Tension-type headache in children: A clinical evaluation

BACKGROUND: Headache Society (IHS) criteria for episodic tension-type headache were included in the present study. Pain characteristics, associated symptoms, and stress-triggering factors were evaluated. Psychiatric and psychosocial evaluations were performed according to DSM-IV criteria. RESULTS: Pain was bilateral in 93.7% of patients and bitemporal in 50% of children. The intensity of pain increased with motion and stress in more than half of the patients, while pain decreased with rest and massage in 43.7% of patients. Ten of the 16 (62.5%) patients were diagnosed as having a psychiatric disorder. The most common stress-triggering factors were difficulty in adaptation at school and relationship problems with family members. All of the children reported 26 stress factors. Of these stress factors, 20 (76.9%) were reported by children diagnosed with psychiatric disorder. CONCLUSION: These results suggest that in children with tension-type headache a thorough psychiatric evaluation should be performed to rule out underlying psychiatric disorders.     

A psychosocial follow-up of ten adolescents with low anorectal malformation

Ten adolescents, aged 12–16 (mean 14.5) years, with corrected low anorectal anomalies were assessed with regard to somatic condition, psychopathology and psychosocial functioning by semistructured interviews and questionnaires. Half of the patients still had a persistent dysfunction involving problems with constipation and/or soiling. Six of 10 adolescents met the criteria for a psychiatric diagnosis and had scores indicating mild to severe impairment of psychosocial function. Psychosocial functioning was correlated with chronic family difficulties. The findings are in contrast to previous studies and reveal hidden problems and unmet social needs. To optimize their mental health and psychosocial functioning, children with low anorectal anomalies need both somatic and psychosocial follow-up.     

Psychosomatic and psychosocial diagnoses at the Zurich University pediatric clinic. A retrospective study of ambulatory patients 1973 to 1982

This study analyses the number and distribution of children (n = 97,161) attending the medical out-patient service at the University Children's Hospital of Zurich with psychiatric diagnoses during the years 1973-1982. The average prevalence (one-year periods) of the patients with psychiatric diagnoses represents 17.8%, the incidence (ten-year period) represents 20.5%. In the group of patients with psychiatric diagnoses, the percentage of children having a psychosomatic diagnosis is 57.2%, the percentage of psychosocial diagnoses is 42.8% (29.9% developmental disturbance, 5.8% psychoreactive syndromes, 4.0% psychoorganic syndromes, 2.8% mental retardation, 0.3% psychosis). 58.7% of the patients with psychiatric diagnoses are boys, 41.3% girls; age-frequency demonstrates the following distribution: 1-4 years 22.6%, 5-7 years 19.3%, 8-10 years 19.5%, 11-13 years 18.5%, 14-16 years 14.5%, 17-20 years 5.6%. The data of this study document the importance of psychosomatic and psychosocial phenomena in childhood and adolescence. They have implications for the content of educational programs and research efforts.     

Abdominal pain in six-year-olds: an epidemiological study in a new town

This study investigated recurrent abdominal pain in all 494 second-year infant children in a new town using a postal questionnaire followed by sampling and detailed interview. A prevalence of between 24.5 and 26.9% was found and there were associations with psychiatric deviance both at home and at school. There were also associations with social support of the mother, difficulties in settling into school and status of house ownership. Details of parental management of their children's symptoms are described.     

Psychosocial outcomes at 15 years of children with a preschool history of speech-language impairment

BACKGROUND: Evidence suggests there is a heightened risk of psychiatric disorder in children with speech-language impairments. However, not all forms of language impairment are strongly associated with psychosocial difficulty, and some psychiatric disorders (e.g., attention deficit/hyperactivity disorder (ADHD)) are more prevalent than others in language-impaired populations. The present study assessed the psychosocial adjustment in adolescence of young people with history of speech-language impairment, and investigated specific relationships between language deficits and psychiatric disorders. METHODS: Seventy-one young people (aged 15-16 years) with a preschool history of speech-language impairment were assessed using a psychiatric interview (K-SADS) supplemented by questionnaires probing social encounters and parental reports of behaviour and attention. Their psycho-social adjustment was compared with that of a cross-sectional control group of age-matched controls. RESULTS: Overall the rate of psychiatric disorder was low in the clinical sample and children whose language delay had resolved by 5.5 years had a good outcome. For those whose language difficulties persisted through the school years, there was a raised incidence of attention and social difficulties. These difficulties were partially independent and associated with different language profiles. The group with attention problems showed a profile of specific expressive language difficulties; the group with social difficulties had receptive and expressive language difficulties; and the group with both attention and social difficulties was of low IQ with global language difficulties. CONCLUSIONS: Amongst children with speech-language delays at 5.5 years, those with more severe and persistent language difficulties and low nonverbal IQ are at higher risk of psychiatric morbidity in adolescence.     

