Psychopathology In Early Childhood Research Articles

Psychiatric disorders in an urban sample of preschool children

To increase limited epidemiological knowledge of early childhood psychopathology, a study of prevalence estimates and demographic correlates of psychiatric disorders was conducted in a sample of preschool children. In a two-stage study, parents of 339 children aged 4-6years who came for a medical check-up at three primary care centres in Reykjavik were invited to participate. First, the participants were screened with Brigance Screens and the Strengths and Difficulties Questionnaire (SDQ) for parents and teachers. Subsequently, the children were tested with a short version of Wechsler Preschool and Primary Scales of Intelligence - Revised and their parents were interviewed with the Schedule for Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime Version. Weighted prevalence estimates were calculated and logistic regression was used to analyse the association between risk factors and psychiatric disorders. Of those invited to participate, 317 (93.5%) were included in the screening and of those, 131 received a full diagnostic assessment. The final study sample included 151 girls (47.6%) and 166 boys (52.4%) who represented 11.6% of the total birth cohort in Reykjavik. Weighted prevalence of DSM-IV psychiatric disorders was 10.1% (95% CI 6.7-13.5%) and 57/317 or 18.0% (95% CI 13.8-22.2%), including elimination disorders. Anxiety disorders (5.7%) and attention deficit hyperactivity disorder (3.8%) were the most common disorders in this preschool sample. Poor physical health of parents and higher education was associated with DSM-IV psychiatric disorders of the children. SDQ Total Difficulties score was associated with male gender and poor physical health of parents. This study indicates that psychiatric disorders in preschool children are common and may be correlated with parental health factors.

What have birth cohort studies asked about genetic, pre- and perinatal exposures and child and adolescent onset mental health outcomes? A systematic review

Increased understanding of early neurobehavioural development is needed to prevent, identify, and treat childhood psychopathology most effectively at the earliest possible stage. Prospective birth cohorts can elucidate the association of genes, environment, and their interactions with neurobehavioural development. We conducted a systematic review of the birth cohort literature. On the basis of internet searches and 6,248 peer-reviewed references, 105 longitudinal epidemiological studies were identified. Twenty studies met inclusion criteria (prospectively recruited, population-based cohort studies, including at least one assessment before the end of the perinatal period and at least one assessment of behaviour, temperament/personality, neuropsychiatric or psychiatric status before 19 years of age), and their methodologies were reviewed in full. Whilst the birth cohort studies did examine some aspects of behaviour and neurodevelopment, observations in the early months and years were rare. Furthermore, aspects of sampling method, sample size, data collection, design, and breadth and depth of measurement in some studies made research questions about neurodevelopment difficult to answer. Existing birth cohort studies have yielded limited information on how pre- and perinatal factors and early neurodevelopment relate to child psychopathology. Further epidemiological research is required with a specific focus on early neurodevelopment. Studies are needed which include the measures of early childhood psychopathology and involve long-term follow-up.

Impact of life events on child mental health before school entry at age six

The study examined the association between life events and early child mental health prior to school entry. The impact of single life events and the cumulative effect of multiple life events on child mental health were examined. In a northern German city, the complete 1-year intake of preschool children at the primary school entry assessment was included. In 1,887 children, life events and psychiatric symptoms were recorded by means of standardized parent questionnaires. Included were all life events between child's birth and school entry. For more than 80 percent of all children, at least one life event was reported. The number of life events was independent of any demographic variable; the mean was 2.2. The number of life events had a highly significant effect on the prevalence of child mental health problems. Six family-change-factors, especially coherent in content, could be identified by factor analysis. The study provides important data on the epidemiology and clinical impact of life events and psychopathology in early childhood. For child mental health, the cumulative effect of multiple life events was found to be much more important than the effect of specific single life events.

An experimental test of parenting practices as a mediator of early childhood physical aggression

Parenting practices predict early childhood physical aggression. Preventive interventions that alter parenting practices and aggression during early childhood provide the opportunity to test causal models of early childhood psychopathology. Although there have been several informative preventive intervention studies that test mediation models in older children, no such studies have been conducted with younger children at high risk for psychopathology. Within the context of a randomized controlled trial, we examined whether changes in parenting practices mediate the effects of a family intervention on observed physical aggression among African American and Latino younger siblings of adjudicated youths. Improved parenting practices partially mediated the intervention effect on physical aggression. Improvements in harsh parenting, responsive parenting, and stimulating parenting explained a significant amount of the intervention effect on child physical aggression observed in the context of parent-child interactions. Parenting practices accounted for 38% of the intervention effect on physical aggression. There was support for the hypothesized model of the prevention of physical aggression during early childhood. Intervention benefits on parenting practices partially accounted for intervention effects on physical aggression in young high-risk children.

