Journal of Child Psychology and Psychiatry

Children's judgements about pain at age 8-10 years were examined comparing two groups of children who had experienced different exposure to nociceptive procedures in the neonatal period: extremely low birthweight (ELBW) < or = 1000 g (N = 47) and full birthweight (FBW) > or = 2500 g (N = 37). The 24 pictures that comprise the Pediatric Pain Inventory, depicting events in four settings: medical, recreational, daily living, and psychosocial, were used as the pain stimuli. The subjects rated pain intensity using the Color Analog Scale and pain affect using the Facial Affective Scale. Child IQ and maternal education were statistically adjusted in group comparisons. Pain intensity and pain affect related to activities of daily living and recreation were significantly higher than psychosocial and medically related pain on both scales in both groups of children. Although the two groups of children did not differ overall in their perceptions of pain intensity or affect, the ELBW children rated medical pain intensity significantly higher than psychosocial pain, unlike the FBW group. Also, duration of neonatal intensive care unit stay for the ELBW children was related to increased pain affect ratings in recreational and daily living settings. Despite altered response to pain in the early years reported by parents, on the whole at 8-10 years of age ELBW children judged pain in pictures similarly to their term peers. However, differences were evident, which suggests that studies are needed of biobehavioural reactivity to pain beyond infancy, as well as research into beliefs, attitudes, and perceptions about pain during the course of childhood in formerly ELBW children.

Genotype x environment interaction (G x E) arises when genes influence sensitivity to the environment. G x E is easily recognized in experimental organisms that permit randomization of genotypes over fixed environmental treatments. Genotype-environment correlation (rGE) arises when genetic effects create or evoke exposure to environmental differences. Simultaneous analysis of G x E and such 'active' or 'evocative' rGE in humans is intractable with linear structural models widely used in behavioral genetics because environments are random effects often correlated with genotype. The causes of the environmental variation, therefore, need to be modeled at the same time as the primary outcome. A Markov Chain Monte Carlo approach is used to resolve three distinct pathways involving genes and life events affecting the development of post-pubertal depression in female twins and its relationship to pre-pubertal anxiety: 1) the main of genes and environment; 2) the interaction of genes and environment (G x E); and 3) genotype-environment correlation (rGE). A model including G x E and rGE in addition to the main effects of genes and environment yields significant estimates of the parameters reflecting G x E and rGE. Omission of either G x E or rGE leads to overestimation of the effects of the measured environment and the unique random environment within families. 1) Genetic differences in anxiety create later genetic differences in depression; 2) genes that affect early anxiety increase sensitivity (G x E) to adverse life events; 3) genes that increase risk to early anxiety increase exposure to depressogenic environmental influences (rGE). Additional genetic effects, specific to depression, further increase sensitivity to adversity. Failure to take into account the effects of G x E and rGE will lead to misunderstanding how genes and environment affect complex behavior.

Rhesus monkeys reared with mothers and peers for the first 6 months of life were subjected to three consecutive 2 week periods of social separations, progressively increasing the degree of social isolation for the infants. During each period of social separation, mesh permitting physical contact with mothers, physical but not visual separation from mothers but unlimited access to peers, and finally physical separation from both mothers and peers, clear patterns of protest and despair were recorded. Reactions to mesh separations were mild relative to the latter two separations, both equally debilitating. Following reunion, separated subjects returned to behavior patterns similar to those of nonseparated control monkeys. Later in the study mothers were removed permanently from the homecages of all subjects, and all subjects reacted with protest and cessation of play activity. However, there was little evidence of despair and previously separated and control monkeys reacted in similar form despite their different early histories.

Previous animal investigations link antenatal stress with a range of persistent behavioural abnormalities in the offspring. The current study examined if the effect was also found in humans through middle childhood. The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, community-based study that has followed a cohort of women from pregnancy. Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period. Children's behavioural/emotional problems were assessed by parent report at age 47 and 81 months. Information on obstetric and psychosocial factors was obtained at several points in pregnancy and the postnatal period. Children whose mothers experienced high levels of anxiety in late pregnancy exhibited higher rates of behavioural/emotional problems at 81 months of age after controlling for obstetric risks, psychosocial disadvantage, and postnatal anxiety and depression (for girls, OR = 1.91, 95%CI = 1.26-2.89; for boys, OR = 2.16, 95%CI = 1.41-3.30). Furthermore, the effect at 81 months was comparable to what was previously obtained at 47 months, suggesting the kind of persistent effect proposed in the animal literature. There is evidence that antenatal stress/anxiety has a programming effect on the fetus which lasts at least until middle childhood.

Background: Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent and commonly studied forms of psychopathology in children and adolescents. Causal models of ADHD have long implicated dysfunction in fronto-striatal and frontal-parietal networks supporting executive function, a hypothesis that can now be examined systematically using functional neuroimaging. The present work provides an objective, unbiased statistically-based meta-analysis of published functional neuroimaging studies of ADHD. Methods: A recently developed voxel-wise quantitative meta-analytic technique known as activation likelihood estimation (ALE) was applied to 16 neuroimaging studies examining and contrasting patterns of neural activity in patients with ADHD and healthy controls. Voxel-wise results are reported using a statistical threshold of p < .05, corrected. Given the large number of studies examining response inhibition, additional meta-analyses focusing specifically on group differences in the neural correlates of inhibition were included. Results: Across studies, significant patterns of frontal hypoactivity were detected in patients with ADHD, affecting anterior cingulate, dorsolateral prefrontal, and inferior prefrontal cortices, as well as related regions including basal ganglia, thalamus, and portions of parietal cortex. When focusing on studies of response inhibition alone, a more limited set of group differences were observed, including inferior prefrontal cortex, medial wall regions, and the precentral gyrus. In contrast, analyses focusing on studies of constructs other than response inhibition revealed a more extensive pattern of hypofunction in patients with ADHD than those of response inhibition. Conclusions: To date, the most consistent findings in the neuroimaging literature of ADHD are deficits in neural activity within fronto-striatal and fronto-parietal circuits. The distributed nature of these results fails to support models emphasizing dysfunction in any one frontal sub-region. While our findings are suggestive of the primacy of deficits in frontal-based neural circuitry underlying ADHD, we discuss potential biases in the literature that need to be addressed before such a conclusion can be fully embraced.

