Colonic transit times and behaviour profiles in children with defecation disorders.

AIMS: To evaluate children referred for defecation disorders using the child behavioural checklist (CBCL). METHODS: A total of 215 patients were divided into three groups: 135 (5-14 years of age) with paediatric constipation (PC), 56 (5-17 years) with functional non-retentive faecal soiling (FNRFS), and 24 (5-16 years) with recurrent abdominal pain (RAP). Behavioural scores were correlated with colonic transit time (CTT) and anorectal function parameters (manometry and EMG). RESULTS: No significant differences in the mean CBCL scores were found among the three patient groups. However, children with PC and FNRFS had significantly more behavioural problems than the Dutch normative sample, while children with RAP had scores within the normal range. No significant differences were found between CTT in the patient groups, with respect to the CBCL. Similarly, no significant difference existed between children able or unable to relax their pelvic floor muscles during defecation attempts and their behaviour profiles. CONCLUSION: There seems to be no relation between colonic/anorectal function and specific behavioural profiles. On the other hand, children with defecation disorders show more behavioural problems than do controls.     

Plethysmographic lung volumes in children with sighing dyspnea

Background: This study compared the plethysmographic lung volumes of children with sighing dyspnea with healthy children and tested the hypothesis that sighing children suffer from hyperinflation or gas trapping as a cause of dyspnea. Methods: From January 2006 to December 2006, pediatric patients with sighing dyspnea presenting to the pulmonary clinic of a tertiary children’s hospital who had no apparent cardiopulmonary diseases were prospectively enrolled; normal healthy children were invited to participate for comparison. Baseline pre‐bronchodilator spirometry and post‐inhaled bronchodilator spirometry were measured for the determination of bronchodilator response. Plethysmographic lung volumes were determined solely for total lung capacity, residual volume (RV) and functional residual capacity (FRC) without the use of inhaled bronchodilator according to standard procedure. Results: Eighteen sighing children (10 boys) and 10 healthy subjects (six boys) were included in the present study. They had a median age of 13 years (range, 8–15 years) and 13 years (range, 8–17 years), respectively. The mean baseline forced vital capacity (FVC) of subjects with dyspnea was 79.4 ± 16.7% of predicted, while that of the normal control children was 88.4 ± 6.7%, which was not statistically significantly different. Forced expiratory volume in 1 s (FEV₁), FEV₁/FVC % of predicted were within normal limits and indicated no bronchodilator response. RV and RV/total lung capacity (TLC) were elevated in children with sighing dyspnea that were not measured by spirometry, but TLC and FRC measured on plethysmography (FRC_pleth) were not increased. Conclusions: RV and RV/TLC were higher in children with sighing dyspnea that were not measured by spirometry, but TLC and FRC_pleth were not increased. The causal link between dysfunctional breathing patterns and changes in static lung volumes was not able to be determined in the present study. The possibility of heterogeneity of patients with sighing dyspnea obscures the significance of lung volume discrepancy in this population; further subdivision of children with sighing dyspnea in a larger cohort of patients is required.     

Psychological evaluation of children with idiopathic constipation and their parents

BACKGROUND: Constipation is one of the most common problems in childhood. In idiopathic constipation it is not possible to identify primary cause in every case. Child behavioral problems and disturbances in parent-child relationships have been cited as causes of constipation. Constipation is a source of anxiety to the child and to the family. The purpose of the present study was to evaluate psychological characteristics of constipated children and their parents. METHODS: Thirty-two otherwise healthy children with idiopathic constipation over 4 years old were prospectively evaluated between January 2002 and June 2003. The Child Behavior Checklist (CBCL) and Symptom Checklist-90 revised (SCL-90-R) were used to assess the psychological profiles of the children and the parents, respectively. Thirty children with inguinal hernia who had no constipation or other problems, and their parents were asked to complete the checklists as controls. The scores of the constipation group were compared statistically with those of the control group. RESULTS: In the constipation group there were 19 boys and 13 girls with a mean age of 7.3 years (4-14 years). All the patients responded to medical treatment. Constipated children and their parents were not found to have more behavior problems than the control group (P > 0.05). CONCLUSIONS: Children with idiopathic constipation and their parents do not show significant behavioral and emotional problems. Their psychological profiles are not different from the general population.     

