Showing papers in "Journal of Child Psychology and Psychiatry in 2002"

Effects of marital conflict on children: recent advances and emerging themes in process‐oriented research

Abstract: Background: The effects of marital conflict on children's adjustment are well documented. For the past decade research has increasingly focused on advancing a process-level understanding of these effects, that is, accounting for the particular responses and patterns embedded within specific contexts, histories, and developmental periods that account for children's outcomes over time. Methods: As a vehicle for presenting an update, this review follows the framework for process-oriented research initially proposed by Cummings and Cummings (1988), concentrating on recent research developments, and also considering new and emerging themes in this area of research. Results: In this regard, areas of advancement include (a) greater articulation of the effects of specific context/stimulus characteristics of marital conflict, (b) progress in identifying the psychological response processes in children (e.g., cognitive, emotional, social, physiological) that are affected and their possible role in accounting for relations between marital conflict and child outcomes, (c) greater understanding of the role of child characteristics, family history, and other contextual factors, including effects on children due to interrelations between marital conflict and parenting, and (d) advances in the conceptualization of children's outcomes, including that effects may be more productively viewed as dynamic processes of functioning rather than simply clinical diagnoses. Conclusions: Understanding of the impact of marital conflict on children as a function of time-related processes remains a gap in a process-oriented conceptualization of effects. Based on this review, a revised model for a process-oriented approach on the effects of marital discord on children is proposed and suggestions are made for future research directions.

The Diagnostic Interview for Social and Communication Disorders: background, inter-rater reliability and clinical use.

Abstract: Background: The Diagnostic Interview for Social and Communication Disorders (DISCO) is a schedule for the diagnosis of autistic spectrum and related disorders and assessment of individual needs. It enables information to be recorded systematically for a wide range of behaviours and developmental skills and is suitable for use with all ages and levels of ability. In addition to helping the clinician to obtain a profile of each individual's pattern of development and behaviour, the DISCO also enables identification of specific features found in autistic spectrum disorders that are relevant for use with established diagnostic systems. Method: This paper describes the historical background of the DISCO, outlines its structure and reports the results of an inter-rater reliability study with parents of 82 children aged 3 to 11 years with autistic spectrum disorder, learning disability, language disorder or typical development. Results: Inter-rater reliability for the items in the interview was high (kappa coefficient or intra-class correlation at .75 or higher). This level of agreement was achieved for over 80% of the interview items.

Emotional and behavioral problems in children and adolescents with and without intellectual disability

Abstract: Background: The main objective of this study was to assess and compare the prevalence of a wide range of emotional and behavioral problems in children with and without intellectual disability (ID) Methods: We studied 1,041 non-residential children randomly selected from special schools for educable (IQ 60 to 80) and trainable (IQ 30 to 60) children without severe additional physical or sensory impairments, and compared them to 1,855 children randomly selected from the general population (both ages 6 to 18) Parents completed the Child Behavior Checklist (CBCL), and teachers the Teacher's Report Form (TRF) Results: Controlling for sex, age, and socioeconomic status, we found that both educable and trainable children had significantly higher mean scores on all CBCL and TRF scales than children without ID, except for trainable children on the scales Anxious/Depressed and Somatic Complaints Almost 50% of children with ID had a Total Problem score in the deviant range compared to about 18% in children without ID Compared to children without ID, the most prominent problem behaviors of educable children were Social Problems, Attention Problems, and Aggressive Behavior, and trainable children had an increased risk for Social Problems, Attention Problems, Withdrawn and Thought Problems Conclusions: Elevated scale scores reflected differences between children with and without ID over a broad range of items, and not solely on items more likely to be related to developmental delay Therefore, problem areas covered by the items in these scales deserve special attention in the mental health care of children with ID

Annotation: the role of prefrontal deficits, low autonomic arousal, and early health factors in the development of antisocial and aggressive behavior in children.

Abstract: Background: This article selectively reviews the biological bases of antisocial and aggressive behavior in children with a focus on low autonomic functioning, prefrontal deficits, and early health factors. Results: Low resting heart rate is thought to be the best-replicated biological correlate of antisocial and aggressive behavior in child and adolescent populations and may reflect reduced noradrenergic functioning and a fearless, stimulation-seeking temperament. Evidence from neuropsychological, neurological, and brain imaging studies converges on the conclusion that prefrontal structural and functional deficits are related to antisocial, aggressive behavior throughout the lifespan. A prefrontal dysfunction theory of antisocial behavior is advanced. This argues that social and executive function demands of late adolescence overload the late developing prefrontal cortex, giving rise to prefrontal dysfunction and a lack of inhibitory control over antisocial, violent behavior that peaks at this age. Birth complications and minor physical anomalies are selectively associated with later violent behavior, especially when combined with adverse psychosocial risk factors for violence. Cigarette smoking during pregnancy may increase the risk for antisocial and violent behavior in later life by disrupting noradrenergic functioning and enhancement of cholinergic receptors that inhibit cardiac functioning. Malnutrition during pregnancy is associated with later antisocial behavior and may be mediated by protein deficiency. Conclusions: It is argued that early health intervention and prevention studies may provide the most effective way of reversing biological deficits that predispose to antisocial and aggressive behavior in children and adults.

Exploring the borderlands of autistic disorder and specific language impairment: a study using standardised diagnostic instruments.