The neurobiological mechanisms by which childhood maltreatment heightens vulnerability to psychopathology remain poorly understood. It is likely that a complex interaction between environmental experiences (including poor caregiving) and an individual's genetic make-up influence neurobiological development across infancy and childhood, which in turn sets the stage for a child's psychological and emotional development. This review provides a concise synopsis of those studies investigating the neurobiological and genetic factors associated with childhood maltreatment and adversity. We first provide an overview of the neuroendocrine findings, drawing from animal and human studies. These studies indicate an association between early adversity and atypical development of the hypothalamic-pituitary-adrenal (HPA) axis stress response, which can predispose to psychiatric vulnerability in adulthood. We then review the neuroimaging findings of structural and functional brain differences in children and adults who have experienced childhood maltreatment. These studies offer evidence of several structural differences associated with early stress, most notably in the corpus callosum in children and the hippocampus in adults; functional studies have reported atypical activation of several brain regions, including decreased activity of the prefrontal cortex. Next we consider studies that suggest that the effect of environmental adversity may be conditional on an individual's genotype. We also briefly consider the possible role that epigenetic mechanisms might play in mediating the impact of early adversity. Finally we consider several ways in which the neurobiological and genetic research may be relevant to clinical practice and intervention.

The main objective of this study was to assess and compare the prevalence of a wide range of emotional and behavioral problems in children with and without intellectual disability (ID). We studied 1,041 non-residential children randomly selected from special schools for educable (IQ 60 to 80) and trainable (IQ 30 to 60) children without severe additional physical or sensory impairments, and compared them to 1,855 children randomly selected from the general population (both ages 6 to 18). Parents completed the Child Behavior Checklist (CBCL), and teachers the Teacher's Report Form (TRF). Controlling for sex, age, and socioeconomic status, we found that both educable and trainable children had significantly higher mean scores on all CBCL and TRF scales than children without ID, except for trainable children on the scales Anxious/Depressed and Somatic Complaints. Almost 50% of children with ID had a Total Problem score in the deviant range compared to about 18% in children without ID. Compared to children without ID, the most prominent problem behaviors of educable children were Social Problems, Attention Problems, and Aggressive Behavior, and trainable children had an increased risk for Social Problems, Attention Problems, Withdrawn and Thought Problems. Elevated scale scores reflected differences between children with and without ID over a broad range of items, and not solely on items more likely to be related to developmental delay. Therefore, problem areas covered by the items in these scales deserve special attention in the mental health care of children with ID.

This study examined the effects of age and two novel factors (intensity and emotion category) on healthy children's developing emotion-processing from 4 to 15 years using two matching paradigms. An explicit emotion-matching task was employed in which children matched the emotion of a target individual, and an implicit task whereby participants ignored the emotive facial stimulus and matched identity. Four intensities (25%, 50%, 75%, and 100%) for each of five emotion categories (sad, anger, happy, fear, and disgust) were included and provided a novel avenue of emotion-processing exploration. Increasing age significantly improved children's performance on both tasks, particularly for fear and disgust. Age was not associated with more subtle processing (i.e., lower intensity of expression). When explicitly matching emotion expressions, increasing intensity was associated with improved performance. When matching identities (implicit emotion-matching), emotion category and intensity influenced task performance. Sex effects were minimal. In children, age, facial expression intensity and emotion category are important for predicting accuracy on emotion-processing tasks. Emotion category and expression intensity differentially affect performance on explicit and implicit emotion-processing tasks.

A minority of patients with attention-deficit hyperactivity disorder (ADHD) do not respond favorably to methylphenidate. This has been partially associated with homozygosity for the Dopamine transporter (DAT1) 10-repeat allele and the presence of one or two Dopamine D4 receptor (DRD4) 7-repeat alleles. This study examined the sibling correlation of methylphenidate response rate and the possible association between response rate and these risk alleles. A sample of 82 Dutch children with ADHD, from 54 families, (including 30 singletons and 28 sib pairs), who used methylphenidate, was phenotyped according to DSM-IV criteria. Patients were members of affected sib pairs and were genotyped for DAT1 and DRD4. The sibling Intraclass Correlation Coefficient for methylphenidate response rate was calculated. The association between individual response rates and the risk alleles was examined using linear regression techniques. The Intraclass Correlation Coefficient was significant (r=.563, p=.001). No evidence was found establishing an association between methylphenidate response and DAT1-homozygosity. There was a positive trend towards association with the presence of one or two DRD4-7R alleles. The sibling correlation may indicate a familial clustering of methylphenidate response. This response is possibly associated with the presence of one or two alleles at the DRD4-7R locus, but not with DAT1-10R homozygosity in the Dutch population.

The aim of this investigation was to follow up a sample of exceptionally short but medically healthy children, and a normal comparison group, previously studied at 4 years of age. They lived in an inner-city area which was, on objective criteria, seriously disadvantaged in socioeconomic terms. When first seen at 4 years, cases were significantly impaired in cognitive abilities relative to comparisons, although firstborns were much less severely affected. Of the original 46 cases, 45 were assessed again at 11 years. Most continued to live in the same geographical area. Case children remained exceptionally short, even when parental stature was taken into account, although a degree of catch-up had occurred. One third had special educational needs, and a similar proportion had been referred for speech therapy. Verbal and nonverbal cognitive skills of both case and comparison children had, on the whole, changed little and group differences persisted. In conclusion, short normal children from socioeconomically disadvantaged backgrounds are at high risk of educational failure at elementary school.

