalence of enuresis and encopresis was ascertained using Rutter's A2 scale. Subsamples of children underwent psychiatric, physical and psychometric evaluations.

RESULTS

Of the children, 18.6% had had an episode of enuresis in the past year and 4.3% in the past week. Four per cent had had an episode of encopresis in the past year. Enuresis was associated with parents' education, physical and psychiatric symptoms in the child, poor academic achievement and lax parental attitudes to toilet training. Encopresis was associated with male sex, physical and psychiatric symptoms, poor academic achievement, early separation and not having a toilet.

DISCUSSION

The prevalence of enuresis compares with western countries, but encopresis is commoner. The associations of enuresis suggested a multifactorial model in which parental competence was prominent. This study de-emphasized the importance of neurodevelopmental factors in enuresis and encopresis in this age group.

Assessing social dysfunction: the contributions of laboratory and performance-based measures

Reviewed research studies in which laboratory and performance-based measures were used with success to identify problematic social interaction patterns and social skills deficits associated with poor peer relationships. However, the clinical utility of these measures remains an empirical question. In this article, social competence is conceptualized as an organizational construct, reflecting the child's capacity to integrate behavioral, cognitive, and affective skills to adapt flexibly to diverse social contexts and demands. Correspondingly, performance-based measures of social functioning that include complex social interaction stimuli and require integrative responses appear more likely to demonstrate social validity than measures focused on isolated behaviors or cognitions. Research studies are reviewed that involve observations of children in three types of analogue social situations: play groups, friendship pairs, and social-challenge situations. In addition, studies that have utilized performance-based measures to screen and evaluate children for social skills training programs are reviewed. We conclude that performance-based measures are unlikely to be useful in determining whether a child is experiencing social dysfunction but may enhance the clinical analysis of the nature of the child's social difficulties. We identify gaps in the current knowledge regarding the clinical utility of performance-based measures of social dysfunction, along with directions for future research.

Forensic assessment of juvenile delinquents: prevalence of psychopathology and decision-making at court in the netherlands

Dutch juvenile criminal law, concerning minors between 12 and 18 years old, is marked by its pedagogical character. In cases of serious psychosocial problems or psychiatric disorders, the juvenile court may request a forensic examination in order to be able to impose a measure of restraint. This study was aimed at investigating to what extent the juvenile criminal law achieves the aim enhancing professional help in those cases for which such assistance is indicated. One hundred and eight juveniles who were brought before the court were assessed multidisciplinarily. Sixty-five per cent of the youngsters were qualified for 'definite caseness'. For less than half of them a forensic assessment was ordered by the court. In conclusion, young delinquents should be screened for psychiatric disorders more adequately as soon as they are taken into custody.

Psychiatric symptoms in children with intellectual disability

In a sample of almost 6000 8-year-old children, we found that 1.5% attended special schools for the educationally subnormal, or training schools. Psychiatric symptoms were studied by means of three screening instruments: the Rutter Parent Questionnaire (RA2) for the parents, the Rutter Teacher Questionnaire (RB2) for the teachers, and the Children's Depression Inventory (CDI) for the children. The prevalence rate of children identified as possibly suffering from a psychiatric disturbance was 32.2% according to the RA2. The corresponding prevalence rate for the RB2 was 34.2%. According to the CDI 11.0% had depressive disturbance. All types of disturbances were more frequent among the intellectually disabled children as compared to the nondisabled children. The differences were statistically significant for emotional and mixed types of disturbance on the RA2, and for emotional and conduct types of disturbance on the RB2.

Psychiatric disorder and cognitive function in children with epilepsy in Kerala, South India

The cognitive and psychiatric associations of childhood epilepsy have not been studied in developing countries. Children with epilepsy were identified during a population-based epidemiological study of 1403 8- to 12-year-old children in Kerala, South India. They were compared with age-, sex- and social class-matched controls on measures of reading, vocabulary, non-verbal reasoning and school performance. In addition, psychiatric symptoms were measured using standard questionnaires and the presence or absence of psychiatric disorder was established by interview. Patients performed as well as controls on the non-verbal test, but performed worse on tests of vocabulary and reading, suggesting a specific disadvantage in the area of education. Psychiatric disorder was more prevalent in the children with epilepsy. It was concluded that epilepsy in the population studied is accompanied by a significant burden of cognitive and psychiatric disorders which need recognition and adequate service provision.

