Behavioural and emotional problems in children with intellectual disability attending special schools in Cape Town, South Africa

A sample of 355 children with intellectual disability (ID) attending special schools in Cape Town, South Africa, were assessed on the Developmental Behavioural Checklist – Teacher Version (DBC‐T). A prevalence rate of 31% for psychopathology was found. Boys manifested more behaviour problems than girls, especially in relation to disruptive, self‐absorbed and antisocial behaviours. Children with severe and profound levels of ID showed more behavioural difficulties than those in the mild and moderate categories. Specific behaviour problems were self‐absorbed and autistic behaviours in children with profound ID, communication problems and anxiety in those with severe ID and antisocial behaviour in children with mild ID. Epilepsy, but not cerebral palsy was associated with higher total behaviour scores. Ambulant children were more disruptive and antisocial, while non‐ambulant children were more anxious. Non‐verbal children had higher scores on all of the subscales except for disruptive behaviour.     

Schizophrenic patients' perceptions of stress, expressed emotion, and sensitivity to criticism

This study was designed to get an "insider's view" of expressed emotion (EE) from the perspective of schizophrenic patients. Thirty-two patient and "influential other" pairs participated in the study. Patients' perceptions of EE attitudes in influential others were examined to determine whether they corresponded with actual EE ratings. Patients also rated how "stressed" they felt when interacting with their influential others, and patients' general sensitivity to criticism (STC) was assessed. As predicted, patients' perceptions of critical attitudes were related to actual EE ratings of criticism, although patients' perceptions of emotional overinvolvement (EOI) were not related to EOI ratings. Patients reported feeling more stressed when interacting with high-EE influential others, supporting an "EE as stressor" hypothesis. Finally, patients' STC influenced the level of stress they reported.     

Assessing expressed emotion: comparing Camberwell Family Interview and Five-minute Speech Sample ratings for mothers of children with behaviour problems

Little is known of the concordance between ratings of expressed emotion (EE) derived from the Camberwell Family Interview (CFI) and Five-minute Speech Sample (FMSS) for parents of children with behaviour problems. Concordance between CFI and FMSS ratings of EE was assessed prior to intervention and compared to parent-rated behaviour after intervention, at follow-up, 12 months later. Female primary caretakers of 75 children (3-10 years) showing behavioural difficulties were interviewed using FMSS and CFI. Interviews were coded independently by criterion-standard raters. Using CFI, 57 families were classified high EE, and 18 low EE. Using FMSS, 65 families were classified high EE and 10 low EE. 55/75 pairs of ratings (73%) were the same (high, n = 51: low, n = 4) and 20 mothers (27%) were allocated different EE status (Kappa = 0.14, n.s.). The FMSS ratings at initial interview appeared more closely related to behaviour rating at follow-up than CFI. Further investigation is required to establish comparability of CFI and FMSS results for carers of children.     

Understanding of facial expressions of emotion by children with intellectual disabilities of differing aetiology

Background Interpreting emotional expressions is a socio‐cognitive skill central to interpersonal interaction. Poor emotion recognition has been reported in autism but is less well understood in other kinds of intellectual disabilities (ID), with procedural differences making comparisons across studies and syndromes difficult. This study aimed to compare directly facial emotion recognition skills in children with fragile X syndrome (FXS), Down's syndrome (DS) and non‐specific intellectual disability (NSID), contrasting ability and error profiles with those of typically developing (TD) children of equivalent cognitive and linguistic status. Methods Sixty children participated in the study: 15 FXS, 15 DS, 15 NSID and 15 TD children. Standardised measures of cognitive, language and socialisation skills were collected for all children, along with measures of performance on two photo‐matching tasks: an ‘identity‐matching’ task (to control for basic face‐processing ability) and an ‘emotion‐matching’ task (happiness, sadness, anger, surprise, fear or disgust). Results Identity‐matching ability did not differ across the four child groups. Only the DS group performed significantly more poorly on the emotion‐matching task and only in comparison to the TD group, with fear recognition an area of particular difficulty. Conclusion Findings support previous evidence of emotion recognition abilities commensurate with overall developmental level in children with FXS or NSID, but not DS. They also suggest, however, that syndrome‐specific difficulties may be subtle and detectable, at least in smaller‐scale studies, only in comparison with TD matches, and not always across syndromes. Implications for behavioural phenotype theory, educational interventions and future research are discussed.     

Emotional and behavioural problems in children and young people with autism spectrum disorder in specialist autism schools

We investigated emotional and behavioural problems in a sample (N = 615) of children and young people with autism spectrum disorders (ASD), most of whom also had intellectual disability (ID), attending specialist autism schools. High rates of parent- and teacher-reported problems were recorded. Teacher-reported levels of hyperactivity were higher in younger children. Teacher- but not parent-reported levels of conduct problems and hyperactivity were highest in children without phrase speech. Greater use of mental health services was associated with higher levels of emotional and behavioural problems, but only a minority of participants had accessed mental health services in the previous 6 months.     

