Showing papers by "Michael Rutter published in 2008"

Inattention/Overactivity Following Early Severe Institutional Deprivation : Presentation and Associations in Early Adolescence

Abstract: The current study examined the persistence and phenotypic presentation of inattention/overactivity (I/O) into early adolescence, in a sample of institution reared (IR) children adopted from Romania before the age of 43 months. Total sample comprised 144 IR and 21 non-IR Romanian adoptees, and a comparison group of 52 within-UK adoptees, assessed at ages 6 and 11 years. I/O was rated using Rutter Scales completed by parents and teachers. I/O continued to be strongly associated with institutional deprivation, with continuities between ages 6 and 11 outcomes. There were higher rates of deprivation-related I/O in boys than girls, and I/O was strongly associated with conduct problems, disinhibited attachment and executive function but not IQ more generally, independently of gender. Deprivation-related I/O shares many common features with ADHD, despite its different etiology and putative developmental mechanisms. I/O is a persistent domain of impairment following early institutional deprivation of 6 months or more, suggesting there may be a possible pathway to impairment through some form of neuro-developmental programming during critical periods of early development.

Do Theory of Mind and Executive Function Deficits Underlie the Adverse Outcomes Associated with Profound Early Deprivation?: Findings from the English and Romanian Adoptees Study.

Abstract: Theory of Mind (ToM) and Executive Function (EF) have been associated with autism and with attention-deficit hyperactivity disorder (ADHD), and hence might play a role in similar syndromes found following profound early institutional deprivation. In order to examine this possibility the current study included a group of 165 Romanian adoptees, of whom 144 were adopted into the UK from deprived institutional settings before 43months of age, and a group of 52 within-UK adoptees, all adopted before 6months of age. Both groups were assessed at 6 and 11years. The Strange Stories task was used to assess ToM and the Stroop task was used to assess EF, both at age 11. The Romanian adoptees displayed deficits in both ToM and EF compared with the within-UK adoptee group. The degree of deficit was greater for children who had experienced more than 6months of institutional deprivation. Deficits in both domains (ToM and EF) were associated with each of the three apparently deprivation-specific problems, namely quasi-autism, disinhibited attachment and inattention/overactivity. Statistical analyses indicated a mediating role for both ToM and EF with respect to quasi-autism; possibly a partial mediating role for EF with respect to inattention/overactivity; and probably no mediating role for either ToM or EF in the case of disinhibited attachment. In conclusion, there is evidence for a possible mediating role for ToM and EF in the development of some apparently deprivation-specific difficulties in institution-reared Romanian adoptees, but neither accounts for the overall pattern of deprivation-related difficulties.

Hyperkinetic disorder in psychiatric clinic attenders.

Abstract: Sixty-eight boys (age-range five to 11 years), referred to a child psychiatric clinic, were studied in order to determine the validity of a broadly-based concept of hyperkinetic syndrome, as generally employed in the USA. Hyperactivity was measured on the Conners' Teacher Questionnaire, the Conners' Parent Questionnaire and by systematic time-sampled observations of each child's behaviour during psychological testing. There were low and statistically insignificant correlations between these different measures of hyperkinesis. On the other hand, overactivity correlated highly with conduct disturbance. Psychiatrically abnormal children with and without hyperkinesis were compared on cognitive functioning, perinatal history, neurological examination, congenital anomalies and psycho-social circumstances. Few differences were found, and it was concluded that there was no evidence for the validity of a broad concept of hyperkinetic syndrome. Nevertheless, a small number of children were found who were overactive in all situations studied. These children had a variety of clinical diagnoses but differed significantly from their peers--matched for age, IQ and diagnosis--with respect to neurological anomalies, erratic responses on the Matching Familiar Figures Test, and early onset of hyperkinesis. It is suggested that this less common clinical picture of hyperkinesis may have some validity, but it remains uncertain whether it constitutes a distinct syndrome or rather a constitutional risk factor.