Background: This longitudinal electrophysiological study investigated the course of multiple impaired cognitive brain functions in attention-deficit/hyperactivity disorder (ADHD) from childhood to adulthood by comparing developmental trajectories of individuals with ADHD and typically developing controls. Methods: Subjects with ADHD (N = 11) and normal controls (N = 12) diagnosed in childhood [mean age ADHD/CTRL = 10.9 years [SD 1.72]/10.0 years (SD 1.03)] were followed up after 1.1 and 2.4 years, and as young adults [ADHD/CTRL: 21.9 years (SD 1.46)/21.1 years (SD 1.29)]. At all four times, event-related potential (ERP) maps were recorded during a cued continuous performance test (CPT). We focused on residual deficits as adults, and on developmental trajectories (time and time × group effects) for CPT performance and attentional (Cue P300), preparatory (CNV: contingent negative variation) and inhibitory (NoGo P300) ERP components. Results: All ERP components developed without significant time × group interactions. Only the CNV remained reduced in the ADHD group, although 8/11 individuals no longer met a full ADHD diagnosis as adults. Cue P300 and NoGo P300 group differences became nonsignificant in early adulthood. The CNV parameters correlated with reaction time (RT) and RT-SD. Perceptual sensitivity improved and the groups' trajectories converged with development, while RT-SD continued to be elevated in adult ADHD subjects. Conclusions: Attentional and preparatory deficits in ADHD continue into adulthood, and the attenuated CNV appears to reflect a particularly stable ADHD marker. Although some deficit reductions may have gone undetected due to small sample size, the findings challenge those developmental lag models postulating that most ADHD-related deficits become negligible with brain maturation.

Abuse by adults has been reported as a potent predictor of borderline personality disorder (BPD). Unclear is whether victimisation by peers increases the risk of borderline personality symptoms. The Avon Longitudinal Study of Parents and Children (ALSPAC) prospective, longitudinal observation study of 6050 mothers and their children. Child bullying was measured by self-report and mother and teacher report between 4 and 10 years. Family adversity was assessed from pregnancy to 4 years; parenting behaviours from 2 to 7 years, sexual abuse from 1.5 to 9 years, and IQ and DSM-IV axis I diagnoses at 7 to 8 years. Trained psychologists interviewed children at 11.8 years to ascertain DSM-IV BPD symptoms (five or more). Accounting for known confounders, victims of peer bullying had an increased risk of BPD symptoms according to self-report (OR, 2.82; 95% CI, 2.13-3.72); mother report (OR, 2.43; 95% CI, 1.86-3.16); and teacher report (OR, 1.95; 95% CI, 1.34-2.83). Children who reported being chronically bullied (OR, 5.44; 95% CI, 3.86-7.66) or experienced combined relational and overt victimisation (OR, 7.10; 95% CI, 4.79-10.51) had highly increased odds of developing BPD symptoms. Children exposed to chronic victimisation according to mother report were also at heightened risk of developing BPD symptoms (OR, 3.24; 95% CI, 2.24-4.68). Intentional harm inflicted by peers is a precursor or marker on the trajectory towards the development of BPD symptoms in childhood. Clinicians should be adequately trained to deal with, and ask users of mental health services routinely about, adverse experiences with peers.

The influences of neonatal hyperbilirubinemia and respiratory complications were examined in 5- to 11-month-old infants in two studies. One study focused on habituation performance and the other on contingency learning. In both experiments, three neonatal jaundice conditions (no jaundice history, measured bilirubin, phototherapy) were crossed with two levels of neonatal respiratory risk (no oxygen intervention, oxygen intervention). For low respiratory risk subjects there were increasingly adverse effects for both habituation and learning the more severe the jaundice history. A complex pattern emerged for the high respiratory risk groups. Only for the learning task were the results consistent with a summative effect of neonatal jaundice and respiratory risk factors.

Appraisal and coping following a disaster are important factors in children's post-traumatic stress (PTS) symptoms. However, little is known about predictors of disaster coping responses. This study examined stress-load, appraisals and coping styles measured prior to the September 11 terrorist attacks as predictors of 9/11-specific appraisals, coping and PTS. A community sample of children and parents (N = 143) participating in an ongoing study were interviewed by phone approximately 1 month following 9/11. Pre-attack stress-load, appraisal and coping styles predicted children's 9/11-specific appraisals, coping, and PTS. 9/11-specific threat appraisals and avoidant coping predicted higher PTS and mediated the effects of pre-attack stress-load and threat appraisal. Pre-disaster stress-load, appraisal and coping styles predict disaster-specific appraisal and coping, which in turn, contribute to PTS. Coping interventions might mitigate PTS symptoms following a disaster.

Background: Differential responses in terms of gender and antisocial behaviour in emotional reactivity to affective pictures using the International Affective Picture System (IAPS) have been demonstrated in adult and adolescent samples. Moreover, a quadratic relationship between the arousal (intensity) and valence (degree of unpleasantness) has been suggested. The picture perception methodology has rarely been applied to middle school-aged children. We examined the subjective ratings of emotional reactivity in children for: i) the relationship between arousal and valence, ii) gender differences, and iii) its association with measures of antisocial behaviour. Method: Twenty-seven IAPS pictures were selected to cover a wide range of affective content and were individually administered to a non-referred community sample of 659 7-11-year-old children using a paper-and-pencil version. Concurrent symptoms of conduct disorder, oppositional defiance and psychopathy were collected from multiple sources (teacher-, parent- and self-report). Results: A quadratic relationship between arousal and valence, similar to that previously reported in adults, was demonstrated. A gender difference was found for valence ratings, with girls rating aversive pictures more unpleasant than boys. No gender differences for arousal ratings were found. A significant difference was found between groups scoring above and below cut-off scores on measures of antisocial behaviour. Children above cut-off reported lower arousal to unpleasant pictures, but higher arousal to pleasant pictures. Conclusions: We confirmed that a paper-and-pencil version of the IAPS for evaluating emotion response to affectively valent and arousing stimuli can be used in school settings and that comparable gender differences in emotional reactivity can be found in children. The differential emotional reactivity of children above cut-off on measures of antisocial behaviour suggested these symptoms to be associated with a combination of increased reward and decreased punishment sensitivity.

The aims of this study were to assess the psychological response of children following the September 11, 2001 terrorist attacks in New York and Washington, DC and to examine prospective predictors of children's post-attack responses. Children's responses were assessed in a community sample of children in Seattle, Washington, participating in an ongoing study. Symptomatology and temperament assessed prior to the attacks were examined as prospective predictors of post-attack post-traumatic stress (PTS), anxiety, depression and externalizing problems. Children demonstrated PTS symptoms and worries at levels comparable to those in children directly experiencing disasters, with 77% of children reporting being worried, 68% being upset by reminders, and 39% having upsetting thoughts. The most common PTS symptom cluster was re-experiencing, and 8% of children met criteria consistent with PTSD. African-American children reported more avoidant PTS symptoms and being more upset by the attacks than European-American children. Girls reported being more upset than boys. Prior internalizing, externalizing, social competence and self-esteem were related to post-attack PTS; and child inhibitory control, assessed prior to the 9/11 attacks, demonstrated a trend towards an association with post-attack PTS symptoms controlling for prior levels of symptomatology. PTS predicted child-report anxiety and conduct problem symptoms at follow-up, approximately 6 months after 9/11. Children experiencing a major disaster at a distance or indirectly through media exposure demonstrated worries and PTS symptoms suggesting that communities need to attend to children's mental health needs in response to national or regional disasters. Pre-disaster symptomatology or low self-regulation may render children more vulnerable in response to a disaster, and immediate post-disaster responses predict subsequent symptomatology. These variables might be used in the identification of children in need of intervention.

