Re: Evaluation of a children's temper-taming program.
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It has been claimed that the childhood behavioural factors "hyperactivity" and "conduct disorder" are highly correlated. The fact that hyperactive symptoms load heavily on the conduct disorder factor has also been used to support the notion that hyperactivity is not an independent behavioural dimension. The present study employs a large sample of combined clinic and normal children to demonstrate that both of these observations are artifacts of methodological technique. When factor score coefficients are used to interpret factors, the hyperactive symptoms do not load on the conduct disorder factor. If factor scores are defined by the use of unit weights, as in previous studies, then the intercorrelation between the hyperactive and conduct disorder factors is high. The use of factor score coefficients to define factors, on the other hand, produces uncorrelated factors. The results support the idea that hyperactivity and conduct disorder are independent behavioural dimensions.
Selected results from the Ontario Child Health Study (OCHS), a cross-sectional community survey of Ontario children four to 16 years of age, are presented in the areas of prevalence, risk indicators and service utilization. The six month prevalence of one or more of four psychiatric disorders (conduct disorder, hyperactivity, emotional disorder, and somatization), in children four to 16 years of age, in Ontario was 18.1%. The highest rate was in 12 to 16 year old girls, and the lowest rate in four to 11 year old girls. Co-morbidity among these four disorders was high while the proportion of disorders identified by more than one respondent was low. Psychiatric disorders co-occurred significantly with other morbidities in children, including poor school performance, chronic health problems, substance use and suicidal behaviour. Chronic medical illness in the child as well as single parent status, living in a family on social assistance and residing in subsidized housing, were all strong indicators of increased rates of psychiatric disorders in children. Specialized mental health/social services, over a six month period, reached fewer than one of five children with psychiatric disorders, as measured in the study. In contrast, ambulatory medical care (primarily visits to family doctors and pediatricians) served almost 60% of Ontario children four to 16 years old, over the same six month period. The results are compared with those in the literature.
This report examines the correlates of emotional disorder (ED) for children in the community. The following models were used to examine the correlates of ED: 1. the variables predicting the presence or absence of ED; 2. the variables predicting the presence or absence of ED when controlling for coexisting hyperactivity and conduct disorder; and 3. the correlates of pure ED versus pure hyperactivity, and pure ED versus pure conduct disorder. Data from the Ontario Child Health Study, a community survey of children aged four to 16 years in the province of Ontario, were used. Many of the correlates proposed in the literature as variables that differentiate children with ED from normal children were supported using the first two models. Only one correlate was found which differentiated pure ED from pure hyperactivity, and no correlates differentiated children with pure ED from children with pure conduct disorder.
This paper reports the results of a chart review and consumer satisfaction evaluation of referrals to a tertiary care child psychiatric inpatient unit. The evaluation involved an examination of the types of child and family difficulties treated during the period of the study; the nature and extent of assessment, treatment and follow-up; treatment outcome and parental perception of factors related to treatment outcome; and the satisfaction of both the parents and referral sources. Results indicated that children admitted for treatment were a heterogeneous group with severe difficulties from families with a number of problems. Most parents and referring therapists were very satisfied with the treatment, recommendations and follow-up provided. Significant correlations were observed between the parents' and referring therapist's satisfaction with the service and the extent to which home based problems were addressed during the child's stay in hospital. In addition, some suggestions are given for strategies to improve services. The findings are discussed with special reference to the value of program evaluations for inpatient child psychiatric services.
This study identified predictor variables associated with outcome in middle childhood in a clinical preschool sample. These variables were examined in relation to functional level at outcome. At Time 1 the sample consisted of 129 children admitted to a psychiatric preschool program; 82 of these children comprised the follow-up sample at Time 2. The results indicated that the variables significantly associated with each child's outcome were IQ, the presence of diagnosis at Time 1 and the length of time each child was in the treatment program. Different predictors were important for different outcomes and a given predictor variable was not equally salient across all levels of outcome.
The demand for day treatment programs for children with severe behaviour problems has greatly increased in the past decade. The objective of this study is to identify characteristics of children who benefit most from such a program. The sample consisted of 63 children, aged five to 13, assessed at admission and discharge from the program. Outcome measures included behavioural improvement and school reintegration. At admission, multivariate analyses revealed that children who made the greatest behavioural improvements had less severe behaviour problems, lower IQ scores and more disturbed family functioning. Children reintegrated into regular classes after discharge were younger at admission, had better reading skills, no attention deficit hyperactivity disorder and little parental marital discord. Findings suggest that successful outcome can be predicted from characteristics of children at intake. A multimodal approach is needed to address the different problems areas in a child's life.