Abstract: Background: Two studies were conducted to test claims that pragmatic language impairment (PLI – previously referred to as semantic-pragmatic disorder) is simply another term for autistic disorder or pervasive developmental disorder not otherwise specified (PDDNOS). Method: In Study 1, 21 children aged from 6 to 9 years with language impairments were subdivided on the basis of the Children’s Communication Checklist into 13 cases of pragmatic language impairment (PLI) and eight cases of typical specific language impairment (SLI-T). Parents completed the Autism Diagnostic Interview – Revised (ADI-R) and the Social Communication Questionnaire (SCQ), and the children were given the Autism Diagnostic Observation Schedule – Generic (ADOS-G). In Study 2, a further 11 children with SLI-T and 18 with PLI were assessed using the SCQ and ADOS-G. In addition, six children diagnosed with high-functioning autism and 18 normally developing children were assessed. Results: There was good agreement between ADI-R and SCQ diagnoses, but poor agreement between diagnoses based on these parental report measures and those based on ADOS-G. In many children, symptom profiles changed with age. Four PLI children from Study 1 and one from Study 2 met criteria for autistic disorder on both parental report (ADI-R or SCQ) and ADOS-G. Many of the others showed some autistic features, but there was a subset of children with pragmatic difficulties who were not diagnosed as having autism or PDDNOS by either instrument. These children tended to use stereotyped language with abnormal intonation/prosody, but they appeared sociable and communicative, had normal nonverbal communication, and showed few abnormalities outside the language/social communication domains. Conclusions: Presence of pragmatic difficulties in a child with communication problems should prompt the clinician to evaluate autistic symptomatology, but it is dangerous to assume that all children with pragmatic difficulties have autism or PDDNOS. Keywords: Autism, PDDNOS, pragmatics, language impairment, semantic-pragmatic disorder, diagnosis. Abbreviations: ADI-R: Autism Diagnostic Interview – Revised; ADOS-G: Autism Diagnostic Observation Schedule – Generic; CCC: Children’s Communication Checklist; HFA: high functioning autism; MLU: mean length of utterance in morphemes; PDDNOS: pervasive developmental disorder not otherwise specified; PLI: pragmatic language impairment; SCQ: social communication questionnaire; SLI(-T): (typical) specific language impairment.

Teen‐aged mothers in contemporary Britain

Abstract: BACKGROUND: This paper describes the circumstances of contemporary young mothers and their children from a nationally representative sample, and compares them to the circumstances of mothers who delayed childbearing beyond age 20. METHODS: The participants are members of the Environmental Risk (E-risk) Longitudinal Twin Study, which follows an epidemiological sample of 1,116 women who became mothers in England and Wales in 1994-95, and their children, and contains an over-sample of young mothers. Home visits were conducted when the children were aged 5 years. Data were collected from mothers via interviews, from children via experimental tasks and observations, and from teachers via postal questionnaires. RESULTS: Young mothers encountered more socio-economic deprivation, had significantly less human and social capital, and experienced more mental health difficulties. Their partners were less reliable and supportive, both economically and emotionally, and were more antisocial and abusive. The children of young mothers showed reduced educational attainment, were rated by multiple informants as having more emotional and behavioural problems, were at increased risk of maltreatment or harm, and showed higher rates of illnesses, accidents, and injuries. CONCLUSIONS: Young mothers today face difficulties known to have long-lasting effects for women and their children. Preventions that target young mothers may reduce harm to the physical health, mental health, and social status of future generations.

Practitioner review: Diagnosis of autism spectrum disorder in 2- and 3-year-old children.

Abstract: Background: Progress has recently been made in the earlier identification of children with autism spectrum disorder (ASD). Whilst being welcome, this progress to earlier referral and diagnosis presents new challenges to clinical practice, including the accuracy and stability of early diagnosis, the utility of standardised assessment instruments with young pre-schoolers and the ability to indicate prognosis. Method: A selective review of recent research literature on the characteristic features of ASD in pre-school children. Results: Multidisciplinary diagnostic assessment should include detailed information on developmental history, parents' descriptions of the everyday behaviour and activities of the child, direct assessment of the child's social interaction style, including where possible with age peers, and formal assessment of communicative, intellectual and adaptive function. Clinical assessments need to concentrate on the identification of impairments in early non-verbal social communication behaviours that characterise children with ASD from the second year of life, including social orienting, joint attention, imitation, play and reciprocal affective behaviour. The particular pattern of symptoms that presents in a 2-year-old with ASD may differ from that seen at the more prototypic age of 4 or 5 years. In particular, overt repetitive and stereotyped behaviours may be less notable, although where these are seen alongside the social and communicative impairments they are highly indicative of ASD. The use of standardised assessment instruments and the strict application of the DSM and ICD diagnostic criteria need to be employed with caution, as an expert clinical view has been shown to be more accurate. An important aspect of early diagnostic consultation is an open and straightforward approach to the negotiation of the diagnostic view with parents over time. Conclusions: Earlier diagnosis and rising recognition of ASD have significant implications for primary healthcare and specialist diagnostic and therapeutic services.

Cognitive profiles and social-communicative functioning in children with autism spectrum disorder