To test whether the retrospective reporting of the age of onset impairment criterion for attention deficit/hyperactivity disorder (ADHD) required in the Diagnostic and Statistical Manual of Mental Disorders - IV (DSM-IV) complicates identification of new and known child and adolescent cases later in life. A birth-records-based cohort of twins assessed at ages 7 to 19 years were blindly reassessed five years later using the MAGIC interview. Study outcome measures were differences in reported ages of onset for attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD) and major depressive disorder (MDD). For all age groups and respondents (parent on youth or youth self-report), later ages of ADHD onset were reported five years later. The same phenomenon was also present for the other diagnostic groups. Of the initial ADHD individuals who continued to meet all other ADHD criteria at follow-up, 46% failed the age of onset criterion five years later. When ignoring the age of onset criterion, late onsets of ages 7-16 years accounted for about 10% of all ADHD. Use of the DSM-IV age of onset criterion for attention deficit/hyperactivity disorder in the assessment of adolescents and young adults results in under-identification of affected individuals. Consideration should be given to revising the current nomenclatures to reflect the reality of retrospective reporting errors in age of onset as well as the presence of late onset cases.

The aim of the study was to examine long-term sequelae in the children of mothers who were depressed at 3 months postpartum. In a community sample from two general practices in South London. 149 women were given psychiatric interviews at 3 months postpartum and 132 of their children (89 %) were tested at 11 years of age. The children of women who were depressed at 3 months postpartum had significantly lower IQ scores. They also had attentional problems and difficulties in mathematical reasoning. and were more likely than other children to have special educational needs. Boys were more severely affected than girls, with the sex difference most pronounced on Performance IQ. The links between postnatal depression and the children's intellectual problems were not mediated by parental IQ and were not accounted for by measures of social disadvantage nor by the mother's later mental health problems. Breastfeeding did not remove the effect of the mother's illness on Full Scale IQ, but exerted its own influence on Verbal IQ and appeared to mediate the link with mathematical ability. The findings show that adverse experiences in infancy predict cognitive ability and academic performance a decade later.

Twelve male and eight female children, median age 12 yr, 7 mth, slept in the laboratory on nine non consecutive nights over a year's time. Stage REM dreams were collected. Subjects were also administered a personality measure (CPQ), an intelligence test (WISC), and an instrument to assess ego level (SCT). The study was designed to examine: the relationship between waking ego level and ego level assessed in stage REM dreams; male and female dream representations of Bakan's (1966) dimensions of agency and communion; and sex role differences on the CPQ in relation to agency communion in dreams. Ego level was found to be continuous from the waking measure (SCT) into dreams, and to be of a comparable absolute level in the two conditions. Male subjects' dreams were rated primarily agentic, whereas females' dreams were primarily communal. Failure of CPQ scales to show strong gender differences made it difficult to test the proposition that waking sex role differences would be stronger determinants of dream agency communion than gender itself.

Child Behavior Checklists (CBCL) were completed by parents of 450 clinically referred Israeli boys aged 6-11. Principal components analyses with varimax rotation yielded 10 syndromes: aggressive, uncommunicative/social withdrawal, depressed, delinquent, hyperactive, somatic complaints, anxious, immature, unpopular, and odd. The first seven syndromes were highly correlated with American and Dutch syndromes derived from the CBCL providing further evidence of their cross-cultural robustness.

As a sequel to comparison between reports by parents, we compared behavioral/emotional problems of 6-11-yr-old Thai and American children reported by teachers. These revealed higher ratings for Thai than for American children on nearly all problems showing significant cross-national differences. Thai children were rated higher on both overcontrolled and undercontrolled behavior and had more overcontrolled than undercontrolled problems (p less than 0.0001). Boys were higher than girls on all 48 problems than showed significant sex differences. The findings underscore (1) the impact of culture on children's problems in the school setting and (2) the importance of surveying teacher as well as parent perspectives.

Child Behavior Checklists completed by parents of 1848 clinically referred American and Dutch girls aged 6-11 and 12-16 were subjected to principal components analyses with varimax rotations. For the 6-11 yr age group, seven of the nine empirically derived syndromes showed cross-national correlations ranging from 0.80 to 0.98. For 12-16-yr-old girls, all eight of the American syndromes were firmly replicated for Dutch girls with correlations ranging from 0.84 to 0.97. Furthermore, cross-national similarities in the distribution of scores for normative samples supported the use of the same syndrome scales by clinicians and researchers in the two countries.

Phonological awareness tests are amongst the best predictors of literacy and predict outcomes of Key Stage 1 assessment of the National Curriculum in England at age 7. However, it is unknown whether their ability to predict National Curricular outcomes extends to Key Stage 2 assessments given at age 11, or also whether the predictive power of such tests is independent of letter-knowledge. We explored the unique predictive validity of phonological awareness and early literacy measures, and other pupil background measures taken at age 5 in the prediction of English, Maths, and Science performance at age 11. Three hundred and eighty-two children from 21 primary schools in one Local Educational Authority were assessed at age 5 and followed to age 11 (Key Stage 2 assessment). Teaching assistants (TAs) administered phonological awareness tasks and early literacy measures. Baseline and Key Stage 2 performance measures were collected by teachers. Phonological awareness was a significant unique predictor of all nine outcome measures after baseline assessment and pupil background measures were first controlled in regression analyses, and continued to be a significant predictor of reading, maths, and science performance, and teacher assessments after early literacy skill and letter-knowledge was controlled. Gender predicted performance in writing, the English test, and English teacher assessment, with girls outperforming boys. Phonological awareness is a unique predictor of general curricular attainment independent of pupil background, early reading ability and letter-knowledge. Practically, screening of phonological awareness and basic reading skills by school staff in year 1 significantly enhances the capacity of schools to predict curricular outcomes in year 6.

