Childhood Emotional Disorders Research Articles

Understanding the agreements and controversies surrounding childhood psychopharmacology

The number of children in the US taking prescription drugs for emotional and behavioral disturbances is growing dramatically. This growth in the use of psychotropic drugs in pediatric populations has given rise to multiple controversies, ranging from concerns over off-label use and long-term safety to debates about the societal value and cultural meaning of pharmacological treatment of childhood behavioral and emotional disorders. This commentary summarizes the authors' eight main findings from the first of five workshops that seek to understand and produce descriptions of these controversies. The workshop series is convened by The Hastings Center, a bioethics research institute located in Garrison, New York, U.S.A.

Neurology: Secondhand Behavioral Problems

Children whose mothers regularly smoked during pregnancy are known to be more likely to exhibit disruptive and aggressive behavior than children of nonsmoking mothers. A new study now finds that children born even to nonsmoking mothers who were exposed to chronic secondhand smoke (SHS) while pregnant face serious problems of attention deficit/hyperactivity disorder (ADHD) and conduct disorder, which includes fighting, truancy, substance abuse, and stealing. At the University of Washington, psychologists Lisa Gatzke-Kopp and Theodore Beauchaine recruited 171 children aged 7–15 years who had emotional and behavioral problems. Their mothers consisted of 21 women who smoked regularly during the second and/or third trimester, 16 nonsmokers who were exposed during the second and/or third trimester to SHS at work or home, and 96 women who neither smoked nor were exposed to SHS (some of the mothers had more than one child in the study). More symptoms of ADHD and conduct disorder were measured in children of smoking or SHS-exposed mothers, compared with children of smoke-free mothers. In fact, severe symptom scores were about the same for children whether they were exposed in utero to maternal smoking or to SHS. Childhood emotional disorders such as depression and anxiety were not significantly associated with maternal smoking or SHS exposure during pregnancy. ADHD and conduct disorder are “externalizing” behaviors, as opposed to “internalizing” outcomes such as depression and anxiety. Animal models show that nicotine impairs brain development during the second and third trimesters, the formative periods for brain regions that control externalizing behaviors, such as the mesolimbic dopamine system. The study, published online 23 May 2007 ahead of print in Child Psychiatry and Human Development, is the first to link SHS exposure in pregnancy to serious disruptive behavior during childhood. However, the level of SHS exposure studied was “chronic and extreme and all day long,” points out Gatzke-Kopp, now at Pennsylvania State University; therefore “pregnant women should not panic about minor exposures to secondhand smoke.” Still, the researchers hope their results will raise awareness about the potential health consequences of SHS to pregnant women in public places and work environments that still permit smoking (such as restaurants and bars). Lauren Wakschlag, an associate professor of psychology at the University of Illinois Institute for Juvenile Research, says the new study “highlights where we need to go to disentangle the complex relationship of prenatal secondhand smoke exposure and antisocial behavior.” However, with only 16 SHS-exposed participants and 21 smokers, the central emphasis on SHS versus smoking needs to be interpreted cautiously. “These preliminary findings suggest a possibility that secondhand smoke affects behavior,” says Wakschlag, “but we need more systematic exploration of this.”

