Psychiatric Problems In Children Research Articles

Screening for emotional and behavioural problems amongst 5–11-year-old school children in Karachi, Pakistan

While a number of studies in the western countries have provided estimates of prevalence for child psychiatric morbidity and associated risk factors, relatively little is known about child psychiatric problems and risk factors in developing countries like Pakistan. A cross sectional survey of 5-11-year-old children attending main stream private and community schools in Karachi was conducted. Seven private and eight community schools agreed to participate. About 1488 consent forms were sent to 700 parents of private school and 788 parents of community school children. A total of 675 parents agreed to participate in the study. The response rate was 45.4%. Assessment of children's mental health was conducted using Strength and difficulties questionnaire (SDQ) by parents based on cut-off provided by Goodman. About 47% children were rated as normal, 19% as borderline and 34% as abnormal by the parents. Ordinal regression was used to identify factors associated with parent's rating. The odds of female children of being normal was 1.5 times relative to male children, adjusting for school type and mother's education (ORadj = 1.5, 95% CI: 1.1-2.0). Children attending private schools were more likely to be normal as compared to community school children, adjusting for child's gender and mother's education (ORadj = 2.3, 95% CI: 1.3-4.0). In the present study, prevalence of child mental health problems was higher than reported in studies from other countries. Prevalence was higher amongst children attending community schools. Consistent with most studies, male children were at a higher risk than females. There is a need for developing programs to train, sensitise and mobilize teachers and parents regarding child's psychological, emotional and behavioural problems with special attention to community schools. Since the male child is at a greater risk we should be cognizant of this while evaluating children for psychopathology.

Co-existing psychiatric problems in ADHD in the ADORE cohort

To study the impact of co-existing psychiatric problems with ADHD on behavioural features, psychosocial functioning and quality of life in subjects of the ADORE cohort (N=1,478). The following six groups of associated psychiatric problems with ADHD were compared: oppositional-defiant disorder or conduct disorder only (ODD/CD); anxiety or depressive disorder only (ANX/DEP); tic/Tourette's disorder only (TIC/Tourette's); developmental co-ordination disorder only (DCD); two or more associated conditions; and none. Dependent variables included the ADHD Rating Scale-IV, the Strengths and Difficulties Questionnaire, the Clinical Global Impression-Severity scale, the Children's Global Assessment Scale and the Child Health Illness Profile-Child Edition. Having multiple co-existing psychiatric problems increased the severity of ADHD in all domains, be it behavioural features, psychosocial impairment or deterioration of quality of life. A similar though less consistent pattern applied to subjects with co-existing ODD/CD. The ADORE study provides impressive evidence for the far-reaching consequences of co-existing psychiatric problems in children with ADHD that warrant intensive consideration in clinical assessment and treatment.

Pervasive Refusal Syndrome among Asylum-seeking Children

A number of asylum-seeking children in Sweden have developed a pervasive loss of function associated with profound social withdrawal. The syndrome is called Depressive Devitalization. The aim of this study was to identify possible aetiological factors, outline the similarities between Depressive Devitalization and Pervasive Refusal Syndrome and to explore possible differential diagnoses. The research was based on a literature study. Databases searched included PsychINFO, Medline, Pub med, COCHRANE and PILOTS. Possible aetiological factors identified included: Children having a perfectionist, ambitious and conscientious premorbid personality, psychiatric problems of children and parents, and traumatic events. Symptoms between the two syndromes differed only in pattern of refusal and neurological symptoms. None of the differential diagnoses explored could account for all features. The individual impact of aetiological factors requires further investigation. Children might previously have been diagnosed with a number of differential diagnoses, though none of these accounts for all symptoms seen in the syndromes. Depressive Devitalization and Pervasive Refusal Syndrome are suggested to be subgroups of the same refusal syndrome.

Explorations of Parenting Environments in the Evolution of Psychiatric Problems in Children

Explorations of Parenting Environments in the Evolution of Psychiatric Problems in Children

Explorations of Parenting Environments in the Evolution of Psychiatric Problems in Children

Explorations of Parenting Environments in the Evolution of Psychiatric Problems in Children

Gender-related pathways for behavior problems in the offspring of alcoholic fathers

