Acta paedopsychiatrica最新文献

The initial assumptions as to the existence of neurodevelopmental disorders have been confirmed by almost a century of studies focused on the nature and causes of reading disability. Dyslexia is an umbrella term for the various manifestations of reading disabilities, each of which is related to its own complex of neuropsychological dysfunctions, sometimes accompanied by neurological symptoms that can be indicative of the specific location involved. Electro-physiology and neuro-imaging in relation to metabolic activity have also confirmed that, to some extent, there is dysfunction in various cerebral areas, more frequently in the left than in the right hemisphere, less often between the hemispheres (corpus callosum) and outside the classical language areas. The rather rare subtype referred to as visual dyslexia and the inter-modal disconnection type resembling alexia are eclipsed by dyslexias related to spoken language: the dysphonemic (auditory-phonological) subtype and the subtypes that are concerned with the production of speech (fluency, word-finding, syntax, sequences), semantics (language comprehension) and linguistic memory. Although it is considered that there are basic brain dysfunctions in dyslexics such as deficits in sequential information processing, there is no "grand unified theory" of dyslexia. There are some new insights as regards the aetiology. In addition to indications of such possible causes as perinatal brain damage, genetic or chromosomal anomalies that manifest themselves in the substrate in an unclear manner, there is also the possibility that the cortical language areas can be disturbed in their development (migration disorders and abnormal asymmetry) due to genetic or epigenetic hormonal and/or immunological factors, so that the normal left hemispheric dominance does not develop. The diagnosis and treatment of dyslexia should begin at an early age and should be acknowledged as being of great social importance.

In a prospective epidemiological longitudinal study of children (n = 399) from age 8 to 18 years, children with specific reading retardation (n = 37) were identified by the modified Research Diagnostic Criteria of ICD-10. The group with specific reading retardation was compared with a group with other specific developmental disorders (n = 62), a group of children with normal intelligence (n = 285) and a group of children with below average intelligence (n = 15). No correlation was found between reading retardation and pre- and perinatal complications. Children with reading retardation suffered from environment-related stress factors in early childhood and adverse familial conditions at 8 years and the educational level of the mother was significantly lower. The number of additional psychiatric symptoms was increased at ages 8, 13 and 18. Conduct disorders, in particular, were more frequent in children with specific reading retardation and the rate of juvenile delinquency was increased (25%). The non-verbal intelligence remained constant between ages 8 and 13, and spelling performance developed parallel to the control group with normal intelligence. Only one out of three showed a significant improvement in spelling ability.

A neurophysiological approach to developmental studies of childhood autism has revealed major cognitive and sensori-motor disturbances which are associated with impairment in social relationships. This new approach suggests the existence of underlying cerebral dysfunction, signs of which are revealed by functional exploration and cerebral imaging.

The Kiddie-Infant Descriptive Instrument for Emotional States (KIDIES), a new instrument that uses affective and behavioral dimensions for categorization, was compared with DSM-III-R criteria to assess diagnostic reliability in childhood pervasive developmental disorder (PDD). Forty-two children with PDD and other developmental disorders were evaluated. Their diagnoses were based on DSM-III-R criteria. Subjects were videotaped during interviews with three different partners and rated using the KIDIES. Cluster analysis of KIDIES ratings revealed a significant correlation with DSM-III-R diagnostic categories, demonstrating the potential reliability of the KIDIES dimensional approach for diagnosing PDD in preschoolers.

Out of a collection of 121 child and adolescent psychiatric or psychological recommendations in family court cases, some 60 opinions were subjected to retrospective study. All the cases studied involved a single child to be recommended. In a retrospective analysis, the aim was to identify dangerous psychological constellations in the separating families, in particular typical behavioral and coping patterns of the parents in the process of separation and the typical reactive patterns of the children caught in the process. The study is designed as a descriptive analysis with the aim of sensitizing the helping-systems involved to better perception of such problem constellations. Thus it offers recommendations for parents, lawyers, judges and social-workers in the separation process.

We studied testicular growth and psychosexual development in 41 young males who had survived malignancies in childhood. The focus of the study was evaluation of the connection between the possible pathologies of these two phenomena. The size of the testicles was measured in millilitres and compared with reference values. The psychosexual development was evaluated using three approaches: the interviewer's evaluation, the patient's subjective assessment and information gained by specific questions. On the basis of the developmental theory of adolescence described by Blos, the appropriate development in each criterion was defined. Our results indicated that both psychosexual and somatic development were impaired. A significant relationship existed between testicular size and three criteria assessed by the patients: the patients who felt that their pubertal development was different from that of their peers, those who felt that their developmental failures were related to their personal medical histories, and those who did not feel that they had the ability to have sexual intercourse and/or children. The last group had significantly smaller testicles than the others. We speculate that the perception of the small size of testicles may trigger the psychological experiences of failed development, leading to narcissistic problems in adolescent development. In order to prevent these harmful consequences it will be necessary for different specialists to work together with the families and patients.

This paper is part of a special section on 'psychopharmacotherapy in children'. The latter may be combined with behavioural treatments, but in children only in the field of attention deficit hyperactivity disorder treatment studies has this combination been investigated and proved to be more effective than any single treatment alone. As to the treatment of depressive disorder, school phobia and obsessive-compulsive disorder in children and adolescents, no controlled empirical studies on combined therapies exist. Nevertheless, positive results from adult studies (e.g. depressive disorder, obsessive-compulsive disorder) may be, with some modification, paralleled in children and adolescents. So far, there are no indications that the combination of medication and behavioural treatment has antagonistic effects. Thus, we would make a plea for combining psychopharmacotherapy and behaviour therapy in child and adolescent psychiatry.