Showing papers in "Journal of The American Academy of Child Psychiatry in 1983"
TL;DR: Children's ratings of depression were positively correlated with hopelessness and parent ratings of somatic complaints and negatively correlated with self-esteem, and children independently diagnosed as depressed (DSM-III) were higher in severity of depression than nondepressed children on child and parent completed measures.
Abstract: The present investigation evaluated the correspondence of child and parental reports of the children's depression. One-hundred-four children (ages 5–13) hospitalized on a psychiatric intensive care service, 101 mothers, and 47 fathers independently completed several measures to assess severity and duration of the children's depression. To validate the depression instruments, measures of hopelessness and self-esteem (completed by the children) and somatic complaints and internalizing (completed by the parents) were also included. The results indicated that different measures of depression completed by the same rater (child, mother, or father) were highly intercorrelated. However, there was little or no relationship between mother-child and father-child reports of the children's depression for the same or different measures of depression. Children's ratings of depression were positively correlated with hopelessness and parent ratings of somatic complaints and negatively correlated with self-esteem. Children independently diagnosed as depressed (DSM-III) were higher in severity of depression than nondepressed children on child and parent completed measures. The implications of the present results for further evaluation of child self-report and factors that may contribute to correspondence with parental report are highlighted.
240 citations
167 citations
TL;DR: The classroom behaviors of 129 Barbadian children who suffered from moderate-severe protein-energy malnutrition in the first year of life were compared with those observed in children with no history of malnutrition, demonstrating that the previously malnourished children had attention deficits, reduced social skills, poorer physical appearance and emotional instability when compared to the matched comparison children.
Abstract: The classroom behaviors of 129 Barbadian children (77 boys and 52 girls) aged 5 to 11 years, who suffered from moderate-severe protein-energy malnutrition in the first year of life were compared with those observed in children with no history of malnutrition. The data were gathered from questionnaires administered to teachers who were unaware of the child's previous nutritional history. The results demonstrated that the previously malnourished children had attention deficits, reduced social skills, poorer physical appearance and emotional instability when compared to the matched comparison children. These behavioral deficits associated with prior malnutrition were independent of IQ and were experienced to a greater extent by boys. Socioeconomic conditions at the time of the study contributed little to the behavioral deficits of the previously malnourished children, as compared with the large contribution of the history of early malnutrition or the conditions producing it.
158 citations
TL;DR: In this paper, the intellectual performance of 129 Barbadian children with histories of moderate to severe protein-energy malnutrition in the first year of life was compared to that of matched comparison cases with no such history, using a modified version of the WISC.
Abstract: The intellectual performance of 129 Barbadian children (52 girls and 77 boys), aged 5 to 11 years, with histories of moderate to severe protein-energy malnutrition in the first year of life was compared to that of matched comparison cases with no such history, using a modified version of the WISC. IQ scores of boys and girls with a history of malnutrition were significantly lower than those of the comparison children. IQ was examined in relation to current socioeconomic conditions of the family, including degree of crowding, income and physical resources of the home. In this study, socioeconomic differences between the two groups were not significantly associated with the reduction in IQ performance. This study supports the important relationship between the early history of malnutrition and conditions associated with this event with later IQ deficits at school age.
125 citations
TL;DR: The need to understand better the amelioration of various ADD symptoms by different medications is underscored, with methylphenidate having a greater efficacy than the other drugs.
Abstract: Twelve boys with attention deficit disorder (ADD) were treated in a double-blind placebo controlled crossover experiment with methylphenidate, clomipramine (CMI) and desipramine (DMI). A Latin square design was followed to control for the order of presentation of the drugs. Behavioral ratings by teachers and child care workers indicated methylphenidate had a greater efficacy than the other drugs. The therapeutic action of the short-acting sympathomimetic agent diminished by evening, whereas the tricyclic antidepressants (TCAs) have a longer half-life and therefore continued to be effective. The TCAs were more effective with affective symptoms and less likely to disturb sleep. The present study underscores the need to understand better the amelioration of various ADD symptoms by different medications.
123 citations
TL;DR: In this survey of 40 consecutive admissions to a child psychiatry inpatient service, at least half of the children had moderate to severe developmental language disorders, found in children with a wide variety of psychiatric diagnoses.