The objective of the present study was to examine gender differences in the influence of paternal alcoholism on children's social-emotional development and to determine whether paternal alcoholism is associated with a greater number of externalizing symptoms in the male offspring. From the Mannheim Study of Risk Children, an ongoing longitudinal study of a high-risk population, the developmental data of 219 children [193 (95 boys and 98 girls) of non-alcoholic fathers, non-COAs, and 26 (14 boys, 12 girls) of alcoholic fathers, COAs] were analyzed from birth to the age of 11 years. Paternal alcoholism was defined according to the ICD-10 categories of alcohol dependence and harmful use. Socio-demographic data, cognitive development, number and severity of behavior problems, and gender-related differences in the rates of externalizing and internalizing symptoms were assessed using standardized instruments (IQ tests, Child Behavior Checklist questionnaire and diagnostic interviews). The general linear model analysis revealed a significant overall effect of paternal alcoholism on the number of child psychiatric problems (F = 21.872, d.f. = 1.217, P < 0.001). Beginning at age 2, significantly higher numbers of externalizing symptoms were observed among COAs. In female COAs, a pattern similar to that of the male COAs emerged, with the predominance of delinquent and aggressive behavior. Unlike male COAs, females showed an increase of internalizing symptoms up to age 11 years. Of these, somatic complaints revealed the strongest discriminating effect in 11-year-old females. Children of alcoholic fathers are at high risk for psychopathology. Gender-related differences seem to exist and may contribute to different phenotypes during development from early childhood to adolescence.

Cognitive functioning and psychiatric disorders in children with a metabolic disease

To report on the intelligence scores and the psychiatric pathology of distinct groups of children with metabolic diseases. The study population consists of 53 children between 0 and 18 years of age. Diagnostic assessment included a semi-structured interview, self-report questionnaires and a standard intelligence test. In 40% of the children older than 5 years, a child psychiatric diagnosis was made. While CBCL total and internalizing scores did not differ between metabolic disease groups, the CBCL externalizing scores for some groups did. Two fifths of the children showed a below normal intelligence, while a performal-verbal IQ discrepancy was found in half of the children. Of the school aged children almost one third attended a special needs school. In spite of the small sample size, the results suggest substantial psychiatric problems in children with a metabolic disease. Further study on larger groups is warranted, which should enable further comparison of patients affected by specific metabolic diseases.

The pathogenesis of childhood anxiety disorders: Considerations from a developmental psychopathology perspective

Anxiety disorders are among the most prevalent psychiatric problems in children and adolescents. The present article summarizes the main evidence that has accumulated on the pathogenesis of childhood anxiety disorders during the past two decades. Various risk and vulnerability factors (e.g., genetics, behavioral inhibition, disgust sensitivity, negative life events, family influences), protective factors (e.g., effortful control, perceived control), and maintaining factors (e.g., avoidance, cognitive biases) will be discussed. The information will be described in terms of a developmental psychopathology perspective, which assumes that (a) most forms of psychopathology are the result of multiple causal influences; (b) both successful and unsuccessful adaptation are important for understanding the origins of psychopathology; and (c) psychopathology occurs in a developing organism.

Family-Based Treatment Research: A 10-Year Update

To provide an update on the state of the art of family-based treatment research. Randomized clinical trials conducted in the past 10 years that included parents as a primary participant in treatment of child and adolescent psychiatric problems were reviewed. Studies were identified from major literature search engines (e.g., PsycINFO, Medline). Current significant pilot work was identified in the National Institute of Mental Health Computer Retrieval of Information on Scientific Projects (CRISP) Web page or from the authors themselves. Family treatments have proven effective with externalizing disorders, particularly conduct and substance abuse disorders, and in reducing the comorbid family and school behavior problems associated with attention-deficit/hyperactivity disorder. Several new studies suggest that family treatments or treatment augmented by family treatments are effective for depression and anxiety. For many disorders, family treatments can be an effective stand-alone intervention or an augmentation to other treatments. Engaging parents in the treatment process and reducing the toxicity of a negative family environment can contribute to better treatment engagement, retention, compliance, effectiveness, and maintenance of gains. Recommendations for the next decade of research and some implications of family-based treatment for child and adolescent psychiatry are explored.

A comparison of mental health problems in kinship and nonkinship foster care

Knowledge of the emotional and behavioural problems of children in kinship foster care is scarce. No data on such problems in European countries have been published. This study compares child psychiatric problems and placement characteristics of children living in kinship and nonkinship foster care. A total of 214 children in kinship and nonkinship foster care, aged 4-13, participated in the study. The Child Behavioral Checklist (CBCL) was completed by their foster parents and demography and placement information was collected. Of the nonkinship group, 51.8 % scored above the borderline on the CBCL Total Problem score, as did 35.8% of the kinship group. The kinship group had fewer previous placements, were more often fostered within their local community and had more contact with their biological parents. Kinship foster parents had lower social status, in terms of educational level. Variables significantly related to high level of the CBCL Total problems score were male gender and location of foster home outside community of birth family. Positive outcome was significantly associated with placement within the child's own community, which in turn was related to kinship placement. Placement in kinship foster care should be considered as a viable possibility.