Colonic transit times and behaviour profiles in children with defecation disorders

Aims: To evaluate children referred for defecation disorders using the child behavioural checklist (CBCL). Methods: A total of 215 patients were divided into three groups: 135 (5–14 years of age) with paediatric constipation (PC), 56 (5–17 years) with functional non-retentive faecal soiling (FNRFS), and 24 (5–16 years) with recurrent abdominal pain (RAP). Behavioural scores were correlated with colonic transit time (CTT) and anorectal function parameters (manometry and EMG). Results: No significant differences in the mean CBCL scores were found among the three patient groups. However, children with PC and FNRFS had significantly more behavioural problems than the Dutch normative sample, while children with RAP had scores within the normal range. No significant differences were found between CTT in the patient groups, with respect to the CBCL. Similarly, no significant difference existed between children able or unable to relax their pelvic floor muscles during defecation attempts and their behaviour profiles. Conclusion: There seems to be no relation between colonic/anorectal function and specific behavioural profiles. On the other hand, children with defecation disorders show more behavioural problems than do controls.     

Evaluation of Quality of Life in Children with GH Deficiency and Idiopathic Short Stature Using the Child Behavior Checklist

The quality of life (QoL) of short children is an important issue that has been studied in Western countries, but not fully in Japan. We assessed the psychosocial profiles of Japanese children with short stature using the Japanese version of the Child Behavior Checklist (CBCL). A higher score in the CBCL means a lower QoL. A total of 116 children with idiopathic short stature (ISS) and 127 children with GH deficiency (GHD), aged 4 to 15 yr, were enrolled in the study. The total CBCL scores of the children in the GHD/ISS group were found to be higher than those of the normal children group. The QoL subscales for social problems and attention problems of the young (4–11 yr) children in the GHD/ISS group were significantly higher than those of the group of children of normal height. The proportion of children with GHD/ISS classified into the borderline/abnormal range was significantly higher than that of normal children. Children with ISS tended to have higher total scores and more subscale problems, and a greater proportion of these children was classified in the borderline/abnormal range than the children with GHD, although the difference was not significant. These results suggest that QoL is impaired in Japanese children due to short stature.     

Child behaviour after anaesthesia: association of socioeconomic factors and child behaviour checklist to the Post-Hospital Behaviour Questionnaire

AIM: In the process of validation of the Swedish translation of the Post-Hospital Behaviour Questionnaire (PHBQ) to assess its relation to the Child Behaviour Checklist (CBCL) and to describe its relation to sociodemographic factors. METHOD: Three hundred and forty children 2-13 years studied in connection with elective procedures which included anaesthesia. Parents completed the CBCL forms before and after hospitalization as well as the PHBQ 2 weeks after hospitalization. RESULTS: In multivariate analysis of PHBQ total score independent risk factors were: age <5 (OR 2.4; CI 1.4-4.0), living in a one parent family (OR 4.4; CI: 1.6-12.6) and not living in a rural area (OR 1.6; CI: 1.0-2.6). The correlation between the total scores for PHBQ and CBCL for children aged 2-4 was moderate: (r = 0.38; p < 0.005). For children aged 4-7 there were significant correlations between PHBQ sleep anxiety and CBCL Other problems (r = 0.4; p < 0.01), PHBQ eating disturbances and CBCL total score (r = 0.3; p < 0.01), though none of these significant correlations were observed for children above 7 years of age. CONCLUSION: There is an association between PHBQ and CBCL which is weaker for older children. The reason for this might be that PHBQ is more sensitive in the younger age group and to minor changes in behaviour. Children younger than 5 years of age or living in a one parent family or not living in rural areas appear to have higher incidence of problematic behaviour in a 2 week follow up after anaesthesia.     

Visceral hyperalgesia in children with functional abdominal pain.

