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PubMed1993

A retrospective study of serum levels and electrocardiographic effects of nortriptyline in children and adolescents.

OBJECTIVE: We retrospectively evaluated a large pediatric population treated with nortriptyline (NT) in an outpatient psychopharmacology clinic to assess pharmacokinetic and electrocardiographic (EKG) effects. METHODS: A systematic search revealed 82 children and adolescents treated naturalistically with NT. All patients with available EKGs and serum NT levels were included in the series with the exception of those receiving concomitant antipsychotic agents. Forty-three percent of subjects were receiving medications in addition to NT. RESULTS: Patients received an average (+/- SE) NT dose of 2.0 +/- 0.1 mg/kg yielding mean serum NT levels of 105.5 +/- 7.4 ng/mL. There was a linear relationship of NT dose (mg/kg) to serum NT levels (r = 0.50, p < 0.0001). NT treatment resulted in small increases in heart rate, and PR, QRS, and QTc intervals (all ps < 0.01), of similar magnitude in children and adolescents. Individuals with the highest baseline EKG indices had the least amount of change in those indices with NT treatment. There were only a few statistically significant associations between NT dose or serum NT levels and EKG parameters. NT treatment was significantly associated with the onset of asymptomatic sinus tachycardia (heart rate > 100 beats per minute), and prolongation of the EKG QRS (> 100 msec) and QTc (> 440 msec) intervals. CONCLUSIONS: These findings suggest: (1) NT has a predictable dose to level relationship, (2) the effect of NT on the EKG in this age group is mild and similar to that reported with other tricyclic antidepressants, and (3) there are few age-specific differences in NT-induced EKG changes.

Adolescent↗
PubMed1994

The efficacy of psychoanalysis for children with disruptive disorders.

OBJECTIVE: This paper describes a chart review of 763 cases of child psychoanalysis and psychotherapy at the Anna Freud Centre, and illustrates its usefulness by examining predictors of treatment outcome in children with disruptive disorders. METHOD: 135 children and adolescents with a principal diagnosis of disruptive disorder were individually matched with others suffering from emotional disorders. Outcome was indicated by diagnostic change and change in overall adaptation (clinically significant improvement or return to normal functioning). RESULTS: Improvement rates were significantly higher for the emotional than for the disruptive group. Within the disruptive group, significant improvement was more frequent among children with oppositional defiant disorder (56%) than those with attention deficit hyperactivity disorder (36%) or conduct disorder (23%). However, 31% of the children terminated treatment within 1 year. Of those disruptive children who remained in treatment more than 1 year, 69% were no longer diagnosable on termination. Fifty-eight percent of the variance in outcome ratings could be accounted for within this group. The crucial variables in predicting attrition and symptomatic improvement were found to be quite different in the disruptive and emotional groups. CONCLUSION: Although the study has several methodological limitations, it does suggest demographic, clinical, and diagnostic characteristics of those disruptive children most likely to benefit from intensive and nonintensive psychodynamic treatment.

Adolescent↗
PubMed1994

Modifying quiet room design enhances calming of children and adolescents.

OBJECTIVE: To determine whether altering design of a quiet room (QR) produced more rapid calming of agitated or aggressive hospitalized children. METHOD: One of five similar QRs was modified by painting the white walls tea rose, carpeting the vinyl floor, and painting a picturesque mural on one wall. The effects of these modifications were assessed in 19 patients (mean age = 9.6 years), using a within-subjects, repeated-measures design. Overt Aggression ratings were made at the time of placement, and at 5-minute intervals thereafter, until the child was dismissed. Children were blind to the fact that a study was being conducted; raters and staff were not. RESULTS: Total aggression ratings were 45% lower in the modified QR than in the standard QR (p < .03), and initial aggression scores fell by 50% during 5 minutes of placement in the modified QR, but only after 20 minutes of placement in the standard QR (p < .0001). Motor excitement and verbal aggression were the two component factors most strongly influenced by QR design. CONCLUSION: This preliminary report suggests that it may be possible to modify QRs to facilitate calming of aggressive, agitated children and provides preliminary support for redesign of QRs.

Acting Out↗
PubMed1996

A treatment outcome study for sexually abused preschool children: initial findings.