A replicated molecular genetic basis for subtyping antisocial behavior in children with attention-deficit/hyperactivity disorder

Abstract: Context. Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous neurodevelopmental disorder that in some cases is accompanied by antisocial behavior. Objective. To test if variations in the catechol O-methyltransferase gene (COMT) would prove useful in identifying the subset of children with ADHD who exhibit antisocial behavior. Design. Three independent samples composed of 1 clinical sample of ADHD cases and 2 birth cohort studies. Participants Participants in the clinical sample were drawn from child psychiatry and child health clinics in England and Wales. The 2 birth cohort studies included 1 sample of 2232 British children born in 1994-1995 and a second sample of 1037 New Zealander children born in 1972-1973. Main Outcome Measures. Diagnosis of ADHD and measures of antisocial behavior. Results. We present replicated evidence that the COMT valine/methionine polymorphism at codon 158 (COMT Val158Met) was associated with phenotypic variation among children with ADHD. Across the 3 samples, valine/valine homozygotes had more symptoms of conduct disorder, were more aggressive, and were more likely to be convicted of criminal offenses compared with methionine carriers. Conclusions. The findings confirm the presence of genetic heterogeneity in ADHD and illustrate how genetic information may provide biological evidence pointing to clinical subtypes.

Early Hospital Admissions and Later Disturbances of Behaviour: An Attempted Replication of Douglas' Findings

Abstract: This study confirms the findings of Douglas (1975) that single hospital admissions of children for up to a week carry no increased risk of later emotional or behavioural disturbance. The study also confirms Douglas' finding that repeated hospital admissions are significantly associated with disturbance in later childhood. The association probably applies to both emotional and conduct disorders, is most marked in the case of children from disadvantaged homes, and it may well reflect a causal influence. The validity of the finding is strengthened by the fact that detailed psychiatric assessments gave rise to much the same findings as did teacher questionnaire scores. However, in both cases, repeated hospital admissions are associated with only a small minority of disorers and account for little of the variance in children's behaviour.

Emotional difficulties in early adolescence following severe early deprivation: findings from the English and Romanian adoptees study.

Abstract: The study assessed conduct and emotional difficulties in a group of Romanian adoptees at age 11, and serves as a follow-up to assessments made when the children were 6 years old. It was found that there was a significant increase in emotional difficulties, but not conduct problems, for the Romanian sample since age 6. It was also found that emotional difficulty was significantly more prevalent at age 11 in the Romanian group than in a within-UK adoptee group. Emotional difficulties in the Romanian adoptee group were found to be significantly and strongly related to previous deprivation-specific problems (disinhibited attachment, cognitive impairment, inattention/overactivity and quasi-autism); however, the presence of such early problems did not account fully for the onset of later emotional problems. Five contrasting hypotheses concerning possible mediators for later onset of emotional difficulties for the Romanian group were examined. No links were found to duration of deprivation or other deprivation-related indices, stresses/difficulties in the postadoption family environment, or educational attainment and self-esteem. There was some evidence that emotion recognition might play a role in the emergence of these problems, but other measures of social competence and theory of mind showed no associations with the onset of emotional problems.

The effects of early social- emotional and relationship experience on the development of young orphanage children