This study investigated the effect of family counselling on the child's mental health in low- and high-risk families. The material consisted of 160 families with a baby born in 1975-76. First, the families were classified with a weighted risk index into low- and high-risk families. Eighty of the families attended a five-year-long family counselling program. The results of a ten year follow-up study showed that both the initial family risk and the counselling made a statistically significant contribution to the 10-11-year-old child's mental health. The counselling had a positive effect both in low- and high-risk families.

Background: Recent research on adults suggests that "beneficial" psychostimulant effects of caffeine are found only in the context of caffeine deprivation; that is, caffeine improves psychomotor and cognitive performance in habitual caffeine consumers following caffeine withdrawal. Furthermore, no net benefit is gained because performance is merely restored to "baseline" levels. The effects of caffeine in children is an under-researched area, with only a handful of studies being carried out in the US where children's consumption of caffeine appears to be lower on average than in the UK. Method: Twenty-six children aged between 9 and 11 years completed a double-blind, placebo-controlled study. Habitual caffeine consumers (mean daily caffeine intake = 109 mg) and non/low-consumers (12 mg) were tested on two separate days following overnight caffeine abstinence. On each day measures of cognitive performance (a number search task), and self-rated mood and physical symptoms, including alertness and headache, were taken before and after administration of 50 mg of caffeine, or placebo. Results: At baseline (before treatment), the habitual consumers showed poorer performance on the cognitive test than did the non/low-consumers, although no significant differences in mood or physical symptoms were found between the two groups. There were significant habit by treatment (caffeine vs. placebo) interactions for accuracy of performance and headache, and a significant main effect of treatment for alertness. Post hoc comparisons showed that caffeine administration improved the consumers' accuracy on the cognitive test (to near the level displayed by the non/low-consumers at baseline), but that it had no significant effect on the non/low-consumers' performance. In the consumers, caffeine prevented an increase in headache that occurred after placebo, and it increased alertness relative to placebo. Again, however, caffeine did not significantly affect levels of headache or alertness in the non/low-consumers. Conclusions: These results suggest that, like adults, children probably derive little or no benefit from habitual caffeine intake, although negative symptoms associated with overnight caffeine withdrawal are avoided or rapidly reversed by subsequent caffeine consumption.

This study examined the applicability of the Chinese Version of Teacher's Report Form (TRF-CV) and estimated the prevalence of behavioral problems in a general population sample of 2,936 children aged 6 through 11 years in the Shandong Province of China. Teachers completed the TRF-CV and the Conners Hyperkinesis Index (CHI). The TRF-CV total scale showed satisfactory 2-week test-retest reliability (r = .83) and internal consistency (Cronbach's alpha = .94). The TRF-CV Total Problems, Attention Problems, Delinquent Behavior, and Aggressive Behavior had acceptable concurrent validity with the CHI (mean r = .62). With the TRF-CV Total Problems score of 26 as a cutoff, an overall correct classification rate of 90% for clinical sample and nonreferral required children was obtained. Exploratory factor analysis yielded six syndromes: Aggressive/Delinquent Behavior, Withdrawn/Depressed, Somatic Complaints, Attention Problems, Social Problems, and Thought Problems, with significant correlations with corresponding American cross-informant syndromes (mean r = .84). The overall prevalence rate of behavioral problems was 15.5% (95% CI = 14.2-16.8%), with a boy-to-girl ratio of 2.0:1 (chi2 = 59.70, p < .001). Younger boys exhibited more externalizing problems. These findings indicate that the TRF-CV is applicable for Chinese children, and the prevalence of behavioral problems shown by it among Chinese children seems comparable to that found in other countries. Although most of the American syndromes were well replicated, the differences in the present subjects, when submitted to principal components analysis, from American samples from whom the original syndromes were derived, could have prevented the study from replicating distinctions between aggressive vs. delinquent and depressed vs. withdrawn syndromes.

Temperament (EAS teacher and parent questionnaire) and mental state (modified DISC-C interview with adolescent) was systematically assessed in 193 11 to 16 year olds (112 girls, 81 boys) screened for major depression in the community. Sex differences in the structure of temperament were noted from both parent and teacher reports. High (negative) emotionality alone was associated with major depression, particularly (but not exclusively) in girls.

Child Behavior Checklists completed by parents of 1863 clinically referred American and Dutch boys aged 6-11 and 12-16 were subjected to principal components analyses with varimax rotations. For each age group, the construct validity of seven empirically derived syndromes was supported by cross-national correlations ranging from 0.80 to 0.98. These syndromes were designated as Aggressive, Delinquent, Depressed (ages 6-11 only), Hyperactive, Schizoid (ages 12-16 only), Somatic Complaints, Uncommunicative, and Withdrawal (Social Withdrawal for ages 6-11; Hostile Withdrawal for ages 12-16). Cross-national similarities in the distribution of scores for normative samples supported the use of the same syndrome scales by clinicians and researchers in the two countries. The cross-national construct validity of Obsessive-Compulsive and Immature syndromes did not receive adequate support.

Interviews with parents of a non-referred sample of 11-16-year-old girls (n = 82) revealed that a significantly greater proportion of mothers with a lifetime history of any psychiatric disorder also reported one or more recent undesirable life events focused on the adolescent compared with mothers with no such history. Lifetime episodes of maternal depression and recent undesirable life events exerted significant additive effects on the likelihood of depression occurring in the previous 12 months in adolescent girls. Some families may be "life event prone" as a consequence of lifetime episodes of parental psychopathology.