OBJECTIVE: Our purpose was to evaluate visceral sensitivity and psychologic profiles in children with functional gastrointestinal disorders. STUDY DESIGN: We measured visceral perception in the stomach and in the rectum by using an electronic barostat. Psychologic questionnaires were completed. Ten children with recurrent abdominal pain (RAP)(8 female, mean age 11.3 +/- 0.8 years), 10 children with irritable bowel syndrome (IBS) (8 female, mean age 13.0 +/- 0.9 years), and 15 control children (8 female, mean age 12.7 +/- 1.2 years) completed the study. RESULTS: Thresholds for visceral perception in the rectum were decreased in patients with IBS (P <.001 vs control patients) and in patients with RAP (P <.05 vs control patients). Children with IBS had lower thresholds than children with RAP (P <.01). In contrast, thresholds for perception were decreased in the stomach of children with RAP (P <.005 vs control patients) but not in children with IBS. There were elevated anxiety scores in 45% of patients. Duration of symptoms was associated with higher scores of anxiety (P <.001) and depression (P <.02). CONCLUSIONS: Hyperalgesia was demonstrated in children with RAP and IBS; sites of hyperalgesia appear to be associated with different symptom phenotypes; anxiety was common, and there was an association between the duration of symptoms and increased scores for both anxiety and depression.     

漏斗胸患儿心身健康调查

目的　调查漏斗胸患儿心身健康状况 ,进一步了解漏斗胸矫治手术的意义。方法　采用儿童行为量表 (CBCL)、症状自评量表 (SCL -90 )和自编的漏斗胸患儿心身健康调查问卷 ,对观察组 87名漏斗胸患儿和对照组 87名正常儿童进行调查分析。结果　观察组较对照组行为问题检出率高 ,尤其表现为人际关系敏感、抑郁、焦虑、强迫因子等方面。结论　漏斗胸患儿的心身健康水平低下 ,早期手术矫治有利于患儿在生理 心理 社会方面全面发展。     

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??Objective??To estimate the occurrence of attention deficit hyperactivity disorder comorbiding anxiety and depression and to compare the behavior characteristics of ADHD with and without anxiety or depression. Methods??A total of 105 children with ADHD meeting DSM-4 diagnostic criteria aged from 8 to 14 years were involved in this study. They were evaluated with the Screen for Child Anxiety Related Emotional Disorders??SCARED???? Depression Self-Rating Scale for Children??DSRSC?? by self-report and Achenbach’s Child Behavior Checklist ??CBCL?? by their parents. Another 66??without diagnosis of ADHD?? children aged from 8-14 years who were selected from a school as a control group were evaluated too??according to SCARED and DSRSC?? a ormal group ??43 children?? was selected from control group for analysis. Results??Thirty-nine of 105 children with ADHD compared to 13 of 66 controls scored at or beyond the clinical cut off ??25 points?? of SCARED score . Thirty-three of 105 children with ADHD compared to 10 of 66??15.2%?? controls reached the threshold??15 points?? of DSRSC of Chinese Norm ??χ2 = 5.704??P = 0.017??. In ADHD group 16 of 105??15.2%?? ADHD children comorbid both anxiety and depression??but none in controls. In ADHD children?? all scores of social ability were lower while all CBCL behavior scores were higher than normal controls except somaticcomplaint?? ADHD with anxiety had higher score in somatic complaint??ADHD with depression had higher score in anxious/depressed and ADHD with both anxiety and depression had higher score in Withdrawn?? somatic complaint?? Anxious/Depressed?? thought problems??attention problems andinternalizing problems than ADHD without anxiety and depression. Conclusion??The children with ADHD have high occurrence of comorbidity ofanxiety and depression. Children comorbided both anxiety and depression have more behavior and internalizing problems?? which implies that there is a need for further mental health services for this population.     