Abstract: The relevance of IQ to the etiology and symptomatic expression of autism remains unclear. Although approximately three-quarters of individuals with autism have below-average IQ (< 70), autism can occur with equal severity in individuals of average and above-average IQ. While the finding that IQ can vary widely between identical twins with autism (Le Couteur et al., 1996) would also suggest that it is not a useful marker of genetic subgroup differences in autism, there is nonetheless evidence from large-scale behavioral genetic studies (Bolton et al., 1994; Fein et al., 1999; Szatmari et al., 2000) that IQ broadly defined (e.g., high versus low Verbal or Full Scale IQ) may index etiological heterogeneity and provide a basis for subtyping in autism. In addition to ongoing attempts to elucidate the complex relationship of general intelligence, and particularly of mental retardation, to autism (Bailey, Phillips, & Rutter, 1996), there has also been longstanding interest in the uneven intellectual abilities of individuals with autism. One question has been whether routinely administered IQ tests reveal any consistent pattern of cognitive strengths and weaknesses in autism. A Wechsler (1991, 1997) IQ profile with Verbal IQ (VIQ) depressed relative to Performance IQ (PIQ) and peak subtest score on Block Design (Happe, 1994; Lincoln, Allen, & Kilman, 1995) has traditionally been associated with autism and has even been suggested as a possible diagnostic aid (Lincoln, Courshesne, Kilman, Elmasian, & Allen, 1988). Although a recent meta-analytic review of 23 published studies (Lincoln, Courchesne, Allen, Hanson, & Ene, 1998) confirmed that VIQ is generally lower than PIQ in autism, a VIQ < PIQ profile has not been found consistently across studies (see review by Siegel, Minshew, & Goldstein, 1996). Some authors (Rumsey, 1992; Siegel et al., 1996) have attempted to explain these inconsistent findings by proposing that the difference between Verbal and Performance IQ in autism depends on the severity of impairment and diminishes as intellectual ability approaches the normal range. Yet, a VIQ < PIQ profile has been reported in several studies of high-functioning individuals with autism (see reviews by Lincoln et al., 1998; Siegel et al., 1996). It has also been suggested that the difference between Verbal and Performance IQ lessens with age and associated improvements in language functioning, at least among higher-functioning individuals with autism (Lincoln et al., 1998). This hypothesis has been difficult to evaluate because most studies have included individuals spanning a wide range of ages, and very few studies have provided the opportunity to compare developmental differences between younger and older children. VIQ–PIQ discrepancies have also played a prominent role in efforts to define Asperger syndrome as distinct from autism. Klin, Volkmar, Sparrow, Cicchetti, and Rourke (1995) demonstrated a VIQ > PIQ discrepancy among a sample of individuals diagnosed with Asperger syndrome, opposite to the pattern typically found in autism. However, subsequent studies (Manjiova & Prior, 2000; Ozonoff, South, & Miller, 2000) have failed to differentiate Asperger syndrome from autism on the basis of Wechsler IQ profiles. These inconsistent findings may reflect differences in the way Asperger syndrome was diagnosed. The Klin et al. study used the most stringent criteria, requiring a circumscribed interest and motor clumsiness for inclusion in their Asperger group. It is possible that these specific criteria selected for individuals with a VIQ > PIQ profile, as the development of circumscribed interests is likely to be mediated by verbal skills, and motor problems might be expected to be associated with deficits in PIQ. The problem of circularity in attempts to provide external validation for the distinction between autism and Asperger syndrome has been well recognized (e.g., Klin & Volkmar, 1997; Volkmar & Klin, 2001). Questions of their broader nosological value aside, analyses of cognitive profiles within autism have suffered from two major limitations. First, emphasis on identifying a prototypical cognitive profile has been at the expense of considering the possibility of more than one cognitive profile in autism. At a conceptual level, recent advances in genetics and the understanding of autism as a complex disorder allow for the possibility of genetically meaningful variation in the cognitive phenotype of autism, which could potentially account for variation in the behavioral expression of autism. Yet, little attention has been paid to individual differences in cognitive profiles in autism. Particularly in the case of VIQ–PIQ differences, the report of group means for autistic samples could have the effect of ‘averaging out’ significant individual discrepancies that actually occur in both directions. The second limitation concerns the usefulness of Wechsler subscale discrepancies for characterizing cognitive profiles in autism. Individuals with autism have frequently been reported to exhibit a characteristic pattern of unevenness in the subtest scores from which Wechsler Verbal and Performance IQs are derived (Happe, 1994; Siegel et al., 1996). For example, Block Design, a measure of visuospatial constructional ability, reliably yields the highest Wechsler subtest score in autism. In contrast, Picture Arrangement, another Performance subtest, but one which requires social-inductive reasoning, yields one of the lowest subtest scores on the Wechsler scales. Factor analysis has shown that Picture Arrangement and Block Design are weakly correlated and measure distinct abilities in individuals with autism (Lincoln et al., 1988). Characteristic patterns of scatter are also found on the Wechsler Verbal scale. For example, Digit Span is regularly reported to be a relative strength on the Wechsler scales. Findings such as these raise questions about the interpretability of VIQ and PIQ scores in autism, and of any discrepancy that is (or is not) found between these scores. In the present study, we addressed two main issues. The first was whether children with autism exhibit characteristic patterns of unevenness in their cognitive abilities and, if so, whether such patterns or profiles differ as a function of age or overall ability. To answer these questions, we assessed the cognitive abilities of a large sample of children with autism using the Differential Ability Scales (DAS; Elliott, 1991), a revised version of the British Ability Scales (Elliott, Murray, & Pearson, 1979). The DAS is comprised of a Preschool and a School-Age battery. Each battery consists of only six core subtests, selected for their high loadings on psychometric g, but with sufficient specific variance to support separate cluster scores. The DAS factor structure and corresponding cluster scores are in accord with current models of human intelligence (Carroll, 1993; Mackintosh, 1998). They include Verbal and Nonverbal ability, the latter of which is further differentiated into Nonverbal Reasoning and Spatial ability in the School-Age battery. The DAS thus distinguishes between nonverbal subtests that primarily measure visual-spatial organization from nonverbal subtests that primarily measure inductive reasoning abilities.1 This is in contrast to the Wechsler system, which subsumes similarly divergent nonverbal subtests under its Performance subscale (Elliot, 1990). The second issue was whether different cognitive profiles in autism are associated with differences in core symptomatology. To address this issue, we assessed children’s social and communicative functioning using the Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore, & Risi, 1999). The ADOS is a semi-structured, interactive observation scale that provides quantitative ratings of communicative and social behaviors corresponding to DSM-IV (APA, 1994) and ICD-10 (WHO, 1993) criteria for autism. The summary ratings from the ADOS allowed us to relate children’s neurocognitive profiles to quantitative measures of symptom severity in both the communication and social domains. This approach provided a way of potentially accounting for empirically defined phenotypic variance in autism while avoiding the methodological pitfalls involved in using a priori definitions, such as in recent attempts to differentiate Asperger syndrome from autism.

Depression scale scores in 8–17-year-olds: effects of age and gender

Abstract: Background: The excess of unipolar depression in females emerges in adolescence. However, studies of age effects on depression scale scores have produced divergent estimates of changes from childhood to adolescence. Method: We explored possible reasons for this discrepancy in two large, longitudinal samples of twins and singletons aged 8–17. Results: There were no differences between twins and singletons in their scores on the Short Mood and Feelings Questionnaire (SMFQ), a 13-item self-report depression scale. SMFQ scores for boys fell over this age-range, while those for girls fell from age 9 to age 11 and then increased from age 12 to age 17. The mean scores of girls under 12 and those 12 and over differed by only around one-fifth of a standard deviation. However, given the non-normal distribution of the scores, a cut point that selected the upper 6% of scores created the expected female:male ratio of 2:1. Conclusions: Implications for future research on adolescent depression are discussed.

Reactively and proactively aggressive children: antecedent and subsequent characteristics.