Have psychiatric problems of children in children's homes increased?

This time-trend study was conducted during and after the severe economic recession and the period of high unemployment in Finland in the 1990s. The changes in the behavioral and emotional problems of children and adolescents placed in children's homes were studied in the same area using the Child Behavior Checklist questionnaire at three different time points (1993, 1996 and 1999), and the Children's Global Assessment Scale in 1996 and 1999. Internalizing symptoms of the children increased significantly. The level of psychosocial problems among boys was already high at the first rating in 1993, and it remained high during the whole study period. Behavioral and emotional problems of the girls placed in children's homes increased significantly, being at the same level as the boys’ by the end of the study period.

Characteristics of repeat users of an inpatient psychiatry service at a large military tertiary care hospital.

The purpose of this study was to identify clinical and demographic variables that correlated with readmission to a large tertiary care military psychiatric inpatient service located in the Washington, DC area. Data from 983 consecutive inpatient admissions (comprised of 814 individual patients) over a 13-month period (July 1999-July 2000) were abstracted from medical records for retrospective analysis. Repeat users were defined as those individuals receiving two or more inpatient admissions to Walter Reed Army Medical Center during the study period. Statistical comparisons were made between repeat and single admission groups to identify variables predictive of rehospitalization. Of 814 individual patients under study, 117 (14%) were identified as repeat users. A history of childhood psychiatric problems, previous psychiatric hospitalization, current or past substance abuse, legal problems, and presence of a psychotic or nonbipolar mood disorder were associated with readmission after controlling for active duty status. Current comorbid substance use or personality disorder diagnoses were not predictive. Having at least one child was protective against readmission. The 117 repeat users accounted for 3,838 (37%) of the total 10,393 hospital bed-days during the study period. Logistic regression analysis of all variables correlated with readmission demonstrated statistical significance for past psychiatric hospitalization and age of onset of psychiatric problems before age 18 when active duty status, age, and gender variables were included in the equation. This study is one of the largest to investigate predictors of rehospitalization in a population that enjoys universal "free" access to comprehensive mental health care services and other benefits of employment. This retrospective analysis documented three important facts: That there seem to be only minor differences between military and civilians with respect to variables associated with psychiatric rehospitalization, that a relatively small proportion of patients accounted for a disproportionately large number of inpatient bed-days, and that an unexpectedly high proportion of active duty patients admitted to this study site reported childhood psychiatric problems and psychiatric hospitalizations before their first hospitalization at Walter Reed Army Medical Center.

Empirical classification of behavioral and psychiatric problems in children and adolescents with mental retardation.

A quantitative method for typing psychopathology of youngsters with mental retardation was assessed. Parents of 601 students in special educational placements rated them with the ABC. The sample was randomly divided into two subgroups. We used Ward's hierarchical method of cluster analysis and derived eight clusters in Subsample 1 and satisfactory agreement, kappa =.64, for the eight-cluster solution in Subsample 2. Clusters were: Problem Free, Within Normal Limits, Conduct Problem, Shy/Inactive, Hyperactive, Social Withdrawal With Agitation, Undifferentiated Behavior Disturbance, and Autistic-Like Behavior. We also used demographic (age, gender, IQ, physical handicaps) and clinical variables (DSM diagnoses and target behaviors) extracted from school records of 228 participants to appraise validity of the empirically derived clusters. The external data provided modest to strong support for all except one cluster (Social Withdrawal With Agitation).

Psychopathology in adults with congenital heart disease: the attribution of longitudinal cohort studies

In accordance with the comment of Tayebjee and Lip on our article concerning psychosocial functioning in a cohort of adults with congenital heart disease,1we agree with the importance of assessing psychopathological symptoms and development of optimal psychological treatment. About a decade ago, our research group investigated a broad range of psychiatric problems in children, adolescents and young adults in the first follow-up of this same cohort.2–4A broad range of psychiatric problems was investigated. Besides symptoms of depression and anxiety, somatic complaints (without medical cause), withdrawn behaviour, delinquent behaviour, aggressive behaviour, social problems, thought …

PSYCHIATRIC MORBIDITY IN CHILDREN WITH CHRONIC MEDICAL ILLNESS: A CROSS SECTIONAL STUDY IN KALAWATI SARAN CHILDREN’S HOSPITAL, NEW DELHI