Long‐term psychosocial adjustment following pediatric liver transplantation

This study assessed long-term psychosocial adjustment to pediatric liver transplantation in 146 patients aged 4-25 yr, who had received a transplant 2-12 yr previously. Evaluations of psychosocial adjustment and related variables were based on the Harter Self-Perception Profiles for children, Child Behavior Checklist (CBCL), and children's academic level. Up to the age of 8 yr, transplant children as a group did not perceive themselves as less competent than healthy peers. Gender effects were characterized by older girls perceiving significantly less scholastic cognitive competence than their healthy peers. Adolescent and young adult boys had significantly lower global self-worth and lower perceived athletic competence than their healthy peers. In comparison to normative data of healthy children, CBCL parent-reported scores revealed significant deficits in competences for all age groups. Only for the older boys, however, did these deficits reported by the parents reach a pathological level. The majority of transplant children also had significantly higher problem scores, but they remained within the normal range, except for the older boys whose internalizing problems reached a borderline level. Our results suggest that liver transplantation does not substantially affect schooling. Regardless of statistically significant differences in psychosocial adjustment, the majority of the transplant children functioned at a normal level. For adolescent and young adult boys, however, the presence of problems and the lack of competences observed by parents and by the youngsters themselves reached borderline to pathological levels. Our findings stress the importance of psychological post-transplant follow-up with increased attention of caregivers to child and parental concerns about their long-term psychosocial adjustment process.     

注意缺陷多动障碍共患焦虑和抑郁情况及其行为特点的研究

评估注意缺陷多动障碍（ADHD）患儿共患焦虑和抑郁情况,同时探讨共患疾病对其行为的影响特点。方法　2007-2009年在中南大学湘雅二医院儿童精神卫生专科门诊收集105例ADHD患儿,年龄8～14岁,均符合DSM-IV诊断标准,但不存在对立违抗障碍、品行障碍和抽动障碍。于某学校选取66名同年龄段,无ADHD、对立违抗障碍、品行障碍和抽动障碍的学生作对照组。对所有研究对象采用ADHD诊断量表、Achenbach儿童行为量表（CBCL） 、儿童焦虑性情绪障碍筛查表（SCARED）、儿童抑郁障碍自评量表（DSRSC）进行评定,对照组儿童经SCARED、DSRSC评定后选择正常的43名作为正常对照组用于分析。结果　105例ADHD中39例（37.1%）共患焦虑,66名对照组中13例（19.7%）共患焦虑,两者间差异有统计学意义（χ2 = 5.829,P = 0.016）。ADHD共患抑郁者33例31.4%）,对照组10例（15.2%）,差异有统计学意义（χ2 = 5.704,P = 0.017）。ADHD同时共患焦虑与抑郁者16例（15.2%）,对照组中未发现共患焦虑与抑郁者。ADHD患儿CBCL社会能力得分均低于对照组,行为问题得分除躯体主诉外均显著高于正常对照组,差异有统计学意义（分别P = 0.000～0.010、P = 0.000～0.007）。ADHD单纯共患焦虑组CBCL躯体主诉得分显著高于单纯ADHD组,差异有统计学意义（P < 0.05）;ADHD单纯共患抑郁组CBCL焦虑/抑郁得分显著高于单纯ADHD组,差异有统计学意义（P < 0.05）;ADHD同时共患焦虑与抑郁组CBCL退缩、躯体主诉、焦虑/抑郁、思维问题、注意问题和内化性问题均显著高于单纯ADHD组,差异有统计学意义（P < 0.05）。结论　ADHD患儿有较高的抑郁和焦虑共患情况,同时共患抑郁与焦虑的ADHD患儿存在更多的行为问题,需要更多的精神卫生服务。     

Inhaled corticosteroids do not affect behaviour

AIM: To determine whether children with asthma and on inhaled corticosteroids have more behavioural problems, such as aggressiveness and hyperactivity, as compared with healthy controls and with children under medical care because of other disorders. METHODS: Questionnaires were given to three groups of children: a group of asthmatic children with inhaled corticosteroids (ICS), a group of children attending the ear, nose and throat (ENT) outpatient clinic and the healthy controls. Included were questions about health, medication use, demographical data and about behaviour, including the child behaviour check list (CBCL) and questions about attention deficit hyperactivity disorder (ADHD). RESULTS: Forty asthmatic children on ICS, 50 children visiting the ENT outpatient clinic and 183 healthy controls were studied. The total CBCL and mean ADHD scores of the children on ICS were 28.1 and 9.1, which were both significantly higher than the scores of the healthy controls (20.4 and 7.1), but not when compared with the ENT outpatient group (26.2 and 8.6). Further analysis revealed statistically significant differences between the ICS group and healthy controls in CBCL-axes. There were, however, no differences between the ENT group and the ICS on one side and the healthy controls on the other. CONCLUSION: There is a difference in behaviour between healthy children and asthmatic children on ICS, but not when compared with children visiting the ENT department. Although hyperactivity, aggressiveness and anxiety might occur in children on ICS, this is probably caused by individual susceptibility. Being under specialist care can possibly explain behavioural differences between children on ICS and healthy controls.     

