Abnormal Psychosocial Situations and ICD-10 Diagnoses in Children and Adolescents Attending a Psychiatric Service

Two recent WHO drafts for ICD-10 diagnoses and the assessment of abnormal psychosocial situations were used in a large cohort of patients attending a child and adolescent psychiatric service. In addition to revealing frequency distributions of psychosocial features, it was shown that a total score of abnormal psychosocial features was mainly dependent on socioeconomic status and was to a lesser extent dependent on age. Sex was not found to be significant. In addition, there was a significant association between IQ and some main categories of the list of psychosocial features. Among diagnoses, the strongest correlations with psychosocial conditions exist for conduct disorders and mixed disorders of conduct and emotions. A high symptom load is associated with higher frequencies of abnormal psychosocial situations.     

Attachment and callous-unemotional traits in children with early-onset conduct problems

Background: Antisocial children with callous‐unemotional (CU) traits appear to be disconnected from other people’s emotions; although little is known about their experience of the parent‐child emotional bond. This study examined parent‐child attachment relationships and levels of CU traits in conduct‐problem children. Method: Attachment classifications in boys (M = 6.31 years) with disruptive behaviour disorders were assessed using the Manchester Child Attachment Story Task. Multiple informants rated children’s CU traits. Results: Independent of severity of conduct problems, high levels of CU traits were associated with more insecure attachment; specifically, disorganised attachment representations; however, CU traits were not associated with avoidant representations. Conclusions: Among conduct‐problem children, those higher on CU traits appear to be at increased risk of experiencing disruptions in parent‐child attachment relationships; attachment may be an important area for treatment and prevention efforts for CU traits in young children.     

Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology

We review recent research on the presentation, nosology and epidemiology of behavioral and emotional psychiatric disorders in preschool children (children ages 2 through 5 years old), focusing on the five most common groups of childhood psychiatric disorders: attention deficit hyperactivity disorders, oppositional defiant and conduct disorders, anxiety disorders, and depressive disorders. We review the various approaches to classifying behavioral and emotional dysregulation in preschoolers and determining the boundaries between normative variation and clinically significant presentations. While highlighting the limitations of the current DSM-IV diagnostic criteria for identifying preschool psychopathology and reviewing alternative diagnostic approaches, we also present evidence supporting the reliability and validity of developmentally appropriate criteria for diagnosing psychiatric disorders in children as young as two years old. Despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. We review the implications of these conclusions for research on the etiology, nosology, and development of early onset of psychiatric disorders, and for targeted treatment, early intervention and prevention with young children.     

Quality of life in paediatric inflammatory bowel disease measured by a generic and a disease-specific questionnaire

This study assessed the impact of inflammatory bowel disease (IBD) on the health-related quality of life (HRQoL) of children and adolescents, using both a generic and a disease-specific instrument. Three questionnaires were sent to all patients (8-18 y old) from the database of two large secondary/tertiary hospitals in the western part of The Netherlands. In total, 83 (66%) children responded, 18 were between 8 and 12 y old and the remaining 65 were older. HRQoL was measured using a generic instrument, the TNO-AZL Children's Quality of Life questionnaire (TACQOL), assessing seven domains, and the Impact-II (NL), a disease-specific instrument assessing six domains. Disease activity was measured by a five-item symptom card. Compared with scores from a large reference population (n= 1810), younger children with IBD had a comparable HRQoL (measured by the TACQOL) on six domains, and better cognitive functioning, although they did not have severely active disease. Adolescent patients with IBD had a significantly impaired HRQoL on four domains (body complaints, motor functioning, autonomy and negative emotions). The Impact-II discriminated well between patients with varying disease activity states on all domains. CONCLUSION: Adolescents with IBD have a severely affected HRQoL. Impairment on motor functioning and autonomy is a threat to gaining independence from caregivers, and a high occurrence of negative emotions places patients at risk for depressive and behavioural disorders. The Impact-II is recommended for clinical use because of its high discriminative validity.     

