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Chromosome 22q11 deletion syndrome (CATCH 22): neuropsychiatric and neuropsychological aspects.

Twenty children and young adults (age range 5 to 33 years, 12 females and eight males) with genetically confirmed 22q11 deletion syndrome (CATCH 22: Cardiac anomaly, Anomalous face, Thymus hypoplasia/aplasia, Cleft palate, and Hypocalcaemia), recruited from a large ongoing study, were given comprehensive assessments with a view to determining the pattern of neuropsychiatric and neuropsychological deficits thought to be part of the syndrome in many cases. IQ ranged between 46 and 100 with a mean score of 70. Half the group had an IQ <70. In 13 individuals, attention-deficit-hyperactivity disorder (ADHD), mainly inattentive or combined type in most cases, and/or autism spectrum problems were diagnosed. Many participants, even among those who had an IQ within the normal range and had neither ADHD nor autistic spectrum problems, showed a characteristic and pronounced behavioural profile with low mental energy, initiation difficulties, deficits in sustained attention, and social interaction (often augmented by limited facial expression and communication and speech problems).

Abnormalities, Multiple↗

A 3-year follow-up of children with and without behavioral inhibition.

OBJECTIVE: Previous work suggested that children of parents with panic disorder and agoraphobia were likely to be classified as behaviorally inhibited and that behaviorally inhibited children were likely to develop anxiety disorders. Although these findings suggested that "behavioral inhibition to the unfamiliar" may be associated with risk for anxiety disorders in children, longitudinal data were needed to confirm the initial impressions. METHOD: Using DSM-III structured interviews, the authors examined psychiatric disorders at 3-year follow-up in children of two independently ascertained, previously described, and preexisting samples of children. One sample was cross sectional and clinically derived (Massachusetts General Hospital at-risk sample), and the other was epidemiologically derived and longitudinal (Kagan et al. Longitudinal Cohort). RESULTS: Analyses of follow-up findings revealed significant differences between inhibited and not inhibited children in the rates of multiple > or = 4 psychiatric disorders, multiple > or = 2 anxiety disorders, avoidant disorder, separation anxiety disorder, and agoraphobia. Among inhibited children, the rates of anxiety disorders increased markedly from baseline to follow-up assessments, attaining statistical significance for multiple > or = 2 anxiety disorders and avoidant disorder. Our findings also show there were significant differences between inhibited and not inhibited children in the emergence of multiple > or = 2 anxiety disorders, avoidant disorder, and separation anxiety disorder in children who did not have these diagnoses at baseline. CONCLUSIONS: These findings indicate that inhibited children are at high risk for developing childhood-onset anxiety disorders and provide additional support for the hypothesis that behavioral inhibition is a predictor of later anxiety disorder.

Adolescent↗

[Effects of partial inpatient treatment of preschool children with behavior disorders and developmental delay].

In a sample of 55 preschool children, four to seven years of age, treated by a therapeutic day-treatment programme up to 3;4 years, developmental delays and behavioral disorders, rated by parents and preschool teachers, were assessed every five months until discharge. Developmental delays and behavioral disorders were reduced clinically and statistically significant between onset of treatment and discharge. This result could also be verified preponderantly by analysing several measurement points in parts of the sample with different treatment durations. Comparing changes during a waiting period of one year at most with changes during a waiting period of one year at most with changes during day-treatment of equal duration, treatment effects could be verified at least as a tendency for changes in behavior problems but not for developmental abilities due to methodological problems.

Affective Symptoms↗

Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification.

The prevalence, in children aged under 15, of severe impairments of social interaction, language abnormalities, and repetitive stereotyped behaviors was investigated in an area of London. A "socially impaired" group (more than half of whom were severely retarded) and a comparison group of "sociable severely mentally retarded" children were identified. Mutism or echolalia, and repetitive stereotyped behaviors were found in almost all the socially impaired children, but to a less marked extent in a minority of the sociable severely retarded. Certain organic conditions were found more often in the socially impaired group. A subgroup with a history of Kanner's early childhood autism could be identified reliably but shared many abnormalities with other socially impaired children. The relationships between mental retardation, typical autism, and other conditions involving social impairment were discussed, and a system of classification based on quality of social interaction was considered.

Adolescent↗

A follow-up investigation of offspring of parents with bipolar disorder.