Prevalence of recurrent complaints of pain among Greek schoolchildren and associated factors: a population-based study

AIM: To determine the prevalence of recurrent complaints of pain (RCP) in Greek children, and to examine associations with socio-demographic characteristics and psychosocial factors. METHODS: Cross-sectional study comprising a nationally representative population of 8130 7-y-old Greek schoolchildren. Data were collected by mailed questionnaires (response rate 89%). RCP was defined as present if at least one of the complaints of headache, abdominal pain or limb pain occurred at least once a week. RESULTS: The RCP prevalence rate was 7.2%, with significant gender differences (8.8% of girls, 5.7% of boys; p<0.001). RCP was significantly positively associated with a chronic health problem among the children, frequent change of residence, poor school performance, often watching TV and rarely playing with other children. There were no statistically significant associations of RCP with family structure and socio-economic status. CONCLUSION: The results are indicative of the prevalence of RCP in Greek schoolchildren. This study enlightens the psychosocial component of RCP and emphasizes the importance of gathering information on children's social background in medical settings.     

Psychiatric features of children and adolescents with pseudoseizures

BACKGROUND: Pseudoseizures may occur as a somatoform disorder in children and adolescents as well as adults. However, few data are available about psychiatric features or outcome in pediatric patients. PATIENTS AND METHODS: We studied 34 patients (25 girls [74%]) who were evaluated by a child psychiatrist at our institution immediately after diagnosis of pseudoseizures by ictal video electroencephalogram (EEG) at ages 9 to 18 years (mean age, 14 years). Each patient had at least 1 pseudoseizure recorded by video EEG that was judged by the patient and family as typical, characterized by unresponsiveness plus limb twitching or limpness and other features, with EEG showing persistence of normal cortical background rhythms. RESULTS: In addition to conversion disorder, 11 patients (32%) had mood disorders including major depression, bipolar disorder, or dysthymic disorder, usually with severe psychosocial stressors. Eight children (24%) had separation anxiety and school refusal with moderate psychosocial stressors. Two patients (6%) had brief reactive psychosis or schizophreniform disorder. A few (1-3) patients each had panic disorder, overanxious disorder, adjustment disorder, oppositional/defiant disorder, or impulse control disorder. Four patients (12%) also had personality disorders. Eleven patients (32%) had a history of sexual abuse. This was especially frequent in the subgroup with mood disorders (7 [64%] of 11 patients). Fifteen patients (44%) had severe family stressors including recent parental divorce, parental discord, or death of a close family member. Two patients (6%) had a history of physical abuse. Freedom from pseudoseizures for the preceding 9 to 55 months (mean, 30 months) was achieved for 15 (72%) of the 21 patients who could be reached for telephone follow-up. For 8 (53%) of these 15 patients, the last pseudoseizure was within 1 month of diagnosis by video EEG. CONCLUSIONS: Major mood disorders and severe environmental stress, especially sexual abuse, are common among children and adolescents with pseudoseizures and should be considered in every case. A subgroup of children with separation anxiety and school refusal had less severe psychiatric problems and moderate psychosocial stressors. Clear diagnosis by video EEG, together with prompt psychiatric evaluation and treatment, may result in freedom from pseudoseizures for most children and adolescents.     

Pediatric chronic daily headache associated with school phobia

Background:  Children and adolescents with school phobia sometimes complain of severe and persistent headaches that are diagnosed as chronic daily headache (CDH).
Methods:  We investigated 24 children with CDH and school phobia, and 26 children with CDH but without school phobia.
Results:  Of 24 children with CDH and school phobia, 4% had chronic migraine (CM), 46% had chronic tension-type headache (CTTH) and 50% had both CTTH and migraine. However, of 26 children with CDH but without school phobia, 61% had CM, 24% had CTTH, 11% had CTTH and migraine, and 4% had new daily-persistent headache. There was a significantly higher rate of CTTH and both CTTH and migraine in children with CDH and school phobia than that in children with CDH but without school phobia ( P  < 0.0001). All of the 24 children with CDH and school phobia were found to have psychiatric disorders. Of 24 children, 71% were found to have adjustment disorders, 21% were found to have anxiety disorders, and 8% were found to have conversion disorder. Of 26 children with CDH but without school phobia, only 20% were found to have psychiatric disorders. There was a significantly higher rate of psychiatric disorders in children with CDH and school phobia than in children with CDH but without school phobia ( P  < 0.0001).
Conclusions:  Our study indicated that children with CDH and school phobia had problems in school and/or family and psychiatric disorders. They should be diagnosed and treated attentively not only for headaches but also for their psychosocial problems and psychiatric disorders.     

