Acta paedopsychiatrica最新文献

We recently presented the theory that parents should be intensively involved in the treatment of adolescents with anorexia nervosa during the acute re-feeding period and during follow-up. Thirteen anorectic patients with a mean age of 14.6 years (range: 12.6-16.5 years) were being treated in our pediatric day-care unit in Israel according to this treatment model when the Gulf War broke out. Because of the war, treatment was abruptly interrupted for approximately 6 weeks. Immediately after the war the patients were re-evaluated. We found that all of them maintained their weight, and two had even continued to gain weight. These results encouraged us to assume that our treatment model, based on intensive parental involvement especially during the acute re-feeding period, was effective.

By the end of the nineteenth century, anorexia nervosa had acquired a certain amount of recognition in the medical literature in many countries. In Norway, however, little attention had been paid to this eating disorder. Some anorexic-like conditions can be found in case reports on "hysteria" in children, of which the article by Selmer, from 1891, is quoted in extenso.

An important issue in current research on dyslexia is to what extent the reading deficits of dyslexic children are related to processing deficits at the sensory-visual level, at the cognitive-linguistic level or at both levels. Event-related potential mapping distinguishes the split-second processing stages during reading as brief brain-electric micro-states and can address this issue directly. Previously, conventional studies have yielded inconsistent patterns of event-related potential differences between dyslexic and control children, but most of these discrepancies could result from the widely differing methodologies. We used event-related potential mapping during silent reading of correct and incorrect sentence endings to examine the neurophysiology of sensory and cognitive processes in dyslexic and control children (n = 12/group). Selected findings from spatio-temporal analyses of map strength (global field power), map latency and map topography measured in three dimensions are presented. Both sensory-visual processes in a P110 micro-state and cognitive-linguistic processes in an early N400 micro-state were affected in dyslexic children, and processing delays, as well as qualitatively different patterns of neural activation, were found. Our findings also indicated that the use of specific cognitive tasks and of appropriate spatio-temporal analyses of event-related map series are critical factors for successful identification of specific processing deficits in brain mapping studies.

Twenty-five adolescents referred to an outpatient clinic because of school refusal in 1985-1986 were followed up after an average of 5 years. DSM-III diagnoses and scores on the Maudsley Symptom Checklist were obtained at initial contact and a follow-up. At follow-up, information was also gathered on psychosocial adjustment, and subjects completed self-ratings of anxiety and depression. At initial contact, school refusal was associated mainly with anxiety symptoms, and to a lesser extent with depressive and somatoform disorders. No specific relationships were found between diagnoses at baseline and at follow-up. About half of the sample still had a psychiatric disorder at follow-up. Outcome was negatively associated with a history of previous psychosocial or psychiatric treatment and a small family size, and positively with a history of frequent somatic complaints.

Repressive defense style, characterized by low levels of self-reported distress and high levels of defensiveness, has been well studied in adult patients. This study identified four adaptive styles (repressor, impression manager, low anxious, and high anxious) in an adolescent psychosomatic patient sample (n = 120) by standardized psychometric examination. Adolescents with an active medical diagnosis on DSM III-R axis III or with an axis I diagnosis associated with physical symptoms (conversion disorder, somatization disorder, and psychological factors affecting physical condition) were more likely to be repressors. Those with affective disorders were more likely to be impression managers. Implications for pediatric and psychiatric management are discussed.

Contrary to the current assumption that there are no specific correlates of dyslexia in the standard clinical EEG, we have often noted a spontaneous "intermittent left parietal alpha desynchronization" (ILPAD) when visually evaluating the standard EEGs of children with delayed speech and language development and/or dyslexia. Visual evaluations of EEGs, as well as computer-assisted frequency analysis of three pairs of matched groups (healthy and hyperkinetic children with vs. without relatively "low levels" of verbal performance, as well as children with other child psychiatric disorders with vs. without dyslexia), revealed that healthy children did not display the ILPAD phenomenon. It was seen neither in healthy children with a homogeneous performance profile ("high level" of verbal performance) nor in those with a relatively "low level" of verbal performance. However, the ILPAD phenomenon was evident mainly in children with psychiatric disorders who suffered from dyslexia. Its intermittent occurrence prevented its detection by means of the usual computer-supported analyses of EEG power spectra. Nevertheless, auditory cognitive loading was accompanied by a decrease in alpha power in both healthy and hyperkinetic children with "high" or "low" levels of verbal performance. In a further group of 8-year-old children with dyslexia, but otherwise healthy, the ILPAD phenomenon was also observed if their CNS maturation as reflected in the EEG was normal for their age. These results seemed to indicate at least a deficit-specificity of the ILPAD phenomenon, which is interpreted as an electrophysiological correlate of a "brain-electrical developmental deviation" with regard to the "functions of communication": speech, language, reading and spelling.

According to Boder, there are two processes involved in reading: visual-gestalt and analytic-phonetic. The gestalt process is activated for known words, forming part of the child's "sight vocabulary", and it enables him/her to recognize words even when they are exposed for a very short time. The analytic-phonetic process involves the auditory channel when the words are not part of the "sight vocabulary" and require a spelling process. At first, neither the English version nor the Italian adaptation of the Boder test included a control of word exposition time (ET) and reading time (RT). Both parameters are necessary for a check of the gestalt and phonetic processes. The aim of this paper was the assessment of minimum ET for the words belonging to the "sight vocabulary" and of RT for a word read through a gestalt process. Seventy-five primary schoolchildren from the first to the fifth class were presented with 100 meaningful words (MF) and 100 meaningless (ML) words, using ETs ranging from 150 to 650 ms. The results showed that, at the age of 7 years, the gestalt process was completely developed. Of MF words, 95% were correctly read and it did not change significantly with longer ETs. The RT for MF words did not change with different ETs and remained stable after the age of 7 years. Finally, the RT for ML words was always longer than the RT for MF words, and the difference was significant in 8-, 9- and 10-year-old children.