Situational and generalised conduct problems and later life outcomes: evidence from a New Zealand birth cohort

Background: There is considerable evidence suggesting that many children show conduct problems that are specific to a given context (home; school). What is less well understood is the extent to which children with situation‐specific conduct problems show similar outcomes to those with generalised conduct problems. Methods: Data were gathered as part of the Christchurch Health and Development Study, a 25‐year longitudinal study of a birth cohort of New Zealand children. Information was obtained on: (a) conduct problems during the period 7–9 years; (b) criminal offending during the period 16–25 years; (c) measures of DSM‐IV mental disorders and suicidal behaviour over the interval 16–25 years; (d) measures of DSM‐IV substance dependence over the interval 16–25 years; and (e) measures of relationship, pregnancy, and parenthood outcomes during the period 16–25 years. Results: Latent‐class modelling suggested three distinct groups of children with conduct problems: those with mother reports; those with teacher reports; and those with both mother and teacher reports. Both situation‐specific and generalised conduct disorder were associated with increased risk of criminal offending, mental health disorders, substance dependence, and relationship and parenthood issues in late adolescence and early adulthood. Conclusions: There is a need for recognition of the significance of situation‐specific conduct problems in both developmental theory and in the treatment of childhood conduct disorders. A focus only on those children with generalised conduct problems is likely to overlook the features and needs of children whose conduct problems are confined to a specific context.     

The impact of pre- and perinatal factors on attention-deficit and disruptive behavior disorders

Diagnosis of attention-deficit and disruptive behavior disorders defines a group of disorders which have common properties. This group consists of attention-deficit hyperactivity disorder, conduct disorder and oppositional defiant disorder. In order to differentiate these disorders, which share similar properties, it is important to verify the existing differences. In this respect, differences between and distribution of perinatal factors in these three disorders were investigated. The study was conducted in the Child Psychiatry and Pediatric Neurology Departments over a 20-month period. Two hundred and seventy children out of 1,556 attendant with various complaints were diagnosed to have one of the following disorders: 121 had attention-deficit hyperactivity disorder, 50 had oppositional defiant disorder and 99 had conduct disorder. The prenatal and perinatal data of the patients were evaluated retrospectively by a neonatologist. With regard to the investigated parameters, none showed any significant difference between the three groups when compared. The three disorders, which share many similarities in terms of the symptoms, also show similarities in terms of perinatal factors. Since we did not find any study similar in design, our results, although statistically not significant, are discussed in light of the little data available.     

Conversion disorder in children and adolescents: clinical features and comorbidity with depressive and anxiety disorders

The aim of this study was to determine some of the demographical and clinical characteristics of conversion disorder in children and adolescents and to ascertain comorbidity with depressive and anxiety disorders. For this purpose 51 children and adolescents (mean age: 13.2 +/- 1.9, range: 9-16 years) who met DSM-IV criteria for conversion disorder were compared with a control group. The subjects of this study were mostly postpubertal girls, and pseudoseizure was the most frequent presentation. Misdiagnoses were frequent among these patients. Eight (15.7%) patients received a comorbid diagnosis of major depression and 19 (37.2%) patients had comorbid anxiety disorders according to DSM-IV diagnostic criteria. Significant differences between the two groups on depression and anxiety scales supported the clinical findings. It was concluded that clinicians should screen every patient with conversion disorder for major depression and anxiety disorders for a better outcome.     