Eurythmy therapy in chronic disease: a four-year prospective cohort study

BackgroundMany patients with chronic diseases use complementary therapies, often provided by their physicians. In Germany, several physician-provided complementary therapies have been reimbursed by health insurance companies as part of health benefit programs. In most of these therapies, the patient has a predominantly passive role. In eurythmy therapy, however, patients actively exercise specific movements with the hands, the feet or the whole body. The purpose of this study was to describe clinical outcomes in patients practising eurythmy therapy exercises for chronic diseases.MethodsIn conjunction with a health benefit program, 419 outpatients from 94 medical practices in Germany, referred to 118 eurythmy therapists, participated in a prospective cohort study. Main outcomes were disease severity (Disease and Symptom Scores, physicians' and patients' assessment on numerical rating scales 0–10) and quality of life (adults: SF-36, children aged 8–16: KINDL, children 1–7: KITA). Disease Score was documented after 0, 6 and 12 months, other outcomes after 0, 3, 6, 12, 18, 24, and (SF-36 and Symptom Score) 48 months.ResultsMost common indications were mental disorders (31.7% of patients; primarily depression, fatigue, and childhood emotional disorder) and musculoskeletal diseases (23.4%). Median disease duration at baseline was 3.0 years (interquartile range 1.0–8.5). Median number of eurythmy therapy sessions was 12 (interquartile range 10–19), median therapy duration was 119 days (84–188).All outcomes improved significantly between baseline and all subsequent follow-ups (exceptions: KITA Psychosoma in first three months and KINDL). Improvements from baseline to 12 months were: Disease Score from mean (standard deviation) 6.65 (1.81) to 3.19 (2.27) (p < 0.001), Symptom Score from 5.95 (1.75) to 3.49 (2.12) (p < 0.001), SF-36 Physical Component Summary from 43.13 (10.25) to 47.10 (9.78) (p < 0.001), SF-36 Mental Component Summary from 38.31 (11.67) to 45.01 (11.76) (p < 0.001), KITA Psychosoma from 69.53 (15.45) to 77.21 (13.60) (p = 0.001), and KITA Daily Life from 59.23 (21.78) to 68.14 (18.52) (p = 0.001). All these improvements were maintained until the last follow-up. Improvements were similar in patients not using diagnosis-related adjunctive therapies within the first six study months.Adverse reactions to eurythmy therapy occurred in 3.1% (13/419) of patients. No patient stopped eurythmy therapy due to adverse reactions.ConclusionPatients practising eurythmy therapy exercises had long-term improvement of chronic disease symptoms and quality of life. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that eurythmy therapy can be useful for patients motivated for this therapy.

Emotional and Behavioral Problems among Diabetic Children

Emotional and Behavioral Problems among Diabetic Children

Prevention of Childhood Emotional Disorders: Reducing the Burden of Suffering Associated with Anxiety and Depression

Anxiety and depression are the most common mental health problems affecting young people today. This review presents a description of the prevalence and impact of these emotional disorders in children and youth. While treatment offers one approach to intervening, research indicates that most sufferers will not actually receive clinical intervention, and of the minority who do, many will terminate prematurely, fail to respond, or experience recurrent difficulties despite treatment. Prevention approaches offer an alternative and adjunct to treatment, and have become a priority for governments, offering a cost effective and efficient means of providing services to children and youth prior to the onset of psychopathology. This review describes current practises in prevention research and provides an overview of an Australian developed cognitive-behavioural programme that has acquired a solid evidence-base as well as popularity in schools as one approach to building emotional resilience in children and youth, whilst effectively reducing the burden associated with emotional disturbances of anxiety and depression. Future directions for prevention practice and research are highlighted.

The prevalence of mental health problems in Ethiopian child laborers

Child labor refers to a state when a child is involved in exploitative economical activities that are mentally, physically, and socially hazardous. There are no prevalence studies on the magnitude of psychiatric disorders among child laborers. A cross-sectional population survey was conducted in Addis Ababa using the Diagnostic Interview for Children and Adolescents (DICA). Subjects were a random sample of 528 child laborers aged between 5 and 15 years and comprising child domestics, street-workers and private enterprise workers. These were compared with 472 non-economically active controls. The aggregate prevalence of any DSM-III-R childhood emotional and behavioral disorders was found to be 16.5%, with 20.1% and 12.5% among child laborers and controls respectively, OR = 1.89 (95% CI, 1.34-2.67, p < .01). Internalizing disorders such as mood disorders were significantly higher among the laborers than the non-laborers, OR = 6.65 (95% CI, 2.20-22.52, p = .0001). Anxiety disorder was seen over twofold among child laborers while psychosocial stressors were one and half times more likely among the study subjects than controls. When all factors were taken into account, child labor status was the only significant factor in determining DSM-III-R diagnosis. In this study childhood emotional and behavioral disorders are found to be more common among child laborers than among non-laborers. We recommend a larger study to look into childhood disorders and risk factors in child labor. As part of the concerted effort, government, NGOs, and the public should at least view child labor as a menace in a child's development, with risk of psychosocial difficulties.