Predictors of components of expressed emotion in major caregivers of Turkish patients with schizophrenia

Background Expressed emotion (EE) is a concept reflecting the emotional atmosphere of the home environment. Specific components of EE, namely criticism, hostility and emotional over-involvement, have been found to be important predictors of relapse for schizophrenic patients. The main aim of this study was to examine the predictive power of patient and caregiver characteristics and caregivers' perceptions of frequency, coping, distress/discomfort, control of symptom behaviours by the patient, and attributions on locus of causality for the development of the illness on two components of EE (criticism/hostility and emotional over-involvement) in a sample of major caregivers of Turkish schizophrenic patients. Methods Seventy-two caregivers of schizophrenic patients were administered a set of questionnaires tapping socio-demographic and illness-related variables, the family questionnaire tapping perceived frequency, distress/discomfort, coping and control of symptom behaviours, causal attributions for illness and, finally, the Expressed Emotion Scale in the hospital setting. Results The results showed that caregivers' perceptions of coping with specific symptom behaviours decreased criticism/hostility (C/H), whereas perceptions of higher frequency of symptom behaviours increased C/H. For emotional over-involvement (EOI), the number of individuals living in the household, being the mother, father or the spouse, perceptions of coping with symptom behaviours and reported distress/discomfort about symptom behaviours were significant predictors. Conclusions Caregivers' perceptions of their ability to cope with symptom behaviours and their reported distress due to these behaviours are important variables related to components of EE and need to be targets in intervention studies. The cultural and clinical implications of the results for the management of schizophrenia and for support for the caregivers are discussed. Accepted: 26 September 2001     

Competence, emotional and behavioural problems in Russian adolescents

Competence, emotional and behavioural problems were examined in 256 school-children, aged 13–17 years, in Novosibirsk, Russia, using the Youth Self-Report (YSR), the Child Behavior Checklist (CBCL) and the Teacher's Report Form (TRF). The internal consistency of syndrome scales for all three instruments was generally adequate. Interrater agreements for the problem scales were higher for girls than for boys in all combinations of informants. These findings are discussed in terms of gender role development. Gender effects on the scales' scores were more numerous and stronger than age. No SES differences were found. Russian children reported more problems than children of other nationalities did. Compared with American children, Russians were lower on competencies and higher on Somatic complaints and self-reported behavioural problems. On competence scales, Russian children in an unselected sample scored themselves lower than American children in a clinical sample. It is supposed that low self-esteem may be the first effect of the unfavourable development in Russian adolescents. Accepted: 7 May 1999     

Discrepant illness perceptions,affect and expressed emotion in people with psychosis and their carers

Background Illness perception, a measure of illness representations developed from physical medicine, has recently been applied to psychosis. We investigated how illness perceptions relate to affect and expressed emotion (EE) in carer-patient dyads, particularly if their perceptions differed. Method We interviewed 82 carer-patient dyads, after a relapse of psychosis. Carers were assessed for illness perceptions, distress, self-esteem and EE; patients for illness perceptions, depression, anxiety and self-esteem, in a cross sectional study. Results Carers were more pessimistic than patients about illness persistence and consequences, and carers with low mood were particularly pessimistic about persistence and controllability. Discrepant views about illness consequences were related to greater anxiety, depression, and lower self-esteem in patients, while discrepant views on controllability were associated with greater distress, depression, and lower self-esteem in carers. Illness perceptions did not relate directly to EE. Conclusions In this sample, meta-cognitive carer representations of illness in psychosis are related to negative affective reactions in carers, but not to EE. Resolving discrepant illness perceptions between carers and patients might provide a way of improving family reactions to the health threat of psychosis.     

Collaboration with families for the rehabilitation of schizophrenic patients and the concept of expressed emotion

Recent interest in community care of schizophrenic patients has led to publication of a number of studies that deal with patients' rehabilitation in their families. Joint efforts of psychologists, psychiatrists and social workers have produced a number of techniques for collaboration with families of schizophrenic patients, including techniques based on the concept of expressed emotion. This concept is presented with reference to its spectrum consistency in time, generalizability to nonfamily setups, relationship to relapse, prevalence in disorders other than schizophrenia and usefulness in comparison to other concepts in family therapy of schizophrenia. Caution is urged in not incriminating the family in causing relapse, after the quiet abandonment of older theories that blamed families for initiating the illness of schizophrenic members.     

