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Are there biological programming effects for psychological development? Findings from a study of Romanian adoptees.

Associations between experiences and outcomes could be due to (a) continuation of adversity or (b) organismic changes, including experience-expectant and experience-adaptive developmental programming. The adoption into British families of children who had been reared in profoundly depriving institutions in Romania presented an opportunity to test mechanisms. Romanian children reared from infancy in very depriving institutions for periods up to 42 months were compared with 52 nondeprived UK-born children placed into adoptive families before the age of 6 months. The results at 6 years of age showed substantial normal cognitive and social functioning after the provision of family rearing but also major persistent deficits in a substantial minority. The pattern of findings suggests some form of early biological programming or neural damage stemming from institutional deprivation, but the heterogeneity in outcome indicates that the effects are not deterministic.

Adoption↗

The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: a randomized preventive trial.

The development of insecure attachment relationships in the offspring of mothers with major depressive disorder (MDD) may initiate a negative trajectory leading to future psychopathology. Therefore, the provision of theoretically guided interventions designed to promote secure attachment is of paramount importance. Mothers who had experienced MDD since their child's birth were recruited (n = 130) and randomized to toddler-parent psychotherapy (DI) or to a control group (DC). Nondepressed mothers with no current or history of major mental disorder and their toddlers also were recruited for a nondepressed comparison group (NC; n = 68). Children averaged 20.34 months of age at the initial assessment. Higher rates of insecure attachment were present in both the DI and the DC groups at baseline, relative to the NC group. At postintervention, at age 36 months, insecure attachment continued to predominate in the DC group. In contrast, the rate of secure attachment had increased substantially in the DI group and was higher than that for the DC and the NC groups. These results demonstrate the efficacy of toddler-parent psychotherapy in fostering secure attachment relationships in young children of depressed mothers.

Adult↗

From acting to communicating: the analysis of a boy with a pathological organization.

The author presents the analysis of an 8 year-old boy prematurely born after a high-risk pregnancy, then hospitalized for two weeks. He was never breastfed and presented vomiting, intense activity and inadequate behaviour as symptoms. His highly dysfunctional family is composed of a non-productive father and a homely, though aggressive, mother. The patient displayed a rigid defensive structure with perverse aspects and a cruel superego. His constant interest in magical characters frequently disguises an avoidance of reality. By means of transference interpretations, a trustworthy link with the analyst now allows him his own mental space, where hidden psychotic states come to light. In the clinical material, this boy's skills for insight mingle with oscillations from severely defensive states to integration and vice versa. The analytic relationship in this often hostile scenario has become strong. The analysis is hampered by constant demands from family and school--both expect the analyst to prevent his frequent acting out. Whereas some perverse polymorphism is part of childhood and may persist throughout life, it is likely that the patient's pathological organization may yield to reality and facilitate reparation, relinquishing the world of make-believe as well as the intense projective mental functioning.

Acting Out↗

Clinical significance of decreased serum concentration of cartilage oligomeric matrix protein in systemic juvenile idiopathic arthritis.

OBJECTIVE: Serum cartilage oligomeric matrix protein (COMP) concentration is elevated in patients with early osteoarthritis and early rheumatoid arthritis, and may be a biomarker of cartilage turnover. We investigated whether serum COMP concentration could be a clinically significant marker of arthritis and/or growth impairment in juvenile idiopathic arthritis (JIA). METHODS: Specimens were collected from 82 healthy blood donors under 22 years of age with no growth impairment who served as healthy controls, and from 24 patients with JIA (6 with oligoarthritis, 10 with polyarthritis, 8 with systemic JIA) presenting with active arthritis. Serum COMP concentration was determined using a human COMP assay kit. RESULTS: Serum COMP concentrations were significantly higher in all controls less than 16 years of age than in all controls aged 16 years or older. There was a significant negative correlation between serum COMP concentration and serum C-reactive protein in patients with JIA. Serum COMP concentrations in patients with systemic JIA were significantly lower than those in controls. CONCLUSION: Serum COMP concentrations in healthy children reflected increased cartilage turnover in the growth phase. Because the serum COMP concentration was decreased in cases of systemic JIA in which growth impairment was pronounced, the systemic inflammation occurring in systemic JIA may have an effect on cartilage turnover, which plays an important role in growth. Serum COMP concentration may prove to be a marker that indicates growth impairment in systemic JIA.