Depression and anxiety in chronic hepatitis B: effect of hepatitis B virus infection on psychological state in childhood

We aimed to evaluate the effect of chronic hepatitis B virus infection on the psychological state of children. Children who were carriers of hepatitis B virus (n:20) and those with chronic hepatitis B virus infection (n:20) for at least one year formed study Groups 1 and 2, respectively. Healthy children with similar demographic characteristics (n:43) were enrolled as the control group. The "Children's Depression Inventory" and "State-Trait Anxiety Inventory for Children" were used for the assessment of the extent of depression and anxiety, respectively. Then, mean depression and anxiety scores of the study and control groups were compared. In addition, the children in each group were further evaluated for depression and anxiety with respect to gender and age as prepubertal and postpubertal. The mean depression and anxiety scores of study Groups 1 and 2 and of the control group were 8.35 +/- 5.6, 8.22 +/- 6.85, 9.12 +/- 5.2 (depression scores) and 32.7 +/- 6.85, 33.4 +/- 10 and 34 +/- 6.5 (anxiety scores), respectively. These three groups did not differ significantly from each other with respect to anxiety and depression scores (p>0.05). Athough there was no child with overt depression (with a depression score over 19) in study Group 2, two children in study Group 1 and one child in the control group were determined to be in overt depression. Children with chronic hepatitis B virus infection were not different with respect to depression and anxiety from children who were carriers of hepatitis B virus nor from the healthy controls.     

Urge incontinence and voiding postponement in children: somatic and psychosocial factors

AIM: To analyse the number of urinary tract infections, uroflowmetry, behavioural symptoms and intrafamilial interaction in two groups of daytime wetting children in a paediatric and a child psychiatric unit. METHODS: Ninety-four children with either voiding postponement (52) or urge incontinence (42) were examined prospectively for history of urinary tract infections (UTIs), uroflowmetry, the syndrome scales of the Child Behaviour Checklist (CBCL 4/18-Achenbach) and the Family Adaptability and Cohesion Evaluation Scales (FACES-III) (Olson) questionnaire. RESULTS: Children with urge incontinence had a significantly higher rate of previous urinary tract infections (50%) than children with voiding postponement (19.2%; p < 0.001), who showed a high rate of plateau (12.2%) and staccato (20.4%) curves and were characterized by a wide variety of behavioural symptoms, including withdrawn (11.6%), aggressive (11.8%), delinquent (19.6%) behaviour and attention problems (13.7%). Clinically relevant behavioural scores were 4-10 times higher for the voiding postponers, and 2-3 times higher for children with urge incontinence. Furthermore, families of voiding postponers had significantly fewer balanced types of intrafamilial function (FACES-III). Problematic "rigid/disengaged" and "rigid/separated" types predominated. CONCLUSION: Urge incontinence is characterized by a higher rate of UTIs, a lower urine volume in uroflowmetry, a lower rate of behavioural scores in the clinical range and well-functioning families. Voiding postponement children, on the other hand, have a higher, though not significant, rate of abnormal uroflow curves, a wide variety of clinically relevant behavioural symptoms, which were significantly higher for attention and delinquent problems. Conduct problems predominated; only 13.7% of the children had attention problems in the clinical range. The findings lend empirical support to the entity of voiding postponement as an acquired or behavioural syndrome characterized by wetting in association with a delay of micturition and other externalizing conduct problems.     

