Fears in British Children and Their Relationship to Manifest Anxiety and Depression

In the present study, we examined the pattern and intensity of fears in 327 British school children and the relation of those fears to anxiety and depression. The fears reported by the British children were found to be nearly identical to those found in Australian and American children (Ollendick, King & Frary, 1989). Further, although a moderate relation was found between fear and anxiety, only a modest relation was found between fear and depression. Anxiety and depression, however, were highly inter-related. Results of the study are explored in terms of the uniqueness of the constructs of fear, anxiety, and depression and their possible contribution to a more global construct, labeled 'negative affectivity' by Watson and Clark (1984).     

Fears in American, Australian, Chinese, and Nigerian Children and Adolescents: A Cross-Cultural Study

The fears of childhood and adolescence may differ from one cultural context to another. We explored this possibility in 1200 American. Australian. Chinese, and Nigerian children and adolescents between 7 and 17 years of age. Responses to a standard fear survey schedule revealed significant differences in the number, content, pattern, and level of fears. Nigerian children and adolescents endorsed fears at higher levels than American, Australian, or Chinese youth who did not differ from one another. However, differences in the pattern and content of fears for boys and girls of different ages were noted across the countries. Results were interpreted within a cultural context, which suggested that cultures which favor inhibition, compliance, and obedience serve to increase levels of fear. Alternative interpretations are offered and limitations of cross-cultural research are explored.     

The Sexual Abuse of Male Children and Adolescents: A Review of Current Research

Inevitably, in a wide ranging review, there will be some important omissions. The main difficulties in assessing the available information have been the lack, in so many studies, of analysis along gender lines, the lack of control groups, and, in many instances, too small sample size. Despite these limitations there has, over the past decade, been an upsurge of interest in and awareness of the significance of the sexual abuse of boys. It permits us to identify a number of important trends and to draw certain conclusions. Firstly, the scale of the sexual abuse of boys is much greater than was believed 10 years ago. There is no reason to think this is simply an artifact of definition, or information gathering, or indeed of an increased willingness to recognize abusive behaviour between children, even though these will all have an effect. Whilst the trend is clear, the actual prevalence rate is difficult to determine, with a reported range of between 3% and 31%. A current 'best guess' suggests contact abuse in the range of 2-5% in the male population. As each study controls for its own definition of abuse, the narrowing in the ratio of boys to girls abused can be accepted as quite reliable, and additional evidence of a delayed recognition effect. Retrospective community evidence shows 1 boy is abused for every 2-4 girls abused. In contrast, the highest clinical ratios are for 1 boy to every 4 girls. Those who work with runaways, male child prostitutes, or child and adolescent psychiatric inpatient units appear particularly likely to encounter abused boys. Secondly, a variety of explanations have been advanced to explain the apparent under-reporting or under-detection of the sexual abuse of boys. Prominent among them have been the boy's fears of disbelief and of being labelled homosexual. Police patterns of reporting extra-familial abuse may mask its extent from protection or health agencies, which is important because extra-familial abuse does appear to be more common in boys, especially older boys, than girls. Although there has been some diminution of the cultural denial that girls can be abused, a parallel decrease of denial regarding boys has lagged behind. This is particularly true of father-son and of the much less common mother-son abuse. It is plausible that certain 'alertors' are more relevant for boys. The recent development of aggressive behaviour, homophobic anxiety, co-abuse of a sibling and abusing behaviour in particular deserve consideration.(ABSTRACT TRUNCATED AT 400 WORDS)     

The ''Jupiter'' Sinking: Effects on Children''s Fears, Depression and Anxiety

Twenty-five girls who survived the sinking of the cruise ship 'Jupiter' were compared with three other groups of girls--71 controls from a separate school; 46 girls in the same school who had not wanted to go on the cruise; and 13 girls who were in a 'near miss' group in that they wanted to go but did not get places. All completed the Fear Survey Schedule for Children (revised form), the Children's Manifest Anxiety Scale and the Birleson Depression Inventory. Survivors did not become generally more fearful. Rather, they developed significantly greater fears to stimuli related to the traumatic event. The results are discussed in relation to the conditioning theory of the acquisition of phobias.     

