Biomedical subjects
Publications and source records attributed to I Kolvin.
The dexamethasone suppression test was carried out on 44 children to assess agreement with diagnosis of depression. No significant association was found between suppression of plasma cortisol and depression diagnosed clinically or by cluster analysis.
A total of 275 successive referrals to a university child psychiatry unit out-patient department were examined using the Child Depression Inventory. Of these, 95 children were examined further by a structured clinical interview, and the relationship between different instruments for the assessment of depression in childhood was investigated. Just over one-third of the children (35%) had significant depression, and it was found that depression may be missed unless children with other psychiatric diagnoses are examined closely. Multivariate analyses of the clinical data provided factorial validation of diagnoses when employing different clinical diagnostic schemas.
A cohort of boys weighing below the 2nd centile at birth between 1973 and 1974 were assessed at 10 to 11 years of age. Control children from the same population were matched for social class and age. Two boys in the light-for-dates group were profoundly disabled and were excluded from assessment. After these exclusions, there were no differences in intelligence or school achievement between the two groups, although tests of temperament and behaviour suggested some correlation between features of the 'attention deficit disorder' and the extent to which birthweight deviated from normal. Matching for social class is likely to have eliminated the confusing environmental and family influences associated with the poor outcome reported in a previous study of light-for-dates boys. In addition, improved perinatal care is likely to have contributed to the protection from long-term sequelae of the light-for-dates infants in the present study.
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A rare opportunity to study deprivation and criminality across generations arose from the follow-up of the families who participated in the Newcastle Thousand Family Survey. The data on these families had been preserved and it was possible, using criminal records, to examine longitudinally whether children who grew up in 'deprived' rather than 'non-deprived' families were more at risk of offending during later childhood and beyond. The results of this study suggest that this is indeed so.
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As part of a larger study, a brief rating-scale was developed which focuses on the mid-adolescent phase of development. Completed by teachers, the questionnaire has an inter-rater reliability of 0.78, with a test-retest correlation of 0.82. When the performances of various screening instruments were compared it became clear that no single questionnaire was obviously more efficient than the others at detecting potential disturbance in an urban adolescent population. Indeed, different questionnaires seemed to highlight particular facets of functioning. The Newcastle Adolescent Questionnaire proved to be a reliable and valid screening measure.
The timing and number of recent stressful life events occurring in the year before onset of emotional or behavioural disorder was examined in a consecutive sample of children. Overall, events increase the relative risk of psychiatric disorder by 3-6 times. Events occur throughout the 12 months, but tend to cluster in the 16 weeks nearest onset of symptoms. The number of events influences the onset of disorder: cases with multiple events are more likely to have an event within 16 weeks of onset; cases with single events are more likely to have the event 36-52 weeks before onset. Cases whose onset occurs within 4 weeks of an event may have experienced single or multiple events. The results support the concept of additivity of recent stressful events in some cases of emotional and behavioural disorders in childhood.
In a consecutive sample of school-aged children attending a routine child psychiatry clinic, four clinical groups were classified based on presenting signs and symptoms, conduct (N = 44), mild emotional (N = 55), severe emotional (N = 32) and somatic (N = 26). The groups were divided by age and sex and comparisons made between the groups and community subjects (N = 76) for the number of children experiencing one or more recent stressful life events. The results indicated that with the possible exception of severe emotional disorders, neither age nor sex substantially influenced the association between events and psychiatric disorder.
5% of the children attending psychiatric clinics in the UK have difficulties with school attendance and these stem from difficulties which are predominantly social (truancy) or predominantly psychological or dynamic (school refusal). Adolescents who display school refusal are three times more likely to develop neurotic difficulties in adult life, especially if marked family difficulties are persistent. Up to 20% of the senior school pupils may truant in a 2-week period and teachers report these youngsters to be more aggressive and to show more neurotic symptoms then the regular school attenders. Their peers choose them significantly less often as friends, and the marked differences in the rate of absence between schools seems related to school philosophy and the degree of school involvement in the community. Truancy can be influenced by greater vigilance in the school and by legal intervention. Although absence from school in itself does not seem to adversely influence the youngsters' adult functioning, if it is associated with conduct problems and educational retardation, long-term difficulties are common.
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.
A sample of children and adolescents (n = 157) attending a child psychiatry outpatient clinic with conduct or emotional disturbance were compared with community controls (n = 76) for the number and type of recent life events. A Life Events Schedule for children and adolescents was developed and used as a semi-structured interview. Four clinical groups were identified according to their predominant presenting symptoms (conduct, mild mood, severe mood, or somatic). An excess of events carrying a severe degree of negative impact was found for all four groups, compared with matched controls. Eleven classes of events were examined: there is a suggestion that two classes (martial/family, accident/illness) may be more important for conduct and mild mood disorders, and that a further class (permanent separations, termed exits) may be more important for somatic and severe mood disorders.
The concept and classification of depression in childhood is currently under review. A modern view is that childhood depression is similar to adult depressive disorders, although the extent of variation with age and sex is not yet clear. Reliable and valid diagnostic criteria are being established, which will allow a more accurate estimation of prevalence rates, aetiology, and prognosis.
Fifty-one school phobic children, aged nine to fourteen years, were assessed for psychiatric diagnosis; this revealed the presence of two clinically meaningful sub-groups--depressed and residual school phobic. A wide range of symptoms were studied to identify those which might prove useful in diagnosing adult-type depression in childhood and early adolescence, both in terms of frequency of symptoms in the depressed group and the extent of the distinction between the two groups. Eleven such key symptoms were identified and based on these, a formula for diagnosing adult-type depression was evolved. The validity of several different ways of classifying the above cases were explored; these covered: kind of disorder; type of onset; adolescence versus pre-adolescence; and sex of the child. However, on only one dichotomy--depression versus absence of depression--were there many significant discriminants. Affective symptomatology of more recent onset was contrasted with pre-morbid personality traits, usually associated with school phobia. There was no evidence to support the concept of 'masked depression' in childhood.
Four groups of aggressive body ( and one group of controls) were studied, on the basis of: clinical referrals to a hospital clinic; teacher reports of assaultive behaviour in school; teacher reports of severe aggressive behaviour in school; and peer reports of aggressive behaviour. Questionnaire techniques were used to study behaviour and temperament. The last three groups proved to have rather similar patterns of behaviour and temperament and, therefore, they have been combined to give rise to an 'any school criterion' group. We compared three main groups: (i) clinical referrals; (ii) 'any criterion' (school-identified); and (iii) controls. On behaviour, the clinical group had the most adverse scores, especially on antisocial behaviour. The school-identified group also had a higher score than the controls on this dimension, and differed in degree from the clinical referral group. On temperament, the clinical referral group had a significantly more adverse score on all dimensions than both the controls and the 'any criterion' group. The 'any criterion' group scores were intermediate between the other two sets of scores. The differences on temperament between the control and the 'any criterion' groups appeared to be one of degree but not of type. Moreover, no specific type of temperament was associated with the different kinds of aggression we have studied. Principal components analysis supports the notion of no qualitative temperamental differences between the 'any criterion' and the control groups.
A free-field study of 22 epileptic children, selected on the basis of past electroencephalographic abnormality, identified a group who exhibited a significant increase in epileptiform discharge rate on electroencephalography in a discothèque environment (p less than 0.05). Laboratory investigations showed that these children were activated by a wide range of stimuli, including intermittent photic stimulation and exercise. The response to exercise was a good predictor of a child's electroencephalographic response in a discothèque. The findings suggest that most epileptic children are not particularly vulnerable in a discothèque environment.
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