Abstract: vii I. THEORETICAL, EMPIRICAL, AND PRACTICAL RATIONALE 1 II. BABY HOMES IN THE RUSSIAN FEDERATION 16 III. RESEARCH DESIGN AND INTERVENTIONS 3 0 IV. ASSESSMENTS 57 V. EVIDENCE THAT THE INTERVENTIONS WERE IMPLEMENTED AS PLANNED 8 4 VI. CAREGIVER BEHAVIOR O N THE WARDS (HOME INVENTORY) 9 5 VIL ORPHANAGE STAFF ATTITUDES, PERCEPTIONS, AND FEELINGS 108 VIII. INTERVENTION EFFECTS O N PHYSICAL GROWTH 124 IX. THE EFFECTS OF THE INTERVENTION O N CHILDREN'S GENERAL BEHAVIORAL DEVELOPMENT (BATTELLE DEVELOPMENTAL INVENTORY) 142 X. EFFECTS OF THE INTERVENTIONS OF CAREGIVER-CHILD INTERACTIONS DURING FREE PLAY (PCERA) 167 XL INTERVENTION EFFECTS O N CAREGIVER-CHILD INTERACTIONS (INFANT AFFECT MANUAL, ATTACHMENT VARIABLES) 1 8 7 XII. SCIENTIFIC AND PRACTICAL CONCLUSIONS AND IMPLICATIONS 2 2 4 REFERENCES 2 4 5 ACKNOWLEDGMENTS 261

New-onset psychiatric disorders in individuals with autism

Abstract: A follow-up study to at least the age of 21 years of 135 individuals with an autism spectrum disorder diagnosed in childhood and an IQ of over 30 was conducted. The study is distinctive in its large size, low attrition rate and use of systematic interviews to obtain clinical information. Questionnaires completed by caregivers asked about the development of new psychiatric disorders. For the 39 individuals with a possible new disorder, a detailed psychiatric assessment was undertaken through parental interview. Of all participants, 16 percent developed a definite new psychiatric disorder. A further 6 percent developed a possible new disorder. Five individuals developed an obsessive-compulsive disorder and/or catatonia; eight an affective disorder with marked obsessional features; three complex affective disorders; four more straightforward affective disorders; one a bipolar disorder; and one an acute anxiety state complicated by alcohol excess. There was no case of schizophrenia.

Psychological disorders in crippled children. A comparative study of children with and without brain damage.

Abstract: SUMMARY A detailed standardised study was made of all crippled children aged between five and 15 years and of normal intelligence on the local-authority lists of handicapped children in three London boroughs. Psychiatric disorder was twice as common in children whose crippling was due to cerebral disease or damage rather than some peripheral lesion. As the groups were well matched in terms of physical incapacity and social background, it was concluded that brain damage was responsible for the children's increased vulnerability to emotional problems. Brain damage was also associated with a marked increase in reading difficulties and a lowering of intelligence within the normal range. Psychiatric disorder was found to be related not only to cerebral injury but also to various types of family disturbance. It is concluded that emotional and behavioural disturbance stemmed from both an increased biological vulnerability and psychosocial hazards. RESUME Troubles psychologiques chez les enfants handicapes: etude comparative d'enfants avec et sans lesion cerebrale Il s'agit d'une etude standardisee et detaillee de tous les enfants infirmes âges de cinq a quinze ans et d'intelligence normale repertories sur des listes administratives locales d'enfants handicapes de trois quartiers de Londres. Les troubles psychiatriques etaient deux fois plus frequents chez les enfants infirmes par pathologie cerebrale par rapport aux cas de lesions peripheriques. Comme les groupes etaient bien apparies sur le plan de l'incapacite physique et de l'environnement social, on peut conclure que la pathologie cerebrale etait responsable de la vulnerabilite accrue vis a vis des problemes emotionnels. La presence d'une lesion cerebrale etait aussi associee a un accroissement marque des difficultes de lecture et a une intelligence plus faible de la zone normale. Les troubles psychiatriques etaient relies non seulement a l'agression cerebrale mais egalement aux differents types de perturbation familiale. Il a done ete conclu que les troubles caracteriels et de comportement relevaient a la fois d'une vulnerabilite organique et de conditions psychologiques. ZUSAMMENFASSUNG Psychologische Probleme bei verkruppelten Kindern: eine vergleichende Studie von Kindern mit und ohne Hirnschaden Es wurde eine detailierte standardisierte Studie an alien in den Listen der Ortsbehorden von drei Londoner Vororten aufgefuhrten behinderten Kindern mit normaler Intelligenz im Alter von 5 bis 15 Jahren durchgefuhrt. Psychiatrische Storungen waren bei den Kindern, deren Behinderung cerebral bedingt war, zweimal so haufig wie bei denen mit peripheren Lasionen. Da die Gruppen im Hinblick auf physische Behinderung und soziale Herkunft gut ausgesucht waren, wurde gefolgert, das die Hirnschadigung als Ursache fur ein Auftreten emotionaler Probleme bei diesen Kindern anzusehen ist. Bei Hirnschaden traten deutlich haufiger Leseschwierigkeiten auf und die Intelligenz war im unteren Normbereich. Psychiatrische Storungen waren nicht nur durch Hirnschaden sondern auch durch verschiedene familiare Probleme bedingt. Es wird angenommen, das Storungen im emotionalen—und Verhaltensbereich sowohl durch eine erhohte biologische Anfalligkeit sowie psychosoziale Umstande entstehen. RESUMEN Alteraciones psicologicas en ninos minusvalidos: Estudio comparativo de ninos con o sin lesion cerebral Se realizo un detallado estudio standardizado de todos los ninos minusvalidos de 5 a 15 anos de edad, con inteligencia normal, que constaban en las listas de las autoridades locales de ninos minusvalidos en tres barrios de Londres. La alteration psiquiatrica era dos veces mas corriente en ninos cuya minusvalencia se debia a una patologia cerebral, mas bien que a una lesion periferica. Puesto que los grupos se correspondian bien en cuanto a la incapacidad fisica y el fondo social, se concluyo que la patologia cerebral era responsable de la aumentada vulnerabilidad de los ninos para los problemas emocionales. La lesion cerebral estaba tambien asociada con un marcado aumento en las dificultades para leer y una disminucion de la inteligencia dentro de los margenes normales. La alteracion psiquiatrica se hallo que estaba en relation no solo con el insulto cerebral, sino tambien con varios tipos de disturbio familiar. Se concluyo que la alteraciones amocionales y de comportamiento procedian de una vulnerabilidad biologica aumentada y tambien de azares psicosociales.

