Psychiatric diagnoses of infants and toddlers referred to a community mental health system

There has been increased interest in improving mental health assessment and treatment of young children. However, there are limited data regarding the prevalence of psychiatric disorders among infants and toddlers. The recent development of measures and classification systems that are specific to this age group has enabled researchers to begin to investigate the social, emotional, and behavioral problems of young children. The present study reviews the major research that has been conducted in this area and examines the prevalence of psychiatric diagnoses of infants and toddlers referred to a public community mental health system. The current investigation also compares the frequency of diagnoses of children who have been evaluated based on the Diagnostic and Statistical Manual (4th edition) with another group of children who were diagnosed based on the Diagnostic Classification: 0-3 system. Although there were some differences between the two samples and classification systems, analysis indicated that parent-child relational problems, adjustment difficulties, regulatory problems, and developmental disorders are some of the more common diagnoses prevalent among young children referred for outpatient treatment. As diagnostic measures and classification systems continue to improve, clinicians will have a better understanding of the mental health problems and treatment needs of young children.     

Posttraumatic stress and worry as mediators and moderators between political stressors and emotional and behavioral disorders in Palestinian children

This study was designed to assess whether the symptoms of posttraumatic stress mediate or moderate the relationship between political stressors and emotional and behavioral disorders in Palestinian children. It was hypothesized that (a) posttraumatic stress and worry mediate the effect of political stressors on behavioral and emotional disorders and (b) the relationship between political stressors and behavioral and emotional disorders should be attenuated for children with low levels of worry and posttraumatic stress and strengthened for children with high levels of worry and posttraumatic stress. The total sample was 1267 school age children of both sexes with a mean age of 11.97 years. Interviews were conducted with children at school. As hypothesized, the results indicated that posttraumatic stress and worry mediated and moderated the relationship between political stressors and emotional and behavioral disorders in children. Cognitive-behavioral therapy may be used to reduce the incidence of posttraumatic stress and decrease self-reported worry, somatic symptoms, general anxiety, and depression among children exposed to political trauma. Cognitive-behavioral treatment that exclusively targets excessive worry can lead to clinical change in the other interacting subsystems at the cognitive, physiological, affective and behavioral levels.     

A multiple-risk interaction model: Effects of temperament and divorce on psychiatric disorders in children

Effects of family status on the trajectory of problematic temperament-adjustment at 1 to 10 years of age and associated psychiatric disturbance 8 years later were examined in an epidemiological sample of 648 children. After adjusting for predivorce temperament-adjustment and background factors, logistic regression yielded independent effects of single custodial mother (SCM) family status for increased risk of disruptive and anxiety disorders, and of stepfamily status for increased risk of disruptive disorders. Increased risk of psychiatric disorders was more pervasive for SCM family boys versus intact family boys than for SCM family girls versus intact family girls, however only significantly more so for depression. No significant sex interaction was observed for stepfamily status. When girls and boys were treated independently, patterns of family status and outcomes of internalizing disorders varied. In stepfamilies, an elevated risk of depression and anxiety disorders was observed in girls but not boys, whereas in SCM families an elevated risk of depression was observed in boys but not girls. Within each family status group there was support for an altered risk of later psychiatric disorders given specific problematic predivorce temperament-adjustment characteristics. Implications for future research and treatment are discussed.The research described was supported by grants from the National Institute of Mental Health and by the W. T. Grant Foundation.     

Timing and force control in boys with attention deficit hyperactivity disorder: subtype differences and the effect of comorbid developmental coordination disorder

This study examined the motor and performance outcomes of boys with subtypes of attention deficit hyperactivity disorder (ADHD) (DSM-IV, [American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 4th ed., Washington, DC, 1994]). It also examined the differences between boys with a single diagnosis of ADHD versus those who have the dual categorisation of ADHD and developmental coordination disorder (DCD). The participants were 157 boys, aged 7.70-12.98 years recruited from a community sample. Parent report was used to classify 143 boys into either a comparison group or one of the three DSM-IV ADHD subtypes. Participants were given a battery of tests that included the Movement Assessment Battery for Children [Movement Assessment Battery for Children, Psychological Corporation/Harcourt Brace-Jovanovich, New York, 1992], the Wechsler Intelligence Scales for Children--Third Edition [Manual for the Wechsler Intelligence Scale for Children, Psychological Corporation, New York, 1992] and a finger tapping task targeting motor processing, preparation, and execution. Boys with subtypes that included inattentive symptomatology had significant difficulties with timing, force output and showed greater variability in motor outcomes. Boys with the comorbid condition (i.e., ADHD and DCD) had particular difficulty with force control. These outcomes identify a need for increased recognition of the clinical and research implications of the relationship between ADHD and motor dysfunction. This potentially impacts on assessment, intervention, theoretical modelling and the general interpretation of cognitive abilities research with children with ADHD.     

