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PubMed1992

Incidence of psychiatric disorder in offspring at high and low risk for depression.

First onsets (incidence) of suicide attempts and DSM-III psychiatric disorders, including major depression, any anxiety disorder, conduct disorder, or substance abuse were determined in a 2-year longitudinal study of 174 offspring at high and low risk for major depression. All of the suicide attempts, the first onsets of major depression, and anxiety disorders were in offspring of depressed parents. Compared with asymptomatic offspring, offspring with subclinical manifestations of major depression, conduct disorder, and substance abuse at the initial interview were significantly more likely to become incident cases of the same disorder over the next 2 years. Either conduct disorder or substance abuse at initial interview were highly predictive of first onset of each other, but not of any other disorders 2 years later. Family risk factors (such as poor marital adjustment, parent-child discord, low cohesion, and affectionless control) at initial interview were associated with increased incidence of substance abuse, or conduct disorder, but not major depression or anxiety disorder. Combining both retrospective and prospective data, the overall suicide attempt rate was 7.8% in the offspring of depressed parents as compared with 1.4% in the offspring of nondepressed parents. By age 20, over 50% of the offspring of depressed patients reported a major depression.

Adolescent↗
PubMed1994

The efficacy of psychoanalysis for children: prediction of outcome in a developmental context.

OBJECTIVE: This is the third report from a chart review of 763 cases of child psychoanalysis and psychotherapy at the Anna Freud Centre. This paper examines the way in which the age of a child or adolescent at the time of treatment in psychoanalytic psychotherapy relates to the outcome of that treatment. METHOD: One hundred twenty-seven children were selected from each of three age bands (younger than 6 years, 6 to 12 years, and adolescents); they were matched on broad diagnostic grouping, gender, socioeconomic status, global adaptation (Children's Global Assessment Scale), and frequency of sessions. Outcome was indicated by diagnostic change and clinically significant change in adaptation. RESULTS: Younger children were more likely to show significant improvement. Children younger than 12 benefited from intensive (four or five times weekly) treatment more than from nonintensive (one or two times weekly) treatment; this was not true of adolescents. There were interactions between certain diagnostic categories, age, and outcome. Predictors of good and poor outcome were different for the three age groups, further highlighting the importance of a developmental perspective. CONCLUSIONS: Within the limitations of a retrospective design, this study suggests that in psychodynamic treatment, younger age is an advantage and developmental factors considerably affect the outcome of this form of therapy.

Adolescent↗
PubMed1995

Untoward effects of lithium treatment in children aged four through six years.

OBJECTIVE: To explore the relationship between lithium dose and serum lithium level on the occurrence of untoward or toxic effects of lithium in the treatment of 20 hospitalized aggressive and/or mood-disordered children aged 4 through 6 years. METHOD: Clinical and research records of 20 children treated with lithium according to an established inpatient protocol were reviewed. Side effects as reported by psychiatric staff were categorized by organ system affected and severity. RESULTS: During the initial 2 weeks of lithium treatment, 60% of the children manifested one or more types of side effects, most commonly central nervous system effects. Side effects were seen at doses of 25.6 to 52.1 mg/kg per day and at serum levels from 0.65 to 1.37 mEq/L. In general, adverse effects were associated with higher lithium doses and lithium levels and were most common during the first week of treatment. A potential interaction between concurrent infection and more severe side effects was seen. CONCLUSIONS: Side effects occur frequently in children aged 6 years and younger during the initiation phase of lithium treatment; are related to higher milligram per kilogram doses, higher serum lithium levels, and phase of treatment; and may be related to concurrent medical illness.

Aggression↗
PubMed1999

Grandparents, parents, and grandchildren at high risk for depression: a three-generation study.