The relationships between expressed emotion,affective style and communication deviance in recent-onset schizophrenia

The relationships between expressed emotion (EE), affective style (AS) and communication deviance (CD) were studied during hospitalization and after discharge. EE was measured with both the Camberwell Family Interview (CFI) and the Five-Minutes Speech Sample (FMSS). The study subjects were patients with recent-onset schizophrenia and related disorders, who were consecutively admitted to an in-patient unit for adolescents, and their parents. The results revealed that CFI/EE was significantly correlated with AS criticism scores during hospitalization, but did not predict AS scores after discharge. FMSS/EE correlated significantly with AS criticism when both measures were administered after discharge. During hospitalization, FMSS/EE was not significantly correlated with AS. No consistent relationship was found between CD and both affective factors (EE and AS). It is concluded that EE and AS overlap with regard to level of criticism when both measures are administered over a short period of time and independent of the time of assessment. In addition, the results indicate that affective and communication factors identify independent family attributes.     

The neurology of learning and behavioural problems in pre-adolescent children

OBJECTIVE: The aim of the study was to evaluate whether in pre-adolescent children specific types of minor neurological dysfunction (MND) are related to specific types of learning and behavioural problems, and whether it is the type or the severity of neurological dysfunction that matters most. METHOD: A total of 1186, 5.5-11-year-old, children were examined for the presence of clusters of signs of MND. Parents and teachers completed brief behaviour rating scales. In school-aged children (n = 580) cognitive achievement was assessed using standardized Dutch tests. Least-squares regression was used to examine neurobehavioural and neurocognitive links. RESULTS: Children with more MND clusters performed worse scholastically and had more signs of attention deficit than others. Externalizing and internalizing behaviour were only linked to specific forms of MND. CONCLUSION: Evaluation of the neurological condition of the child with learning and behavioural problems offers insight into the aetiology and pathogenesis of these problems.     

Relationship between expressed emotion and family burden in psychotic disorders: an exploratory study

This study explored the relationship between level of expressed emotion (EE) and level of family burden in 20 families of individuals with psychotic disorder. Results indicated that a relationship between EE and family burden did exist, but it appeared to be strongly influenced by demographic and illness-related variables. The usefulness of the 5-min speech sample method of assessing EE was limited by the aversion of some family members to being videotaped and by denial of patient symptoms by some relatives. Other methodological weaknesses are discussed. The relationship between demographic and illness-related variables and level of EE needs further exploration.     

Reliability of the 5-min speech sample for assessing expressed emotion in Japanese patients

Expressed emotion (EE) has been shown in various countries to be a good predictor of the clinical course of a patient's mental illness. Because the traditional EE interview requires considerable time and effort, this study examined the reliability of a method called the five-minute speech sample (FMSS) for assessing EE. The samples of 65 subjects were rated by the FMSS-EE coding system, and the interrater reliability among four authorized raters was investigated. Of these 65 samples, 10 (15%) were rated as high-EE (high critical, 6%; high emotional over-involvement (EOI), 9%), and 19 (29%) were rated as borderline (b-)-high-EE (b-critical, 15%; b-EOI, 14%). The intraclass correlation coefficient (ICC) was 0.91 for the overall category, 0.74 for criticism, 0.85 for EOI, 0.63 for b-critical and 0.54 for b-EOI. The FMSS was shown to be reliable for the assessment of EE, even outside of Western countries. However, the lower agreement in the subcategories of EOI and b-critical has to be considered as a limitation of this brief method.     

The relationship between psychosocial and cognitive functioning in schizophrenic patients and expressed emotion and communication deviance in their parents

The relationship between the family variables of expressed emotion (EE) and communication deviance (CD) and patient attributes of cognitive functions and clinical symptoms were examined. Eleven schizophrenic patients and their parents were evaluated at the beginning and the end of a 2-year treatment programme. The test battery for the patients included the Global Assessment Scale (GAS), Brief Psychiatric Rating Scale and a cognitive test battery. Parents’ CD was evaluated with the Communication Conflict Situation and their EE level with Camberwell Family Interview. A significant correlation between patients’ GAS score and mother's criticism score was found. The cognitive variable of backward masking was the measure that most consistently showed a close relationship to parent's EE level. The masking measure also differentiated significantly between parents who improved and parents who did not improve on EE during the 2-year treatment period. An empirical basis for a link between patients’ cognitive functioning and parents’ style of communication was not found.     

Behavioural and emotional difficulties in students attending schools for children and adolescents with severe intellectual disability

Background   For several decades, researchers and clinicians have been aware of an increased prevalence of psychiatric disorder in children with intellectual disability. However, there are few research studies exploring this issue.
Methods   The parents of 123 children attending schools for children with 'severe learning difficulties' completed the Developmental Behaviour Checklist (DBC) in order to identify those children with clinically significant behavioural and emotional problems. Comparisons were made with norms for the DBC and a range of child variables were investigated as possible correlates of disorder.
Results   Some 50.4% of the children scored above the cut-off on the DBC for psychiatric disorder. The child's severity of physical disability was related most strongly to parental ratings of behavioural and emotional problems. There were also effects for the child's age and the absence of Down's syndrome.
Conclusions   The present study confirms previous research findings of a high prevalence of behavioural and emotional difficulties amongst children with intellectual disability, and identifies a number of correlates of disorder which require further investigation.