The Influence of Organic and Emotional Factors on the Origins, Nature and Outcome of Childhood Psychosis

Abstract: UMMARY I believe that child psychosis is not part of schizophrenia. It is a disorder which is usually associated with receptive and executive speech defects. These are often, but not always, part of a more general organic damage to the brain. Other disorders of perception are probably important in some children. Psychosis is not primarily emotional in origin and psychogenic factors usually play only a secondary role in the development of the condition. However, the child's emotional relationships may be fundamental in determining whether or not he is able to overcome his handicaps. Finally, the education received by the autistic child is a very important influence on outcome. RESUME L'influence de facteurs organiques et emotifs sur l'origine, la nature et les consequences des psychoses de l'enfance. Je crois que la psychose de l'enfance ne fait pas partie de la schizophrenie. C'est un desordre habituellement associea des deficiences de parole receptives et executives. Celles-ci constituent souvent, mais pas toujours, un aspect d'une lesion organique plus generale du cerveau. D'autres desordres de la perception sont probablement importants chez quelques enfants. La psychose n'est pas principalement emotive d'origine; les facteurs psychogeniques ne jouent habituellement qu'un role secondaire dans le developpement de cet etat. Pourtant, les relations emotives de l'enfant peuvent etre fondamentale pour determiner s'il sera capable ou non de surmonter son handicap. Finalement, l'education recue par l'enfant autiste a une tres importante influence sur l'avenir. ZUSAMMENFASSUNG Die Auswirkungen organischer und emotionaler Faktoren bei Ursprung, Charakter und Folgen der Kinderpsychose Kinderpsychose gehort nicht zu den schizophrenen Krankheiten. Es ist eine Storung, die meistens mit rezeptiven und exekutiven Sprechbehinderungen verbunden ist. Diese sind oft, doch nicht immer, Bestandteile einer mehr organischen Gehirnschadigung. Andere Perzeptionsstorungen sind wahrscheinlich wichtig bei einigen Kindern. Psychose ist nicht an erster Stelle emotionalen Ursprungs, und psychogenische Faktoren spielen mesitens nur eine zweitrangige Rolle bei der Entwicklung dieses Zustandes. Trotzdem konnen die emotionalen Beziehungsverhaltnisse des Kindes von wesentlicher Bedeutung sein, wenn man feststellen will, ob es fahig sein wird, seine Behinderungen zu uberwinden. Die Erziehung und Ausbildung, die man dem autistischen Kinde zukommen lasst, ubt einen sehr wichtigen Einfluss auf das Endergebnis aus. RESUMEN La influencia de factures organicos y emocionales en los origenes, el caracter, y el progreso de la psicosis en los ninos. Creo que la psicosis en los ninos no forma parte de la esquizofrenia. Es una enfermedad asociada por lo general con defectos receptivos y ejecutivos de lenguaje. Muchas veces, pero no siempre, estos defectos forman parte de un dano mas general del cerebro. Es probable que otros disturbios de percepcion sean importantes en algunos ninos. El origen de la psicosis no es primariamente emocional, y los factores psicogenicos son generalemente de importancia secundaria en el progreso de la enfermedad. Sin embargo, las relaciones emocionales del nino pueden ser cardinales en decidir si puede o no vencer sus incapacidades. Por ultima, la education que recibe un nino autistico tiene una influencia muy importante sobre su progreso.

