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PubMed1994

Differential diagnosis of childhood depression: using comorbidity and symptom overlap to generate multiple hypotheses.

Childhood depression is often found to share symptoms and coexist with several other childhood disorders and physiological conditions, leading to diagnostic errors and possibly inappropriate treatment. Literature relevant to the differential diagnosis of childhood depression is reviewed with particular attention given to the similarities and differences between depression and coexisting conditions such as anxiety disorders, conduct disorders, and attention deficit hyperactivity disorder. The characteristics of childhood depression are compared and contrasted with other possible coexisting disorders. Diagnostic reasoning, confirmatory bias, and the advantages of considering multiple hypotheses when diagnosing depression are discussed.

Adjustment Disorders↗
PubMed1983

Mothers' evaluation of a parent training program completed three and one-half years earlier.

The purpose of the present study was to examine the long term effects of a parent training program. Mothers who completed treatment, a mean of 3.6 yr earlier, were asked to fill out measures that examined parent perceptions of child adjustment and parent satisfaction with treatment. Of the 68 mothers to whom questionnaires were mailed, 34 (50%) returned them while 10 questionnaires were returned with an insufficient address. A comparison of pre-treatment, post-treatment and follow-up child adjustment scores indicated that the mothers perceived their children as significantly better adjusted after treatment and that this effect maintained at follow-up. Generally favorable responses were also reported by mothers on a consumer satisfaction measure.

Adolescent↗
PubMed1990

Primary disorder of vigilance: a novel explanation of inattentiveness, daydreaming, boredom, restlessness, and sleepiness.

We present a novel condition, designated as a primary disorder of vigilance, that has symptoms which overlap those of attention deficit-hyperactivity disorder. Vigilance is the state of being watchful, awake, and alert. When vigilance is lost, the individual has difficulty sustaining attention. The most obvious evidence of lowered vigilance is motor restlessness (fidgeting and moving about, yawning and stretching, talkativeness, or a combination of these) to improve alertness when sitting or standing still or when involved in tasks requiring continuous mental performance. When prevented from being active to stay awake, persons with lowered vigilance will stare off, daydream, show minor hyperactivity, and finally may fall asleep. They will also have decreasing attention to current activities and usually avoid or lose interest in structured or repetitive activities (complaining of boredom and monotony). The primary disorder of vigilance (for which criteria have been established) is a dominantly inherited condition with onset in early childhood and worsening symptoms with age. Persons with the primary disorder of vigilance have a remarkably kind and caring temperament. When untreated this disorder can cause chronic failure at school and work, but when properly recognized it responds well to treatment with stimulant medication and schedules that avoid sameness and repetition.

Arousal↗
PubMed2001

Errorless compliance training with physically abusive mothers: a single-case approach.

OBJECTIVE: "Errorless compliance training" is a recently developed, success-based approach for teaching children to comply with parental requests without the use of coercive consequences. Two mothers were trained to use this intervention to reduce severe child defiance that was precipitating mother/child confrontations and physical abuse. METHOD: To determine probability of child compliance to specific requests, we observed mothers delivering requests to their child. We then developed a hierarchy of compliance probabilities for each child. Mothers were trained to deliver a high density of Level 1 requests (those that typically yielded compliance), and provide praise for child compliance. Lower probability request levels were introduced gradually, at a slow enough pace to preclude noncompliant responses, reducing the need for mothers to respond aversively to child behavior. RESULTS: At treatment completion and follow-up, both children demonstrated substantial improvements in compliance. CONCLUSIONS: The errorless approach may be well suited to managing parenting deficits and child opposition commonly associated with family violence.

Adult↗
PubMed2003

Brief report: Behavioral adjustment of siblings of children with autism.

Existing research studies have shown mixed results relating to the impact upon children of having a sibling with a disability. However, siblings of children with autism may be more at risk than siblings of children with other disabilities. In the present study, data were gathered on 22 siblings of children with autism. These children were rated by their mothers as having more behavior problems and fewer prosocial behaviors than a normative sample. Analysis of variables predicting sibling behavioral adjustment revealed that boys with siblings who have autism, and also those younger than their sibling with autism, engaged in fewer prosocial behaviors. Psychological adjustment of mothers (stress) and the child with autism (behavior problems) were not predictive of sibling behavioral adjustment.

Adolescent↗
PubMed1995

Recreational multifamily therapy for troubled children.

Recreation-based family groups were formed as modalities in the treatment of school-age children enrolled at a day treatment center and of preschoolers with potential for enrollment. The groups, which had psychoeducational and self-help components, were successful in involving hitherto unwilling parents in their children's treatment, in helping them acquire parenting skills, and in reducing family conflict.

Anxiety Disorders↗
PubMed1998

Clonidine poisoning--an emerging problem: epidemiology, clinical features, management and preventative strategies.

OBJECTIVE: To ascertain whether the incidence of clonidine poisoning in children has increased given the probable increase in clonidine use for treatment of childhood behavioural disorders. METHODS: Cases of clonidine poisoning requiring hospital admission between 1985-95 inclusive were reviewed and demographic data pertinent to each admission were recorded. A literature review was also performed, with particular emphasis on incidence, clinical presentation and management of clonidine poisoning. RESULTS: There were 14 cases of clonidine poisoning during the specified period eight cases presenting in the last 2 years. These eight children or their siblings had been prescribed clonidine for behavioural disorders. The most common signs at presentation were alteration of conscious state (71%) and bradycardia (50%). Nine children were given activated charcoal while seven cases underwent gastric lavage or induced emesis. Although six children were admitted to intensive care, length of hospital stay was less than 24 h in all cases and all had a favourable outcome. CONCLUSION: We concluded that the incidence of clonidine poisoning had increased over the specified period and that, based on our results, this was likely to be due to an increase in clonidine use in childhood behavioural disorders. Based on our data and that from literature review it was evident that there are inconsistencies in the management of clonidine poisoning and that safety measures, namely packaging and education, are inadequate given the increasing profile of clonidine use.

Attention Deficit Disorder with Hyperactivity↗
PubMed1992

Liaison psychiatry in pediatric surgery--a promising approach.

Liaison psychiatry in pediatric surgery is described and the experiences at the University Children's Hospital in Zurich are reported. The patients seen by the child psychiatrist in surgery are specified and compared with those seen in pediatrics. For the most part the same psychiatric diagnoses were made in both groups with some differences in frequency. It is concluded that liaison psychiatry should be implemented in pediatric surgery, as has long been the case in pediatrics.

Accidents↗
PubMed1993

A psychiatric population of prenatally cocaine-exposed children.

The backgrounds and behaviour of 40 prenatally cocaine exposed children referred to the child psychiatry program of an inner-city teaching hospital are explored. The population described is unique to the literature in these ways: (1) Most of the children were not detected as cocaine-exposed at birth, and were disclosed as cocaine-exposed by historical account. (2) Most of the children had lived within drug-dominated home environments for varying lengths of time. Findings indicated that the children receiving intervention early in life, whether detected as cocaine-exposed at birth or by historical account, fared much better socially and emotionally as measured by rate of abuse and severity of psychiatric symptoms. It is concluded that instances of prenatal cocaine exposure should be ascertained at the earliest possible point to intervene in potentially deleterious environmental outcome and associated psychiatric morbidity. Four illustrative cases are presented.

Attention Deficit Disorder with Hyperactivity↗