To investigate the prevalence and associated psychosocial factors of occasional and repetitive direct self-injurious behavior (D-SIB), such as self-cutting, -burning, -biting, -hitting, and skin damage by other methods, in representative adolescent samples from 11 European countries. Cross-sectional assessment of adolescents was performed within the European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), which was conducted in 11 European countries. The representative sample comprised 12,068 adolescents (F/M: 6,717/5,351; mean age: 14.9 ± 0.89) recruited from randomly selected schools. Frequency of D-SIB was assessed by a modified 6-item questionnaire based on previously used versions of the Deliberate Self-Harm Inventory (DSHI). In addition, a broad range of demographic, social, and psychological factors was assessed. Overall lifetime prevalence of D-SIB was 27.6%; 19.7% reported occasional D-SIB and 7.8% repetitive D-SIB. Lifetime prevalence ranged from 17.1% to 38.6% across countries. Estonia, France, Germany, and Israel had the highest lifetime rates of D-SIB, while students from Hungary, Ireland, and Italy reported low rates. Suicidality as well as anxiety and depressive symptoms had the highest odds ratios for both occasional and repetitive D-SIB. There was a strong association of D-SIB with both psychopathology and risk-behaviors, including family related neglect and peer-related rejection/victimization. Associations between psychosocial variables and D-SIB were strongly influenced by both gender and country. Only a minor proportion of the adolescents who reported D-SIB ever received medical treatment. These results suggest high lifetime prevalence of D-SIB in European adolescents. Prevalence as well as psychosocial correlates seems to be significantly influenced by both gender and country. These results support the need for a multidimensional approach to better understand the development of SIB and facilitate culturally adapted prevention/intervention.

The absence of a clear understanding of aetiology has a pervasive impact in our field’s efforts to craft valid diagnostic criteria and classification schemata. Among the conundrums that this deficit poses, one that touches clinicians and researchers alike concerns the place of functional impairment in diagnostic formulations. This is also a domain where historically the framers of the ICD and DSM have differed. In DSM-IV “clinically significant distress or impairment” is almost universally a criterion for diagnosis whereas in ICD-10 it is not. In this issue, Rapee and colleagues (2102) review this issue and report that efforts are underway to frame DSM-5 so that impairment will be viewed as a consequence of disorder rather than a requisite feature of the disorder itself. However, whether this recommendation will be fully implemented in DSM-5 remains open to question. Clearly, views remain divided today much as they did during the publication of DSM-IV and ICD-10. These authors review in detail five additional arguments why functional impairment should not be included in the criteria. These range from the importance of context in determining the degree of impairment to the inherent difficulties in sorting out discrete impairment due to one disorder when many disorders are judged to be present. They also explicitly spell out three counter arguments including that child and adolescent mental disorders (CAMDs) are not physical diseases and hence the consistency of nosological systems between general medicine and mental health should not be a high priority. In addition, better specification of the functional impairments associated with individual disorders might be useful in more directly linking the disorder to an underlying disturbance well as a establishing a diagnostic threshold for disorders with an inherently dimensional character. The debate continues, but many clinicians will continue to rely on their assessment of distress, impairment, and quality of life in order to judge whether or not to initiate treatment and assess its benefits.

This study examined the relation between stress and change in emotional and behavioural problems in children and adolescents referred for mental health services. At three waves across four years, children and their parents (N = 310, mean age at the first wave = 11.26 years, SD = 3.18) reported emotional and behavioural problems, as well as stressful life events (parent report) and perceived stress (child report). Major life events before referral were associated with higher levels of parent-reported internalising and externalising problems at referral. Life events after referral were associated with a slower recovery from internalising problems. The associations between stressful life events and the course of parent- and self-reported problems were mediated by children's subjective feelings of stress. Stressful life events appear to interfere with recovery from internalising problems in the years after referral through increasing the experience of stress in daily life.

Three subgroups of kindergarten boys (stable conduct disordered-hyperactive (SCDH), stable conduct disordered (SCD), stable non-deviant control (SC)) were defined and followed up three, four and five years later in primary school. Using assessments from multiple informants (teachers, mothers, peers, self), the results showed that SCDH boys were more hyperactive (i.e. overactive/inattentive) and displayed a greater diversity of conduct problems in school and home at follow-up compared to the other groups. These results and the fact that during early adolescence SCDH boys tend to develop a worse prognosis than SCD boys suggest that they should be distinguished. Keywords: Hyperactivity, conduct problems, development

Hurricane Katrina devastated the Mississippi Gulf Coast in August 2005. Intrusive re-experiencing is a common posttraumatic stress symptom. However, young children with limited introspection skills might have difficulties identifying their intrusive thoughts. A sample of 165 5- to 9-year-old children were surveyed about their unwanted intrusive thoughts and their knowledge about thinking, 10 months following the hurricane. Results replicate and extend the findings from a previous study (Sprung, 2008). Although there was no difference in the overall occurrence of intrusive thoughts, there was a striking difference between hurricane-exposed and control children in their contents. Children's knowledge about thinking was linked to their ability to report on their negative intrusive thoughts, even taking language ability into account. There is a shift toward negative content following hurricane exposure compared with non-hurricane-exposed children and knowledge about thinking is linked to the reporting of such intrusive thoughts. Implications for current research on autobiographical memory and for interventions following potentially traumatic events are discussed.

Prenatal exposure to inappropriate levels of glucocorticoids (GCs) and maternal stress are putative mechanisms for the fetal programming of later health outcomes. The current investigation examined the influence of prenatal maternal cortisol and maternal psychosocial stress on infant physiological and behavioral responses to stress. The study sample comprised 116 women and their full term infants. Maternal plasma cortisol and report of stress, anxiety and depression were assessed at 15, 19, 25, 31 and 36 + weeks' gestational age. Infant cortisol and behavioral responses to the painful stress of a heel-stick blood draw were evaluated at 24 hours after birth. The association between prenatal maternal measures and infant cortisol and behavioral stress responses was examined using hierarchical linear growth curve modeling. A larger infant cortisol response to the heel-stick procedure was associated with exposure to elevated concentrations of maternal cortisol during the late second and third trimesters. Additionally, a slower rate of behavioral recovery from the painful stress of a heel-stick blood draw was predicted by elevated levels of maternal cortisol early in pregnancy as well as prenatal maternal psychosocial stress throughout gestation. These associations could not be explained by mode of delivery, prenatal medical history, socioeconomic status or child race, sex or birth order. These data suggest that exposure to maternal cortisol and psychosocial stress exerts programming influences on the developing fetus with consequences for infant stress regulation.