OBJECTIVE: High-risk studies of psychiatric disorders in parents and offspring that include 3 generations are uncommon. Multigenerational studies can be clinically useful as they can provide information for risk prediction from one generation to another for the development of empirically based interventions. Using a high-risk design, this study examines the association of grandparent major depressive disorder (MDD) and parent MDD with psychopathology in grandchildren. METHOD: Using Cox proportional hazards in a sample of 90 grandchildren at high and low risk for depression by virtue of their grandparents' and parents' depression status, the authors examined the risk for offspring depression and anxiety. RESULTS: Grandparent and parent MDD were associated with grandchild anxiety (relative risk [RR] = 5.51 and R = 3.09, respectively). Grandchildren with both a depressed parent and grandparent had the highest risk for anxiety. Parental MDD is associated with an increased risk for grandchild disruptive disorder (RR = 10.77). Forty-nine percent of the grandchildren in families in which both the parent and grandparent were depressed had some form of psychopathology. The grandchildren from those families were the most impaired. CONCLUSIONS: Prepubertal-onset anxiety disorder is a risk factor for the later development of clinically significant recurrent MDD across several generations of families at high risk for depression. Parental impaired functioning increases the risk for disruptive disorders. Children in families with multiple generations of depression are at particularly high risk for some form of psychopathology.

Adolescent↗
PubMed1999

Effectiveness of psychotherapy.

Meta-analytic studies demonstrate that psychotherapy works. This paper reviews the methodologic challenges that slow the research needed to explain what works, how, and for whom. The definition of psychotherapy is addressed briefly. Recognizing both the accomplishments and limitations of the recent focus on efficacy studies of highly specified therapies, researchers are turning to examining the effectiveness of psychotherapies. Effectiveness research examines issues of feasibility, ease in generalizing, and costs versus benefits. Research designers are interested in both moderators and mediators of treatment effect. Developmental theory and developmental psychopathology provide valuable focuses for research design. The paucity of research on process, on psychodynamic psychotherapies, and on combined treatments is noted. The paper concludes with a summary of recent psychotherapy research in several specific categories: prevention, autism, anxiety disorders, disruptive disorders, and depression.

Anxiety Disorders↗
PubMed1980

Psychiatric disorders in mentally handicapped children: a clinical and follow-up study.

The clinical psychiatric syndromes encountered in sixty mentally retarded children treated in a child psychiatric out-patient clinic setting are described. It was possible to classify these syndromes according to the multi-axial classification scheme for psychiatric disorders in childhood and adolescence. The children were followed-up for some years in many cases and the natural history of these disorders was in the main comparable to that of similar disorders in children of normal intelligence, although there was a tendency for some of the disorders to prove unusually persistent. Sometimes the persistence of these disorders seemed to be related to the children's continuing dependency needs arising from their mental retardation and to stresses within the family circle. The disorders responded reasonably satisfactorily to standard child psychiatric treatment techniques, and child psychiatric services should include the assessment and treatment of psychiatric disorders in mentally handicapped children within their remit.

Adjustment Disorders↗
PubMed1988

Rett syndrome: a survey of North American patients.

Parents of 63 North American girls with Rett syndrome filled out retrospective questionnaires in a project of the International Rett Syndrome Association, a parent group. No consistent pattern was revealed of possible etiological factors related to environmental insults; however, additional information gathered supported a genetic etiology. The survey included one pair of identical twins and one child with consanguineous parents. There were 46 male sibs and 34 female sibs. These data weigh against any theory relating etiology to a gene on the X chromosome which is lethal to males in utero. Figures were gathered on a number of clinical items. These were: onset of symptoms between 6 and 18 months of age, 83%; autistic withdrawal, 73%; never walked independently, 23%; hyperventilators with abdominal swelling, 63%; night laughter, 83%. The average age of walking of those who walked was 19 months and the average onset of seizure disorders was between 3 1/2 and 4 years of age. This paper ends by discussing the limitations of a parent questionnaire.

Adolescent↗
PubMed1991

Psychosocial effects on siblings of children with autism and mental retardation: a population-based study.

