Journal of the American Academy of Child Psychiatry最新文献

We assessed the psychiatric histories and DSM-III diagnoses of all schoolchildren (N = 177) in one geographic area who were referred for potential placement in classes for children with social and emotional disturbances (SED). An extremely high prevalence of serious psychopathology was demonstrated among the entire group. In children aged 6–12 years, Attention Deficit Disorder was the most common diagnosis, while Affective Disorders were the most frequent in older children (13–18 years). The types of psychiatric disorders were similar but of significantly greater severity in children subsequently recommended for SED placement. The SED group had significantly more abused children and parents with psychiatric disorders. Nevertheless, a majority of the children had not received previous psychiatric care or special educational help.

A sample of low birthweight preterm infants was assessed for temperamental characteristics at 3, 6 and 12 months of age by parent report. Results indicate that this sample contains a significantly higher percentage of “difficult‘’ infants (p < 0.02) than reported in full-term samples. Infant characteristics such as severity of perinatal and postnatal complications and maternal characteristics, such as socioeconomic status and available support structures, were found to be unrelated to parent temperament reports. However, mother-infant interaction in the first year was shown to be related to both the style and stability of temperament reports. These findings suggest that temperament, at least during the first year of life, is a reflection of the transactions between the infant and his or her caregivers.

In this paper the traumatic situation of children witnessing a parent being murdered is examined. The purposes are to (1) evaluate the psychiatric consequences of such a trauma, in terms of meeting diagnostic criteria, and (2) assess the impact on the affective and cognitive functioning of the child. Methodological complications are present in such rare events. When a parent is seriously wounded in an attempted murder but survives, the situation is dissimilar from a parental death; when a child is directly involved, such as being shot at, a key variable has changed; the response to the child may change the outcome; differences in family structure, and the clinical status of the perpetrator (e.g., was the person psychotic and for how long?) are all relevant. This study investigated 16 children between the ages of 5 and 10 who had witnessed a parental murder. The children were assessed clinically as well as by utilizing the Impact of Event Scale. Complex legal situations often arise when children are exposed to a parental homicide. The situations may involve participation in a criminal trial as well as civil issues involving mental distress. Both may demand the child's participation as a witness, beyond the initial traumatic event of witnessing a parent murdered.

Thirty-five local children and their parents were studied 1 1/2 years after the Three Mile Island (TMI) nuclear accident. On a standardized self-report measure, the children were found to have a level of residual anxiety that was not identified by their parents. These children also consistently reported stronger and more symptomatic responses to the TMI accident for themselves than their parents did for them. Child intensity-of-reaction scores were significantly related to mother-father discordance in mood and reaction to the event. Four of the children who were psychiatrically disturbed showed significantly high or low intensity-of-reaction levels.

Within the strategy of risk research, disaster is conceptualized as risk and situations are appraised in terms of their riskiness. Thus, with natural disasters, the site is chosen that is at high risk for floods, tornadoes, and earthquakes, and the sample of the population is evaluated with the expectation that they will be retested following the disaster. In this presentation, the calamity is man-made and the potential victims are the children of psychotic parents where the risk for developing psychosis in adult life is 10–15 times that found in the general population, but the risk of exposure to psychotic behavior is very much greater. Much of the earlier work on disaster appeared fixated on the horror of the situation so that controlled investigations seemed out of place (“statistics don't bleed!”). The research field is currently moving into a transitional phase intermediate between the anecdotal and the rigorous, but spanning both. Even aftermath research so far has not conclusively answered such questions as the similarities and differences between natural and man-made disasters in terms of the psychological response.

This report reviews baseline cortisol dynamics and the test performance of the dexamethasone suppression test (DST) in a study population of 97 psychiatrically hospitalized children aged 3–16 years. Only 5% of depressed patients failed to maintain a diurnal variation in cortisol secretion and elevated basal cortisols were a nonspecific finding in some depressed children and nondepressed controls. Fifteen of 34 children who met DSM-III criteria for Major Affective Disorder failed to suppress their serum cortisol below 5μg/dl following 1 mg of dexamethasone giving test sensitivity of 44%, specificity of 88% and diagnostic confidence of 68%. Nonsuppression was negligible (3% (1/34) in a wide range of nondepressed diagnostic categories), but 21% (4/19) children with Depressive Neurosis and 33% (2/6) with Adjustment Disorder with depressed mood also failed to suppress. Only 1/22 or 4.5% of the positive DST results would have been missed by drawing a single cortisol sample at 4:00 P.M. In spite of a weight range of 15–83 kg in the children, there was no significant difference in the percentage of depressed children who failed to suppress at high, medium or low dose of dexamethasone per kg body weight when a 1 mg standard dose was used in all children. However, when the high dose children were grouped by age, 9 young children in the 0–6-year age range showed poor sensitivity and specificity, indicating a need for further study of the effects of dose, age, weight and diagnostic variables in this population.