OBJECTIVE: Treatment outcome for sexually abused preschool-age children and their parents was assessed, comparing the effectiveness of a cognitive-behavioral intervention to nondirective supportive treatment. METHOD: Sixty-seven sexually abused preschool children and their parents were randomly assigned to either (1) cognitive-behavioral therapy adapted for sexually abused preschool children (CBT-SAP) or (2) nondirective supportive therapy (NST). Treatment consisted of 12 individual sessions for both the child and parent, monitored for integrity with the therapeutic model through intensive training and supervision, use of treatment manuals, and rating of audiotaped sessions. Parents completed the Child Behavior Checklist, the Child Sexual Behavior Inventory, and the Weekly Behavior Report to measure a variety of emotional and behavioral symptoms. RESULTS: Within-group comparison of pretreatment and posttreatment outcome measures demonstrated that while the NST group did not change significantly with regard to symptomatology, the CBT-SAP group had highly significant symptomatic improvement on most outcome measures. Repeated-measures analyses of variance demonstrated group x time interactions on some variables as well. Clinical findings also supported the effectiveness of the CBT-SAP intervention over NST. CONCLUSIONS: Findings provide strong preliminary evidence for the effectiveness of a specific cognitive-behavioral treatment model for sexually abused preschool children and their parents.

Affective Symptoms↗
PubMed1997

A treatment study for sexually abused preschool children: outcome during a one-year follow-up.

OBJECTIVE: Treatment outcome in sexually abused preschool children was evaluated 6 and 12 months after treatment. METHOD: Forty-three sexually abused preschool children and their parents were evaluated 6 and 12 months after completion of either Cognitive-Behavioral Therapy for Sexually Abused Preschoolers (CBT-SAP) or nondirective supportive therapy (NST). Parents completed the Child Behavior Checklist, Child Sexual Behavior inventory, and Weekly Behavior Report to measure a variety of symptoms in their children. RESULTS: Repeated-measures analyses indicated that there were significant group by time interactions on several outcome measures from the beginning of the study to the end of the 12-month follow-up period, with the CBT-SAP group exhibiting significantly more improvement over time than the NST group. Clinical findings also indicated the superior effectiveness of CBT-SAP over NST in reducing sexually inappropriate behavior. CONCLUSIONS: Findings support the superior efficacy of CBT-SAP over NST in maintaining symptom reduction in the year after treatment completion. The importance of using cognitive-behavioral interventions for sexually inappropriate behaviors and including nonoffending parents in the treatment of sexually abused preschool children is discussed.

Analysis of Variance↗
PubMed1998

Cognitive-behavioral treatment of school-refusing children: a controlled evaluation.

OBJECTIVE: To evaluate the efficacy of a 4-week cognitive-behavioral treatment program for children who refuse to go to school. METHOD: Thirty-four school-refusing children (aged 5 to 15 years) were randomly assigned to a cognitive-behavioral treatment condition or a waiting-list control condition. Treatment consisted of individual child cognitive-behavioral therapy plus parent/teacher training in child behavior management skills. Measures taken before and after treatment included school attendance, child self-report of emotional distress and coping, caregiver reports on emotional and behavioral problems, and clinician ratings of global functioning. RESULTS: Relative to waiting-list controls, children who received cognitive-behavioral therapy exhibited a significant improvement in school attendance. These children also improved on self-reports of fear, anxiety, depression, and coping. Significant improvements also occurred in relation to caregiver reports and clinician ratings. Maintenance of therapeutic gains was demonstrated at a 3-month follow-up assessment. CONCLUSIONS: Cognitive-behavioral treatment of school refusal was efficacious and acceptable. The relative contributions of child therapy and parent/teacher training require further study.

Adolescent↗
PubMed2000

Summary of the practice parameters for the assessment and treatment of children and adolescents who are sexually abusive of others. American Adademy of Child and Adolescent Psychiatry.

This summary provides an overview of the assessment and treatment recommendations contained in the Practice Parameters for the Assessment and Treatment of Children and Adolescents Who are Sexually Abusive of Others. The parameters were written to aid clinicians in the assessment and treatment of children and adolescents with symptoms of sexually abusive behavior. The assessment and treatment of children and adolescents with sexually abusive behavior requires an understanding of normal sexual development. A multiplicity of biological and psychosocial factors determines the child's sexual development, gender role, sexual orientation, patterns of sexual arousal, sexual cognitions, sexual socialization, and the integration of sexual and aggressive patterns of behavior. The individual's sexuality evolves in concert and as a result of interaction with family, ethnic, social, and cultural influences. These parameters summarize what we know about the epidemiology and phenomenology of sexually abusive youths and provide guidelines for the assessment and the selection of treatment interventions for these youths. Essential considerations in the assessment and treatment of sexually abusive youths, as well as the different categories of sexually abusive youths which should be recognized and which influence treatment decisions, are presented. The spectrum of currently available psychosocial and biological treatments will be summarized.