The probands of this study were 60 children and young adults between 5 and 20 years of age, 20 of whom had siblings with autism, 20 of whom had siblings with mental retardation, and 20 of whom had siblings who were free of handicap. The three proband groups were matched for gender, birth order and socioeconomic status. The children were questioned about their sibling relationships and about particular problems they faced concerning their handicapped brothers or sisters and about problems concerning themselves. Parents were interviewed about the healthy child's behaviour and social adjustment. Mothers completed the Eysenck Personality Inventory concerning themselves. Siblings of handicapped children and especially siblings of children with autism were more concerned about the future. They also felt lonely more often and many of them had peer problems. They often regarded their handicapped siblings as a burden. They tended to have only one sibling. Siblings often did not know why their handicapped brother or sister was different from other children. There were more behaviour disturbances in the siblings of handicapped children and mothers with a child with autism reported more 'stressful events'. There were no differences as regards the personality of the mothers and the self-concept of the children between the three groups.

Adaptation, Psychological↗
PubMed1983

The use of nonvocal communication techniques with autistic individuals.

Studies reporting the use of sign languages and symbol systems with autistic children and young people are reviewed. The studies suggest that signs and symbols can be used in communication by individuals who are above and below the age of five, mute and mentally handicapped. The communication skills developed may, in some cases, be complex, and speech may develop in the context of sign or symbol programmes. However, problems concerned with the description of subjects, methods and outcome of studies mean that many conclusions can only be supported tentatively by existing data.

Adolescent↗
PubMed1985

Behaviour problems and language abilities at three years and behavioural deviance at eight years.

A representative sample of 535 children were followed up from their third to their eighth birthday using measures of language ability and behaviour. At age 8 yr it was found that there were significantly more boys with behavioural deviance than girls, and that children from manual social class backgrounds also showed more behavioural deviance. The only difference between the immigrant and non-immigrant children was a less frequent occurrence of neurotic deviance in the immigrant group. It was found that behaviour problems at age 3 yr were strongly related to behavioural deviance at school at age 8 yr, particularly for boys. This medium-term stability in behaviour problems had not been found in previous studies looking at younger children. A low score on a measure of language structure at age 3 yr was found to be related to a high rate of neurotic deviance at age 8 yr even when behaviour at age 3 yr was controlled. The implications of these findings for the early identification and intervention with children at risk for later behaviour deviance are discussed.

Antisocial Personality Disorder↗
PubMed1989

IQ and behavioural adjustment of ex-institutional adolescents.

A group of children raised in institutions until at least 2 years of age, then adopted or restored to a biological parent, have been followed longitudinally into mid-adolescence. No effect of early institutionalisation was found on IQ which depended largely on the type of family placement. Behavioural and emotional difficulties were more common in the ex-institutional group than in a matched comparison group, according to teacher questionnaires and interviews with the adolescents and their parents. The findings are discussed in relation to placement policy and the question of the long-term effects of early experience.

Adaptation, Psychological↗
PubMed1991

Reliability of clinical ratings by trainee child psychiatrists: a research note.

Trainee and senior psychiatrists separately rated the symptoms and signs of 14 consecutive referrals to a child psychiatric team. Inter-rater reliabilities ranged from 0.61 to 0.94 on four clinically relevant dimensions of psychopathology. Aggregating all items, trainees' ratings identified whether or not items were definitely present with greater than 95% accuracy, as judged by a senior psychiatrist's ratings and a review of the case notes. This pilot study suggests that trainees' ratings can be of acceptable reliability for research purposes.

Affective Symptoms↗
PubMed1992

Family change, parental discord and early offending.

The relationship between exposure to family change, exposure to parental discord during the period from birth to 10 years and risks of offending by the age of 13 years was studied in a birth cohort of New Zealand children. This analysis showed that while exposure to parental discord during middle and early childhood led to increased risks of early offending, exposure to family change in the absence of parental discord did not lead to increased risks of offending. The results also suggested that children with a history of early conduct problems were particularly susceptible to parental discord but that the effects of discord did not vary with the child's gender. These results persisted when errors of measurement in the reporting of offending were taken into account using latent class methods.

Adolescent↗