Who Is at Greatest Risk of Adverse Long-Term Outcomes? The Finnish From a Boy to a Man Study

To study associations between comorbid psychopathology and long-term outcomes in a large birth cohort sample from age 8 to early adulthood. The sample included long-term outcome data on 2,556 Finnish boys born in 1981. The aim was to study the impact of early childhood psychopathology types (externalizing versus internalizing versus both) and informant sources (self-report versus parent/teacher reports) on young adult outcomes, based on data from a military registry of psychiatric diagnosis, a police registry on criminal and drug offenses, and self-reported problems in late adolescence and early adulthood. Children with combined conduct and internalizing problems at age 8 had the worst outcomes and highest risk of subsequent psychiatric disorders, criminal offenses, and self-reported problems at follow-up, with 62% of these boys manifesting psychiatric disorders, committing criminal offenses, or both at follow-up. Although these children included only 4% of the sample, they were responsible for 26% of all criminal offenses at follow-up. In contrast, children with conduct problems without internalizing problems and those with attention problems had much less severe but nonetheless elevated levels of risk of antisocial personality disorder and criminal offenses. Long-term outcomes for these two groups were substantially better than for children with combined conduct and internalizing problems. Children with "pure" emotional problems had an elevated risk only of similar emotional problems at follow-up. The subjective suffering and long-term burden to society is especially high among children with comorbid conduct and internalizing problems in childhood. A major challenge for child and adolescent psychiatric, education, and social services is to develop effective intervention strategies focusing on these children. Additional longitudinal epidemiological studies of this comorbidity group are needed, and, if replicated, such findings will have important implications for future diagnostic classification systems (DSM-V).

Does Bipolar Disorder Exist in Children? A Selected Review

Although there is increasing recognition that a substantial proportion of patients with bipolar disorder (BD) experience an onset of illness in adolescence, significant controversy remains over the validity of the diagnosis in very young children. In careful studies of adult patients dating from Kraepelin, first mood episodes not uncommonly occurred during adolescence. Some of these early-onset patients experienced subthreshold mood disturbances or predisposing temperaments earlier in childhood. Earlier onsets of BD have been reported in more recent clinical and community samples of children. Several factors possibly contributed to these earlier onsets, including exposure to psychotropics, bias in favour of a mood rather than a psychotic diagnosis, and recognition of softer-spectrum BDs. However, the validity of the diagnosis of BD in impulsive, irritable, labile, or behaviourally dysregulated children remains to be proven. Studies of high-risk children of well-characterized parents with BD have demonstrated that BD most often debuts as a depressive episode in mid to late adolescence and that activated episodes are rare prior to age 12 years. Some children manifest antecedent nonspecific psychopathology in early childhood. Therefore, as currently diagnosed, BD does not manifest as such typically until at least adolescence.

A Lost Connection: Existential Positions and Melanie Klein's Infant Development

This article presents some links between the work of Eric Berne and that of Melanie Klein before discussing Berne's theory of the four existential positions and some later developments of this model. The author examines a lost connection with Klein's theory on positions along with a Kleinian perspective on early childhood development and psychopathology, which provided the inspiration for Berne's positions. The article suggests that transactional analysis theory and practice would be enriched by the addition of such a Kleinian perspective. This argument is supported by case examples along with some clinical discussion. A new interpretation of existential positions is proposed.

The Copenhagen County child cohort: Design of a longitudinal study of child mental health

Epidemiological studies of psychopathology in the first years of life are few, and the association between mental health problems in infancy and psychiatric disturbances later in life has not been systematically investigated. The aim of the present project was to study mental health problems and possibilities of intervention from infancy and onward. The basic study population consists of a birth cohort of 6,090 children born in the year 2000 in the County of Copenhagen, the Copenhagen County Child Cohort, CCCC 2000. At stage one CCCC 2000 was established on data from the Civil Registration System, Danish national registers, and standardized, longitudinal data from the first year of living obtained by public health nurses. At stage two a subsample was assessed at 1(1/2) years of age concerning child psychiatric illness and associated factors in a case-control study nested in the cohort, including a random sample. Participation rate at stage one was 92%. Ongoing studies of CCCC 2000 include studies of failure to thrive, register studies, and studies of the predictive validity of public health screening. A follow-up study concerning the prevalence of psychopathology at age 5 is planned. The Copenhagen County Child Cohort CCCC 2000 is a longitudinal study of mental health from infancy investigating psychopathology in early childhood. Results from this study will add to the knowledge of risk factors and course of mental health problems in childhood and contribute to the validation of the mental health screening made by public health nurses.

Mindful Parenting: a group approach to enhancing reflective capacity in parents and infants

Fonagy ( 1998a ) has suggested that the core of prevention of psychopathology in early childhood should be the enhancement of mentalizing. To that end, this paper introduces Mindful Parenting, an innovative psychotherapeutic group designed to promote reflective functioning in parents and their infants/toddlers. The interdisciplinary underpinnings of this group work, including the utility of applied infant observation, is followed by exposition of the structural components of Mindful Parenting. Evocative moments from the group experience are interwoven, in an effort to make plain the ways that Mindful Parenting seeks to restore, cultivate, and sustain the most basic, verbal and nonverbal, affective contacts between parent and child. The paper concludes with clinical material on the birth of a thinking couple.