Problematic behaviours of 3-year-old children in Japan: relationship with socioeconomic and family backgrounds

AIM: The purpose of our study was to elucidate factors in socioeconomic and family backgrounds of 3-year-old children in Tokyo, Japan that were associated with problematic behaviours among the children. STUDY DESIGN: 670 eligible 3-year-old children underwent an evaluation of problematic behaviour by the Japanese Child Behaviour Checklist (CBCL/2-3) and of socioeconomic and family backgrounds. RESULTS: Stepwise multi-logistic regression analyses using all 28 variables showed that longer hours watching TV, smoking during pregnancy, coffee drinking during and after pregnancy increased, whereas higher family income, a larger number of older brothers/sisters, higher educational level of father decreased problematic behaviours. Maternal anxiety measured by trait anxiety using the STAI was associated with behaviour problems measured by CBCL, particularly with externalizing domains composed by aggressiveness, oppositional and attention domains. CONCLUSION: These results suggest that problematic behaviours among children may be increased by adverse socioeconomic and family backgrounds that may be associated with maternal anxiety.     

Psychosocial adjustment and quality of life after renal transplantation in early childhood

Psychosocial adjustment and quality of life has been reported good in children after a successful renal transplantation (Tx). There are, however, few reports of using standardized methods in evaluating these issues, particularly in small children. We investigated the psychosocial adjustment in 32 children at school age (mean 9.6 +/- 1.6), who had received a renal Tx under the age of 5 yr, using the Achenbach Child Behavior Checklist with data collected from both parents (CBCL) and teachers (CBCL-TRF). Health-related quality of life (HRQOL) was assessed by interviewing the children using a 17-dimensional (17D) health-related measure and compared to HRQOL of 244 normal school children. The effect of additional diseases and comorbidity on psychosocial adjustment and HRQOL was assessed. The total scores on the CBCL did not differ from normative samples of healthy children. However, somatic complaints and social problems were reported more frequently in boys, and attention problems in both boys and girls. Patients with pathological scores had significantly more comorbidity (p = 0.03) and were more often attending a special school (p = 0.007) than patients with normal scores. The global 17D HRQOL index was significantly lower than measured in healthy controls (94 +/- 5 for controls and 85 +/- 7 for patients, p < 0.0001). It is of crucial importance to further minimize the risk factors leading to comorbidity in children after Tx. HRQOL assessment by the children themselves can be used to direct interventions and support the children's psychosocial adjustment.     

Behavioural problems in children and parenting stress associated with primary nocturnal enuresis in Hong Kong

The aim of this study was to investigate the behavioural problems and parenting stress of enuretic children in the local Chinese community. The study recruited 89 children with primary nocturnal enuresis (PNE) from the paediatric clinics of 9 regional hospitals in Hong Kong, and 131 age- and gender-matched control children without PNE from the Student Health Centres. After adequate instruction, the parents completed the Child Behaviour Checklist (CBCL) and Parenting Stress Index (PSI). A trained interviewer interviewed the parents and children and rated the children on the Global Assessment of Functioning (GAF). The PNE group had worse overall scores in both the Problem and Competence scales of CBCL; in particular, they had more attention problems and aggressive behaviours, and lower social competence and school performance than the control group. Their parents demonstrated more parenting stress as shown by higher PSI scores. Conclusion: In the local Chinese population, PNE was associated with more childhood behavioural problems and greater parenting stress. Attention to the psychosocial functioning of the child and parents may be important in the management of enuresis.     

Associations between Different Diagnostic Approaches for Child and Adolescent Psychopathology

Objective: To test the convergence between the empirical-quantitative approach of the Child Behavior Checklist (CBCL) and the clinical-diagnostic approach of the DSM. Method: The parent version of the NIMH Diagnostic Interview Schedule for Children (DISC), version 2.3, was administered after completion of the CBCL for 231 children and adolescents consecutively referred to an outpatient mental health clinic. Results: Of the subjects with a DSM-III-R diagnosis, 60% scored in the clinical range of the CBCL total problem score. The Withdrawn scale predicted affective and anxiety disorders. The Somatic Complaints scale predicted anxiety and mood disorders and Attention Deficit Hyperactivity Disorder. The Anxious/Depressed scale predicted anxiety and mood disorders and, to a lesser extent, disruptive behavior disorders. The Social Problems scale predicted Oppositional Defiant Disorder. The Attention Problems scale was the only significant predictor of "pure" Attention Deficit Hyperactivity Disorder (ADHD). The Aggressive Behavior scale predicted several disruptive behavior disorders, and Major Depression. The Delinquent Behavior scale was strongly associated with Conduct Disorder. Conclusions: Empirically based CBCL scale scores and DISC-P based DSM-III-R diagnoses converged. However, both approaches do not converge to a degree that one approach can replace the other. Instead, combining both approaches may be valuable by adding information from one approach that is not captured by the other.     