Predictive validity of DSM‐IV oppositional defiant and conduct disorders in clinically referred preschoolers

Background: Diagnostic validity of oppositional defiant and conduct disorders (ODD and CD) for preschoolers has been questioned based on concerns regarding the ability to differentiate normative, transient disruptive behavior from clinical symptoms. Data on concurrent validity have accumulated, but predictive validity is limited. Predictive validity is critical to refuting the hypothesis that diagnosing ODD and CD in young children leads to pathologizing normal behavior. ODD and CD have emerged as gateway disorders to many forms of adult psychopathology. Establishing how early we can identify symptoms and disorders that herald poor prognosis is one of the most important goals for research on etiology and prevention. Methods: Subjects were 3–5‐year‐old consecutive referrals to a child psychiatry clinic (n = 123) and demographically matched children from a pediatric clinic (n = 100). A diagnostic interview was used to assess DSM‐IV ODD and CD in a prospective follow‐up design from preschool to school age. Stability of ODD and CD diagnoses and level of impairment were tested as a function of preschool diagnosis. Results: Over 80% of preschoolers diagnosed with ODD and approximately 60% of preschoolers diagnosed with CD met criteria for the same disorder during follow‐up. Impairment over time varied significantly as a function of stability of diagnosis across three years. Conclusions: These results provide the first evidence of the predictive validity of DSM‐IV ODD and CD in clinically referred preschool children. The findings challenge the assumption that symptoms of disruptive behavior disorders that occur during the preschool period tend to be transient.     

Validity and clinical feasibility of the ADHD rating scale (ADHD-RS) A Danish Nationwide Multicenter Study

Aim: To establish the validity of a Danish version of the Attention Deficit Hyperactivity Disorder Rating Scale (ADHD-RS), secondly to present national norm scores compared to that of United States and other European data and thirdly to evaluate ADHD-RS when used for monitoring treatment effectiveness.
Methods: A Danish translation of the ADHD-RS was used on a normative sample of 837 children. Two clinical samples, 138 hyperkinetic disorder (HKD) cases and 110 clinical controls were recruited from eleven Danish Child and Adolescent Mental Health (CAMH) centres and assessed according to usual clinical standards. The HKD children were rated by parents and teachers at baseline and at follow-up 3 months later.
Results: Internal validity of ADHD-RS was high and the factor structure supported the diagnostic classification system ICD-10. The questionnaire discriminated HKD patients in a mixed clinical sample, and was sensitive to change in symptom load as measured before and after commencing of the treatment.
Conclusion: The Danish version of ADHD-RS is valid and clinically feasible when measuring HKD symptom load in a CAMH-setting. The questionnaire provides useful data in patient management, quality improvement and service planning as well as in effectiveness studies of different interventions for patients with HKD and related disorders in routine clinical settings.     

Construct validity of the five‐factor Strengths and Difficulties Questionnaire (SDQ) in pre‐, early,and late adolescence

Background: The Strengths and Difficulties Questionnaire (SDQ) is designed to measure psychological adjustment in children and adolescents. Psychometric evaluations of the instrument have shown satisfactory convergent and discriminant validity, while factor analysis studies have shown mixed results across countries. In the present study, the construct validity of the five‐factor SDQ is evaluated in a large community sample of Norwegian pre‐, early, and late adolescents. Methods: The sample consisted of 26,269 children and adolescents (10–19 years) with valid answers on all 25 items of the SDQ self‐report. Complete parent/proxy data of respective pre‐adolescent children was available for 6,645 cases. A Lisrel approach to Confirmatory Factor Analysis (CFA) was used to evaluate the five‐factor model and the presence of a positive construal factor. In the sample of pre‐adolescents and their parents/proxies, convergent and discriminant validity was evaluated by a CFA approach to multitrait‐multimethods (MTMM). Results: Fit statistics for the hypothesized five‐factor model were satisfactory, but introducing correlated error terms for some of the items led to significant model improvement in all age groups. All factor loadings were higher than .30, except for item 11 (good friend). The loadings differed across age groups and differed markedly between the parent/proxy and self‐report measures. The MTMM showed that the source of ratings made a difference on the validity of all subscale ratings, with self‐reports discriminating more on ratings of emotional and peer problems, and parents/proxies discriminating more on hyperactivity symptoms. A positive construal factor was identified but had a modest effect compared with the original five traits. Results suggested an unclear construct and meaning of the Prosocial behaviour subscale. Conclusion: The results of the present study indicated support for the proposed five‐factor structure of the SDQ ( Goodman, 2001 ) across a wide age range (10–19years), including older adolescents and different informants. However, some improvements should be considered to improve internal reliability and conceptual clarity.     