Recent investigations suggest that experience plays an important role in the development of face processing. The aim of this study was to investigate the potential role of experience in the development of the ability to process facial expressions of emotion. We examined the potential role of experience indirectly by investigating the relationship between the emotional environment provided by mothers (as indexed by affective measures of their personality) and 7-month-olds' processing of emotional expressions (as indexed by visual attention and event-related potentials [ERPs]). For positive emotion, infants with highly positive mothers looked longer at fearful than happy expressions, and a subset of these infants who themselves also scored highly on positive temperament showed a larger negative central (Nc) component in the ERP to fearful than happy faces. For negative emotion, there were no detectable influences of maternal personality, although very fearful infants showed a larger Nc to fearful than happy expressions over the right hemisphere. To the extent that these variations in maternal disposition reflect variations in their expression of positive facial expressions, these results suggest that the emotional environment experienced by infants contributes to the development of their responses to facial expressions.

Parents' and teachers' reports of behavioral/emotional problems in 1161 children aged 4-12 from the general population and assessed via the Achenbach Child Behavior Checklist were compared. Low to moderate agreement was found, with parents reporting more problems than teachers. Agreement was higher for externalizing problems than for internalizing problems and higher for children receiving special education than for those receiving regular education. Agreement was slightly higher for older than younger children. Sex of the child did not influence parent-teacher agreement. Teachers scored children higher on problems related to peer relations and on problems interfering with academic functioning, whereas parents scored their children higher on problems associated more strongly with externalizing than with internalizing syndromes.

The science of reading and developmental dyslexia has experienced spectacular advances during the last few years. Five aspects of this research are discussed in the article. (1) The holistic phenomenon of reading is complex. Many lower-level psychological processes (e.g., phonemic awareness, phonological decoding, ability to process stimuli rapidly and automatize this process, memory, ability to recognize words) contribute to a single act of reading. Conceptualizing the complex process of reading through its partly overlapping but partly independent components--which contribute to, but do not fully explain, the holistic process of reading--provides an excellent model for understanding complex hierarchies of higher mental functions. Those who master reading skills successfully and those who have difficulties doing so differ in a wide range of reading-related processes. The central deficit experienced by poor readers appears to be related to phonological processing (a complex hierarchy of functions related to processing phonemes), whereas characteristics of automatization processes seem to moderate the reading outcome for people whose phonological skills are weak. (2) There are new data addressing models of dyslexia in languages other than English. The most fascinating finding is that the model implicating phonological deficit as central to dyslexia, and the lack of ability to automatize as leading to troubled reading, appears to be universal, regardless of the specific language. However, there is an interaction effect between the characteristics of a particular language and the developmental model of dyslexia. In phonologically more difficult languages (e.g., English), the most pronounced weakness appears to occur in phonological processing, whereas in phonologically easier languages (e.g., German), the crucial role in the manifestation of dyslexia is played by the lack of the skills needed to achieve automatization. (3) There is abundant evidence that reading (i.e., any single act of reading as well as reading as a holistic process) is "cooked" by the brain. Although no unified brain map of reading has been developed, some specific areas of the brain have been implicated in different reading-related cognitive processes by different laboratories and on different samples. (4) Indisputable evidence has been accumulated suggesting the involvement of the genome in developmental dyslexia. As of now, specific regions of the genome have been identified as being intimately involved with a number of different reading-related processes. Today the field of developmental dyslexia is the only area of genetic studies of human abilities and disabilities in which linkages to the genome have been robustly replicated in independent laboratories. (5) Finally, evidence suggests that developmental dyslexia might be only one of the manifestations of a deep, underlying, anatomical syndrome. The comorbidity of developmental dyslexia with both internalizing and externalizing behavioral disturbances, as well as with other learning disabilities, underscores the need for wide-ranging cognitive and behavioral approaches in the remediation programs offered to dyslexic children.

In a previous experiment, 6 rhesus monkey mothers were removed from their infants for 13 days, the infants being left in their familiar environment. Here the procedure was reversed–5 infants were removed to an isolation cage in a strange room, the mothers staying in their familiar environment. Contrary to expectation these infant-removed infants were less disturbed than the mother-removed infants. This difference was associated with, and was probably due to, a more positive role by the mothers of the infant-removed group in mother-infant interaction after reunion. It is suggested that the effects of a separation experience may be mediated in part by the disturbance to the mother-infant relationship which results.

This study examined "physical" and "psychological" dimensions of disability associated with different DSM-III disorders in a large sample of 13-year old adolescents. The measure of disability was based upon the World Health Organization (1980) classification. We found that adolescents with multiple DSM-III disorders and those with attention deficit and anxiety disorders showed the highest levels of parent perceived disablement; depression and conduct disorder showed the least. In addition, adolescents with any kind of DSM-III disorder showed a rate of parent-reported hospitalization twice that of the remainder of the sample. They also had poorer perceived health, as suggested by lower parent and self health ratings than those without disorder.

This study examined the association between prenatal cocaine exposure (PCE) and autonomic regulation at 13 months of age. Measures of respiratory sinus arrhythmia (RSA) were obtained from 156 (79 exposed, and 77 nonexposed) infants during baseline and during tasks designed to elicit positive (PA) and negative affect (NA). There was a significant suppression of RSA during the negative affect task for nonexposed infants but not for exposed infants. Maternal symptoms of depression or anxiety (MDA) did not mediate this association. However, gender and MDA did moderate this association such that exposed boys and exposed infants whose mothers had higher levels of MDA had an increase in RSA during a task designed to elicit NA rather than the typical pattern of RSA suppression. These results suggest that there are several possible pathways from PCE to physiological dysregulation during late infancy.

This study's aim was to estimate the prevalence and describe the clinical characteristics of Tourette syndrome (TS) in 13–14-year-old schoolchildren attending mainstream secondary schools. A three-stage ascertainment procedure was used to identify those who had TS. First, all 1012 Year 9 pupils were screened for tics using validated self-report questionnaires, which were completed by parents, teachers, and pupils. Data were available from at least one informant for 918 (90.7%) subjects. Tics were identified in 189 (18.7%) pupils. Second, families were contacted and a semistructured interview was carried out to determine whether they had TS. Finally, to ensure that the diagnosis of TS was correct, all those assessed as having TS were systematically assessed by an expert clinician in the field of TS. Seven young people were identified as fulfilling the criteria for TS, giving a minimum prevalence rate amongst 13–14-year-olds of 0.76% (95% CI 0.31 to 1.57) and a more realistic estimate of 1.85% (95 % CI 1.00 to 2.95). Behavioural problems, in particular hyperkinetic disorder, were frequently associated with the TS group. These findings lend further support to the contention that the prevalence of TS in the community has hitherto been underestimated, though the symptoms may be generally milder than cases of TS presenting to clinics. This study supports the need for vigilance for TS in school-age children in primary care and in educational settings, so that children with this potentially serious disorder can be identified and assessed and effective management packages can be formulated to address their needs, when necessary.