Abstract: Background: Reactive and proactive subtypes of aggressive 10–11–12-year-old children were compared with non-aggressive children to examine whether the two forms of aggression were differentially related to antecedent and subsequent measures Method: A large community sample of boys and girls was used Reactive and proactive aggression was measured through teacher ratings when the children were 10, 11 and 12 years old Antecedent measures were age 6 temperament and behavioral dispositions; subsequent measures were age 13 delinquency and depressive symptoms Results: Results indicated that reactive and proactive children had distinctive profiles on antecedent and subsequent measures Conclusions: We conclude that children characterized by reactive or proactive aggression differ on several dimensions of personal functioning, and that reactive and proactive aggression are distinct forms of aggression, although both co-occur in a large proportion of aggressive children Keywords: Adolescence, aggression, behavior problems, delinquency, depression, temperament

Neuropsychological profiles of adolescents with ADHD: effects of reading difficulties and gender

Abstract: Background: Executive function, particularly behavioral inhibition, has been implicated as a core deficit specific to Attention-Deficit/Hyperactivity Disorder (ADHD) whereas rapid naming has been implicated as a core deficit specific to reading disabilities (RD). Females may be less impaired in executive function although adolescent females with ADHD have yet to be studied. Method: Neuropsychological profiles of four adolescent groups aged 13–16 with equal female representation were investigated: 35 ADHD, 12 RD, 24 ADHD+RD, and 37 normal controls. A semi-structured interview (K-SADS-PL), the Conners Rating Scales and the Ontario Child Health Study Scales were used to diagnose ADHD. RD was defined as a standard score below 90 on at least one of the following: Reading or Spelling of the WRAT3 or Word Attack or Word Identification of the WRMT-R. The WISC-III, Rapid Automatized Naming, Stroop and Stop tasks were used as measures of cognitive and executive function. Results: The two ADHD groups (ADHD, ADHD+RD) showed deficits in processing speed, naming of objects, poor behavioral inhibition and greater variability in reaction times whereas the two RD groups (RD, RD+ADHD) showed verbal working memory deficits and slower verbal retrieval speed. Only the comorbid group was slower with naming of numbers and colors and had slower reaction times. Regression analyses indicated that incongruent color naming (Stroop) and variability in go reaction time were the best predictors of hyperactive/impulsive ADHD symptoms whereas variability in go reaction time and processing speed were the best predictors of inattentive ADHD symptoms. Speed of letter naming and verbal working memory accounted for the most variability in composite achievement scores. No gender differences were found on any of the cognitive tests. Conclusions: This study challenges the importance of behavioral inhibition deficits in ADHD and that naming deficits are specific to RD. Further investigation into cognitive deficits in these groups is required. ADHD: Attention-Deficit/Hyperactivity Disorder; RD: Reading Difficulties; SES: socio-economic status; CTRS: Conners' Teacher Rating Scale; OCHSS: Ontario Child Health Study Scales; WRAT: Wide Range Achievement Test; WRMT: Woodcock Reading Mastery Test; MDD: Major Depressive Disorder; SAD: Separation Anxiety Disorder; GAD: Generalized Anxiety Disorder; OCD: Obsessive Compulsive Disorder; WISC: Wechsler Intelligence Scale for Children; RAN: Rapid Automatized Naming; SSRT: Stop Signal Reaction Time;

High motion coherence thresholds in children with autism

Abstract: Background: We assessed motion processing in a group of high functioning children with autism and a group of typically developing children, using a coherent motion detection task. Method: Twenty-five children with autism (mean age 11 years, 8 months) and 22 typically developing children matched for non-verbal mental ability and chronological age were required to detect the direction of moving dots in a random dot kinematogram. Results: The group of children with autism showed significantly higher motion coherence thresholds than the typically developing children (i.e., they showed an impaired ability to detect coherent motion). Conclusions: This finding suggests that some individuals with autism may show impairments in low-level visual processing - specifically in the magnocellular visual pathway. The findings are discussed in terms of implications for higher-level cognitive theories of autism, and the suggestion is made that more work needs to be carried out to further investigate low-level visual processing in autism.

The severity and nature of motor impairment in Asperger's syndrome: a comparison with specific developmental disorder of motor function.

Abstract: Background: The aims of this study were to measure objectively the extent and severity of motor impairment in children with Asperger's syndrome and to determine whether the motor difficulties experienced by such children differed in any way from those classified as having a Specific Developmental Disorder of Motor Function (SDD-MF). Criteria derived from ICD 10-R were used to identify 11 children with Asperger's syndrome and a matched group of 9 children with a Specific Developmental Disorder of Motor Function. Children in both groups were required to have a verbal IQ of 80 or greater on the WISC IIIR. Method: The Autism Diagnostic Interview (Revised; Lord, Rutter, & LeCouteur, 1994) was used to identify features of AS in the first group and to exclude them in the latter. The Movement Assessment Battery for Children (Henderson & Sugden, 1992) provided a standardised test of motor impairment. A Gesture Test based on that by Cermak, Coster, and Drake (1980) was used to assess the child's ability to mime the use of familiar tools and to imitate meaningless sequences of movements. Results: All the children with Asperger's syndrome turned out to meet our criterion for a diagnosis of motor impairment, five of the six most severely motor impaired children in the whole study being from this group. Performance of the Asperger group was also slightly poorer on the Gesture Test. The profile of performance on each test was examined in detail but no evidence of group differences in the pattern of impairment was found. Conclusions: This study is consistent with others suggesting a high prevalence of clumsiness in Asperger's syndrome. Our findings also attest to the widespread prevalence of motor impairment in developmental disorders and the problems such co-morbidity poses for attempts to posit discrete and functionally coherent impairments underlying distinct syndromes.

Young adult academic outcomes in a longitudinal sample of early identified language impaired and control children

Abstract: Background: The long-term academic consequences of childhood language impairment are both theoretically and clinically important. An unbiased appraisal of these outcomes, however, requires carefully designed, longitudinal research. Method: A group of children first identified as having speech and/or language impairment in a community-based, longitudinal study at 5 years of age and matched controls were re-examined during young adulthood (age 19). A comprehensive battery of speech and language, cognitive and achievement tests, psychiatric interviews, and questionnaires were completed by subjects, their parents and teachers. Results: While children with early speech problems showed only a few academic differences from controls in young adulthood, early language impaired (LI) young adults lagged significantly behind controls in all areas of academic achievement, even after controlling for intelligence. Further, rates of learning disabilities (LD) were significantly higher in the LI group than both the controls and community base rates. Concurrent individual difference variables, including phonological awareness, naming speed for digits, non-verbal IQ, verbal working memory, and executive function, all contributed unique variance to achievement in specific areas. Conclusion: Early LI rather than speech impairment is clearly associated with continued academic difficulties into adulthood. These results speak to the need for intensive, early intervention for LI youngsters. Keywords: Adulthood, educational attainment, language disorder, learning difficulties, longitudinal studies, outcome.