Fear in Children and Adolescents: Relations with Negative Life Events, Attributional Style, and Avoidant Coping

In this study, we explored relations among negative life events, negative attributional style, avoidant coping, and level of fear in 99 children who had survived residential fires. Overall, negative life events, negative attributional style, and avoidant coping were found to be predictive of levels of fear. However, the relation between negative life events and fear was moderated by mother's level of education such that this prediction was obtained only for those children whose mothers were low in education level. Age, ethnicity, and sex did not moderate these relations. In addition, negative attributional style and avoidant coping were related to levels of fear in those children whose mothers were high in education levels but not those whose mothers were low in education level. Results are discussed within a stress and coping framework.     

Fears and Fearfulness in Children and Adolescents: a Genetic Analysis of Twin Data

A sample of 175 same sex dizygotic pairs and 144 monozygotic twin pairs aged between 8:00 and 18:00 completed the Fear Survey Schedule for Children--Revised. The heritabilities were significant for Fear of the Unknown (h2 = 0.46, p less than 0.001), Fear of Injury and Small Animals (h2 = 0.46, p less than 0.001), Fear of Danger (h2 = 0.34, p less than 0.001) and for Total Fear Score (h2 = 0.29, p less than 0.001). Multiple regression was used to estimate the heritability of extreme fearfulness (h2g). For each of the fear factors the values of h2g were of similar magnitude to those of h2 suggesting that there is no evidence of greater genetic influences at more extreme levels of fearfulness.     

C3 Deposition in IgA Nephropathy in Children and Adolescents

The aim of this study was to assess the significance of C3 deposition in IgA nephropathy in children and adolescents. One hundred and two patients aged 5–21 years (57 male and 45 female) were studied. The findings of C3 deposition were classified into 8 groups by immunofluorescent (IF) pattern and intensity as follows: group MC3+ (N = 12): mesangiocapillary pattern and 3+ in intensity; group MC2+ (N = 13): mesangiocapillary and 2+; group MC1 + (N = 4): mesangiocapillary and 1 +; group M3+ (N = 11): mesangial and 3+; group M2+ (N = 24): mesangial and 2+; group M1 + (N=18): mesangial 1 +; group S (N = 12): only segmentally positive; and group N (N = 8): negative. Histological changes were scored semiquantitatively as an activity index (cellular proliferation, necrosis, interstitial cell infiltration, and cellular crescents) and a chronicity index (mesangial sclerosis, segmental and global glomerular sclerosis, fibrous crescents, adhesion and tubulo-interstitial change). IF findings were scored semiquantitatively and laboratory findings were also studied. The following results were obtained: 1) The scores of total activity index in MC groups were higher than in the M, S or N groups, and the greater the degree of C3 deposition, the higher the score; 2) Such result was not evident in the chronicity index; 3) High IF scores of IgG and IgM were found in the MC3+ and MC2+ groups; 4) Hematuria was more severe in MC3+ and MC2+ than in other groups, and proteinuria was more prominent in the MC than other groups. Thus the degree of C3 deposition was parallel with histological activity and urinary findings.     

The Validity of Mixed Disorders of Conduct and Emotions in Children and Adolescents: A Research Note

In a study of differential validity, three diagnostic groups based on ICD-10 criteria were compared, namely children with emotional disorders, children with conduct disorders, and children with mixed disorders of conduct and emotions. The patients were taken from a consecutive series of child and adolescent psychiatric service attenders from 1988 to 1992 and represented the total entire subgroups of patients with the respective diagnoses. Based on standardized item sheets that were filled out by the clinicians who were responsible for the respective cases, the groups were compared with regard to age, sex ratio, family background, premorbid behavioral abnormalities, abnormal psychosocial situations, and treatment. It was found that children with mixed disorders of conduct and emotions share many characteristics with pure conduct disordered children. It is concluded that the former group is a subgroup of the latter, and there is little evidence in this study supporting the validity of a separate category of mixed disorders of conduct and emotions.     