Validation of the Hektner Future Emotions Questions as a Scale for Use with Youth in New Zealand

As the fields of resilience and positive psychology grow, there is increased focus on understanding the resources that facilitate wellbeing and positive development rather than factors preventing negative outcomes. As these developments occur, there is an increasing need for measures validated on high risk and marginalised populations of youth that assess the resources that potentiate wellbeing. Using data from a cross-sectional study of 1,477 youth (12-to-17 years old) in New Zealand, who were in either high risk or low risk environments, this paper presents the validation of questions developed by Hektner (Journal of Research in Rural Education, 11, 3–14, 1995) as a scale for use with youth, assessing their feelings about their own futures. A bi-dimensional construct composed of positive (three items) and negative (four items) emotions has been identified and confirmed through the use of exploratory factor analysis and confirmatory factor analysis that also tested factorial invariance across the two groups. Inter-item correlations ranged from 0.357 to 0.517 (negative emotions) and 0.295 to 0.455 (positive emotions). The two sub-scales show good internal reliability. Convergent and divergent validity testing of the measure is assessed using scales of risk (conduct problems and risk of depression), resilience, and satisfaction with life. Patterns in the responses of youth across the two groups are also compared.     

Tic disorders in children and adolescents. Clinical and genetic features, comorbidity]

Tic disorders in children and adolescents. Clinical and genetic features, comorbidity. BACKGROUND: Aim of the study is to evaluate the clinical and genetic characteristics of tic disorders, in view of individuating similarities or differences relevant to the prognosis among different nosological groups. METHODS: A retrospective study of 79 children and adolescents (average age 9.3 yrs) was performed. The cases were diagnosed according to DSM-IV as: transitory tics (TT) 13 cases; chronic tics (CT) 50 cases; Tourette disease (TD) 16 cases. They were compared to a control group of 18 school age children without any neurological or psychiatric disturbance. The study included: semi-structured interviews focused on natural history of the disturbances, familiarity, presence of perinatal pathology, comorbidity; neurological examination, EEG, psychodiagnostic tests and investigation. RESULTS: Mean age of onset and type of first symptoms are the same in the three groups. Compared to the control group there is a significant increase in: familiarity for tics disturbances in TD; presence of perinatal pathological factors in the three groups of patients; comorbidity for obsessive-compulsive disorder (OCD) in CT and TD, comorbidity with ADHD in CT group. Three clinical cases are reported to exemplify the mixed features in the families and the different responsivity to the pharmacological treatment.     

Temporomandibular disorders in Turkish children with mixed and primary dentition: prevalence of signs and symptoms

The prevalence of signs and symptoms related to TM (temporomandibular) disorders was examined in 40 children with primary dentition and in 40 children with mixed dentition. The purpose of this study was to evaluate the relationship between dentition and TM disorders in the examined population. Maximum mouth opening was also evaluated. Clinical examination was done by one investigator. A questionnaire was used in combination with the clinical examination. The results showed that there was an increase in signs and symptoms from the primary to the mixed dentition group, but only the joint sounds were found significantly different between the two groups. There was no statistically significant difference in maximum mouth opening capacity between the groups.     

A comparison of pure and comorbid CD/ODD and depression

BACKGROUND: We studied the symptomatology of conduct/oppositional defiant disorder and major depression/dysthymic disorder in 'pure' and comorbid presentations. METHOD: The sample comprised 382 children of 8 to 17 years of age attending for psychiatric outpatient consultation. Ninety-two had depressive disorders without conduct disorders, 165 conduct disorder or oppositional defiant disorder without depressive disorders and 125 had both. RESULTS: In general, there were few differences in the distributions of the symptoms of shared disorders between the pure and the comorbid groups. Comorbidity accentuated depressive and emotional symptoms and functional impairment. After controlling for the presence of other disorders and severity of symptoms, comorbid children were more globally impaired than the pure conduct group and more impaired than the pure depressive group in school, the home, and in relationships with other people. CONCLUSIONS: The clinical presentations of 'pure' and comorbid depressive and conduct disorders are similar. Differences found in phenomenology and in functional impairment between the groups have implications for treatment planning and for nosology.     