Seven male children who each had a manic-depressive parent (five alos had a parent with unipolar depression) and 12 control children were studied. The proband children had shown a range of adjustment problems as infants and toddlers. Four years later, they continued to have substantial behavior problems, including ones that could be classified as DSM-III psychiatric diagnoses. On the basis of psychiatric interviews and psychological assessments, the proband children received more DSM-III diagnoses than the control children. Proband children reported internalizing symptoms; this pattern was corroborated by their mothers, who also characterized these children as showing antisocial behavior patterns.

Adjustment Disorders↗

Maternal beliefs as long-term predictors of mother-child interaction and report.

2 kinds of parental beliefs: endorsed rearing philosophy (authoritative-authoritarian dimension) and affective attitude toward child (positive-negative affect dimension) were examined in 20 normal and 36 depressed mothers as long-term predictors of their rearing behaviors and interaction patterns with their children, and of their ratings of child externalizing problems (Achenbach CBCL). The beliefs were measured when the children were toddlers (Time 1), and maternal behaviors 2-3 years later (Time 2). Mothers' endorsement of the belief in authoritative parenting predicted their frequent avoidance of prohibitive interventions. It also predicted maternal autonomy-granting to the child (more compliant and liberal responses to child-initiated control interventions). Endorsed child-rearing philosophy was a relatively more important predictor of behavior for normal mothers, and affective attitude toward child for the behavior of depressed mothers. Both actual child noncompliance and parental beliefs predicted mothers' ratings of externalizing problems in their children. The former was relatively more important for normal and latter for depressed mothers.

Affect↗

Behavior problems associated with sleep disordered breathing in school-aged children--the Tucson children's assessment of sleep apnea study.

OBJECTIVE: The purpose of the current study was to examine prevalence of and relations between a commonly used measure of nighttime breathing problems, the Respiratory Disturbance Index (RDI), and a range of problem behaviors in community children. METHODS: Participants were 403 unreferred children aged 6-12 years. Recruitment was completed through public elementary schools. Overnight unattended in-home polysomnography was used to assess sleep and breathing. The RDI was used as the indicator of respiratory events during sleep. The Child Behavior Checklist and the Conners' Parent Rating Scales-Revised were used to assess behavior. RESULTS: Prevalence rates for Attention, Cognitive Problems, Aggression, Oppositional behavior, and Social Problems were greatest for subjects with high RDIs. Prevalence for Internalizing behaviors was not greater for those subjects with high RDIs. Hyperactivity was not strongly related to higher RDIs. CONCLUSIONS: Behavioral problems may exist in the presence of nocturnal breathing events in unreferred children. Specific patterns of behavioral morbidity have still not been established. Some behaviors, such as hyperactivity, may show differing sensitivity and specificity in relation to the RDI.

Adolescent↗

Classification issues of bipolar disorders in childhood.

As systematic interviewing has become more widespread, it has been possible to identify significant populations of children and adolescents who meet adult criteria for depression. The difficulties associated with identifying correctly the phenomenology of major depression in children are reviewed. The significance of separation anxiety, anorexia, attention deficit and conduct disorder, as 'depressive equivalents' is discussed, although a change in mood or ability to experience pleasure appear to carry greater diagnostic weight. While the identification of mania and hence of bipolar disorder in children is more difficult, the appearance of a definite maniac syndrome in preadolescence is relatively uncommon. Data are reviewed suggesting the existence of an alternative and more common form of bipolar disorder in childhood, characterized by affective lability, irritability and explosive behavior. However, available data do not support the view that attention deficit disorder and 'emotionally unstable character disorder' are variants of bipolar syndromes.

Adolescent↗

Unmasking masked depression in children and adolescents.

The authors examined depressive symptoms and behavior disorders in 102 systematically interviewed children aged 7 to 17 years to elucidate the category of masked depression. They found that it was possible to diagnose these children using adult research criteria and that more children with depression were identified using a systematic interview than were identified using standard evaluation procedures. Although children with a depressive disorder may also exhibit behavior disorders that overshadow the depression, an alert clinician conducting a thorough interview should be able to identify the "masked" depression.

Adjustment Disorders↗

Use of the structured descriptive assessment with typically developing children.