The impact of recurrent abdominal pain: predictors of outcome in a large population cohort

AIM: Recurrent abdominal pain is one of the commonest complaints of childhood, affecting approximately 10% of children at any one time. This study aims to describe the outcome of recurrent abdominal pain amongst 6-year-old children, and to identify risk factors (in both the children and their parents), which predict these outcomes. METHODS: 7128 6-year-old children in the Avon Longitudinal Study of Parents and Children (ALSPAC) were followed up for 1 year. The principle outcomes were abdominal pain, number of days missed from school in the preceding year and psychiatric diagnoses. RESULTS: Children with recurrent abdominal pain at age 6 years had higher rates of further abdominal pain [odds ratio 4.88 (95% CI: 4.01, 5.95)], school absence (10 or more days off school in a year) [OR 1.89 (1.53, 2.33)] and anxiety disorders [OR 2.36 (1.68, 3.32)] at age 7 years. Maternal anxiety was the most consistent predictor of subsequent adverse outcomes for these children. CONCLUSION: Children with recurrent abdominal pain are at significant and continuing risk of adverse functioning. It is important for clinicians to take a whole family perspective, and particularly to consider parental anxiety, when a child with recurrent abdominal pain presents to them.     

Psychosocial and neuropsychological function in children with epilepsy

This paper reviews the psychosocial and neuropsychological effects of epilepsy on children and families across environments in which children function, specifically home and school. Epilepsy is a chronic disorder, affecting one percent of the population, that alters neurocognitive functioning effecting learning, memory and family adaptation. A review of epilepsy and its impact on quality of life, family and school function and psychiatric comorbidity are discussed.     

Psychosomatic disorders in pediatrics

Psychosomatic symptoms are by definition clinical symptoms with no underlying organic pathology. Common symptoms seen in pediatric age group include abdominal pain, headaches, chest pain, fatigue, limb pain, back pain, worry about health and difficulty breathing. These, more frequently seen symptoms should be differentiated from somatoform or neurotic disorders seen mainly in adults. The prevalence of psychosomatic complaints in children and adolescents has been reported to be between 10 and 25%. These symptoms are theorized to be a response to stress. Potential sources of stress in children and adolescents include schoolwork, family problems, peer pressure, chronic disease or disability in parents, family moves, psychiatric disorder in parents and poor coping abilities. Characteristics that favour psychosomatic basis for symptoms include vagueness of symptoms, varying intensity, inconsistent nature and pattern of symptoms, presence of multiple symptoms at the same time, chronic course with apparent good health, delay in seeking medical care, and lack of concern on the part of the patient. A thorough medical and psychosocial history and physical examination are the most valuable aspects of diagnostic evaluation. Organic etiology for the symptoms must be ruled out. Appropriate mental health consultation should be considered for further evaluation and treatment.     

Beyond psychopathology: assessing seriously disruptive students in school settings

OBJECTIVE: To obtain a demographic profile of aggressive students in an urban setting and discern psychiatric diagnoses, functional impairment, and psychosocial stressors. STUDY DESIGN: Participants were 33 students in an urban public school district referred for comprehensive psychiatric evaluation by school staff because they were viewed as a threat to school safety. Evaluations included a review of records, interviews with school and mental health professionals, and student and parent interviews. RESULTS: Students were characterized by severe and untreated or undertreated psychopathology together with high levels of psychosocial stressors and learning disorders. Thirty-two students received at least one Axis I diagnosis, and the mean number of diagnoses for each student was 3; 33% had substance abuse problems, and 30% had nonpsychiatric medical conditions. CONCLUSIONS: The sample is a chronically impaired group of students confronting serious adversity in their daily lives, whose psychosocial and psychiatric needs are not met by current educational and mental health programming. Necessary interventions include prevention and early identification, substance abuse and family treatment, and appropriate psychopharmacological treatment. A comprehensive psychiatric assessment can help change the outcomes for this group of aggressive students.     