Chronic fatigue syndrome of childhood

To examine clinical specificity in chronic fatigue syndrome (CFS) of childhood, by comparing clinical features in childhood CFS and in emotional disorders (ED). METHOD SAMPLE: 28 children with CFS; 27 with ED. History of disorder; K-SADS psychiatric interviews; self-esteem and physical symptoms questionnaires; premorbid history, behavioural and personality assessments. There were high levels of comorbid emotional disorders in children with CFS, and the two groups were comparable on self-esteem, but CFS children endorsed more fatigue and other somatic symptoms. The two groups were comparable on age at illness onset, but parents of children with CSF reported more biological illness precipitants, more pre-morbid recurrent medical problems and infections. The CFS group had fewer pre-morbid psychological problems and less psychiatric comorbidity than the ED group. There is considerable clinical overlap between CFS and ED of childhood, but there are also differences in clinical presentation between these disorders.

Childhood and Early Adult Predictors of Risk of Incident Back Pain: Ontario Child Health Study 2001 Follow-up

Musculoskeletal disorders of the back and spine are a leading cause of disability in working-age populations. There is limited information on the potential consequences of childhood socioeconomic and health status on the risk of incident back pain in early adulthood. The authors describe factors associated with having had a first episode of back pain during the past year in the Ontario Child Health Study, a prospective cohort study of children who were aged 4-16 years at the time of enrollment in 1983 and were resurveyed in 2001. Respondents reporting a first episode of back pain (n=143) were compared with respondents who had never experienced back pain (n=896). The annual incidence of a first episode of back pain in this sample of young adults was 74.7/1,000. Following adjustment for age, sex, childhood conditions, childhood health status, and measures of early adult health, behavior, socioeconomic status, and work environment, the risk of incident back pain was associated with both low (odds ratio (OR)=1.86, 95% confidence interval (CI): 1.14, 3.03) and moderate/high (OR=1.85, 95% CI: 1.07, 3.02) levels of psychological distress, current heavy smoking (OR=1.85, 95% CI: 1.10, 3.10), lower levels of parental education in childhood (OR=1.72, 95% CI: 1.06, 2.80), and emotional or behavioral disorders in childhood (OR=1.87, 95% CI: 1.02, 3.41). The associations of low childhood socioeconomic status and childhood emotional and behavioral disorders with risk of incident back pain in early adulthood are important findings with implications for better understanding the etiology of soft-tissue disorders.

Family Health and Characteristics in Chronic Fatigue Syndrome, Juvenile Rheumatoid Arthritis, and Emotional Disorders of Childhood

To compare family health and characteristics in children with chronic fatigue syndrome (CFS), in juvenile rheumatoid arthritis (JRA), and emotional disorders. Parents of 28 children and adolescents aged 11 to 18 years with CFS, 30 with JRA, and 27 with emotional disorders (i.e., anxiety and/or depressive disorders) were recruited from specialty clinical settings and completed interviews and questionnaires assessing family health problems, parental mental distress, illness attitudes, and family burden of illness. Parents of children with CFS were significantly more likely than those of children with JRA to report a history of CFS-like illness, high levels of mental distress, and a tendency to experience functional impairment in response to physical symptoms. Families of children with CFS were characterized by significantly greater emotional involvement and reported greater family burden related to the child's illness in comparison with families of children with JRA. CFS in childhood and adolescence is associated with higher levels of parental CFS-like illness, mental distress, emotional involvement, and family illness burden than those observed in association with JRA, a chronic pediatric physical illness.

Tobacco use across the formative years: a road map to developmental vulnerabilities.

Different vulnerabilities are launched or play a more active role at different developmental stages and different ages. Furthermore, the interplay between developmental and biological, psychosocial, and environmental vulnerabilities is expected to differ across stages of smoking. This article focuses on the intersection of vulnerability associated with adolescence with tobacco-use vulnerability resulting from biological, psychological, and environmental characteristics of an adolescent. Recommendations include the following: (a) Effectively treat childhood and adolescent behavioral and emotional disorders that place adolescents at risk; (b) target programs toward specific high-risk subgroups; (c) incorporate training in self-control, affect regulation, and healthy coping strategies into educational programs and extracurricular activities; (d) encourage youth to develop healthy sources of success and satisfaction; (e) encourage communities and states to launch environmental, policy, and regulatory initiatives to protect youth from tobacco; (f) consider bold initiatives that will require fundamental changes in public attitudes, including monetary rewards for nonsmoking, heightened penalties for facilitating and engaging in underage smoking, and government subsidies for substitute pharmacological agents.