Psychological findings in preterm children related to neurologic status and magnetic resonance imaging

OBJECTIVE

Preterm children experience learning disabilities more often than full-term children, but detailed information on their neuropsychological and neurologic determinants is lacking. We therefore examined these problems more closely and also studied if clinical neurologic examination and/or magnetic resonance imaging (MRI) can be used as tools to screen the preterm children at risk for these problems.

METHODS

In a population-based study, the psychological performance of 42 preterm children with a birth weight <1750 g and of their matched controls was assessed at 8 years of age and the findings were then related to clinical neurologic examination and MRI. Learning disabilities of these children, reported by the teachers, were also studied.

RESULTS

The cognitive ability of the preterm children, although in the normal range, was significantly lower than that of the control children. They performed particularly poorly in tasks requiring spatial and visuoperceptual abilities, which were associated with the finding of periventricular leukomalacia in MRI, especially with posterior ventricular enlargement. The preterm children with minor neurodevelopmental dysfunction (MND) had the most problems in neuropsychological tests, whereas the clinically healthy preterm children and those with cerebral palsy had fewer problems. The problems of MND children emerged in the domain of attention. They also experienced the most problems at school.

CONCLUSIONS

Visuospatial problems were associated with periventricular leukomalacia in MRI, but learning disabilities were most frequent among the preterm children with minor neurologic abnormalities. We recommend closer follow-up of preterm children with MND.

Practice parameters for the psychiatric assessment of children and adolescents. American Academy of Child and Adolescent Psychiatry

These practice parameters have been developed by the American Academy of Child and Adolescent Psychiatry as a guide for clinicians evaluating psychiatric disorders in children and adolescents. The document focuses on the assessment, diagnostic, and treatment planning process, emphasizing a developmental perspective. The assessment process is intended for all children and adolescents presenting with psychiatric disorders that impair emotional, cognitive, physical, or behavioral functioning to assist the clinician in arriving at accurate diagnoses and in appropriate treatments. Details of the parent and child interviews are presented as well as an outline of specific areas of inquiry necessary for this process. The use of standardized tests and rating scales is addressed. These parameters were previously published in J. Am. Acad. Child Adolesc. Psychiatry, 1995, 31:1386-1402.

Children raised in fatherless families from infancy: family relationships and the socioemotional development of children of lesbian and single heterosexual mothers

The aim of the study was to investigate family functioning and the psychological development of children raised in fatherless families from their first year of life. Thirty lesbian mother families and 42 families headed by a single heterosexual mother were compared with 41 two-parent heterosexual families using standardised interview and questionnaire measures of the quality of parenting and the socioemotional development of the child. The results show that children raised in fatherless families from infancy experienced greater warmth and interaction with their mother, and were more securely attached to her, although they perceived themselves to be less cognitively and physically competent than their peers from father-present families. No differences were identified between families headed by lesbian and single heterosexual mothers, except for greater mother-child interaction in lesbian mother families.

The persistence of psychiatric disturbance among children

This study assessed the persistence of psychiatric disturbance and factors associated with it. The material consisted of the Rutter A2 Scale the Rutter B2 Scale and the Children's Depression Inventories (CDI) of 1268 children completed respectively by parents, teachers and the children themselves. Three questionnaires were filled out twice, with an interval of 4 years. The mean scores obtained from the questionnaires were lower for both boys and girls in study 2 than in study 1. Differences between genders in both studies were most prominent when information given by teachers was used. Children screened as disturbed in study 1 were clearly more prone to be disturbed in study 2 as well. The risk varied between 5- and 8.8-fold when the same assessment method was used in both studies. Another variable clearly connected with disturbance in study 2 was psychiatric consultation reported by the parents. The sex of the child also proved to be important when the disturbance was assessed using the information given by the teacher.