Long-Term Follow-Up of Children and Adolescents Diagnosed with Hypertrophic Cardiomyopathy: Risk Factors for Adverse Arrhythmic Events

Our aim was to identify prognostic factors for an arrhythmic event (AE) in children with hypertrophic cardiomyopathy (HCM) without a previous AE. One hundred thirty-one nonconsecutive patients (≤20 years) with HCM but no previous AE were evaluated at the NIH Clinical Center from 1980 to 2001. At a median follow-up of 6.4 years, 22 patients experienced an AE [sudden death (SD) (n = 12), resuscitated cardiac arrest (n = 3), clinical sustained ventricular tachycardia (VT) (n = 2), and implantable cardiac defibrillator discharge (n = 5)], resulting in a 2% annual AE rate. Baseline factors that were most predictive in univariate risk analysis included ventricular septal thickness (ST) (P = 0.01), VT induction by programmed ventricular stimulation (PVS) (P = 0.01), age (P = 0.05), and presyncope/syncope (P = 0.05). In multivariate analysis, ST, age, presyncope/syncope, and PVS were not independently predictive of risk for an AE. However, the 5-year event rates for AE was 15% (95% CI: 5–23%) if ST ≥ 20 mm, 19% (95% CI: 6–31%) when age ≥ 13 years and ST ≥ 20 mm were combined together, and 23% (95% CI: 3–39%) when PVS and ST ≥ 20 mm were combined together. Of the various risk factors that were considered in our pediatric HCM cohort, ST and inducible VT were the most significant univariate predictors of risk for an AE. More traditional risk factors identified in older patients (family history of SD, VT on Holter, and exercise-induced hypotension) were not predictive of an AE in patients age under 21 years.     

Psychological Aspects in Children and Adolescents With Major Thalassemia: A Case-Control Study

Background:

Thalassemia is an inherited blood disease. It is a serious public health problem throughout the Mediterranean region, the Middle East and the Indian subcontinent, as well as in Southeast Asia.

Objectives:

Thalassemia is an inherited blood disease. It is a serious public health problem. In this study we assessed psychological aspects in Iranian children and adolescents with thalassemia major.

Patients and Methods:

In this case-control study sixty healthy subjects aged 7-18 years and Sixty Patients with confirmed diagnosis of major thalassemia were enrolled. After obtaining informed consent from parents of all participating thalassemia patients and healthycontrols, we assessed psychological aspects and quality of life by Pediatric Quality of LifeTM (PedsQL™), Strengths and Difficulties Questionnaires (SDQ), State and Trait Anxiety, Children''s Depression Inventory (CDI).

Results:

The results of this study indicate that there are significant changes in depression, anxiety, QOL and behavioral screening between children with thalassemia major compared with healthy subjects by means of both parents and children reports. According to the results, children with thalassemia major have more psychological problems than healthy ones. Patients with thalassemia have a lower QOL than their peers (P = 0.001), the rate of depression is higher in this group (P = 0.015), Also behavioral problems in these children are more than healthy subjects (P = 0.009).

Conclusions:

We recommend appropriate treatment and counseling procedures in addition to specific treatment of thalassemia. According to the results we suggest to establish pediatric psychiatric clinics beside thalassemic clinics to cure psychological aspects of the disease.     

The Longitudinal Stability of Psychiatric Problems in Children with Hemiplegia

A representative sample of 328 children with hemiplegia was assessed by behavioural screening questionnaires completed by parents and teachers; just under half were also individually assessed. Four years later, 90% of the sample were followed up by questionnaire. There was substantial continuity across time for most measures of psychopathology. Depending on the measures used, around 70% of children who were psychiatric "cases" initially were still cases 4 years later. In addition, around 30% of children who were not psychiatric cases initially had become cases 4 years later. In the preschool years, externalising symptoms were predictive of later conduct and hyperactivity problems, whereas emotional symptoms were not predictive of later problems. In the school years, hyperactivity was particularly predictive of continuing psychiatric problems. Neurological, cognitive, demographic, and family factors did not add much predictive power once allowance had been made for the severity and type of the initial psychiatric problems. Since the psychiatric complications of childhood hemiplegia are persistent as well as common, they warrant increased clinical and research attention. All children with hemiplegia deserve careful monitoring for psychiatric problems, with a view to early intervention or the deployment of preventative approaches.     

