Journal of the American Academy of Child Psychiatry最新文献

The therapeutic modality adopted with schizophrenic children has more often reflected the therapist's clinical bias than the child's treatment needs. Clinical case material is used to illustrate how the treatment modality utilized should be fitted to an individual child's needs. It is suggested that the therapist of schizophrenic children be prepared to function as auxiliary ego, as facilitator of sensory perceptions, and as coordinator of a multidisciplinary treatment team.

Fragile X syndrome, a recently described form of X-linked mental retardation, has been reported to be associated with infantile autism. In chromosomal analysis of 40 children who met DSM-III criteria for infantile autism, a large number of possible autosomal fragile sites were noted, but only one child was positive for fragile X. The authors concluded that the association of fragile X syndrome and infantile autism may be less frequent than previously thought.

A sample of 231 children referred for psychiatric treatment were assessed with structured diagnostic instrument, the National Institute of Mental Health Diagnostic Interview Schedule for Children (DISC). A hierarchy of suicidal ideation from nonspecific ideation to suicidal behavior was empirically derived. Both the symptoms and syndrome of depression were correlated with the severity of suicidality, but there was considerable overlap between categories. Parents and their children showed low agreement, but high internal consistency for ratings of suicidality. The continuity between suicidal ideation and suicidal behavior is explored. These findings are compared to those of others in the literature, and implications for further research are discussed.

Precocious puberty is an experiment in nature from which we can learn about the effects of early and continuous exposure to sex steroids on human behavior. We studied the relationships between behavior problems, brain lesions, height, and two measures of sex steroid exposure in 77 children with precocious puberty. Behavior problems were assessed using the Child Behavior Checklist. We found that the diagnosis of precocious puberty regardless of the etiology was a risk factor for increased behavior problems. Although there may be important effects related to environmental and psychological variables, we found that older girls with idiopathic precocious puberty who looked closer to expected peer height and who had less pubic hair had more behavior problems.

Twenty-three boys and girls with cancer, ages 5-10, were matched with a comparison group of healthy children. They were administered measures of cognitive development, adjustment, and humor. Few differences were found between ill and well children across a broad array of measures. Ill children were found to have lower scores on two measures of cognition, and more frequently rated a cartoon funny when they did not understand the joke. The generally comparable performances of ill and well children were interpreted as a manifestation of healthy denial among the ill group. Age and health group interactions offered evidence of the effects of age as a moderating variable in the relationship between a stressor and its impact.

DSM-III-defined schizophrenia is rare in children, but because it can be severely disruptive to children's lives, continuing investigation of its clinical manifestations, pathophysiology, and treatment are important. Recent studies of the offspring of schizophrenic parents suggests that Bender and Fish's ideas concerning the phenotypic manifestations of schizophrenia in young children may be correct. Few studies of treatment have been undertaken to date. Recent investigations of risk factors in the families of adult onset schizophrenics have suggested ways in which innovative treatment programs could be developed.

The authors evaluated mother-infant interaction in multiproblem families to help identify those children vulnerable to development of psychopathology. They videotaped 16 infants exposed prenatally to methadone and 23 comparison infants interacting with their mothers at ages 4 and 12 months. Using a scale they developed, the authors rated the quality of communication. Neither maternal resources nor infants' level of neonatal risk predicted infant interaction or infant Bayley Scale performance. At infant age 12 months, mothers' interactive behavior was a significant concurrent predictor of infant functioning. The authors conclude that the variability of the lives of multiproblem families makes prediction over time very difficult. However, evaluating mother-infant interaction was a helpful “marker” of infants who were contemporaneously experiencing problems.

Of 60 children and adolescents referred for assessment of depression, 11 cases were found which met diagnostic criteria for both conduct disorder and affective disorder. These 11 subjects could not be distinguished from those with major depression on the basis of psychiatric ratings of depressive symptoms—both diagnostic groups were characterized by multiple depressive symptoms of high severity. Psychiatric ratings also indicated that depressive symptoms were more severe in cases of conduct disorder with depression than in cases of dysthymic disorder. Child and adolescent self-reports of depression were consistent with this pattern of results.