Adolescent↗

[Problem of specific syndrome formation in psychosomatic disease situations. (Psychodynamics of rheumatic diseases)].

Three features of psychosomatic diseases with negative rheumafactor were psychoanalytically investigated (35 patients). Each of these diseases (the Palindromic Rheumatism, the Reiters Disease and the Psoriatic Arthritis), showed a characteristic syndrome. Corresponding with the patients with rheumafactor-positive Rheumatoid Arthritis was only the fact of inhibited aggressive impulses in the somatic field by the blockade of the muscle system. We believe that this study proves our earlier found thesis, that in psychosomatic diseases we have to work out the specific conflict, the specific psychodynamic ambivalence.

Adolescent↗

Interpersonal impairment and the prediction of depressive symptoms in adolescent children of depressed and nondepressed mothers.

OBJECTIVE: Different pathways to youth depression should be explored. Based on an interpersonal impairment perspective on depression, the currently depressed children of depressed mothers were hypothesized to differ in predictors of their depression compared with depressed children of nondepressed mothers. Chronic social difficulties were expected to be more predictive of depressive symptoms in offspring of depressed women, while recent stressful life events were expected to predict depression in offspring of never-depressed women. METHOD: A community sample of 812 fifteen-year-old children of depressed and nondepressed women was studied in Queensland, Australia, between 1996 and 1999; chronic and episodic stress in the past 6 to 12 months were examined in relation to current depressive disorders. RESULTS: Depressive states in children of depressed mothers were more associated with chronic interpersonal difficulties than were the depressions of children of nondepressed women, and the latter group had greater increases in depression level associated with episodic stressors than did children of depressed women. CONCLUSIONS: The results may reflect greater depression reactivity to chronic social difficulties among offspring of depressed mothers. Depressive experiences may have different predictors in subgroups of depressed youths and imply potentially different courses and needs for treatment.

Adolescent↗

A neuronal fibrillary inclusion shares the epitope of p24 of human immunodeficiency virus.

A monoclonal antibody to p24 of human immunodeficiency virus (HIV) was demonstrated to react with degenerated neurons immunohistochemically. In a case of Pick's disease, the neurons of the dentate gyrus were labeled with the antibody, while normal-looking ones and glial components were negative. The positive structures showed argyrophilia by the Bielschowsky and Bodian methods. Antibodies to ubiquitin, paired helical filament and tau did not react with the inclusions. Ultrastructurally, they consisted of skeins of fuzzy-surfaced fibrils with a diameter of 15 nm. In cases of Alzheimer type dementia, thread-like positive profiles were observed in some neurofibrillary tangle-bearing neurons. These studies revealed the cross-reactivity of the anti-HIV p24 antibody to unknown types of neuronal inclusions and provide a new aspect for research into neurodegenerative disorders.

Adolescent↗

Drug abuse as a problem of impaired control: current approaches and findings.

The author presents a selective and integrative overview of current research examining acute effects of abused drugs on aspects of behavioral control in humans. The review discusses the concept of behavioral control and reviews research models that examine inhibitory influences as a central mechanism of control. Evidence for drug-induced impairment of inhibitory mechanisms is reviewed from current neuroanatomical, neuropharmacological, and behavioral perspectives. Model-based laboratory assessments of behavioral control are described in terms of their application to behavioral pharmacology and evidence for alcohol and psychostimulant effects on basic inhibitory mechanisms is reviewed. Drug effects on inhibitory mechanisms are also discussed in terms of their relevance to higher-order cognitive and behavioral functions, and in relation to impulsive behaviors, such as drug abuse. The review concludes by identifying important drug-related phenomenon (e.g., drug tolerance, cue reactivity) that might also be studied in behavioral control frameworks in future research.

Adult↗

Reacting to autistic children: the danger of trying too hard.

Recent work has revealed that autistic children's predominating tendency to avoid social interactions is actually enhanced by the 'friendly' approaches to others. In this study it was recorded on video-tape how eight autistic children reacted to four styles of adult behaviour. The adult reacted to the child's looks at her by (i) smiling, (ii) gaze averting, (iii) gaze averting plus other 'timid' behaviours and (iv) doing nothing except continuing to look back. For this last condition--when the adult did not react--it was found that autistic children showed less avoidance behaviour after eye contact and spent more time within one metre of the adult. The implications for treatment are contrary to much modern practice and to what seems to be adults' 'natural' response. Reactivity by others appears to enhance the child's avoidance, and it is suggested that adults should be circumspect in the degree of sociability with which they respond to autistic children.