Abstract: Surveys of language-impaired children at speech and hearing clinics invariably show a high frequency of psychiatric disorders. However, there have been few investigations of the frequency of developmental language disorders in children referred for psychiatric services, although the presence of such a disorder would clearly be expected to influence diagnosis and treatment. In this survey of 40 consecutive admissions to a child psychiatry inpatient service, at least half of the children had moderate to severe developmental language disorders. The disorders were found in children with a wide variety of psychiatric diagnoses, and routine intellectual testing did not invariably detect the presence of developmental dysphasia. Recommendations for screening, diagnosis and treatment of language-disordered children with psychiatric problems are given.
120 citations
TL;DR: Fenfluramine was administered to 14 outpatients with the syndrome of autism in a double blind crossover study to determine its effects on blood serotonin concentrations, platelet counts, and symptomatic behaviors and revealed that certain symptoms improved significantly while patients were on medication and worsened when placebo was reinstituted.
Abstract: Fenfluramine was administered to 14 outpatients with the syndrome of autism in a double blind crossover study (ABA design) to determine its effects on blood serotonin concentrations, platelet counts, and symptomatic behaviors. Blood serotonin concentrations decreased an average of 51% after 1 month on medication and returned to baseline levels within 1 month after return to placebo. Platelet counts were unaffected. Serial observation scales, developmental profiles, intelligence scales, and parental interviews and diaries were obtained. They revealed that certain symptoms improved significantly while patients were on medication and worsened when placebo was reinstituted. Patients with both normal and elevated baseline serotonin had symptomatic improvements. No adverse reactions to medication nor clinically significant side effects were noted. Definitive conclusions regarding relationships among initial serotonin levels, clinical features, and symptom responses cannot yet be drawn since data are available on only 14 patients. The encouraging findings in these 14 patients are being studied further at 18 medical centers throughout the United States on approximately 150 patients.
113 citations
TL;DR: The various traumatic components of the child abuse syndrome are described and their impact on the psychopathology, cognitive impairment, and developmental sequelae observed in abused children are explored.
Abstract: This paper describes the various traumatic components of the child abuse syndrome and explores their impact on the psychopathology, cognitive impairment, and developmental sequelae observed in abused children. The child abuse syndrome consists of two broad categories of trauma: the acute physical and psychological assault confronting the child with the threat of annihilation is superimposed upon the long-term traumatic components resulting from chronic abnormal parenting such as harsh, punitive child rearing, scapegoating, and maternal deprivation. Central nervous system impairment, which is frequently associated with child abuse, may be regarded as an additional source of trauma which potentiates the pathological impact of the acute and long-term components of the abusive environment. Most abused children exhibit the characteristic symptoms of the Post Traumatic Stress Disorder described in DSM-III.
109 citations
TL;DR: Although some group differences in parental personality may have antedated terminal care, parental reports of more adequate family adjustment following participation in a structured Home Care Program are confirmed.
Abstract: Twenty-four families who had participated in a Home Care Program for children terminally ill with cancer and 13 families of similar children who had died in the hospital completed inventories on parent and sibling personality as well as family functioning three to 29 months after the child9s death. Parents of patients who received terminal care in the hospital were more anxious, depressed, and defensive and had greater tendencies toward somatic and interpersonal problems than parents of patients in the Home Care Program. Siblings of patients who received terminal care in the hospital were more emotionally inhibited, withdrawn, and fearful than their counterparts in the Home Care Program. Although some group differences in parental personality may have antedated terminal care, these results confirm parental reports of more adequate family adjustment following participation in a structured Home Care Program.
98 citations
TL;DR: The relationship between family life events and rates of childhood morbidity was studied prospectively in a birth cohort of New Zealand children during the period from ages 1 to 4 years when a series of measures of family social and economic background was taken into account statistically.
Abstract: The relationship between family life events and rates of childhood morbidity was studied prospectively in a birth cohort of New Zealand children during the period from ages 1 to 4 years Family life events were associated with increased risk of medical consultation and hospital attendance for illness of the lower respiratory tract, gastroenteritis, accidents, burns, scalds, and accidental poisoning In addition, children from families experiencing large numbers of life events had an increased risk of hospital admission for suspect or inadequate care The correlation between life events and rates of child morbidity persisted when a series of measures of family social and economic background was taken into account statistically Possible explanations of the role of family life events in the development of childhood morbidity are discussed
94 citations
TL;DR: Parents who had cared for their terminally ill child at home displayed more positive adjustment patterns as indexed by their perception of how the child's death had affected their marriage, social reorientation, religious beliefs, and views on the meaning of life and death.