The Effect of Statins in Children and Adolescents With Familial Hypercholesterolemia: A Systematic Review

IntroductionFamilial hypercholesterolemia (FH) is a genetic disorder that causes elevated low-density lipoprotein–cholesterol (LDL-C) levels. If undiagnosed and untreated in childhood, affected individuals can suffer premature health complications. Statins reduce the risks of complications for adults, but less is known about children. This systematic review examined the effectiveness of statin therapy for lowering LDL-C levels in children with FH.MethodMedline Ovid, Embase, CINAHL, and Allied Health Literature Plus were searched for studies that examined the effectiveness of stains in children ages 1–18 years with heterozygous FH.ResultsOf the 706 articles identified, 10 were included in the review. Statin therapy significantly reduced LDL-C levels in pediatric patients with FH. Statins were safe and well-tolerated with minimal adverse effects.DiscussionPediatric providers should be familiar with diagnosis, treatment, and management of FH to successfully lower LDL-C levels and avoid potential long-term health effects. Evidence suggests statins are safe and effective in children with FH.     

Reliability and Validity of HeartSmartKids: A Survey of Cardiovascular Risk Factors in Children

Introduction

Reliable and valid instruments to measure counseling effectiveness related to eating, activity, and inactivity are lacking. HeartSmartKids (HSK; HeartSmartKids, LLC, Boulder, Colorado) is a bilingual decision-support technology that can be used to assess and counsel families on cardiovascular risk factors in children. The purpose of this study was to establish preliminary test–retest reliability and convergent validity of HSK questions relative to a previously validated questionnaire, HABITS.

Changes in Trunk and Head Stability in Children with Cerebral Palsy after Hippotherapy: A Pilot Study

ABSTRACT

Hippotherapy (HPOT) is a therapy that uses horse movement. This pilot investigation objectively evaluated the efficacy of HPOT in improving head/trunk stability in children with cerebral palsy (CP). The participants were six children with spastic diplegia and six children without disability. Head and trunk stability was challenged by using a motorized barrel and measured by a video motion capture system before and after a 12-week intervention of 45 min of HPOT a week. The variables measured were anterior–posterior (AP) translation of the head, and spine at five points and average AP head angles. At pre-testing, children with CP demonstrated significant differences in AP translation and AP head rotation compared with children without disability. Following HPOT, children with CP demonstrated significant reductions in head rotation and AP translation at C7, eye, and vertex. At post-testing, translation at C7 did not differ significantly between children with CP and children without disability. After HPOT intervention, children with CP reduced their AP head rotation and translation, suggesting that they had increased stability of the head and trunk in response to perturbations at the pelvis. The findings suggest that HPOT might improve head and trunk stability in children with CP.     

The Growing Epidemic of Hypertension Among Children and Adolescents: A Challenging Road Ahead

Currently, it is clear that primary hypertension begins in childhood and that it contributes to the early development of chronic kidney disease (CKD). Hypertension also increases the risk of cardiovascular morbidity and mortality, and that risk rises as blood pressure levels escalate. As among adult patients, overweight and obesity rates are on the rise among children and adolescents with primary hypertension and can develop target organ damage including left ventricular hypertrophy. An elevated level of C-reactive protein (CRP) and microalbuminuria are early manifestations of cardiovascular disease and CKD in hypertensive patients. Lifestyle interventions are recommended for all children with hypertension. Pharmacologic therapy should be added for symptomatic children, those with stage 2 hypertension, and children with prehypertension and stage 1 hypertension who exhibit an insufficient response to lifestyle modifications. Although the recommendations for choice of drugs generally are similar for children and adults, dosages for children should be lower, based on weight, and adjusted very carefully. Medications that are effective and safe for children and adolescents include thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and calcium channel-blockers. Hypertension is not being detected early enough for initiation of a treatment regimen to reduce death and disability. Initiatives should be undertaken to make health care providers and the general population more aware of the seriousness of hypertension in children and adolescents. This review focuses on the principles underlying the importance of a team approach for hypertension control, especially one that incorporates increased data sharing using enhanced health information technology for early detection and intervention.