Mental health and psychosocial functioning in adolescents with congenital heart disease. A comparison between adolescents born with severe heart defect and atrial septal defect

Twenty-six adolescents, aged 13–18 years, with severe congenital heart disease were matched for sex, age and living area with 26 adolescents with repaired atrial septal defect and regarded as physically fit. These two groups were compared according to somatic condition, psychopathology, psychosocial functioning and chronic family difficulties. A higher rate of psychiatric problems in the complex group, an association between psychosocial functioning and physical capacity, as well as an association between psychosocial functioning and chronic family difficulties were observed. These findings suggest that physical capacity is of crucial importance for mental health and functioning of adolescents with congenital heart disease. The association with chronic family difficulties also suggests that a comprehensive biopsychosocial approach is necessary in the treatment and rehabilitation of these patients.     

Chronic illness, psychosocial problems, and school absences. Results of a survey of one county

The number of days absent from school during the 1979-80 school year for 573 children aged 6-17 years in Berkshire County, Massachusetts was ascertained by parent reporting in a random household survey. Children with a wide range of chronic health impairments were reported as missing more school than their healthy peers (8.7 days vs. 5.8, p less than .001). Although there was a trend for children reported as having functional impairments to miss more school than those with chronic conditions without functional impairments (11.0 vs. 8.1), the difference was not statistically significant. Children with a variety of reported psychosocial difficulties missed more school than those without psychosocial difficulties for the sample as a whole and for those with reported chronic conditions. These findings document support for the assumption that children with a wide range of physical and psychological problems miss more school than their healthy peers and illustrate that the etiology of school absences is multifactoral and reflects behavioral as well as purely physical phenomena.     

Facteurs de risque psychosociaux et troubles psychiatriques des jeunes pris en charge par l’aide sociale à l’enfance et ayant recours à des soins hospitaliers

Background

Children and adolescents involved with foster care are a population at high risk of developing psychiatric disorders. Here, we aimed to assess in children and adolescents admitted in a University Department of Child and Adolescent Psychiatry whether being involved with foster care would change psychopathology and risk factors they face.

Method

We conducted a case-control study in a sample of 103 inpatients aged 6 to 18 years (52 supported by foster care; 51 not supported). Assessment included family and medical histories, psychopathology using the MINI neuropsychiatric interviews (Kid and parents) for axis 1 diagnoses and the diagnostic interview for borderline for axis 2 diagnoses. We also scored the following scales: Global Assessment Functioning, Eysenck Impulsivity and Empathy Scale, Buss and Durkee Hostility Inventory, Harvey Affective Liability Scale.

Results

We found more psychosocial life events, both past and recent (occurring less than 2 years) in inpatients involved with foster care (family conflicts, single parent, repeated breaks in places of life, academic failures). We also found more family history of antisocial personality disorder, alcoholism and other drug abuses in first-degree relatives. Regarding axis 1 psychopathologies, we found significantly more conduct disorders, specific developmental disorders and learning difficulties among youths supported by foster care. Finally, we found several prevalent traits of the borderline personality and higher scores of impulsivity, emotional liability and hostility. However, we did not find significant difference for empathy score between the two groups. The results emphasize a condition of cumulative risk factors in the inpatients population involved with foster care.

Conclusion

The severity and prevalence of psychiatric disorders among youths involved with foster care and requiring psychiatric inpatient stay show the impact of interactions with the environment on the development of psychopathology in children and, for some of them, the inadequacy of the means of prevention.     

Disease patterns in early onset pauciarticular juvenile chronic arthritis

A group of 76 children with early onset pauciarticular juvenile chronic arthritis (JCA) was studied in order to establish different disease patterns and to try and identify parameters associated with an unfavourable outcome. An intermittent pattern of disease was found in 60 children (79%). Of the remaining 16 patients continuous persistent pauciarticular disease activity was present in 7 (9.2%) and extended pauciarticular in 9 children (11.8%). An extended pauciarticular pattern was seen predominantly in children with continuous disease activity. It appeared to be impossible to predict the course of the disease on the basis of clinical parameters. The frequency of complications, such as local growth disturbances or psychosocial problems and of chronic anterior uveitis resulting in visual handicap correlated with continuous disease activity. The extended pauciarticular pattern, resulting in polyarthritis resembled seronegative polyarticular JCA, underlining previous reports that the joint pattern during the course of disease may be more important than joint pattern at onset of disease.     