Abstract: Mothers and fathers of 37 deceased pediatric oncology patients were interviewed 3 to 28 months after their child's death. Twenty-four of these families had participated in a formal Home Care Program for dying children, whereas the remaining 13 families had children who died in the hospital. Parental adaptation following the home care experience appeared to be more favorable than following terminal care and death in the hospital. Specifically, the parents who had cared for their terminally ill child at home displayed more positive adjustment patterns as indexed by their perception of how the child's death had affected their marriage, social reorientation, religious beliefs, and views on the meaning of life and death. Ratings given by parents providing home care indicated a significant reduction in guilt during the home care experience which was maintained at 6 and 12 months following the child's death. In contrast, parents who did not provide home care reported intensified feelings of guilt during their child's terminal hospitalization which were unresolved at one year after the child's death. The results are discussed in terms of the practical and emotional benefits that may be derived from a family's voluntary choice of home care for dying children.
TL;DR: The consulting child psychiatrist has an important role to play to assure that the children and parents involved in these cases receive appropriate medical and psychologic care and are protected from the apparently high child mortality rate of this serious disease.
Abstract: The Munchausen by Proxy Syndrome, in which a parent makes a child appear to be ill, was first reported in 1977. Although the features of this syndrome have been delineated and the psychodynamics are increasingly well understood, our experience with a new case, expanded review of the literature, and examination of certain follow-up data suggest that there exist important obstacles to the appropriate management of these cases. The obstacles include a failure to appreciate fully the relationship of this syndrome to that of nonaccidental poisoning; the striking symbiotic tie between parent and child that exists in these cases; the characteristic and highly persuasive denial on the part of parents when confronted with the situation; and the understandable skepticism on the part of legal authorities when asked to intervene on behalf of the child. The consulting child psychiatrist has an important role to play to assure that the children and parents involved in these cases (which are probably more numerous then previously recognized) receive appropriate medical and psychologic care and are protected from the apparently high child mortality rate of this serious disease.
TL;DR: A new type of nonorganic failure to thrive is observed, best characterized as a separation disorder, which needs to be differentiated from the well studied nonorganicfailure to thrive due to a disturbance in attachment between mother and child.
Abstract: We have observed a new type of nonorganic failure to thrive, best characterized as a separation disorder, which needs to be differentiated from the well studied nonorganic failure to thrive due to a disturbance in attachment between mother and child. This type of failure to thrive is due to food refusal by the infant. The infant refuses to eat in an attempt to achieve a degree of autonomy and control with regard to the mother, a maneuver which only serves to involve the mother more deeply in the child's eating behavior. The onset of the disorder usually occurs during the second half of the first year of life, during the developmental phase of separation and individuation, and reflects a disturbance in somatopsychological differentiation. It is a serious condition which, without intervention, will lead to severe disturbances in physical as well as emotional growth.
TL;DR: In this article, age stage-specific changes in patterns of sleep and bedtime behavior were examined in 109 normally developing preschool-aged children who were the subjects of the New York Longitudinal Study of Temperament and Development.
Abstract: Age stage-specific changes in patterns of sleep and bedtime behavior were examined in 109 normally developing preschool-aged children who were the subjects of the New York Longitudinal Study of Temperament and Development. The data were derived from information abstracted from interviews conducted with parents about the behavior of their children in daily life situations at 1, 2, 3, 4, and 5 years of age. The following age trends were found: older children were significantly more likely to exhibit a prolongation of bedtime routine, insist on sleeping with the light on, take a treasured object to bed, request parental attention after being told good night, and experience delays in falling asleep than were younger children. The frequency of occurrence of night awakening was not different at the different age levels examined, although older children were significantly more likely to experience nightmares. The fathers of older children were significantly more likely to participate in bedtime routines, and older children were also significantly more likely to share a bedroom with a sibling. No sex differences were found.
TL;DR: It is suggested that depression is a more common accompaniment in patients with anorexia nervosa than is usually appreciated and may co-exist with major depressive disorder.
Abstract: The case histories of 84 patients with a diagnosis of anorexia nervosa were evaluated on the basis of Research Diagnostic Criteria (RDC) for Major Depressive Disorder and Endogenous Major Depressive Disorder. Fifty-six percent met RDC criteria for a major depressive disorder and 35% met RDC criteria for an endogenous depression. MMPI data revealed a mean depression (D) score of 68 with the mean profile showing elevation of scales 2(D), 7(PT) and 8(SC). This study suggests that depression is a more common accompaniment in patients with anorexia nervosa than is usually appreciated. The evidence suggests that anorexia nervosa and major depressive disorder may co-exist and the significance of this is discussed.