Adolescent↗
PubMed1998

Evaluation and long-term treatment of aberrant behavior displayed by young children with disabilities.

We trained parents to conduct functional analyses and functional communication treatment for 28 young children with developmental disabilities who displayed aberrant behavior. Of this sample, 22 parents conducted treatment for at least 3 months and 11 for 1 year. We conducted single-case analyses of the results of assessment and treatment. The functional analysis identified social functions (positive and negative reinforcement) for 86% (24 of 28) of the children. Treatment resulted in a pre/post decrease in aberrant behavior averaging 87% across the range of children, with the greatest decrease occurring at 3 months. Appropriate social responding increased, on average, by 69% across the range of children. Decreases in aberrant behavior were demonstrated in all children, and all except one child displayed increased social behavior during treatment. On a measure of parent-rated treatment acceptability, ranging from 1 (not at all acceptable) to 7 (very acceptable), the average overall acceptability was 6.35.

Behavior Therapy↗
PubMed2002

Too young for ADHD: the potential role of systems of care.

This article discusses a number of issues related to the diagnosis and treatment of children with attention-deficit hyperactivity disorder (ADHD), with specific implications for preschoolers. A brief review of diagnostic and treatment issues for young children is followed by a discussion of developmental issues that contextualize the preschool years and have an impact on cognitive and emotional development underlying self-regulation. The characteristics of the high numbers of children with ADHD receiving services within community-based systems of care and symptom outcomes are reported, as well as a description of the components of the systems of care approach. Recent federal initiatives that impact the care of children with ADHD within community settings are highlighted. It is concluded that the identification and management of preschool children with ADHD can be effective within the context of fully integrated service system approaches.

Attention Deficit Disorder with Hyperactivity↗
PubMed1983

Familial subtypes of childhood hyperactivity.

On the basis of family history data we defined two subtypes of childhood hyperactivity: family history-positive (FH+), in which at least one biological parent of the child had a diagnosis in the antisocial spectrum; and family history-negative (FH-), in which neither parent had such a diagnosis. While children in both subgroups were equally deviant on measures of the core components of childhood hyperactivity (e.g., inattention and reactivity), the FH+ children were also deviant on dimensions of conduct disturbance and had siblings with a high prevalence of conduct disorder. FH- children showed little evidence of conduct disturbance, had more learning and academic problems, and had siblings with attentional and learning disabilities, but not conduct disorder. These findings suggest that the study of family constellations should be a fruitful method for resolving the heterogeneity of the hyperactive child syndrome.

Age Factors↗
PubMedDate not supplied

Compulsive-like behavior in individuals with Down syndrome: its relation to mental age level, adaptive and maladaptive behavior.

This study examined the nature of repetitive, ritualistic, and compulsive-like behaviors in 50 typically developing children and 50 individuals with Down syndrome (DS), matched on mental age (MA; M = 59.72 months). Parents reported on their children's compulsive-like behaviors-including ritualistic habits-and perfectionistic behaviors, as well as their children's adaptive and maladaptive behaviors. Results indicated that children with DS show similar MA-related changes in compulsive-like behaviors compared to the MA-matched comparison group. Younger children (both typical and DS) exhibited significantly more compulsive-like behaviors than older children. In general, children with and without DS did not differ from each other in terms of the number of compulsive-like behaviors they engaged in, although participants with DS engaged in more frequent, more intense repetitive behaviors. Compulsive-like behaviors were differentially related to adaptive and maladaptive behaviors across the MA and mental retardation groups. The results extend the "similar sequence" model of development to the construct of compulsive-like behaviors, and also suggest that some repetitive behaviors may be among the behavioral phenotype of individuals with DS.

Adaptation, Psychological↗
PubMed2002

Parental expressed emotion in depressed adolescents: prediction of clinical course and relationship to comorbid disorders and social functioning.

