[Epidemiology of child behavior disorders].
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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.
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.
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.
One hundred ninety cases of lithium carbonate use in children and adolescents are reviewed and divided by the authors according to DSM-II criteria into major affective disorders, behavior disorders of childhood and adolescence, and schizophrenia, childhood type. Of these 190 cases, only 46 cases were described in detail. In this group of 25 males and 21 females, aged 3 to 19, there were 30 positive responses to lithium carbonate. A family history of diagnosed manic-depressive illness was reported in only eight cases, while 19 had a family history of other psychiatric disorders. We were impressed by the affective component, irrespective of diagnosis, in youngsters responding to lithium carbonate and by the use of the drug despite multiple neurological problems. Thirty cases had positive neurological findings. Nevertheless, the many incompletely reported cases prevent conclusive generalization and demonstrate the need for well-documented studies correlating clinical, familial, and biochemical indices.
Criteria for mania in children have been established on the basis of criteria for mania in adults. Mania in children is an episodic disorder characterized by marked irritability and agitation, a considerable increase in activity level, push of speech, sleep disturbances, distractability, and noticeable mood instability that persists for longer than one month. Euphoria is frequently present in children with mania and is manifested as an adamant denial of any illness or problem. Previous reports have not stressed the characteristic appearance of depressive symptoms, such as hopelessness and helplessness, crying spells, death wishes, and beliefs of persecution, all of which can occur during the manic episode in children.
In chronic schizophrenics, disordered motor development in childhood is followed by more early cognitive and social impairment and poorer outcome; childhood schizophrenics represent the most extreme variants of this. Preschizophrenic infants show a fluctuating dysregulation of maturation--or "pandevelopmental retardation" (PDR)--that involves physical growth; gross motor, visual-motor, and cognitive development; proprioceptive and vestibular responses; muscle tone; and possibly arousal. Pandevelopmental retardation was significantly related to a genetic history for schizophrenia (less than .05), but not to obstetric complications. The severity of PDR was significantly related to the severity of later psychiatric and cognitive disorder (less than .01). Pandevelopmental retardation provides a "marker" in infancy for the inherited neurointegrative defect in schizophrenia. These disordered functions should be studied by anyone interested in the biology of the schizophrenic genotype or in specific early interventions for children at risk.
The recent upsurge in megavitamin therapy raises questions about the role of vitamin deficiencies and dependencies in mental health. With this in mind, the plasma levels of folic acid, ascorbic acid, pyridoxine, and riboflavin were studied in approximately 125 children admitted to a child psychiatric unit. There were no apparent decreased levels of vitamins in these children in terms of their age, race, or psychiatric diagnosis. It is postulated that vitamin deficiencies per se cannot be proposed as etiological factors in any of the psychiatric deficits represented. Megavitamin therapy, if successful, is not effective due to crrection of vitamin deficiencies as opposed to vitamin dependencies and may be due to the metabolic onus and consequent effects of such heavy doses of vitamins.
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A sample of 99 early treated phenylketonuric children showed higher levels of behavioural deviance than 197 matched controls. For boys this excess of behavioural deviance persisted when IQ was taken into account. For phenylketonuric girls however it was restricted to those with IQs less than 70. The type of behavioural deviance shown by the boys over the whole IQ range was predominantly neurotic. The levels of behavioural deviance found in phenylketonuric children were among the highest that have been reported for children with various handicapping conditions.