TL;DR: In this article, a critical appraisal of primary prevention of children's psychosocial disorders indicates that our knowledge on this topic is limited and that there are few interventions of proven value.
Abstract: A critical appraisal of primary prevention of children9s psychosocial disorders indicates that our knowledge on this topic is limited and that there are few interventions of proven value. Nevertheless, there are possibilities for effective prevention. Myths associated with unwarranted claims for the value of prevention are reviewed in terms of unproven assumptions that: (1) prevention cuts costs; (2) prevention in childhood will improve adult health; (3) improved living standards will reduce mental illness; (4) sensible interventions can only be beneficial; (5) providing people with information leads to preventive action; (6) the main issue in prevention is implementing what we know; (7) the best approach is to tackle the basic cause; and (8) the crucial issue is to identify that one basic cause. Principles of causation are discussed and a model of causative influences is used to consider potentially effective primary prevention policies with respect to those directed at (a) individual predisposition; (b) ecologic factors; (c) influences on opportunity and situation; and (d) current stresses and strengths. It is concluded that a good deal is known about risk factors and the areas in which primary prevention might be effective, but that less is known concerning precisely how to intervene in order to bring about the desired results. There is a potential for effective primary prevention but, so far, it remains largely unrealized.
TL;DR: Results reveal that half this group of children with severe language deficits evidence some features similar to autism, and findings for research into the natural history of developmental language disorders are discussed.
Abstract: Longitudinal data on 28 children diagnosed during the past decade as aphasic are reported. These subjects have been involved in a series of studies on the biological, psychological, social, and linguistic correlates of neuropsychiatric disorders of childhood. Results reveal that half this group of children with severe language deficits evidence some features similar to autism. Progress in language and behavioral areas is generally modest at best, although a few subjects make great gains. Children with and without autistic characteristics who have some strengths in the comprehension of language tend to make gains in social engagement, even if social skills were very poor to begin with. The implications of these; findings for research into the natural history of developmental language disorders are discussed.
TL;DR: Abusive and neglectful parents were more frequently given psychiatric diagnoses than were control parents, and perpetrators of abuse were given diagnoses different from their nonabusing spouses.
Abstract: Seventy-six parents of abused and neglected children who were referred for psychiatric treatment to a child abuse and neglect treatment program in a general medical hospital were compared to 38 control parents of nonmaltreated pediatric outpatients of the same hospital in terms of the presence of diagnosed psychopathology. The psychiatric assessment was made using a standard semistructured instrument, the SADS-L, and was based on Research Diagnostic Criteria. Abusive and neglectful parents were more frequently given psychiatric diagnoses than were control parents, and perpetrators of abuse were given diagnoses different from their nonabusing spouses.
TL;DR: It is concluded that adolescents with signs and symptoms consistent with attention deficit disorder do respond to stimulant medication and that the use of a double-blind assessment is practical in the determination of drug response.
Abstract: Twenty-two adolescents with attention deficit disorder participated in a double-blind, active drug and placebo cross over study with methylphenidate. Sixteen of the children responded positively to medication as measured by improvement on the Conners' abbreviated teacher questionnaire, as well as improvement on daily narratives of the youngsters' behavior and school performance provided by their teachers. It is concluded that adolescents with signs and symptoms consistent with attention deficit disorder do respond to stimulant medication and that the use of a double-blind assessment is practical in the determination of drug response.
TL;DR: These results demonstrate maladaptive patterns in both mother and infant beyond the abuse itself which reflect an interactive failure of continuing risk to the infant's cognitive and social development.
Abstract: Twelve abusing and 12 control mother-infant pairs, matched for infant age, sex, race, and socioeconomic status were videotaped during free play. Standardized coding revealed differences in the quality of maternal stimulation: abusing mothers ignored more, initiated less play and did less verbal teaching. Abusing mothers differed emotionally also, demonstrating more negative behavior and less positive affect than control mothers. Abused infants complied less with their mothers' attempts to direct their play. These results demonstrate maladaptive patterns in both mother and infant beyond the abuse itself which reflect an interactive failure of continuing risk to the infant's cognitive and social development.
TL;DR: One of the recent debates in Irish society was the contribution made by teachers to the Celtic Tiger, something they said was unrecognised and undervalued but few have highlighted the positive aspects.