BACKGROUND: High expressed emotion (EE) predicts worse clinical course for a number of disorders. High EE is more frequent in parents of disordered children than normal controls. It is uncertain whether EE and its components are disorder-specific, whether EE is more closely related to parent characteristics or child characteristics, and whether EE predicts clinical course independently of clinical variables that reflect severity of disorder. EE has not been investigated in adolescent depression. METHOD: The 57 participants in this study were a sub-sample of a longitudinal study of the clinical course of depression. Adolescents and parents were recruited from consecutive referrals to all psychiatric outpatient clinics and inpatient units in a geographic catchment area. The association between EE and one-year clinical outcome of major depressive disorder was tested and associations between EE and characteristics of the adolescent, the parent, and the family were examined. RESULTS: EE was independent of socio-demographic characteristics, comorbid diagnoses, and parental depression. High EE was associated with worse adolescent social functioning according to either adolescent or parent report. High EE was associated with the presence of more depression symptoms. Low EE predicted major depression remission in participants without comorbid attention-deficit/hyperactivity disorder (ADHD), but this association was not independent of the association between social functioning and depression remission. CONCLUSIONS: The findings indicate a need to examine possible protective effects of low EE. Relationships between EE, social functioning, and depression persistence and remission require further examination.

Adolescent↗
PubMedDate not supplied

Health visiting and pre-school children with behavioural problems in the County of South Glamorgan: an exploratory study.

This study surveys firstly, using a modified semantic differential technique, how a sample of health visitors in the County of South Glamorgan perceived different behavioural problems in pre-school children. A selection of visiting records, covering a 1-year period, is also studied. Results from the semantic-differential indicate that health visitors perceive eating and sleeping as the most common problem areas. Hyperactivity and sleeping problems are seen as being the most difficult to deal with and the most disruptive to family life. Although health visitors generally feel it is necessary to follow up children with behaviour problems, they find these difficult to resolve. About one third of children are referred to other agencies. Visiting records reveal that children with hyperactivity and sleeping problems receive the highest number of visits from health visitors and that there is little improvement in these children over a period of 1 year. An extension of the health visitor's role and training to include behavioural treatments for pre-school children is discussed.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Preschool children with intellectual disability: syndrome specificity, behaviour problems, and maternal well-being.

BACKGROUND: Children with intellectual disability (ID) are at heightened risk for behaviour problems and diagnosed mental disorder. Likewise, mothers of children with ID are more stressed than mothers of typically developing children. Research on behavioural phenotypes suggests that different syndromes of ID may be associated with distinct child behavioural risks and maternal well-being risks. In the present study, maternal reports of child behaviour problems and maternal well-being were examined for syndrome-specific differences. METHODS: The present authors studied the early manifestation and continuity of syndrome-specific behaviour problems in 215 preschool children belonging to 5 groups (typically developing, undifferentiated developmental delays, Down syndrome, autism, cerebral palsy) as well as the relation of syndrome group to maternal well-being. RESULTS: At age 3, children with autism and cerebral palsy showed the highest levels of behaviour problems, and children with Down syndrome and typically developing children showed the lowest levels. Mothers of children with autism reported more parenting stress than all other groups. These syndrome-specific patterns of behaviour and maternal stress were stable across ages 3, 4 and 5 years, except for relative increases in behaviour problems and maternal stress in the Down syndrome and cerebral palsy groups. Child syndrome contributed to maternal stress even after accounting for differences in behaviour problems and cognitive level. CONCLUSIONS: These results, although based on small syndrome groups, suggest that phenotypic expressions of behaviour problems are manifested as early as age 3. These behavioural differences were paralleled by differences in maternal stress, such that mothers of children with autism are at elevated risk for high stress. In addition, there appear to be other unexamined characteristics of these syndromes, beyond behaviour problems, which also contribute to maternal stress.

Adult↗
PubMed1990

The social competence of children born prematurely: effects of medical complications and parent behaviors.

36-month-old, full-term children (n = 21) and low-birthweight (LBW) children of high (n = 25) and low (n = 23) medical risk status were observed in interactions with mothers in teaching and social context. Child compliance, self-directed behaviors, and problem behaviors were evaluated as well as associations among aspects of children's social competence, mothers' behaviors, and context factors. Degree of medical risk was associated with impairments in children's self-directed behavior and quality of response to maternal directives. Mothers of LBW children showed a smaller proportion of behaviors that provided choices compared to mothers of full-term children. Medical complications, children's cognitive status, and mothers' interactive behaviors were significantly associated with LBW children's social competence. Results of regression analyses suggested that mothers and LBW children influence each others' behavior in ways similar to mothers and full-term children in both teaching and social contexts.

Attention↗