Nonmaternal care in infancy and emotional/behavioral difficulties at 4 years old: moderation by family risk characteristics.

Abstract: The authors examined the role of familial risk and child characteristics in the association between the type of child care in infancy (maternal care [MC]) versus nonmaternal care [NMC]) and emotional/behavioral difficulties at 4 years old. Canadian families (N=1,358) with children between 1 and 12 months old were followed over 4 years. Family risks were found to moderate the association between type of child care and physical aggression. MC in infancy was associated with lower levels of physical aggression among children from a low-risk family background but not among those from a high-risk family background. The effect size was small (d=-0.16; confidence interval [CI]=-0.3, -0.01). Family risk and the sex of the child moderated the association between child care and emotional problems. MC in infancy was associated with a lower level of emotional difficulties among girls from low-risk families but not among boys or among children from high-risk families. The effect size was moderate (d=-0.44; CI=-0.65, -0.23). The study indicates that the effect of child care type in infancy varies by family and child characteristics.

The Long-term Effects of Early Experience

Abstract: Empirical research findings are reviewed with respect to the long-term effects of early experiences on intellectual and social development. Particular attention is focused on the question of whether adverse experiences in infancy can lead to enduring impairment, even when later experiences are positive and beneficial. It is concluded that, although there are continuities between infancy and maturity, the residual effects of early experiences on adult behaviour tend to be quite slight, both because of the maturational changes that take place during middle and later childhood and because of the effects of beneficial and adverse experiences during all the years after infancy. The long-term effects of early deprivation depend heavily on whether or not the deprivation continues, but there is a suggestion that, in some circumstances, infantile experiences may have some persisting effects in spite of later environmental change. However, there is a lack of critical data to test this hypothesis.

How should we construct psychiatric family history scores? A comparison of alternative approaches from the Dunedin Family Health History Study.

Abstract: BackgroundThere is increased interest in assessing the family history of psychiatric disorders for both genetic research and public health screening. It is unclear how best to combine family history reports into an overall score. We compare the predictive validity of different family history scores.MethodProbands from the Dunedin Study (n=981, 51% male) had their family history assessed for nine different conditions. We computed four family history scores for each disorder: (1) a simple dichotomous categorization of whether or not probands had any disordered first-degree relatives; (2) the observed number of disordered first-degree relatives; (3) the proportion of first-degree relatives who are disordered; and (4) Reed's score, which expressed the observed number of disordered first-degree relatives in terms of the number expected given the age and sex of each relative. We compared the strength of association between each family history score and probands' disorder outcome.ResultsEach score produced significant family history associations for all disorders. The scores that took account of the number of disordered relatives within families (i.e. the observed, proportion, and Reed's scores) produced significantly stronger associations than the dichotomous score for conduct disorder, alcohol dependence and smoking. Taking account of family size (i.e. using the proportion or Reed's score) produced stronger family history associations depending on the prevalence of the disorder among family members.ConclusionsDichotomous family history scores can be improved upon by considering the number of disordered relatives in a family and the population prevalence of the disorder.