To date, only a limited number of studies have focused on functional assessment with typically developing populations. The most commonly reported method of functional assessment with this population seems to be descriptive assessment; however, the methods used in the descriptive assessment often are unclear. This is unfortunate as researchers and practitioners often are left with little guidance as to how to conduct a functional assessment with typically developing children. The purpose of this study was to determine whether the structured descriptive assessment (SDA) might be used with typically developing children. Four children with problem behavior participated in the study, and hypotheses about functional relations were developed for all children. Furthermore, efficacious interventions were developed and implemented for 2 children based on the results of the SDA.

Aggression↗

The relationship between defenses and symptoms in adolescent psychopathology.

The relationship between defense mechanisms and symptoms was assessed in a group of 196 psychiatrically hospitalized adolescents. Defense mechanisms were measured through the use of the Defense Mechanisms Inventory (DMI); symptoms and problem behaviors were measured with the Youth Self-Report. Univariate and multivariate analyses indicated that externalizing symptoms are associated with defenses that locate the conflict outside of the self, whereas internalizing symptoms are associated with defenses that locate the conflict within the self. In contrast to previous reports, no gender differences were found in defense preference, though gender differences were found in the relation of defenses to symptoms. The findings are consistent with clinical theory of defense processes and support the distinction between internalizing/externalizing behaviors and personality dimensions for both symptoms and defenses. The study supports the validity of the adolescent form of the DMI.

Adjustment Disorders↗

Behavioral inhibition in childhood: a risk factor for anxiety disorders.

Childhood antecedents of anxiety disorders in adulthood remain poorly understood. We have, therefore, examined from longitudinal and familial perspectives the relationship between behavioral inhibition in children and anxiety disorders. We review a series of studies describing the association between behavioral inhibition and anxiety disorders in two independently ascertained and previously described samples of children. One sample was cross-sectional and clinically derived (Massachusetts General Hospital at-risk sample), and the other was epidemiologically derived and longitudinal (Kagan et al. longitudinal cohort). Our studies have found that (1) children of parents with panic disorder with agoraphobia, either alone or comorbid with major depressive disorder, are at increased risk for behavioral inhibition; (2) children identified as having behavioral inhibition have high rates of childhood-onset anxiety disorders themselves; (3) behavioral inhibition is associated with familial risk for anxiety disorders; (4) children with behavioral inhibition and anxiety disorders have greater familial loading of anxiety disorders; (5) children who remain inhibited over time are at highest risk for anxiety disorders in themselves and their families; and (6) these differences between inhibited children and not-inhibited controls become more robust at 3-year follow-up. Our research strongly indicates that behavioral inhibition is an identifiable early childhood predictor of later anxiety disorders.

Adolescent↗

[Disturbances of mental development in infants and preschool children. Their recognition and treatment (author's transl)].

After a short introduction setting out the importance of development dimensions for the understanding of disturbances of development and some statistics on the frequency of peculiarities of behavior in the preschool age, some disorders of mental development of practical importance in the first years of life are dealt with. Psychomotor disturbances, disorders of speech and speaking and emotional and contact disturbances are emphasized.

Anxiety↗

Adolescent outcomes of childhood conduct disorder among clinic-referred boys: predictors of improvement.

Much remains to be learned about the adolescent outcomes of clinic-referred boys whose childhood conduct problems are serious enough to meet diagnostic criteria for conduct disorder (CD). Six structured diagnostic assessments were conducted over 7 years of 73 clinic-referred 7-12-year-old boys who met criteria for CD in Wave 1. There were substantial individual differences in the adolescent outcomes of CD, ranging from worsening to sustained recovery, with most boys showing persistent, but fluctuating levels of CD. Improvement in CD was not accounted for by treatment or incarceration, but more positive outcomes over Waves 2-7 were predicted prospectively with substantial accuracy, using a combination of baseline predictors: less initial severity of CD, fewer symptoms of attention-deficit hyperactivity disorder, higher child verbal intelligence, greater family socioeconomic advantage, and not having antisocial biological parents.

Adolescent↗

Patterns of coping in families of psychotic children.

The nature of family adaptation to severely and chronically disabling cognitive and behavioral conditions is considered. The relationship between atypical development and family response is examined to derive basic concepts--parents' perceptions of their child's unusual characteristics, effects on social relationships, etc.--and suggest strategies for intervention and research.

Adaptation, Psychological↗