Psychiatric morbidity is common in the medically ill children, although it is frequently unrecognized anduntreated. This study was conducted to determine the nature and extent of psychiatric morbidity in childrenwith chronic medical diseases. 100 children attending the different follow-up clinics at a tertiary carepediatric referral Centre were evaluated using Childhood Psychopathology Measurement Schedule (Malhotraet.el.1988). Thirty one percent children showed abnormally high levels of emotional and behavioral problemsindicative of a possible psychiatric disorder. Attendance at Pediatric OPD was associated with an increasedrisk of common type of childhood psychiatric problems with about 21% children scored abnormally high infactor III (Anxiety) &amp; VII (Physical illness with Emotional problems) suggestive of a definitive psychologicaldisorder. The result indicates that about 1/3 rd children attending pediatric follow-up clinics with chronicmedical illness need a formal psychiatric evaluation for certain psychological disturbances. This also advocatesthe provision of a hospital based pediatric psychiatric liaison service that would help to address this needand create opportunities for pediatricians to train in child psychiatry.Key Words: Psychiatric morbidity; children; chronic medical illness.

Psychiatric emergencies in children.

To examine the demographic and clinical characteristics of children using the pediatric emergency department (ED) in a medical center in Baltimore, Maryland. The rate of admission and length of stay for children who were evaluated in the ED were also examined. A large, urban medical center with approximately 15,500 visits per year. During a 13-month period, more than 600 visits to the ED were made for mental health concerns for children aged 2 to 18 years, with psychiatric visits constituting more than 5% of total visits to the ED. Psychiatric visits averaged more than 5 hours' duration in the ED and involved significant effort by medical staff, with approximately one half of visitors undergoing psychiatric admission. Interviews conducted with the ED staff revealed that addressing psychiatric problems in children is a considerable burden and that there is a general lack of resources within the ED and the surrounding community to respond to the needs of children with psychiatric emergencies. The challenge in most communities is to build a true system of care that involves proactive and more preventive care in natural settings, such as schools, and coordination and improvement of care for youth with more serious problems.

Questionnaire screening for mental health problems in Bangladeshi children: a preliminary study.

In the developing world, child psychiatric disorders are common but child mental health professionals are scarce. A cheap and effective method for detecting child psychiatric problems would be useful. The present study examined the potential suitability of the Strengths and Difficulties Questionnaire (SDQ) for this role. SDQs were administered to the parents and teachers of 261 Bangladeshi 4-16 year olds: 99 drawn from a psychiatric clinic and 162 drawn from the community. Self-report SDQs were completed by 11-16 year olds. Children from the clinic sample were assigned psychiatric diagnoses blind to their SDQ scores. SDQ scores distinguished well between community and clinic samples, and also between children with different psychiatric diagnoses in the clinic sample. A simple algorithm based on SDQ scores was used to predict whether children had hyperkinesis, conduct disorders, emotional disorders or any psychiatric disorder--rates of predicted disorder varied markedly between clinic and community samples. Predictions based on multi-informant SDQs potentially provide a cheap and easy method for detecting children in the developing world with significant mental health problems. The potential effectiveness of any such screening programme should be evaluated on a broad range of children, using both international and culture-specific assessments.

Psychiatric Problems in Children Linked to Exposure to Violence

Psychiatric Problems in Children Linked to Exposure to Violence

The persistence of psychiatric deviance from the age of 8 to the age of 15 years.

Earlier research has shown that psychiatric problems in children tend to persist over years. This investigation assessed the persistence of psychiatric deviance among children over a 7-year period from the age of 8 to the age of 15 years. We also explored the relationship between problems leading to special attention at the well-baby clinics before school age and future psychiatric deviance. The study material consisted of three questionnaires filled out by the parents, teachers and children themselves (N = 1268) at three time points, together with data concerning the children gathered from the records of well-baby clinics. At the age of 15 years, girls scored higher than boys on the parental scale and on the Beck's Depression Inventory (BDI), while boys scored higher than girls on the teachers' scale. Parental ratings had a high correlation over 3 years and a moderate correlation over 7 years. Teachers' and children's ratings correlated moderately over 3 years, but did not correlate significantly over 7 years. The probability of being deviant at the age of 15 years was elevated if the child scored high on the parents' or teachers' scale at the age of 8 or 12 years, or on the Children's Depression Inventory (CDI) at the age of 12 years. Problems noted by health professionals (problems in growth, somatic diseases, emotional/behavioural problems of the child, psychosocial problems of the family) before school age were related to future deviance on the parental scale. Emotional/behavioural problems before school age elevated the probability of scoring high on the teachers' scale at the age of 15, and problems in psychomotor development elevated the probability of scoring high on the BDI. Psychiatric deviance is persistent over several years in children. Primary health care professionals can identify children who are at risk for future psychiatric problems.

Child and adolescent psychiatry

Childhood psychiatric problems are less intractable than their adult counterparts. Jonathon Goldin reviews the branch of psychiatry with development on its side