Is sub‐nutrition necessary for a poor outcome following early institutional deprivation?

Abstract: Institutional deprivation is multifaceted and includes adverse psychosocial and nutrition-related components. In this study we partitioned these risks in relation to cognitive impairment and mental ill health, and explored the mediating role of reduced head/brain size. There were 138 participants (61 males, 77 females) in the study. Participants were Romanian adoptees who had experienced at least 2 weeks of early institutional deprivation. The sample was stratified on the basis of duration of deprivation (high risk >6mo in institutions) and sub-nutrition (i.e. 1.5 SD below UK age-related norms for weight at UK entry). UK children adopted before 6 months of age and a group of non-institutionally deprived Romanian children constituted the comparison groups. Duration of deprivation was associated with smaller head circumference, lowered IQ, and increased mental heath problems, independently of effects found for sub-nutrition on head circumference and IQ. The mediating role of head circumference was limited to either sub-nourished (IQ) or non-sub-nourished (inattention/overactivity and disinhibited attachment) subgroups. Many negative effects of early deprivation, including stunted brain growth, occur without sub-nutrition: psychosocial deprivation plays a major role in neurodevelopmental effects of deprivation. Further studies of functional and structural neuroanatomy following institutional deprivation are required to delineate the role of brain development in its effects.

Biological implications of gene-environment interaction.

Abstract: Gene–environment interaction (G × E) has been treated as both a statistical phenomenon and a biological reality. It is argued that, although there are important statistical issues that need to be considered, the focus has to be on the biological implications of G × E. Four reports of G × E deriving from the Dunedin longitudinal study are used as exemplars of the biological considerations that should lead to an hypothesis-driven choice of the specific genetic polymorphisms and the specific environmental influence to be investigated. The same four studies are used to discuss how the assessment of internal and external validity can be undertaken and how experimental approaches in humans and with animal models may be informative in the elucidation of the relevant operative biological mechanisms.

Interrelations between the choreiform syndrome, reading disability and psychiatric disorder in children of 8-11 years.

Abstract: SUMMARY Judgements about the presence of choreiform movements were found to be fairly consistent when the results of examinations by two independent observers were compared. The movements were commoner in boys, in younger children and in children of subnormal intelligence. However, significant associations were not found between choreiform movements and reading disability, psychiatric disorder, neurological abnormality or pregnancy complications. The clinical significance of the syndrome is called in question. REUME Interrelations entre le syndrome choreiforme, L'incapacite a lire et le desordre psychiatrique chez les enfants de huit a onze ans Les resultats des examens par deux observateurs independants ont ete raisonnablement consistants dans leur opinion sur la presence de mouvements choreiformes. Ces mouvements etaient plus communs chez les garcons, les enfants plus jeunes, et parmi les enfants d'intelligence sub-normale. Pourtant aucune association significative n'a ete trouvee entre les mouvements choreiformes et rincapacite a lire, les desordres psychiatriques, L'anomalie neurologique et les complications de la grossesse. La signification clinique du syndrome est mise en question. ZUSAMMENFASSUNG Wechselbeziehungen zwischen dem Choreiform Syndrome, Lesensunfahigkeit und psy-chiatrischer Storung bei acht bis elfjahrigen Kindern Urteile uber das Vorhandensein von Choreiform-Bewegungen erwiesen sich als ziemlich ubereinstimmend beim Vergleich der Untersuchungsergebnisse von zwei unabhangigen Beobachtern. Die Bewegungen traten haufiger auf bei Knaben, kleirien Kindern und bei Kindern von unterdurschschnittlicher Intelligenz. Jedoch wurden keine bedeutendm Beziehungen gefunden zwischen Choreiform-Bewegungen und Lesensunfahigkeit, psychia-trischer Storung, neurologischer Abnormalitat oder Schwangerschaftskomplikationen. Die klinische Bedeutung des Syndroms wird in Frage gestellt. RESUMEN Relaeiones entre el sindrome coreiforme, una inhabilidad para la lectura, y trastornos psiquidtricos en ninos de ocho a once anos Se hallo que opiniones sobre la presencia de movimientos coreiformes eran bastante consistentes cuando se compararon los resultados de examenes por dos observadores independientes. Los movimientos se encontraban mas frecuentemente en varones, ninos jovenes, y ninos de inteligencia subnormal. No obstante, no se hallaron asociaciones significantes entre los movimientos coreiformes y la inhabilidad para la lectura, el desorden psiquiatrico y la anormalidad neurologica, o complicaciones del embarazo. Se pone en duda la importancia clinica del sindrome.