Childhood behavioral and emotional disorders.

We reviewed the literature on family treatment for childhood behavioral and emotional disorders and found an increase in the number of studies since 1995; however there was significant variation by disorder and therapy model. There is substantially more research on externalizing disorders (i.e., conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder) then internalizing disorders, depression and anxiety disorders. The data support the conclusion that family-based interventions produce results comparable to individually oriented interventions, and in some cases family-based interventions are superior to individual treatments. To date, cognitive behavioral family therapy and parent management have been the two models studied, almost exclusively. Implications for family therapy and future research are considered.

A prospective study of childhood emotional and behavioural problems in Port Pirie, South Australia.

To describe the extent to which emotional and behavioural problems experienced by 5-year-old children living in or around Port Pirie, South Australia, persisted when the children were aged 11-12 years. Childhood emotional and behavioural problems were identified at the age of 5 years using Child Behaviour Checklists completed by mothers. When the children were aged 11-12 years, problems were identified using checklists completed by mothers, children and teachers. Attention problems, aggressive behaviour and anxious/depressed problems were the most persistent problems over this period of the children's lives. In general, the strongest relationship over time occurred when reports were obtained from mothers on each occasion. A weaker relationship existed between earlier mother-reported problems and later teacher-reported problems, while the relationship between mother-reported problems and later self-reported problems occupied an intermediate position. The course of problems among children in Port Pirie appeared similar to that previously reported for children in Holland and North America. To better understand the aetiology of psychiatric disorders and to plan for effective interventions, more information is needed about the natural course of childhood emotional and behavioural disorders in Australia.

Management of depressive disorder in adolescents

Historically, depressive disorders in adolescents have been conceptualised as variants of the nonspecific class of childhood emotional or neurotic disorder, which encompassed depressive, anxiety, hysterical and obsessional disorders. Over the past decade, however, the field has shifted towards greater diagnostic refinement. Research evidence has shown that severe depressive disorders differ from other mental disorders in this age group in their epidemiology, outcome and correlates (Harrington &amp; Wood, 1995). Treatment therefore includes not only general techniques of clinical management, but also a variety of treatments targeted at the symptoms of depressive disorder.

Emotional abuse and neglect: a time for reappraisal

ABSTRACTThis paper explores, from a UK perspective, issues surrounding policy and practice in cases of neglect, which inevitably involves emotional abuse. It does not address cases of emotional abuse in which neglect does not occur. The paper argues that there is a sufficient body of knowledge on the necessary conditions for healthy child development and factors associated with psychological/ emotional disorders in childhood for social workers to be more proactive in work with such cases. There is, however, a need for this evidence to be assembled and organized in ways which will be useful to social workers. Nonetheless, intervention in such cases is unlikely to become more effective unless some of the reasons for the‘neglect of neglecf are better understood and addressed. In the second part of the paper, a range of factors influencing such work is considered, related to the professional, organizational and legal context within which social workers in the UK operate.The paper draws on an ESRC funded project, which ended in 1995, of social workers’ judgements in cases of child sexual abuse and neglect

Nine-month changes of maternal expressed emotion in conduct and emotional disorders of childhood: a follow-up study.

In this follow-up study, mothers of 28 children with conduct disorders (CD) and 29 children with emotional disorders (ED) of 6-11 years of age, were interviewed and rated for expressed emotion 9 months after their first clinical assessment. Mothers of children with CD expressed significantly less criticism and higher warmth after 9 months. Initial externalizing scores in the CD group and initial internalizing scores in the ED group at the first assessment predicted symptomatic change, in contrast with EE scales. Initial externalizing scores and low levels of maternal warmth predicted presence of conduct disorder at the last contact with the clinician. The implications of the findings on the development of treatment techniques are discussed.

