Journal of the American Academy of Child Psychiatry最新文献

Acute hallucinations in children aged 2–6 is not a rare occurrence. Emerging at times of stress, they are associated with severe anxiety and phobic behavior. The hallucinations are almost always visual and/or tactile. Contrary to reports of hallucinations at other ages, they tend to occur in bright, independent children. They are self-limited, with the acute hallucinatory phase over in a matter of several days and a subacute phobic phase which may last from weeks to months. In all of our cases there was a return to normal functioning. Hallucinations in this age group appear to be a different phenomenon from those occurring in older children, which are more frequently associated with more serious illnesses. These need to be understood in a developmental framework, but current knowledge does not permit a thorough explanation.

A double-blind study compared the effects on 14 children with attention deficit disorder (ADD) with hyperactivity of 1-week trials of each of the following: tyrosine 140 mg/kg/day, tryptophan 100 mg/kg/day, d-amphetamine 5 mg or 10 mg/day, and placebo. Parent and teacher ratings and measures of attention were obtained at baseline and at the end of each condition. Tyrosine was not significantly different from placebo on any of the variables measured. Tryptophan, while not significantly different from placebo on teachers ratings, was significantly better by parents ratings. This suggests that tryptophan may have some benefit in selected cases of ADD, primarily with home behavior problems.

Children who have been victimized by sexual abuse are being asked regularly to testify against their sexual perpetrator. It is important to know whether some sexually abused children can testify competently without long-term negative psychological effects. This paper is a case study of a 14-year-old adolescent girl who suffered repeated sexual abuse from her grandfather. She was evaluated in a child witness project and given trial preparation. Her performance as a witness was assessed at her two trial appearances. She was evaluated after each court appearance and by phone 15 months later. A discussion of the legal and psychological assessment issues in the use of such children as witnesses is included.

A representative sample of 5-year-old kindergarten children was assessed for speech and language disorders. Those identified as having a speech/language disorder (N = 142) as well as a matched control group, were then assessed for behavioral or emotional problems by parents, teachers, and by a psychiatrist. Results indicated that the speech/language-impaired group was more likely than the control group to (1) show behavioral disturbance according to teachers and a primary parent (usually the mother); (2) be diagnosed as having some DSM-III Axis I disorder, particularly Attention Deficit Disorder; and (3) suffer from psychosocial stressors. Not only was the speech/language-impaired group at a relatively higher risk for psychiatric disorder; this level of risk was relatively high, ranging from 22.1% (parents) to 48.7% (psychiatric evaluation). Surprisingly, speech/language-impaired girls were consistently at greater risk than were speech/language-impaired boys; the percentage of girls rated in the clinical range varied from 37.0% (teachers) to 44.9% (parents), while the figures for the boys were 23.0% and 25.0%. These results argue strongly for increased support to the health and educational systems dealing with these children, better screening for behavioral and emotional problems among the girls, and further research investigating the factors associated with these disorders.

The failure of professionals to report many cases of suspected child abuse is welldocumented. However, a related, serious failure, the failure to inform parents that suspected abuse is being reported or actively considered, has received scant attention. When a certain threshhold of suspicion has been reached, it becomes deceptive not to inform parents. This deception by omission violates a moral rule and can be justified only in specific situations. Deception undermines therapeutic work. Informing parents facilitates empathy and enhances the possibilities for more effective intervention. Thus, informing parents face-to-face is both ethically required and clinically sensible in most cases.