Abstract: A lot of negative inferences have been drawn from these trends but few have highlighted the positive aspects. Usually where you find a lot of negativity, you find a lot of ignorance. One of the negative inferences is that older people are a burden on society and as society ages there will be a greater number of older people dependent on fewer workers. Yet, how many older people have taken on the role of childminding so that their sons and daughters can go out to work? One of the recent debates in Irish society was the contribution made by teachers to the Celtic Tiger, something they said was unrecognised and undervalued. How much more could grandparents claim that they were one of the pillars of the Celtic Tiger? Economists have never put a value on their contribution and dependency ratios they quote do not take account of those over 65 who are in employment. One of the reasons in fact why there are fewer older people in the workforce can be attributed directly to ageist attitudes.
TL;DR: The Psychosocial Schedule is an instrument derived from several pre-existing rating scales, which was designed to measure and record clinical data which are likely to be relevant to child psychiatric disorder.
Abstract: The Psychosocial Schedule (PSS) is an instrument derived from several pre-existing rating scales, which was designed to measure and record clinical data (other than the symptoms of the present episode of disorder) which are likely to be relevant to child psychiatric disorder. These data include: developmental and past symptomatic history, demographics, family functioning, and relationships. Reliability was tested by interrater and test-retest designs with mothers of prepubertal children. Overall, the instrument appeared to be quite reliable. Although it is subject to minor modifications, especially for use with adolescents, it is concluded that the PSS is a practical instrument which should be tested now in adolescents, and can be utilized in future studies with prepubertal subjects.
TL;DR: It is suggested that only minimal academic deficits exist but that wide variability is evident and implications for differential diagnosis are discussed.
Abstract: While some evidence exists that children with emotional disorders are deficient in academic achievement compared to non-handicapped populations, the nature and extent of these deficits remain unclear. For a sample of children admitted to a psychiatric hospital, achievement scores in reading, arithmetic, and spelling were obtained; and underachievement was computed based on mental age. Findings suggested that only minimal academic deficits exist but that wide variability is evident. Implications for differential diagnosis are discussed.
TL;DR: Although there were a few isolated findings of limitation in life philosophy or death dreams without any connectable past fright or helplessness, the vast majority of positive findings in these normal children were directly related to past terror or psychic trauma.
Abstract: Twenty-five normal schoolchildren were asked about their futures, expectations, the likelihood of any disasters, repeated terror dreams or death dreams, and their sense of dream prediction. Each child was asked for any particularly terrifying past episodes. Although there were a few isolated findings of limitation in life philosophy or death dreams without any connectable past fright or helplessness, the vast majority of positive findings in these normal children were directly related to past terror or psychic trauma.
TL;DR: The nature and quality of the authors' knowledge is approached in this paper from a review of studies of the impact of abuse on children, for which a critique of methodology is given.
Abstract: Contained in each causal explanation for child abuse is a theory of etiology. The nature and quality of our knowledge is approached in this paper from a review of studies of the impact of abuse on children, for which a critique of methodology is given. The relation between theory construction, study, and clinical action is addressed. Recommendations with respect to the focus and content of future research are made.
TL;DR: Pilot data concerning one specific eating disorder, nonorganic failure to thrive (NFTT), is presented to illustrate new research approaches and heuristically intersting findings, and a formula for estimation of degree of protein calorie malnutrition predicts the caloric supplementation required for catch up growth.
Abstract: The eating disorders in infancy and early childhood are delineated by an overview of the relevant literature. The special methodological problems which impede reserch in this area of study are described. Pilot data concerning one specific eating disorder, nonorganic failure to thrive (NFTT), is presented to illustrate new research approaches and heuristically intersting findings. Specifically, a formula for estimation of degree of protein calorie malnutrition predicts the caloric supplementation required for catch up growth. This estimate of malnutrition can become a useful tool to investigate the relative contribution of inadequate nutrition and inadequate psychosoical stimulation in NFTT.
TL;DR: Five such behaviors, thumbsucking (non-nutritive sucking), rocking, headbanging, use of a pacifier, and attachment to a soft object have been reviewed in detail and a community survey of these five described.
Abstract: Etiological and epidemiological studies of rhythmic motor behaviors in children have been reviewed in the light of a hypothesis that they constitute a single class of behaviors called stereotypies, and thus that they should obey the laws relating to such behaviors. Five such behaviors, thumbsucking (non-nutritive sucking), rocking, headbanging, use of a pacifier, and attachment to a soft object have been reviewed in detail and a community survey of these five described. The results are discussed in the light of other studies and the theory of stereotypies.