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Collaboration of physicians, parents, and teachers is essential in obtaining the best education for children. The spectrum of interaction ranges from acute and chronic medical care, routine exams, and sports evaluations to learning disabilities and attention-deficit hyperactivity disorder to giftedness.
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Several features of pediatric pharmacology applied to psychiatry were mentioned throughout this review. The use of medications in young children requires attention to nuances of informed consent because of limited data and many potentially beneficial, possibly safer medications that are not approved for children. Children more rapidly metabolize and eliminate medications. They differ in sensitivity to main effects and side effects of a variety of medications. Therefore, it is important to start low and aim for the lowest effective dose. Ultimate doses may be higher, split and frequent doses may be necessary, and both clinical and laboratory follow-up may need to be more frequent. Finally, childhood onset of psychiatric disorders, similar to pediatric experience with diabetes or rheumatoid arthritis, frequently confers devastating stress and chronicity. The child's physician shares the frustration of poor treatment response or responses that cannot be sustained in a developing, dependent organism with a more aggressive variant of a disorder and an inevitably longer course. Despite a heartening increase in pediatric psychopharmacology interest and knowledge, much remains to be learned.
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The pedodontic admission histories of 1600 Mexican children were analyzed, to determine general epidemiologic factors or oral habits, as well as their relationship with identifiable biopsychosociologic factors. Fifty-six percent of the children gave evidence of an oral habit, with significant predisposition among female patients, single children, subjects in poor physical health (particularly from allergies), as well as children with histories of chronic health problems. Oral habits should be considered a major health hazard because of their high incidence. Successful treatment requires a multidisciplinary approach to the basic cause of the problem.
Some physique-behavior relations were determined in 75 boys and 51 girls, aged 6 to 14, in a residential treatment center in Holland. Each child's behavior was rated by four group workers on a checklist yielding eight summary scores. Physique was judged from nude photographs for manifest endomorphy, mesomorphy, and ectomorphy. While a number of moderate-sized relations appeared in zero-order and multiple correlations, canonical analysis showed two significant, independent sets of relations between physique and behavior in the boys, one in the girls. Among the boys, one set related mesomorphy and energy level, the other related primarily ectomorphy with unsocialness, excitability, and cooperativeness. Among the girls, these same behaviors were compressed in a single set, primarily relating energy level but also unsocialness, excitability, and cooperativeness positively with mesomorphy and negatively with endomorphy and ectomorphy. Compared with findings on the same instrument in a sample of normal American preschoolers, many individual associations were similar, despite differences in culture and language, age, intelligence, social status, adjustment, and residential setting of the S's.
Subject of this study is the maternal stress as a result of the disabilities of language impaired children. The report concentrates on the influence of the children disabilities and the maternal coping strategies on the stress in the families. The study is based on an inquiry of 98 mothers with speech and language impaired children. Nearly 50% of the mothers suffer from stress because of their children' disabilities. Special caregiving demands, family conflicts, anxiety about the child future, depressive mood, aggressive feeling or deception were often experienced by the mothers as a direct consequence of their child's problems. The correlation of this specific maternal stress with general stress factors was insignificant. The maternal stress was more due to the attention deficits and the behavioural problems of the children than to the language delay. An increased level of stress was hardly related to the severity of the impairment, but to the maternal coping strategies. Mothers applying emotion focused coping strategies experienced more stress than those who predominantly used problem focused strategies. The results prove that mothers of children with even minor disabilities feel overstrained by their children' disorders. During counseling experts should attach more importance to deal with the needs and wishes of mothers and families of language impaired children. Reduction of family stress can be achieved by intervention programs helping the mothers to improve their psychological resources.
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The authors studied 207 children with minimal cerebral dysfunctions. Among this contingent 132 were followed-up from the moment of birth and subsequently during 8-10 years. It was demonstrated that already at the early stages of development certain neurological signs can be detected: somato-vegetative disorders, changes of the muscular tone, a hypertensive syndrome. In some of the children there was a retardation of psychomotor functions and prespeech development. One of the important goals at the present time is the elaboration of preventive measures of minimal cerebral dysfunctions in children with perinatal brain lesions.
Twenty children with hyperkinetic disorders with or without conduct disorders were treated in a home-treatment setting, as an alternative to inpatient treatment, by nurses specialized in child psychiatry and under the constant supervision of an experienced child psychiatrist. Conduct disorders were influenced positively in the child's natural surroundings. Parents were trained as co-therapists. Good cooperation by the family is required for therapy to have positive effects. Case studies serve to illustrate how treatment can be conducted at home.
The aims of the present study were to describe variations in the early course of development in autism by utilizing an in-depth parent interview that incorporated techniques to improve accuracy of parent recall, and to examine the relation between variations in early developmental course in autism and behavioral outcome at 3-4 years of age. The Early Development Interview, which consisted of questions about child's behavior in several domains from birth through 2 years of age, was created and administered to parents of 72 3-4-year-old children with autism spectrum disorder and 34 3-4-year-old children with developmental delay, who were matched on mental and chronological age, and 39 1-4-year-old typically developing children, who were matched to the clinical groups on mental age. At 3-4 years of age, children were administered standardized measures (some clinician administered and some parent report); these included verbal and nonverbal IQ, autism symptom severity, and adaptive and aberrant behavior. Based on the Early Development Interview, children with autism spectrum disorder (ASD) were reported to have elevated symptoms in the social and regulatory domains by 3-6 months. By 12-15 months, parents of children with ASD reported significantly higher levels of social symptoms than parents of children with developmental delay. At 3-4 years of age, children with autism with early vs. late onset of symptoms, and with vs. without a history of loss of skills (regression) were not found to differ on standardized tests of verbal and nonverbal IQ and observational measures of autism symptom severity.
Analysis of data gathered from interviews with adoptive parents supports the hypothesis that female adoptees of antisocial biological backgrounds might have higher percentages of somatic symptoms. The authors compared female adoptees of antisocial parentage with male and female controls, male adoptees of antisocial parentage, and male and female adoptees whose biological parents had other psychiatric conditions. They stress the importance of this hypothesis in the diagnosis and management of childhood and adolescent "medical" and behavioral problems.
The nature and prevalence of comorbid mood disorders were explored in a group of 28 latency-age children diagnosed with oppositional defiant disorder. Findings are preliminary in nature but suggest that children with oppositional defiant disorder are at significant risk for low-grade depressive illness and that this may commonly be overlooked in the presence of their primary disorder's more overt symptoms.
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In a test of Patterson's Coercion Theory with young children, 156 children (82 boys and 74 girls) were studied to assess the extent to which parenting and child variables, assessed at 18 months, would predict teacher ratings of externalizing child behaviors at age 5. Child playgroup behavior, parent coercion during home observations, and marital status each emerged as predictors, whereas child temperament, attachment classification, and gender did not. At age 5, the correlates of externalizing behaviors differed for boys and girls. Boys rated higher on externalizing behaviors by the teachers presented many problems in the home and school, whereas externalizing girls did not. In fact, girls rated higher on externalizing behaviors performed better on an intelligence test, yet the girls perceived themselves as less competent.