The relationship between executive function abilities, adaptive behaviour, and academic achievement in children with externalising behaviour problems.

Abstract: Background: Specific domains of adaptive behaviours and academic achievement may, in part, depend on executive function capacities. Executive function deficits have been found to be associated with Attention Deficit Hyperactivity Disorder (ADHD), not Oppositional Defiant Disorder/Conduct Disorder (ODD/CD). Method: Using a sample of 110 adolescents, comprising four groups, ADHD only, co-morbid ADHD and ODD/CD, ODD/CD only, and a normal community control group, we assessed socialisation and communication skills with the Vineland Adaptive Behaviour Scales, along with reading ability, and executive functioning. Results: Poorer adaptive communication skills were specifically associated with ADHD when compared with either ODD/CD or the control group, and the social competence of adolescents with ADHD was as low as the levels associated with ODD/CD. Presence of ADHD was associated with lower word recognition scores, while the reading levels of adolescents with ODD/CD were equivalent to those without behaviour problems. Executive function test scores correlated with all adaptive behaviour outcomes. Multiple regression analyses indicated that verbal ability predicted communication and reading scores, with executive function abilities contributing significant variance to the prediction in the adaptive behaviour, communication, and socialisation domains. Conclusions: Further research with other samples, both community and clinical groups, is needed to assess the generalisability of the findings. Small numbers of girls in the groups gave us insufficient power to adequately address potential gender differences.

The genetic aetiology of childhood depression: a review

Abstract: Background: We review the evidence for the familiality of major depressive disorder (MDD) and the genetic aetiology of depressive symptoms in children and adolescents. Methods: Databases and reference lists were searched for family, twin and adoption studies of childhood MDD and childhood depressive symptoms. Data from independent family studies that fulfilled specified inclusion criteria were pooled and odds ratios were calculated for top-down and bottom-up family studies. Results: Estimates of familial risk differ by control group and by study design (odds ratio range 1.70, 3.98). Twin studies show that depressive symptoms in young people are heritable although rater and measurement issues are important. Adoption studies show little evidence for a genetic influence on depressive symptoms. Conclusions: MDD in young people is familial although control group and study design affect the magnitude of the familial risk. Estimates of heritability from twin and adoption studies vary widely and few firm conclusions can be made regarding the genetic aetiology of depressive symptoms in childhood. Areas that require future work include the examination of rater effects, measurement issues, the effects of age and comorbidity and reasons for the discrepancy between twin and adoption findings.

Annotation: The `effects' of parenting reconsidered: findings, challenges, and applications

Abstract: Background: Questions remain concerning the ‘effects’ of parenting on behavioural/emotional problems in children. This annotation discusses recent findings concerning the parenting ‘effects’ literature and identifies areas in need of further research. Method: The review begins by examining theories and definitions of parenting, and then considers research findings on the predictors of parent– child relationships and their effects on behavioural/emotional adjustment in children. Evidence for causal processes are then examined in light of findings emphasizing the need to consider the impact of larger systems on child’s well-being, bi-directional processes in parent–child interactions, and alternative hypotheses suggested by behavioural genetics. Results: Different kinds of evidence suggest strong links between parent–child relationship quality and children’s well-being, but difficulties remain for drawing causal connections. The need for greater integration among research traditions and the need for theory development are highlighted. In addition, although a substantial and robust research base exists on parent–child relationships, the applicability of these findings to clinical settings is uncertain. Conclusions: Substantial progress has been made in our understanding of the nature of parent–child relationships and their developmental effects, but a number of basic conceptual and methodological and clinical questions continue to need rigorous study. Keywords: Parent–child relationship, development, behavioural genetics, psychopathology.

Annotation: attachment disorganisation and psychopathology: new findings in attachment research and their potential implications for developmental psychopathology in childhood.

Abstract: Background: The past 10 years have seen a fruitful line of enquiry building on identification of previously unclassifiable patterns of infant–mother interaction. A critical review of these new findings in attachment theory, highlighting their potential relevance to child psychopathology, is presented. Method: Selective literature review relating to disorganised attachment in childhood. Results: Disorganised patterns of attachment have only relatively recently been described. They show characteristic patterns of evolution in development. There is evidence that disorganised attachments are associated with specific forms of distorted parenting, which are distinct from general parental insensitivity and are associated with unresolved loss or trauma in the caregiver. There are also links with aspects of neurodevelopment vulnerability in the child. Attachment disorganisation is a powerful predictor of a range of later social and cognitive difficulties and psychopathology. Conclusions: The identification of disorganised attachment has greatly increased the potential relevance of attachment theory to general clinical work. However, the concept raises many methodological and theoretical issues. Among issues needing further exploration is the way in which attachment disorganisation relates to children's general mental states and may be affected by cognitive functioning and developmental impairment.

Biological, psychological and social processes in the conduct disorders

Abstract: Background: This paper reviews recent evidence on the causes and maintenance of aggressive and disruptive behaviours in childhood and adolescence. It considers the relative merits of several different ways of conceptualising such problems, in relation to the contribution of biological, psychological and social factors. Method: It focuses on conduct problems appearing in young childhood, which greatly increase the likelihood of persistent antisocial behaviours in adolescence and adult life in association with wider interpersonal and social role impairments. It considers the contribution of individual factors, including impaired verbal skills, deficits in executive functions, and an imbalance between behavioural activation and inhibition systems. These are viewed in interaction with commonly associated environmental disadvantages such as hostile or intrusive parenting. The roles of attributional biases, unrealistic self-evaluations, and insecure attachment are considered in relation to affect regulation, and effective social action. The contributions of the wider social environments of peers, neighbourhood and socio-economic conditions are evaluated. Conclusions: The paper concludes that, although considerable progress has been made over the past ten years, there is a need to further refine our conceptualisation of the behaviours to be explained, to develop a coherent theory of the causal and maintaining processes, and to carry out prospective studies with adequate numbers of high risk children.