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The authors evaluate the relation of ethnic, socioeconomic status (SES), and belief match between parents and group leaders and engagement in a preventive intervention for parents of preschoolers. Engagement was assessed through attendance, retention, and quality of participation in sessions with 171 parents and 11 group leaders. SES match predicted attendance, retention, and quality of participation. Parents attended more sessions, remained longer in the program, and participated more actively when their group leader came from comparable SES backgrounds. Ethnic match predicted retention only, with parents attending longer when their ethnicity matched their group leader's. Engagement was unrelated to the extent of match across different characteristics, nor was the link between ethnic match and retention mediated by SES or belief match. Results suggest that social, cultural, and belief similarities between parents and group leaders may be less salient in preventive parenting interventions than is assumed. Implications for research and practice are discussed.
This study involved 50 patients with the frontal arousal rhythm (FAR), a rare pattern (0.22%) seen in children with an average age of 4 yrs who show long bursts of bifrontal sharp waves at a theta frequency upon arousal from stage II sleep. The pattern is seen mainly in males and children with histories of seizures (70%), usually with generalized attacks. Although cognitive/behavior disorders were seen in an overlapping 56%, this incidence was not different from a control group from the same clinic with normal EEGs.
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A comparison of hyperactive boys with and without associated conduct disorder was made to determine the validity of a narrowly defined concept of pure hyperactivity. Although clinical differences between the two sub-groups supported the diagnostic distinction, few differences appeared with respect to various possibly causal background factors. A small group of boys with pure hyperactivity was separated, however, on the basis of subnormal IQ scores. In contrast to the hyperactive boys with normal IQ, these boys showed a more serious history of developmental disturbances which appeared to be linked to organicity. It was concluded that pure hyperactivity is an elusive concept and probably defines a heterogeneous group of children whose primary problems are cognitive in nature.
The distinction between hyperactivity and conduct disorder was explored in a mixed group of 64 children referred to psychiatric clinics because of antisocial or disruptive behaviour. A semi-structured interview measure (the Parental Account of Children's Symptoms, PACS) proved to have adequate inter-rater reliability, internal consistency and factorial validity. The PACS scales of defiance and hyperactivity, and similar subscales from Conners' Teacher Rating Scale, were tested against laboratory and clinical measures of activity, attention, cognitive performance, psychosocial background and family relationships. The hyperactivity (but not the defiance) scales were associated with greater activity, younger age, poorer cognitive performance and abnormalities on a developmental neurological examination. The defiance (but not the hyperactivity) scales were associated with impairment of family relationships and adverse social factors. It was concluded that a dimension of inattentive, restless activity should be separated from one of antisocial, defiant conduct in children with psychiatric disorder.
BACKGROUND: The prevalence rate of behaviour problems and maternal mental disturbance was estimated using a sample of 1047 families with a 3-year-old child from a mixed urban/rural area. METHOD: Parents completed the Child Behaviour Checklist, EAS Temperament Questionnaire, Weiss-Werry-Peters Activity Scale and the GHQ-30. RESULTS: The rate of behaviour problems (13.2%) was similar to that obtained in studies of urban children. The rate of maternal disturbance (27.6%) was lower than in other population samples. Few differences were found in the prevalence rates in the urban and rural areas. CONCLUSIONS: Preschool children and their parents living in non-urban areas had the same rates of problems as those in conurbations. The service needs of such families are similar regardless of locality.
BACKGROUND: There is a lack of clear and explicit models of the way various family and social influences on children's behaviour interact with factors such as temperament to produce behaviour disturbance in young children. METHOD: The following measures had been obtained on a total population sample of 1047 families with a 3-year-old child: the child's perceived cuddliness, difficult temperament, mother's unhappy childhood, maternal disturbance, social class, behaviour problems and overactivity. A latent variable analysis using the LISREL 7 program was applied to the data. RESULTS: A model that allowed the latent variables child 'temperament' and 'mother's mental state' to have separate additive effects on 'child adaptation' proved an excellent fit (goodness of fit index = 0.956). This model suggests that there is a common factor ('child adaptation') underlying behaviour problems and overactivity. Using this model 72% of child adaptation in boys could be explained. For girls however temperament and mother's mental state accounted for only 30% of the variance in child adaptation. CONCLUSION: There is a need to investigate different mechanisms for the origins of behaviour problems in preschool boys and girls.