Genetic effects on environmental vulnerability to disease

Abstract: 1 Michael Rutter Introduction: whither gene-environment interactions? 2 Rudolf Uher Gene-environment interaction: overcoming methodological challenges Discussion 3 Marco Battaglia, Cecilia Marino, Michel Maziade, Massimo Molteni and Francesca D'Amato Gene-environment interaction and behavioural disorders: a developmental perspective based on endophenotypes Discussion 4 Naomi R Wray, William L Coventry, Michael R James, Grant W Montgomery, Lindon J Eaves and Nicholas G Martin Use of monozygotic twins to investigate the relationship between 5HTTLPR genotype, depression and stressful life events: an application of Item Response Theory Discussion Appendix General discussion I 5 Harold Snieder, Xiaoling Wang, Vasiliki Lagou, Brenda W J H Penninx, Harriette Riese and Catharina A Hartman Role of gene-stress interactions in gene-finding studies Discussion 6 Kenneth A Dodge Practice and public policy in the era of gene-environment interactions Discussion 7 Kristi B Adamo and Frederique Tesson Gene-environment interaction and the metabolic syndrome Discussion General discussion II 8 Stephen P Robertson and Richie Poulton Longitudinal studies of gene-environment interaction in common diseases-good value for money? Discussion 9 Kee-Seng Chia Gene-environment interactions in breast cancer Discussion 10 Malak Kotb, Nourtan Abdeltawab, Ramy Aziz, Sarah Rowe, Robert W Williams and Lu Lu Unbiased forward genetics and systems biology approaches to understanding how gene-environment interactions work to predict susceptibility and outcomes of infections Discussion 11 Steven R Kleeberger and Hye-Youn Cho Gene-environment interactions in environmental lung diseases Discussion General discussion III 12 Fernando D Martinez Gene-environment interaction in complex diseases: asthma as an illustrative case Discussion 13 Michael Rutter Conclusions: taking stock and looking ahead Glossary Index of contributors Subject index

The experience of adoption (2): the association between communicative openness and self-esteem in adoption

Abstract: A study of the views of two groups of 11-year-old adopted children (one adopted as babies within the UK, n = 47, the other adopted from Romania, aged between two and 43 months, n = 133) indicates that parents underestimate the difficulty that their children have in talking about adoption. Children who found this harder experienced lower self-esteem at age 11 and were also more likely to feel different from their adoptive families, and both these factors were related to the individual child's level of behavioural or cognitive difficulties. Children in the Romanian sample who had another adopted sibling found it easier to talk about their adoption. In summary, the ease with which children can talk about adoption does appear to be associated with higher self-esteem and the individual child's difficulties, as well as family composition. This article by Celia Beckett, Jenny Castle, Christine Groothues, Amanda Hawkins, Edmund Sonuga-Barke, Emma Colvert, Jana Kreppner, Suzanne Stevens and Michael Rutter follows 'The experience of adoption (1)' (Hawkins et al, 2007), which explored intercountry and domestic adoption from the child's point of view.