Evidence for a pure time perception deficit in children with ADHD

Abstract: Background: Deficits have been found previously in children with ADHD on tasks of time reproduction, time production and motor timing, implicating a deficit in temporal processing abilities, which has been interpreted as either secondary or primary to core executive dysfunctions. The aim of this study was to explore further the abilities of hyperactive children in skills of time estimation, using a range of time perception tasks in different temporal domains. Method: Time estimation was tested in a verbal estimation task of 10 seconds. Time reproduction was also acquired for two time intervals of 5 and 12 seconds. A temporal discrimination task aimed to determine the idiosyncratic threshold of minimum time interval (in milliseconds) necessary to distinguish two intervals differing by approximately 300 milliseconds. Twenty-two children diagnosed with ADHD were compared to 22 healthy children, matched for age, handedness and working memory skills. Results: Children with ADHD were significantly impaired in their time discrimination threshold: on average, time intervals had to be 50 ms longer for the hyperactive children in order to be discriminated when compared with controls. Children with ADHD also responded earlier on a 12-second reproduction task, which however only approached significance after controlling for IQ and short-term memory. No group differences were found for the 5-second time reproduction or verbal time estimation tasks. Conclusions: The findings suggest that children with ADHD perform poorly on time reproduction tasks which load heavily on impulsiveness and attentional processes and they also suggest that these children may have a perceptual deficit of time discrimination, which may only be detectable in brief durations which differ by several hundred milliseconds. A temporal perception deficit in the range of milliseconds in ADHD may impact upon other functions such as perceptual language skills and motor timing.

Sociodynamic relationships between children who stutter and their non-stuttering classmates

Abstract: Background: Previous research has indicated that children who stutter are more likely to be bullied and to hold a lower social position than their peers who do not stutter However, the majority of this research has used data from respondents who were in the educational system more than 20 years ago The current policy on integration of children with severe disabilities into mainstream education and the increased awareness of bullying in schools would indicate that attitudes toward children who stutter might have changed in the intervening period Method: The study uses a sociometric scale (adapted from Coie, Dodge, &, Coppotelli, 1982) to assess children who stutter in classroom groups with fluent peers The peer relationships between 16 children who stutter and their classmates (403 children in total) were examined Results: Children who stutter were rejected significantly more often than were their peers and were significantly less likely to be popular When compared to children who do not stutter, the children who stutter were less likely to be nominated as 'leaders' and were more likely to be nominated to the 'bullied' and 'seeks help' categories Conclusions: The changes in integration policy and the implementation of anti-bullying policies in many schools appear to have made little impact on the social status of children who stutter The incidence of bullying and rejection reported in this study has implications for schools and clinicians

Preschool understanding of emotions: contributions to classroom anger and aggression.

Abstract: Background: We sought to identify patterns of social cognitive differences among preschoolers that were related to risk of stable aggressive behavior with peers. Following Lemerise and Arsenio (2000), we considered the emotional components of early social cognition, reasoning that young children’s substrate of emotion knowledge serves them in decoding social encounters. Method: One hundred and twenty-seven children from a longitudinal study from age 3 to 4 though to their kindergarten year were interviewed on their emotional knowledge initially using a puppet procedure and later with stories about mixed emotions and display rule. Each year their anger and antisocial responses to others’ emotions were observed. Teachers also provided information on each child’s anger and aggression. Results: Children’s deficits in emotion knowledge assessed at age 3 and 4 predicted subsequent years’ aggression. This effect was especially pronounced for boys. Conclusions: The pattern of findings suggests that the processes implicated in Dodge’s work with older children may begin earlier than previously thought, with a focus on emotions. Keywords: Aggression, child development, emotion, emotion recognition. Externalizing behavior problems, so poignantly depicted by current events of youth violence, cause untold difficulty for parents, teachers, children themselves, and society as a whole (Campbell & Ewing, 1990). Consequently, many recent investigations have focused on aggressive behavior in children and adolescents. Most children exhibit some acts of aggression, with onset by the second year; subsequently, however, they largely inhibit

Gaze behavior of children with pervasive developmental disorder toward human faces: a fixation time study.

Abstract: Background: The abnormal gaze behavior of autistic children toward human faces, as observed in daily-life situations, are investigated in two fixation time studies. It has been argued that faces are a special kind of stimuli for normal individuals and that this might not be the case for autistic children. Methods: A group of high-functioning autistic children (including a group of sub-threshold PDD-NOS children) was compared with a group of normal children, with respect to their fixation behavior for photographs of human faces. Using an infrared eye-tracking device, fixation times for the whole face and for the facial elements of faces were compared between the two groups. The first study dealt with faces having an emotional expression. The second study dealt with neutral faces presented either upright or upside-down. Results: Results of the two studies showed that autistic children have the same fixation behavior as normal children for upright faces, with or without an emotional expression. Furthermore, results of the second study showed that normal children spent less time looking at upside-down faces, but that the fixation times of autistic children were not influenced by the orientation of the faces. Conclusions: These results plead against the notion that the abnormal gaze behavior in everyday life is due to the presence of facial stimuli per se. Furthermore, the absence of a face orientation effect in autistic children might be a reflection of a lack of holistic processing of human faces in autism.

Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study.