Stress experienced by mothers of Malaysian children with mental retardation

OBJECTIVE: To compare parenting stress among Malaysian mothers of children with mental retardation and a control group, and to determine factors associated with stress. METHODOLOGY: Seventy-five mothers of children with mental retardation aged 4-12 years and 75 controls (those without disabilities who attended the walk-in paediatric clinic) participated in the Parenting Stress Index (PSI). Intelligence quotient (IQ) and Child Behaviour Checklist (CBCL) scores, together with sociodemographic data, were entered into a multiple stepwise regression analysis, using the PSI as the criterion. RESULTS: Mothers of children with mental retardation scored significantly higher than control subjects in both the child-related domain (difference between means 26.1, 95% confidence interval 19.6-32.5) and parent-related domain (difference between means 15.0, 95% confidence interval 7.9-22.1) of the PSI. The total child behaviour scores from the CBCL (P < 0.01), IQ scores (P < 0. 01) and sibship size (P < 0.01) were associated with child-related domain scores. For the parent-related domain, CBCL (P < 0.01) and IQ scores (P = 0.01) remained important factors but Chinese ethnicity (P < 0.01) and maternal unemployment (P < 0.01) were also significant predictors of stress. CONCLUSION: A large proportion of mothers of children with mental retardation experienced substantial parenting stress, especially Chinese and unemployed mothers, and this warrants appropriate intervention.     

Exposure to violence: psychological and academic correlates in child witnesses.

BACKGROUND: Inner-city children are frequently exposed to violence; however, there are few data regarding the psychological and academic correlates of such exposure in young children at school entry. OBJECTIVES: To document exposure to violence in inner-city children aged 7 years; assess their feelings of distress; and evaluate the relationships of exposure to violence with school performance, behavior, and self-esteem. SETTING: A study center in an inner-city hospital. PARTICIPANTS: One hundred nineteen inner-city children evaluated at age 7 years; 119 caregivers (biological and foster). DESIGN: As part of a longitudinal study, children were administered the following by a masked examiner: Things I Have Seen and Heard (TISH) to assess exposure to violence; Levonn, a cartoon-based interview for assessing children's distress symptoms; and the Culture-Free Self-Esteem Inventory, Second Edition. School performance was assessed by school reports and child behavior by the Child Behavior Checklist (CBCL), the Parent Report Form, and the Teacher Report Form. Caregivers for children were administered the parent report version of the Checklist of Children's Distress Symptoms (CCDS-PRV) as well as the CBCL Parent Report Form. MAIN OUTCOME MEASURES: Exposure to violence (TISH); feelings of distress (Levonn); school performance; behavior (CBCL Parent Report Form and CBCL Teacher Report Form); and self-esteem (Culture-Free Self-Esteem Inventory). RESULTS: We found that these children were frequently exposed to violence. For example, 75% had heard gun shots, 60% had seen drug deals, 18% had seen a dead body outside, and 10% had seen a shooting or stabbing in the home (TISH). Many showed signs of depression and anxiety; eg, 61% worried some or a lot of the time that they might get killed or die and 19% sometimes wished they were dead (Levonn). Higher exposure to violence (TISH Total Violence score) was correlated with higher Levonn composite scores for depression and anxiety and with lower self-esteem (P< or =.04), and was also associated with lower grade point average and more days of school absence (P< or =.02). Caregiver assessment of child anxiety correlated poorly with child report of anxiety (P =.58). CONCLUSIONS: Young inner-city children have a high exposure to violence by age 7 years; many show signs of distress that frequently are not recognized by caregivers. Further, higher exposure to violence in children correlates with poorer performance in school, symptoms of anxiety and depression, and lower self-esteem.