Research diagnostic criteria for infants and preschool children: the process and empirical support.

Systematic research on psychiatric disorders in infants and preschool children (0-5 years old) has lagged considerably behind that for older children, adolescents, and adults. The first step in facilitating such research is developing clearly specified diagnostic criteria that can be reliably applied within standardized assessments across multiple samples. In 2000-2002, a task force of independent investigators developed the Research Diagnostic Criteria-Preschool Age (RDC-PA) for the first time in this age group, with the goal of promoting systematic research on psychiatric disorders. This paper reviews the history of research on psychopathology in early childhood, summarizes the studies on validity, and describes the process behind this effort.

Research Diagnostic Criteria for Infants and Preschool Children: The Process and Empirical Support

ABSTRACT Systematic research on psychiatric disorders in infants and preschool children (0–5 years old) has lagged considerably behind that for older children, adolescents, and adults. The first step in facilitating such research is developing clearly specified diagnostic criteria that can be reliably applied within standardized assessments across multiple samples. In 2000–2002, a task force of independent investigators developed the Research Diagnostic Criteria-Preschool Age (RDC-PA) for the first time in this age group, with the goal of promoting systematic research on psychiatric disorders. This paper reviews the history of research on psychopathology in early childhood, summarizes the studies on validity, and describes the process behind this effort.

Exploring psychopathology in early childhood: PTSD and attachment disorders in DC: 0–3 and DSM‐IV

AbstractStandard nosologies of psychiatric disorders have made preliminary efforts to accommodate developmental differences in symptom manifestation by young children. Significant gaps remain in the validation of disorders for this age group. The DC: 0–3 represents an alternative nosology for disorders of infancy that attempts to complement existing approaches and assist clinicians and researchers. In this commentary we review research on two disorders of early childhood—Posttraumatic Stress Disorder (PTSD), and Reactive Attachment Disorder (RAD)—to illustrate the promises and problems of the DSM‐IV and DC: 0–3 approach to definition and conceptualization of these disorders. In addition we review what is known about RAD and PTSD with regard to key areas of controversy in early childhood psychopathology: (1) continuous versus categorical conceptualization, (2) developmental considerations, and (3) the relationship context. Recommendations are made for future editions of the DSM‐IV and DC: 0–3, as well as for validity research in early childhood disorders. ©2003 Michigan Association for Infant Mental Health.

Psychopharmacology for young children: clinical needs and research opportunities.

In response to concerns about the increasing use of psychotropic medications in preschoolers, the National Institute of Mental Health and the Food and Drug Administration convened a workshop in October 2000 to examine the current state of knowledge regarding psychopharmacology for young children and discuss a variety of topics relevant to research in this age group, including safety, efficacy, investigational methods, and ethical aspects. The meeting gathered researchers, practitioners, ethicists, industry staff, and family and patient representatives. Efficacy and safety of psychotropics have not been systematically evaluated in preschoolers. The major limitation to this research is the diagnostic uncertainty surrounding most manifestations of psychopathology in early childhood. Research in developmental psychopathology is needed to clarify diagnosis and provide sensitive and specific methods for clinical trials. Possible approaches to expanding the research basis of this area of clinical practice, including a recently started study of methylphenidate in preschoolers, are reported here.

Psychopathology in Infancy and Early Childhood: Clinical Perspectives on the Organization of Sensory and Affective-Thematic Experience

The developmental-structuralist approach to psychopathology in infants and young children involves studying adaptive and maladaptive patterns at each level of "experimental organization" from the early sensory, motor, and affective-thematic organizations to the later representational ones. Psychopathology may be related to defects or constrictions at each organizational level, including the representational or symbolic realm, without underlying vulnerabilities in earlier levels of organization, and may also involve the presumed "underbelly" of the personality, those central nervous system organizations that have to do with filtering and processing of perceptions and experience (the early sensory and affective-thematic organizations). The most severe psychopathologies, it will be suggested, occur where there are compromises in both the early sensory and affective-thematic and later representational organizations. Early limitations in "processing" animate or inanimate experiences may, in many instances, be highly specific and reversible rather than global. The early detection of sensory and affective-thematic organizational compromises, followed by approaches that facilitate phase-specific "essential experiences" through intact sensory pathways and the remediation of compromised ones, may provide a systematic base for possible preventive intervention approaches.

Psychopathology in Infancy and Early Childhood: Clinical Perspectives on the Organization of Sensory and Affective-Thematic Experience

Psychopathology in Infancy and Early Childhood: Clinical Perspectives on the Organization of Sensory and Affective-Thematic Experience

Psychopathology and Adaptation in Infancy and Early Childhood: Principles of Clinical Diagnosis and Preventive Intervention

Psychopathology and Adaptation in Infancy and Early Childhood: Principles of Clinical Diagnosis and Preventive Intervention