Abstract: For infants who sleep independently, the ability to self-soothe when falling asleep at the beginning of the night and following nighttime awakenings appears to be a key ingredient for the development of healthy sleep-wake patterns. Although a number of studies have described the development of sleep-wake patterns during infancy, relatively few have examined factors related to the emergence of self-soothing behavior. Theoretically, self-soothing refers to an infant’s ability to regulate states of arousal; for example, calming from crying to quiet wakefulness without parental assistance. In this study, self-soothing refers to an infant’s ability to settle to sleep at the beginning of the night and to put herself back to sleep upon awakening during the night. The purpose of the current study was to objectively monitor infant sleep-wake patterns and other variables thought to relate to the development of self-soothing across the first year of life. The development of sleep-wake patterns follows a somewhat prescribed path during infancy. First, the 24-hour distribution of sleep changes across the first year. Newborns tend to sleep for 16–17 hours in 3–4 hour increments dispersed throughout the 24-hour day (Parmelee, Shulz, & Disbrow, 1961). By 1 year of age, the bulk of sleep shifts to the nighttime hours and sleep periods lengthen (consolidate), but the total amount of sleep per 24 hours decreases relatively little (Anders & Keener, 1985; Kleitman & Engelmann, 1953). Second, the proportions of sleep states change with age, such that rapid eye movement (REM) or active sleep decreases and non-rapid eye movement (NREM) or quiet sleep increases over the first year (Anders & Keener, 1985; Fagioli & Salzarulo, 1982). Although these basic patterns have been confirmed by numerous studies over the past 40 years, few large-scale longitudinal investigations have examined factors associated with the development of nighttime self-soothing. The few investigations that have examined falling asleep and self-soothing after nighttime awakenings during the first year of life have shown that this ability develops in some infants, but not others, by the end of the first year (Anders, Halpern, & Hua, 1992; Keener, Zeanah, & Anders, 1988; Goodlin-Jones, Burnham, Gaylor, & Anders, 2001; Goodlin-Jones, Eiben, & Anders, 1997). During the first months of life, infants most often fall asleep during or immediately after a feeding both at the beginning and during the middle of the night; self-soothing is observed only occasionally. By 4 to 6 months of age, however, self-soothing behaviors at sleep onset and following nighttime awakenings begin to appear in some infants and tend to increase in frequency to the first birthday (Goodlin-Jones et al., 2001). Infants who self-soothe are generally considered by parents to be better sleepers than infants who consistently need assistance to make the wake-sleep transition. Infant sleep disturbances are often brought to the attention of pediatricians during well-child visits due to the sleep disruption imposed on families (Lozoff, Wolf, & Davis, 1985). Indeed, France and Blampied (1999) define a sleep-disturbed infant as ‘one who is unable to settle back to sleep without the parents being aware of the awakening’. More precisely, awakenings are most disturbing to parents when the child cannot return to sleep on her own and requires parental intervention. For the purposes of the current investigation, these infants are considered ‘non-self-soothers’. Clearly, infants who do not develop the ability to self-soothe can create turmoil in some families. A simple linear model that describes the emergence of self-soothing is not sufficient. A transactional model embraces the complexities of interacting systems or domains across a developmental time span (Sameroff & Fiese, 2000). A transactional perspective to self-soothing might include infant characteristics, parental characteristics, and interactions between infants and parents. Figure 1 displays a tentative model of potential domains associated with self-soothing (Anders, 1994; Goodlin-Jones, Burnham, & Anders, 2000). Variables in the four domains are thought to relate to each other and, ultimately, to whether the child is or is not able to self-soothe to sleep from the waking state. The model reflects the notion that self-regulation of wake to sleep transitions results from a dynamic, interactive process between the infant and a number of proximal and distal influences, mediated mostly through interactions with caregivers. This model is a work in progress. Thus far, partial support for the transactional model comes from small-scale and/or cross-sectional investigations (e.g., Goodlin-Jones et al., 2001). There have been no longitudinal studies specifically designed to investigate the hypothesized links. Figure 1 A transactional model for the development of self-soothing behaviors related to wake-to-sleep state transitions. The model, derived from empirical and clinical experience, provides a framework to guide investigation. More research is required to assess ... Within the infant domain, the variable receiving most research attention in relation to infant sleep has been temperament. Infant temperament has been consistently, albeit moderately, related to the quality of nighttime sleep (Halpern, Anders, Garcia Coll, & Hua, 1994; Minde, Popiel, Leos, Falkner et al., 1993; Scher, Tirosh, & Lavie, 1998; Van Tassel, 1985). An association between temperament and middle-of-the-night self-soothing also has been reported (Keener et al., 1988). Fathers were found to rate non-self-soothing infants as more temperamentally difficult than self-soothing infants; however, a similar relationship did not hold for mothers’ ratings of temperament. Minde and colleagues (1993) reported an association between difficult temperament and problem sleep. In their study, problem sleepers were unable to return to sleep without a parental intervention (i.e., they were non-self-soothers). Parental factors also have been associated with infant sleep disruption. Seifer and colleagues (Seifer, Sameroff, Dickstein, Hayden, & Schiller, 1996) reported an association between both higher levels of maternal mental illness and lower levels of overall family functioning and bedtime problems in toddlers. Benoit, Zeanah, Boucher, and Minde (1992) found that all of the sleep-disturbed toddlers in their sample had mothers with insecure attachment styles. Another study, however, failed to find a relation between maternal psychological well-being and infants’ tendency to self-soothe during the night. This null finding may have been due to the non-clinical range of maternal depression scores reported in this study (Goodlin-Jones et al., 2001). Associations between the sleep context and sleep-wake domains and self-soothing have been illustrated most clearly to date. Infants who are placed into their cribs awake at the beginning of the night and who use a sleep aid are more likely to self-soothe than their counterparts (Anders et al., 1992; Goodlin-Jones et al., 1997). In addition, self-soothing infants have longer continuous sleep periods and longer total sleep times at night (Anders et al., 1992; Goodlin-Jones et al., 2001). There is clearly some evidence in support of the relationships between each of the model domains and nighttime self-soothing. A more detailed review of these associations has been published recently (France & Blampied, 1999). The current study had three goals. As the first relatively large-scale longitudinal study to objectively investigate infant sleep, the first goal was to replicate previous work on the basic patterns of sleep-wake development across the first year of life. The second goal was to test a double blind, random assignment intervention trial to enhance self-soothing at night. The third goal was to identify potential factors leading to the development of self-soothing at 12 months of age.

Practitioner Review: The assessment of language pragmatics

Abstract: Background: The assessment of pragmatics expressed in spoken language is a central issue in the evaluation of children with communication impairments and related disorders. A developmental approach to assessment has remained problematic due to the complex interaction of social, linguistic, cognitive and cultural influences on pragmatics. Method: A selective review and critique of current formal and informal testing methods and pragmatic analytic procedures. Results: Formal testing of pragmatics has limited potential to reveal the typical pragmatic abnormalities in interaction but has a significant role to play in the assessment of comprehension of pragmatic intent. Clinical assessment of pragmatics with the pre-school child should focus on elicitation of communicative intent via naturalistic methods as part of an overall assessment of social communication skills. Assessments for older children should include a comprehensive investigation of speech acts, conversational and narrative abilities, the understanding of implicature and intent as well as the child's ability to employ contextual cues to understanding. Practical recommendations are made regarding the choice of a core set of pragmatic assessments and elicitation techniques. The practitioner's attention is drawn to the lack of the usual safeguards of reliability and validity that have persisted in some language pragmatics assessments. Conclusions: A core set of pragmatic assessment tools can be identified from the proliferation of instruments in current use. Further research is required to establish clearer norms and ranges in the development of pragmatic ability, particularly with respect to the understanding of inference, topic management and coherence.