Cerebral involvement in Duchenne-type muscular dystrophy?

Abstract: which occurs with the rise of intracranial pressure accompanying each heart beat. This pulse wave in the intraventricular fluid, which is normally transmitted to the subarachnoid space, opens up the central canal and gradually excavates the syrinx. The theory seems plausible, and GARDNER has certainly made out a good case for careful radiological investigation of the structures in and below the foramen magnum in patients with syringoniyelia since this may be where they should be operated on. GARDNER further suggests that Chiari's Type I and Type I1 malformations are basically the same and that the myelomeningocele which invariably accompanies the Type I1 (ArnoldChiari) malformation is not due to a fusion defect of the neural tube but represents a burst hydromyelic Here he is on less firm ground. The hindbrain deformity differs in the two types, since in Type I1 i t is the cerebellar vermis and not the tonsils which lies in the spinal canal4 and no transitional forms have been described. Furthermore the 4th ventricle is greatly elongated and the vermis lies inside it, being covered by the inferior medullary velum and matted choroid plexus. This arrangement can produce partial or indeed complete obstruction to the outflow of CSF from the 4th ventricle, and hydromyelia or syringomyelia may result. The lay-out of the spinal cord in the myelomeningocele, however. particularly the disposition of the anterior and posterior horns and their roots, strongly suggests that the nervous tissue here is usually an open neural plate and not a ballooned or burst spinal cord. Associated spinal cord anomalies, such as diastematomyelia, can also be better explained as a consequence of fusion defects.' Sometimes the open neural plate lies flat on the vertebral bodies, but sometimes CSF accumulates in front of it so that the plate comes to lie on the surface of the sac. The question of hydromyelia \\'PTSUS unfused neural tube in myelomeningocele is of practical importance. The neural plate may still be functional at birth (leg reflexes and anal sphincter tone, for instance. may be present) and it should clearly not be surgically removed wi th the meningocele sac. S. J . STRICH

Introduction: whither gene-environment interactions?

Abstract: Discussion Appendix General discussion I Role of gene-stress interactions in gene-finding studies Discussion Practice and public policy in the era of gene-environment interactions Discussion Gene-environment interaction and the metabolic syndrome Discussion General discussion II Longitudinal studies of gene-environment interaction in common diseases-good value for money? Discussion Gene-environment interactions in breast cancer Discussion Unbiased forward genetics and systems biology approaches to understanding how gene-environment interactions work to predict susceptibility and outcomes of infections

The Importance of Cultural Identity in Adoption: A Study of Young People Adopted from Romania:

Abstract: This article by Celia Beckett, Amanda Hawkins, Michael Rutter, Jenny Castle, Emma Colvert, Christine Groothues, Jana Kreppner, Suzanne Stevens and Edmund Sonuga-Barke examines attitudes regarding cultural and national identity in a group of 165 young people adopted from Romania. The attitudes of their adoptive parents are also explored. The adoptive parents were interviewed over three or four time periods, when their children were 4/6, 11 and 15 years, and the adopted young people at the age of 11 and 15. The majority of the adopted young people had an interest in Romania and expressed a wish to visit their country of origin. However, there was no association between this interest in Romanian identity and levels of self-esteem. The majority of the adoptees saw themselves as English or Anglo-Romanian. A small minority saw themselves as Romanian; these adoptees had both lower self-esteem and a higher level of deprivation-specific problems. The degree of sustained interest shown by adoptive parents in the im...

The neurobiology of violence: implications for prevention and treatment. Introduction.

Abstract: One contribution of 11 to a Discussion Meeting Issue ‘The neurobiology of violence: implications for prevention and treatment’.