Journal of the American Academy of Child Psychiatry最新文献

This study predicted treatment resistance in 104 adolescents undergoing long-term residential treatment from adoptive status. Resistance was defined by rejection of adults and runaway behavior. Results indicated that these hospitalized adoptees: (1) formed significantly closer bonds with peers while rejecting close ties with adults; and (2) had significantly more runaway episodes and hospitalization terminations by runaway than nonadoptees. Termination runaways occurred after 1 year of hospitalization for adoptees. Significantly more adoptees ran away in groups of two or more patients. Psychodynamic and theoretical considerations for psychiatric treatment of adoptees are discussed and illustrated by case material, emphasizing the value of differentiating treatment approaches for patient subgroups.

The process of the resolution of 200 disputed custody and visitation cases referred for court-ordered evaluation was studied. Although the function of such evaluations is often seen as providing evidence for judicial consideration, in the study sample this was an unusual result, as judges made decisions in only 11% of cases. Highly adversarial parents reached agreement during or at the end of the evaluation in 18% of cases, and the experts' recommendations functioned as a bargaining chip which promoted resolution in 71% of cases. The authors propose a model in which psychiatric evaluation in these cases functions in the legal system as an alternative method of dispute resolution, gaining much of its effect from the shadow of judicial power which looms in the background. The implications of this model for the conduct of psychiatric custody/visitation evaluations are discussed.

Plasma dopamine-β-hydroxylase (DβH) was measured on 420 boys and 128 girls admitted to a children's psychiatric hospital. Children with plasma DβH activities ≥ 6 μM/min/L, the near-zero DβH group, were compared to children with DβH activities > 6 μM/min/L, the comparison group. Fifty-four percent of the boys with near-zero DβH were diagnosed conduct disorder, undersocialized and 24% were diagnosed borderline personality compared to 21% and 10% for the comparison group. Symptomatically the near-zero group had more conduct symptoms, concentration symptoms, impaired relationships, and fewer anxiety and depressive symptoms than the comparison group. Significantly more boys in the near-zero group were discharged on medication and on methylphenidate. Girls did not show these differences. The results show a relationship between near-zero plasma DβH and conduct disorder symptomatology in emotionally disturbed boys.

The concern about widespread abuse of children in modern Western society has led historians and health care professionals to examine the past for evidence of similar abusive practices. The expectation has been that the past, especially the Middle Ages, will reveal even worse attitudes and practices toward children. Our research, based upon an analysis of care given to sick children in early medieval Europe, suggests that considerable attention, effort, and expense were devoted to seeking help for sick and crippled children. At the same time, there is no body of evidence to sustain the notion of widespread child abuse during these Dark Ages of Western civilization.

Although little empirical evidence is available, ideas about how “typical” parents rear their children with respect to sexual issues have been influencing court proceedings. The fact that a child touched a parent's genitals on one occasion has recently been introduced in some child custody cases as supportive evidence of molestation. The authors report on a questionnaire study of this question among 576 children aged 2–10. Parents in this study report that such activity is not uncommon on an “incidental” basis even among 10-year-olds. The authors discuss some legal and psychological implications and child-rearing recommendations drawn from their findings.

The terms competency and credibility are defined as they relate to child witnesses. The criteria employed by the courts in assessing a child's competency to testify are discussed, and research into the effect on children's testimony of limitations of memory, and of suggestibility, susceptibility to external influence, emotional arousal and long delay, is summarized. A systematic approach to the clinical evaluation of credibility is described, and the concept of a specific biopsychosocial syndrome associated with sexual abuse critically discussed.