The development of impulsivity, fearfulness, and helpfulness during childhood: patterns of consistency and change in the trajectories of boys and girls

Abstract: Background: The objective of the present study was to describe the development of boys and girls during the elementary-school years on three dimensions that conceptually and empirically represent risk for maladjustment. Method: Every year between kindergarten and grade six, teachers rated the impulsivity, fearfulness, and helpfulness dimensions among a sample of 1,865 children representative of kindergarten boys and girls in the province of Quebec (Canada) in 1986-87. A group-based trajectory method was used to 1) identify groups of boys and girls following distinct-level trajectories of behaviours (on each dimension) during the elementary-school years; 2) estimate the proportion of children in each of the identified trajectory groups; and 3) estimate the patterns of consistency and variations in trajectories. Results: The results indicated that the best models comprised three distinct-level trajectory groups on fearfulness and helpfulness (a low, moderate, and high group) and four distinct-level trajectory groups on impulsivity. The helpfulness and fearfulness trajectory groups were generally more stable than the impulsivity groups. The broad patterns of development were similar across sexes. However, there were more boys on the higher impulsivity trajectories and low helpfulness trajectory, while there were more girls on the high fearfulness trajectory. Conclusion: We found that behavioural consistency over middle childhood varied across trajectory groups and across dimensions, and we identified sex differences in the distribution of children in the different trajectory groups that may reflect gender-specific risks for psychopathology.

Mechanisms of action in youth psychotherapy.

Abstract: Background: In this review, we address a basic, but unanswered, question about psychosocial interventions for youth: How does psychotherapy work? Methods: We propose a framework for using mediation analysis to answer this question, and we review the youth therapy outcome literature for evidence on mediating mechanisms. We focus our review on clinical trials of empirically supported treatments for youth anxiety, depression, and disruptive behavior (N a 67). Results: Contrary to previous reports indicating that potential mediators are rarely assessed, 63% of the studies included measures of potential mediating mechanisms in their designs. Across treatment domains, percentages ranged from 22% of the studies of learning-based interventions for anxiety (i.e., systematic desensitization, modeling, and reinforced practice) to 91% of parent training investigations. Despite the rather extensive assessment of potential mediators, only six studies included any attempt to use the measures in a formal mediation test. Thus, despite the positive effects of treatments and surprisingly ample assessment of mediators, we still know remarkably little about how youth psychotherapies work. Conclusions: We note common problems that hampered mediation testing (e.g., the design of many trials made it difficult to determine the temporal order of change in the mechanism and outcome), and we offer recommendations for improving study design to better assess mechanisms of therapeutic action. We also note the need to test mediation among referred youth treated in representative practice settings to complement the laboratory-based evidence on therapy mechanisms that prevails to date.

A new `advanced' test of theory of mind: evidence from children and adolescents with Asperger syndrome

Abstract: Background: The aim of the present study was to assess the ability of children and adolescents with Asperger syndrome (AS) (N=21) to infer physical versus mental states on a new advanced' test of theory-of-mind - Stories from Everyday Life. The participants in the AS group were of normal intelligence and were compared with an age-matched control group (N= 20) of normally developing children and adolescents. Method: The test materials comprised 26 short stories or 13 pairs of different types of stories. This contextually complex theory-of-mind battery aimed to record the participants' ability to make inferences about physical as well as mental states. The first part of each story described a physical or mechanical event, and a test question then tested the participants' ability to make an inference about a physical state. The last part of the stories contained two questions, testing the ability to infer a mental state from the story context, e.g., understanding social communication such as a lie, white lie, figure of speech, misunderstanding, double bluff, irony, persuasion, contrary emotions, forgetting, jealousy, intentions, empathy and social blunders. The participants' reaction time and number of prompt questions were also recorded. Results: The participants in the AS group showed significantly more problems attributing mental state inferences relative to the control group. They performed considerably better on tasks involving a physical state, but still did less well than the controls. They had a tendency to interpret behaviour and utterances literally, without regard to context, and to choose a physical explanation when a mental state answer was more appropriate. They also needed significantly more prompt questions and used significantly more time than the controls to solve the tasks, especially those involving mental state inference. Conclusions: This study supports earlier findings that individuals with AS/ HFA have difficulties attributing mental states in context, but seem to have significantly fewer difficulties inferring physical states. The fact that the clinical group also used significant longer reaction time and needed significantly more prompt questions to solve the tasks relative to the control group may also be related to their problems in understanding mental states. However, the possibility remains that these difficulties could represent a separate factor - or a distinct 'cognitive style'- suggesting that at least some individuals with AS may be generally slow in solving cognitive tasks.

Psychosocial adjustment in siblings of children with autism

Abstract: Background: This study investigated psychosocial adjustment in siblings of children with autism compared to siblings of children with Down syndrome and siblings of normally developing children. In addition, the relationships between feelings of loneliness, social support and psychosocial adjustment, and the influence of gender and family size on psychological adjustment were examined. Methods: Ninety siblings (30 per group) between the ages of 8 and 18 and one parent of each child participated in this study. Results: Results indicated that siblings of children with autism, as well as comparison siblings, were well adjusted and reported low levels of loneliness. Siblings of children with autism also reported that they received high levels of social support in their lives. Conclusions: Large family size appears to facilitate healthy adjustment in siblings of children with autism.

The long-term significance of teacher-rated hyperactivity and reading ability in childhood: findings from two longitudinal studies.

Abstract: Background: The aims of this study were twofold: first, to examine behavioural and academic outcomes of children with hyperactivity, using data from two longitudinal studies; and second, to examine comparable psychosocial outcomes for children with early reading difficulties. Methods: Measures of teacher-rated persistent hyperactivity, and reading ability obtained during early primary school were available for children from the Australian Temperament Project and the Dunedin Multidisciplinary Health and Development Study. Both samples were followed up to assess behavioural and academic outcomes during the adolescent and early adult years. Family background, antisocial behaviour and literacy were controlled in the first set of analyses to examine the influence of early hyperactivity. Results: There were strong linear relationships between early hyperactivity and later adverse outcomes. Adjustment for other childhood variables suggested that early hyperactivity was associated with continuing school difficulties, problems with attention and poor reading in adolescence. Early reading difficulties, after controlling for early hyperactivity, predicted continuing reading problems in high school and leaving school with no qualifications. Conclusions: The findings suggest that there are dual pathways from early inattentive behaviours to later inattention and reading problems, and from early reading difficulties to substantial impairments in later academic outcomes.