Autistic Disorder↗

Social stratification, health, and violence in the very young.

Inequalities in human social groups contribute in important ways to the initiation and perpetuation of violence. Because both social inequalities and interpersonal aggression emerge in early life, it is important to study their developmental origins in the collective and individual behavior of young children. As young as 2 years of age, children assemble stable, linearly transitive dominance hierarchies when brought together in novel social groups. Just as the consequences of socioeconomic status may be due in part to experiences of social ordering per se, subjective childhood experiences of occupying a lesser or greater position on a scale of social influence may similarly affect health, safety, and behavior in early development. Children's experiences with social ordering may represent a first, formative encounter with the hierarchical social relations that affect health and susceptibility to violence over the human lifespan. We have studied the health correlates of group stressors, dominance positions, and biobehavioral reactivity within cohorts of preschool children and semi free-ranging rhesus macaques. Social position is ascertained using naturalistic observations of critical dyadic events, and stress-reactivity is measured using assessments of behavioral and biological responses to standardized challenges. Outcome measures, including indicators of mental and physical health and interpersonal injuries, have been assessed--in the case of children--with parent- and teacher-report questionnaires, child self-report protocols, and frequent, objective physical examinations of the child and--in the case of rhesus monkeys--with daily observations of violence-related injuries. Results to date have suggested the following provisional conclusions: (1) Children and monkeys form stable, linearly transitive social hierarchies in which identifiable subgroups of individuals occupy dominant and subordinate social positions. (2) Individuals occupying subordinate positions within the social group show exaggerated adrenocortical and/or autonomic reactivity to challenge and disproportionate rates of chronic medical conditions or violent injuries. (3) Stress-reactivity, naturally occurring stressors, and social position are interactively predictive of rates of morbidity. Monkeys who displayed high biobehavioral reactivity sustained disproportionate numbers of violent injuries during a confinement stressor. Children who were high in the dominance hierarchy and low in reactivity showed significantly higher rates of externalizing mental health symptoms, while those who were in subordinate social positions and high in reactivity showed higher prevalences of internalizing symptoms. In conclusion, the prevention of youth violence--and other forms of early disorder--will require a deeper, developmental understanding of the "headwaters" of aggression and victimization in early childhood and a stronger accounting of how early social inequalities set trajectories toward healthy or disordered behavior.

Animals↗

Reactivation of posttraumatic stress disorder after minor head injury.

This report describes the reactivation of a posttraumatic stress disorder (PTSD) after a minor head injury in two young women who had recovered from extreme stress caused by sexual abuse during adolescence. Intrusive thoughts, images, dreams, and phobic avoidance bear a direct relationship to the specific circumstances of both head injury and sexual abuse, and were associated with obsessive-compulsive symptoms, generalized anxiety with panic, and depression. These findings suggest that in some individuals minor head injuries may induce not only extreme stress reactions, but also cause the reactivation of symptoms related to previous traumatic experiences.

Adolescent↗

Intrinsic motivation and school misbehavior: some intervention implications.

The intrinsic motivational concepts of self-determination, competence, and relatedness to others are highlighted to underscore their value in identifying motivational underpinnings for deviant and devious behavior. These constructs are woven into a working schema to differentiate intentional misbehavior in terms of whether it is reactive or proactive. Finally, from the perspective of such motivational thinking, implications for formal intervention research and experimental practice are illustrated.

Child↗

Maltreatment in psychiatrically hospitalized children and adolescents with developmental disabilities: prevalence and correlates.

OBJECTIVE: The goals of this study were (1) to determine the prevalence of child maltreatment in hospitalized children and adolescents with developmental disabilities and concomitant psychiatric disorders, and (2) to identify the contribution of specific mother and child characteristics to the use of more severe disciplinary practices by mothers. METHOD: One hundred thirty-eight psychiatrically hospitalized children and adolescents with developmental disabilities and mothers were assessed using a semistructured interview (Child Abuse and Neglect Interview Schedule) examining factors associated with risk of child maltreatment, and questionnaires measuring maternal and child functioning. The Child Abuse and Neglect Interview Schedule and hospital charts were then used to derive ratings on the prevalence and severity of child maltreatment. RESULTS: Findings revealed that 61% of children had experienced some form of severe maltreatment by a care provider in their lifetime. Regression analysis indicated that interactions between high levels of social functioning and disruptive/oppositional behaviors and younger age in children, and low levels of social support and increased anger reactivity in mothers, were most predictive of mothers' use of severe disciplinary practices. CONCLUSIONS: Maltreatment in psychiatrically hospitalized children and adolescents with disabilities is very prevalent, and it warrants careful clinical assessment. In the psychiatric setting, families in which the child is younger, higher functioning, and behaviorally disruptive, and where mothers have little social support and exhibit increased anger reactivity, are at especially elevated risk.