Preschool understanding of emotions: contributions to classroom anger and aggression

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.     

Feeling,caring, knowing: different types of empathy deficit in boys with psychopathic tendencies and autism spectrum disorder

Background: Empathy dysfunction is one of the hallmarks of psychopathy, but it is also sometimes thought to characterise autism spectrum disorders (ASD). Individuals with either condition can appear uncaring towards others. This study set out to compare and contrast directly boys with psychopathic tendencies and boys with ASD on tasks assessing aspects of affective empathy and cognitive perspective taking. The main aim of the study was to assess whether a distinct profile of empathy deficits would emerge for boys with psychopathic tendencies and ASD, and whether empathy deficits would be associated with conduct problems in general, rather than psychopathic tendencies or ASD specifically. Methods: Four groups of boys aged between 9 and 16 years (N = 96) were compared: 1) psychopathic tendencies, 2) ASD, 3) conduct problems and 4) comparison. Tasks were included to probe attribution of emotions to self, empathy for victims of aggression and cognitive perspective‐taking ability. Results: Boys with psychopathic tendencies had a profile consistent with dysfunctional affective empathy. They reported experiencing less fear and less empathy for victims of aggression than comparison boys. Their cognitive perspective‐taking abilities were not statistically significantly different from those of comparison boys. In contrast, boys with ASD had difficulties with tasks requiring cognitive perspective taking, but reported emotional experiences and victim empathy that were in line with comparison boys. Boys with conduct problems did not differ from comparison boys, suggesting that the affective empathy deficit seen in boys with psychopathic tendencies was specific to that group, rather than common to all boys with conduct problems. Conclusions: Although both groups can appear uncaring, our findings suggest that the affective/information processing correlates of psychopathic tendencies and ASD are quite different. Psychopathic tendencies are associated with difficulties in resonating with other people’s distress, whereas ASD is characterised by difficulties in knowing what other people think.     

ENCOPRESIS: A Review of Thirty-two Cases

Thirty-two children attending a child psychiatric department with encopresis are described. Twenty-six were discontinuous and only 6 were continuous soilers. As a group they came from low socio-economic, socially incompetent families and a number of children had evidence of developmental lags or neurological impairment. Coercive toilet training featured very rarely in the case histories. Twenty-three of the 26 discontinuous soilers had experienced stressful events prior to the onset of the symptom and many came from disrupted families. They were, as a group, anxious children whose associated symptoms fell into the categories of neurotic or developmental disorders rather than of conduct or mixed disorders.     

Psychiatric disorders in general paediatric referrals.

Detailed interviews with parents of 128 children aged 7 to 12 years consecutively referred to general paediatric clinics identified psychiatric disturbance in 36 (28%) of the children. Emotional disorders were the commonest psychiatric diagnoses (present in two thirds); less frequent diagnoses were conduct disorders (5/36, 14%), mixed conduct/emotional disorders (six, 17%), and hyperkinetic syndrome (three, 8%). Disturbance was related to level of energy, with disturbed children being described significantly more frequently as ''bounding with energy'' or conversely ''tired and apathetic''. Psychosocial problems (broken homes, mentally distressed mothers, family stress including financial stress and marital difficulty) were also increased in the disturbed group, but most of all these mothers reported feeling stressed in relation to the children. Psychiatric disorders, particularly emotional disorders, are common associated problems in paediatric referrals. Family stress, specially that focused on parenting, is likely to be an important factor contributing to disturbed children''s consultations in general paediatric clinics.