The relationship between conduct disorder and attention deficit behaviours in middle childhood (6, 8 and 10 years) and juvenile offending and academic achievement were examined in a birth cohort of New Zealand children. The application of structural equation modelling methods suggested that early behavioural tendencies are related to later developmental outcomes by two highly correlated but distinct developmental progressions. In the first such progression, early conduct disorder behaviours acted as a precursor of future offending patterns but these behaviours were unrelated to later school performance when the correlation between conduct disorder and attention deficit was taken into account. In the second developmental progression early attentional/cognitive behaviours were related to future school performance but were unrelated to the development of antisocial behaviours when the correlations between conduct disorder and cognitive/attentional variables were taken into account. The implications of these findings for validating the distinction between conduct disorder and attention deficit behaviours is discussed and the problems of analysing and explaining the high comorbidity between conduct disorder and attention deficit behaviours are considered.

Background: Tourette's syndrome (TS) is a neurodevelopmental disorder associated with fronto-striatal dysfunction. There is debate as to the extent to which TS is associated with cognitive impairment. Some authors argue that any impairments seen are attributable to comorbid psychiatric symptomatology, whilst others have suggested that uncomplicated TS is associated with mild deficits limited primarily to inhibitory processes. The present study was designed to examine this issue using carefully screened participants with TS and experimental measures thought to involve different areas of the frontal lobes.

This paper reviews recent evidence on the causes and maintenance of aggressive and disruptive behaviours in childhood and adolescence. It considers the relative merits of several different ways of conceptualising such problems, in relation to the contribution of biological, psychological and social factors. It focuses on conduct problems appearing in young childhood, which greatly increase the likelihood of persistent antisocial behaviours in adolescence and adult life in association with wider interpersonal and social role impairments. It considers the contribution of individual factors, including impaired verbal skills, deficits in executive functions, and an imbalance between behavioural activation and inhibition systems. These are viewed in interaction with commonly associated environmental disadvantages such as hostile or intrusive parenting. The roles of attributional biases, unrealistic self-evaluations, and insecure attachment are considered in relation to affect regulation, and effective social action. The contributions of the wider social environments of peers, neighbourhood and socio-economic conditions are evaluated. The paper concludes that, although considerable progress has been made over the past ten years, there is a need to further refine our conceptualisation of the behaviours to be explained, to develop a coherent theory of the causal and maintaining processes, and to carry out prospective studies with adequate numbers of high risk children.

433 medical and mental health institutions in the Netherlands took part in an investigation into the incidence of suicide and suicide attempts in children. The investigation is also concerned with the form that suicidal behaviour takes and an attempt is made to identify demographic and social characteristics of the children involved. The results show that suicide attempts do not constitute a very large problem in children aged 5-14; attempts hardly occur at all in children under the age of 11, but the incidence increases with age. It is also clear that children who make suicide attempts live in a problematic background situation.

To compare siblings of children with autism (SIBS-A) and siblings of children with typical development (SIBS-TD) at 4 and 14 months of age. At 4 months, mother-infant interactional synchrony during free play, infant gaze and affect during the still-face paradigm, and infant responsiveness to a name-calling paradigm were examined (n = 21 in each group). At 14 months, verbal and nonverbal communication skills were examined as well as cognition (30 SIBS-A and 31 SIBS-TD). Most SIBS-A were functioning as well as the SIBS-TD at 4 and 14 months of age. However, some differences in early social engagement and later communicative and cognitive skills emerged. Synchrony was weaker in the SIBS-A dyads, but only for infant-led interactions. Infant SIBS-A revealed more neutral affect during the still-face procedure and were less upset by it than was true for the SIBS-TD. A surprising result was that significantly more SIBS-A responded to their name being called by their mothers compared to SIBS-TD. At 14 months, SIBS-A made fewer nonverbal requesting gestures and achieved lower language scores on the Bayley Scale. Six SIBS-A revealed a language delay of 5 months and were responsible for some of the significant differences between SIBS-A and SIBS-TD. Furthermore, infant SIBS-A who showed more neutral affect to the still face and were less able to respond to their name being called by their mothers initiated fewer nonverbal joint attention and requesting behaviors at 14 months, respectively. Focused on the genetic liability for the broad phenotype of autism as well as the possible influence of having a sibling with autism.

The aim of the study was to examine the relationships between various psychosocial factors and depressive symptoms in early adolescence. A representative sample of 2,465 12-14-year-old adolescents comprising 50.8% girls and 49.2% boys, with a mean age of 13.7 years, was recruited in two counties in Norway. The participation rate was 88.3%. Depressive symptoms were measured by the Mood and Feelings Questionnaire (MFQ). Correlations between the total sum of stressful events/daily hassles and the total sum of MFQ were moderately high, rs = .49 and rs = .53, respectively. Depressive symptoms were more strongly correlated with school-related stress among boys than girls, whereas the correlation between daily hassles and depressive symptoms was higher for girls than boys. The results of univariate analyses showed significantly higher mean total MFQ scores among adolescents not living with both natural parents, those who had moved more than twice and those with more than 3 siblings orhaving fewer than 2 close friends. Further, adolescents from Third World societies and adopted adolescents, those from lower SES groups, having unemployed parents or living in coastal areas had higher mean depressive symptom scores. The results of multiple regression analyses yielded the following six significant predictors of total MFQ scores in order of importance: Sum of daily hassles and sum of stressful life events, gender, number of friends, ethnicity and mother's employment status. Altogether, these variables accounted for 43% of the total variance in MFQ scores. It is concluded that these psychosocial predictors should be addressed when assessing depressive symptoms in early adolescence. The findings of the study are discussed in view of previous research in the field and their clinical significance.