Adolescent↗

Auditory hallucinations: a comparison between patients and nonpatients.

The form and the content of chronic auditory hallucinations were compared in three cohorts, namely patients with schizophrenia, patients with a dissociative disorder, and nonpatient voice-hearers. The form of the hallucinatory experiences was not significantly different between the three groups. The subjects in the nonpatient group, unlike those in the patient groups, perceived their voices as predominantly positive: they were not alarmed or upset by their voices and felt in control of the experience. In most patients, the onset of auditory hallucinations was preceded by either a traumatic event or an event that activated the memory of earlier trauma. The significance of this study is that it presents evidence that the form of the hallucinations experienced by both patient and nonpatient groups is similar, irrespective of diagnosis. Differences between groups were predominantly related to the content, emotional quality, and locus of control of the voices. In this study the disability incurred by hearing voices is associated with (the reactivation of) previous trauma and abuse.

Adult↗

Dense bone--too much bone: radiological considerations and differential diagnosis. Part II.

In conclusion, the attempt has been made to demonstrate that three major forms of new bone formation exist: reactive, neoplastic, and the newborn or relative skeletal sclerosis in congenital (developmental) disorders. A classification of skeletal disorders has been presented and four major groups have been selected from the nine categories in this classification. These are: congenital-developmental, metabolic and endocrine, benign neoplasms and malignant neoplasms. In all four categories a large group of entities which may present with new bone (sclerosis) are listed and are discussed in some, but limited, detail. A number of these entities in each of the four categories are illustrated. Some difficulty is encountered in considering the mechanisms for the production of bony sclerosis in the group of congenital-developmental disorders. In such entities as osteopetrosis, the overproduction of cartilage cords and subsequent excessive mineralization is known to be responsible for the dense bone. However, in various skeletal dysplasias (e.g., pyknodysostosis, van Buchem disease), the exact mechanism for the development of the diffuse sclerotic process is not clearly understood. In the metabolic and endocrine category, the situation as to mechanism is less unclear in considering the reason for the development of bony sclerosis. Yet even in evaluating disorders such as renal osteodystrophy, the reactive bony sclerosis in the presence of secondary hyperparathyroidism and osteomalacia is a source of speculation with no definite proof, as yet.

Adolescent↗

Supplementation with flax oil and vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD).

Considerable clinical and experimental evidence now supports the idea that deficiencies or imbalances in certain highly unsaturated fatty acids may contribute to a range of common developmental disorders including Attention Deficit Hyperactivity Disorder (ADHD). Few intervention studies with LCPUFA supplementation have reported inconsistent and marginal results. This pilot study evaluates the effect of alpha linolenic acid (ALA)-rich nutritional supplementation in the form of flax oil and antioxidant emulsion on blood fatty acids composition and behavior in children with ADHD. Post-supplementation levels of RBC membrane fatty acids were significantly higher than pretreatment levels as well as the levels in control. There was significant improvement in the symptoms of ADHD reflected by reduction in total hyperactivity scores of ADHD children derived from ADHD rating scale.

Ascorbic Acid↗

Radial nerve palsy owing to localized hypertrophic neuropathy (intraneural perineurioma) in early childhood.

Localized hypertrophic neuropathy, also termed intraneural perineurioma, is a rare disorder of unknown etiology that produces a slowly progressive painless focal lesion of a peripheral nerve. It is characterized histologically by concentric whorls ("onion bulbs") of epithelial membrane antigen-reactive, S-100 protein-negative perineurial cells surrounding nerve fibers. We report a radial nerve palsy in a child aged 2 years in whom the diagnosis of localized hypertrophic neuropathy was made by biopsy. Resection of the affected nerve segment and sural nerve grafting produced no useful recovery after 3 years, probably because of the long duration of denervation. When this mononeuropathy presents in early childhood, uncertainty over the time of onset can lead to difficulty in distinguishing this potentially treatable lesion from congenital and other causes of nerve palsy.

Child, Preschool↗