Developmental psychopathology: the impact of recent life events in anxious and depressed school-age children.

Introduction Until the last decade 'social stresses' were frequently perceived as an amorphous and non-specific burden in children's lives. Invariably the amount or degree of stress was the focal point for clinical evaluation or research measurement. This viewpoint is, however, too narrow and ignores the varying qualities and intensities of family and peer group experiences which must be taken into account when considering environmental aetiologies of emotional disorders in childhood and adolescence'-3. In this paper, a number of psychosocial mechanisms are proposed, from information obtained using in-depth face-to-face interviews with anxious and depressed school-age children and their parents. The detail of information, its systematic measurement and analysis have resulted in the description of a variety of patterns of adverse family and peer group experiences suggesting that the environmental risk for emotional disorders will not be explaine' by a single 'stress model'4-6.

Maternal Expressed Emotion in Conduct and Emotional Disorders of Childhood

Maternal expressed emotion (EE) scales were rated for children aged 6-11 with conduct disorders, emotional disorders and a group of non-referred children matched for sex and age (N = 30 in each of the three groups). Maternal warmth distinguished significantly between the three groups (CD < ED < Controls), while criticism distinguished the group of conduct disordered children. Maternal criticism was positively associated with child behaviour ratings even within the non-referred group. These observational ratings of warmth and criticism were found to be much more strongly associated with child behaviour than maternal ratings of their family environment.

Concurrent Treatment of Marital and Child Behaviour Problems in Behavioural Family Therapy

Much research has demonstrated that marital discord and divorce are risk factors for the development of childhood behavioural and emotional disorders. Although theoretical models and research programs that focus attention on possible mechanisms of influence are scarce, it is clear that marital discord can powerfully influence children via its effect on spouse's parenting behaviour. Thus, marital discord can represent a significant impediment for intervention programs that aim to help children by providing parent training. It is argued that marital and child focused interventions can be successfully integrated in behavioural family therapy. A description of the process and content elements of such an integration is presented, and future directions for research and practice are discussed.

"Comorbidity" in Child and Adolescent Psychiatry: Categorical and Quantitative Perspectives

ABSTRACT Apparent comorbidity may arise as an artifact of conceptual or diagnostic models that impute inappropriate boundaries between disorders. To draw firm conclusions about comorbidity, each disorder must be clearly distinguishable from others. Few behavioral or emotional disorders of childhood have been validated as separate diagnostic entities that can be reliably distinguished from one another. Rather than accepting reports of comorbidity at face value, we need to understand how particular conceptual and diagnostic schemas affect the perceived relations among disorders. Categorical and quantitative models offer potentially complementary approaches to differentiating between disorders more effectively, a process that is essential for improving our knowledge of etiology and our assessment of the risks and benefits of particular psychopharmacological interventions.

Somatic emotional disorders in childhood and adolescence.

We conducted a short-term follow-up study of severe somatic emotional disorders in 93 children and adolescents. Our aim was to investigate whether the type of physical presentation influenced the outcome in terms of symptoms and subsequent use of medical services. Three groups of patients were identified. Two groups presented with neurological symptoms and were divided into a pseudo-epilepsy group (n = 23) and other hysterias (n = 30); and a third presented with non-neurological symptoms which we termed 'other somatic presentations' (n = 40). Cases in the hysteria groups were significantly more likely to be female and post-pubertal. Polysymptomatic presentations accounted for 85% of all cases and were as common in boys as in girls at all ages. The greatest number of symptoms was found in the pseudo-epilepsy group. None of the hysterias met DSM III-R criteria for somatization disorder. Outcome in terms of residual physical symptoms and subsequent use of medical services was poorest for the pseudo-epilepsy group, and nearly 40% of these patients were judged by their general practitioner to be unchanged since discharge. By comparison, 85% of all other somatic cases were judged improved since discharge from hospital out-patients. Neither polysymtomatic presentations nor persistent physical symptoms at discharge predicted a poor outcome in any group. The general practitioners considered the psychiatric treatment to have been helpful in the majority of cases, even when the somatic outcome was rated as unchanged.