[Reactive disorders in children: an obsolete concept?].
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Psychiatric and behavioral consequences of congenital rubella are reported for 243 children studies during the preschool period, and for 205 of these who were re-examined at ages 8 to 9. At preschool 37% were retarded, with the skew toward severe and profound; 15% had reactive behavior disorder and 7% had autism. At school age retardation diminished to 25%, but neurotic problems and behavioral pathology due to neurologic damage both increased. There were two remissions and three new instances of autism.
It has been previously hypothesized that hyperactivity may be one childhood form of manic-depressive disorder. The authors contend that it is unlikely that hyperactivity in general is a childhood form of manic-depressive disorder. However, included in those considered to be hyperactive may be youngsters exhibiting an embryonic form of mania. A case of a 5-year-old boy, originally thought to be hyperactive, is presented as evidence for the existence of an embryonic stage of mania. The clinical and research necessity for differentiating between hyperactivity and embryonic mania is stressed.
To determine whether children who demonstrate dexamethasone suppression test (DST) nonsuppression have lower plasma dexamethasone levels than DST suppressors, we administered the DST to 73 patients ranging in age from 5-14 years. Plasma dexamethasone levels and postdexamethasone cortisol levels were measured at 4:00 PM on day 2. We found: (1) DST nonsuppressors had significantly lower plasma dexamethasone levels (p less than 0.03) than suppressors; similar trends were observed when the population was divided into depressed and nondepressed patients; (2) mg/m2 dose of dexamethasone was directly correlated with plasma dexamethasone (p less than 0.003) and inversely correlated with postdexamethasone plasma cortisol levels (p less than 0.04); and (3) a statistically significant inverse correlation between plasma dexamethasone levels and postdexamethasone cortisol levels (p less than 0.04). Our findings show that plasma dexamethasone levels are important in evaluating DST results in psychiatrically disturbed children and suggest that dexamethasone dosage for use in the DST in children might be better calculated in terms of body surface area.
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This prospective study investigated the role that life events play in causing emotional and behavioural problems in a population of 240 primary school children who had recently survived a natural disaster. Life events experienced after the disaster were not found to contribute directly to the number of emotional or behavioural problems when the effect of the disaster was taken into account. This suggested that, in children, life events may not have a simple mechanically additive aetiological effect.
Mothers in the last trimester of the second pregnancy admit to being less active, more tired and moody than previously. Many were more anxious than usual. Their first child frequently showed behavioural changes. Those surveyed were between 1 1/2 and 4 years of age and showed more clinging, sleep disturbance and misbehaviour with tantrums than expected. It is presumed that the mother's pregnancy induces anxiety in her child with consequent behavioural changes.
Childhood behavioral problems are found to be related to both early temperament and parental behavior, in that first-year temperament scores predicted mild (but not more severe) problems. A parental pathology scale discriminated more severe cases among girls only; more severe cases among boys were accompanied by negative temperament changes. For both sexes, the form of subsequent behavioral problems was associated with first-year temperament patterns.
Certain parents use their child as a representative of their own unacceptable impulses, perceiving the youngster as evil and seeking experts to confirm their opinion. They come to mental health clinics for diagnoses but not treatment; evidence that contradicts their view is ignored out of a need to protect their own precarious psychological balance. The child, in spite of good early adjustment, tends to conform to the parents' preferred perception. Legal and ethical implications for professionals working with such cases are discussed.
Children often respond to hospitalization with severe anxiety and depression, frequently manifested by withdrawal or hyperactive and aggressive or hostile behavior. The use of paraverbal therapy, a specialized therapeutic approach, is described in the short-term treatment of patients exhibiting emotional disturbances secondary to illness or trauma.
Increasing survival rates for children with cancer raise questions about the long-term psychosocial impact of the disease and its treatment. Psychiatric evaluations of 114 survivors of childhood malignancies suggest a high rate of adjustment problems, with 59% indicating at least mild psychiatric symptomology. Interviews with former patients highlight the importance of adaptive denial in the face of the uncertainty connected with cancer survival.
This study examines the impact of exposure to family violence on school-aged boys. Boys who had witnessed violence between their parents were compared to boys who had been abused by their parents. The findings indicate that boys exposed to violence had a pattern of adjustment problems similar to those of abused boys and significantly different in severity and type from those of a community comparison group.
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The author describes characteristics of patients, primarily adolescents, who suffer from episodic violent behavior and their relations with their families. Typical family patterns include overly close alliances by the adolescent with one or both parents and transmission by parents of inconsistent values regarding aggression. Family therapy is the preferred treatment approach; treatment should be active, should initially focus on ways of handling dyscontrol episodes, and should emphasize that the patient is responsible for his or her actions.
The authors found that 22 of the 2,015 referrals to a children's psychiatric clinic during a six-year period were twins--half the number that would be expected on the basis of the national incidence of twins. Evidence of minimal brain dysfunction was found in a higher percentage of the twins than in a matched nontwin group. The authors suggest that factors often inherent in twins (e.g., prematurity and birth difficulties) may be related to this finding.
This paper is a clinical one, relating to a four-year analysis of a 28-month-old girl who developed an autistic syndrome as a reaction to the violent abduction of her parents which she had seen. The reality of the violence of the political situation in the country helped blur the distinction between fantasy and reality for both analyst and patient. The author introduced melodic singing (after the failure of singing with lyrics) as a means of communication with the little girl. Her eventual recovery seems to have been possible because of the soundness of her upbringing during the first two years of her life.