Clinical assessment of self-injurious behavior

The Timed Self-injurious Behavior Scale is an observational scale rating the frequency of 16 types of self-injurious behaviors during each 10-sec. interval of a 10-min. observation period. Advantages of the scale are utilization of direct observation and independence from the variable recollection of symptoms by subjects and care givers. 19 videotaped sessions of a subject who exhibited eight types of self-injurious behaviors were rated with the scale independently by three raters. Eighty percent and better agreement was found for the four specific forms of those behaviors exhibited by the subject sufficiently frequently, self biting, head punching, head slapping, and hair removal.

Epidemiology of childhood disorders in a cross-cultural context

The present report summarizes the epidemiologic research on childhood psychopathology that has been carried out in different cultural settings over the past 15 years from either an empirical or a diagnostic perspective. Prevalence and risk factor findings are summarized and contrasted. Some controversies surrounding cross-cultural research are discussed and methodological recommendations applicable to cross-cultural epidemiologic research are provided.

The Use of the Emotional Indicator Scores on the Goodenough-Harris Draw-a-Person Test and the Bender Motor-Gestalt Test to Screen Primary School Children for Possible Emotional Maladjustment

A sample of 140 children were classified as Maladjusted, Borderline Maladjusted or Not Maladjusted based on behavioral data collected from their parents using a standard psychiatric interview schedule. Differences in the children's Emotional Indicator scores on the Bender Motor-Gestalt Test and the Draw-a-Person Test across the Maladjustment categories were observed. The data were then subjected to a Discriminant Function Analysis. The resulting function correctly classified 50% of cases, or over 65% when the distinction between Borderline Maladjusted and Maladjusted was disregarded. The results suggest the usefulness of drawing test emotional indicators in the context of screening for maladjustment.

The Child and Adolescent Psychiatric Assessment (CAPA)

Great advances have been made during the last 20 years in the development of structured and semi-structured interviews for use with psychiatric patients. However, in the field of child and adolescent psychiatry there have been weaknesses in the specification and definition of both symptoms and the psychosocial impairments resulting from psychiatric disorder. Furthermore, most of the available interviews for use with children have been tied to a single diagnostic system (DSM-III, DSM-III-R, or ICD-9). This has meant that symptom coverage has been limited and nosological comparisons have been inhibited. The Child and Adolescent Psychiatric Assessment (CAPA) represents an attempt to remedy some of these shortcomings. This paper outlines the principles adopted in the CAPA to improve the standardization, reliability and meaningfulness of symptom and diagnostic ratings. The CAPA is an interviewer-based diagnostic interview with versions for use with children and their parents, focused on symptoms occurring during the preceding 3 month period, adapted for assessments in both clinical and epidemiological research.

Families created by the new reproductive technologies: quality of parenting and social and emotional development of the children

The creation of families by means of the new reproductive technologies has raised important questions about the psychological consequences for children, particularly where gamete donation has been used in the child's conception. Findings are presented of a study of family relationships and the social and emotional development of children in families created as a result of the 2 most widely used reproductive technologies, in vitro fertilization (IVF) and donor insemination (DI), in comparison with control groups of families with a naturally conceived child and adoptive families. The quality of parenting was assessed using a standardized interview with the mother, and mothers and fathers completed questionnaire measures of stress associated with parenting, marital satisfaction, and emotional state. Data on children's psychiatric state were also obtained by standardized interview with the mother, and by questionnaires completed by the mothers and the children's teachers. The children were administered the Separation Anxiety Test, the Family Relations Test, and the Pictorial Scale of Perceived Competence and Social Acceptance. The results showed that the quality of parenting in families with a child conceived by assisted conception is superior to that shown by families with a naturally conceived child. No group differences were found for any of the measures of children's emotions, behavior, or relationships with parents. The findings are discussed in terms of their implications for understanding the role of genetic ties in family functioning and child development.