An overview of studies on early development, cognition, and psychosocial well-being in children born after in vitro fertilization

OBJECTIVE: To examine whether sufficient research has been done and definite conclusions can be drawn on the psychological outcome of children born after in vitro fertilization (IVF), a review was performed of studies on early development, cognition, and psychosocial well-being in IVF children. METHOD: PubMed and PsycINFO databases were searched. All English language studies up to 2006 addressing these topics were included. RESULTS: After 25 years of follow-up studies on the development, school outcome, and psychosocial well-being of IVF children, it seems that mental and psychomotor development during the first year and preschool years and cognitive development at 5 years are not deviant. At 6-12 years of age, no differences were observed in cognitive and school performance compared with naturally conceived children; however, the number of studies in this age group is limited. No studies are available that evaluate cognitive aspects and school performance at secondary school age. Overall, positive parent-child relationships were reported in IVF families. In some studies, IVF mothers report more difficulties with their child's behavior only in the child's first year. With regard to the children's psychosocial well-being, no differences were found up to the age of 8 years. Although after that age, slight indications for some socioemotional and behavioral problems emerged, a large study on the onset of puberty reported that psychosocial functioning was reassuring. Data for adolescents are still lacking. CONCLUSION: Psychological functioning of those born after IVF is reassuring. However, follow-up should be continued and studies should focus on specific cognitive abilities, school performance, and emotional functioning in adolescence.     

Psychosocial needs of long-term childhood cancer survivors: a review of literature

With improved medical treatment for childhood cancer, many patients are enjoying long disease-free remission or cure. It is important to address the psychosocial adjustment of the survivor's life. There are two approaches to the study of psychosocial adjustment: study of psychiatric disturbances and assessment of quality of life. Incidences of psychiatric disturbances were reviewed with the most commonly reported difficulties being depression, anxiety and chemical dependency for older survivors and school attendance problems and learning difficulties for school age survivors. The assessment of quality of life focused on school performance, social adjustment, employment status, independent living and marital status. In addition, family coping has received increasing emphasis with regard to the effects on marital relationship and financial difficulties, although there is no consistent evidence to suggest an increased divorce rate in these families. Healthy siblings of cancer survivors are also subject to vulnerability. However, there is evidence to suggest most siblings will resolve their feelings of jealousy, fear of abandonment and establish a normal sibling relationship with the survivor.     

Which family factors predict children's externalizing behaviors following discharge from psychiatric inpatient treatment?

OBJECTIVE: Parents' behavior management practices, parental stress, and family environment are highly pertinent to children's conduct problems. Preadolescents' psychiatric hospitalization usually arises because of severe conduct problems, so the relationships of family-related variables to postdischarge functioning warrant investigation. This study examined postdischarge clinical course and select family factors to model outcomes via a) predictors measured at admission, b) predictors measured concurrently with outcome, and c) changes in predictor values from admission through follow-up. METHOD: In a prospective follow-up of 107 child psychiatry inpatients, caregivers completed rating scales pertaining to their child's behavior, parenting practices, parenting stress, caregiver strain, and their own psychological distress at admission and three, six, and 12 months after discharge. RESULTS: The magnitude of reductions in parenting stress between admission and follow-up bore the strongest relationship to improvements in externalizing behavior. The largest and most sustained decreases in externalizing behavior arose among youngsters whose parents reported high parenting stress at admission and low parenting stress after discharge. By contrast, children whose parents reported low parenting stress at admission and follow-up showed significantly less postdischarge improvement. Parenting stress changes were not attributable to changes in behavioral symptoms. Parenting stress eclipsed relationships between behavior management practices and child outcomes, suggesting that parenting stress might have a mediational role. CONCLUSIONS: High initial parenting stress disposed to better outcomes over the year of follow-up. Consistently low stress predicted less improvement. Higher stress at admission may imply more advantageous parent-child relationships or motivation for subsequent persistence with treatment. Interventions that ameliorate high stress may warrant further study. Low parenting stress might signify disengagement, or, alternatively, that parents of some chronically impaired children become rather inured to fluctuations in behavioral problems. If confirmed, further examination of these and other accounts for a relationship between low parenting stress and suboptimal child outcome seems warranted.     

Chest pain in children. Follow-up of patients previously reported

During a 1-year period, 407 children with chest pain were seen in the Emergency Department of Children's Hospital of Philadelphia. Analysis of the clinical data of these children was reported previously. The authors successfully followed 149 of these children for 6 months or more, and 51 for 2 years or more. These patients returned for an average of 3.4 visits during the follow-up period. Thirty-four percent of the initial diagnoses were altered. Usually, during the follow-up period, the authors concluded that chest pain resulted from nonorganic causes. A new organic etiology was uncovered in only 12 of 149 cases. Only 1 child was found to have a heart abnormality (mitral valve prolapse), and 3 were found to have asthma. Chest pain did not resolve during the follow-up period in 43 percent of those followed. Children with chest pain should have follow-up care because of the persistence of symptoms, but serious disease is unlikely to be found over time.