Assessing the prevalence of mental health disorders and mental health needs among preschool children in care in England

Although school‐aged children living in foster care have been identified as a high‐risk group for mental health and developmental disorders, there is a paucity of data relating to preschool children in care (CIC). This study aimed to identify the prevalence of mental health and developmental disorders along with corresponding need for interventions in preschool CIC. All CIC aged 0 to 5 years in an inner city local authority underwent comprehensive, multifaceted assessments consisting of the Ages and Stages Questionnaire (J. Squires, D. Bricker, & E. Twombly, 2003), interviews with caregivers based on the Preschool Age Psychiatric Assessment (H.L. Egger & A. Angold, 2006), Mullen Scales of Early Learning (E.M. Mullen, 1995 ), and systematic clinical observation. Of 58 eligible preschoolers, 43 completed the assessment. At least one mental health disorder was found in 26 (60.5%) participants, and at least one developmental disorder was found in 11 (25.6%). When mental health and/or developmental disorders were considered together, 30 (69.8%) preschoolers fulfilled criteria for at least one diagnosis, and 18 (41.9%) had two or more comorbid conditions. Whereas 36 (83.7%) of the preschoolers needed an intervention, only 3 of these had received adequate input. In conclusion, preschool CIC constitute a high‐risk group for mental health and developmental disorders. Without age‐appropriate assessments, their needs go undetected, and opportunities for early intervention are being missed.     

亲子沟通问题与青少年社会适应的关系

从北京市一所普通中学、济南市一所重点中学选取887名初一至高三学生为被试,采取匿名的方式让被试报告与父母之间存在的沟通问题,以及自己的社会适应情况,以此探讨亲子沟通问题与青少年社会适应的关系.结果发现:(1)总体上,青少年报告的亲子沟通问题并不是很多.在9项亲子沟通问题中,排在第一位的问题是行为约束,排在最后一位的问题是缺乏信任.除高二和高三学生外,男女生,以及初一到高一学生的情况基本与总体相似;(2)男生报告的缺乏分享明显多于女生,而在9个方面的亲子沟通问题均存在明显的年级差异,且随年级升高呈现倒U型发展趋势,在缺乏分享方面,初二学生的得分最高,而其余8个方面均为初三的学生得分最高;(3)所有亲子沟通问题均与青少年的自尊呈显著负相关,与抑郁、社交焦虑和问题行为呈显著正相关;(4)亲子沟通问题的不同方面可以预测不同方面的青少年社会适应,但对自尊和抑郁的预测作用超过对社交焦虑和问题行为的预测作用.     

A cognitive‐behavioral model of anxiety disorders in children and adolescents

This study investigated a cognitive‐behavioral model of anxiety disorders in Japanese children and adolescents. Participants comprised 532 children from elementary schools and 751 adolescents from junior high schools as a community group, and 41 children and adolescents who fulfilled the criteria for childhood anxiety disorders as a clinical group. All participants completed three questionnaires about anxiety symptoms, self‐statements, and cognitive errors. While the clinical group showed more anxiety symptoms, negative self‐statements, and cognitive errors than the community group, there was no significant difference in positive self‐statements. Multigroup structural equation modeling found the presence of cognitive links for the community and clinical groups. Specifically, cognitive errors generated negative self‐statements, exacerbating a higher‐order factor (childhood anxiety) affecting six anxiety symptoms corresponding to the diagnostic criteria of psychological disorders. Mediated relationships were supported in only the community sample. Clinical implications for prevention and treatment of anxiety disorders in children and adolescents are discussed.     

Comorbidity of anxiety and depression in children and adolescents.

Anxiety and depression in children and adolescents are reviewed, including differential diagnosis, assessment of symptoms, family history data, developmental features, and clinical correlates. Findings indicate that 15.9% to 61.9% of children identified as anxious or depressed have comorbid anxiety and depressive disorders and that measures of anxiety and depression are highly correlated. Family history data are inconclusive. Differences emerged among children with anxiety, depression, or both disorders. Anxious children were distinguishable from the other 2 groups in that they showed less depressive symptomatology and tended to be younger. The concurrently depressed and anxious group tended to be older and more symptomatic. In this group, the anxiety symptoms tended to predate the depressive symptoms. Findings are discussed in the context of a proposed developmental sequence.     

儿童2～4岁行为抑制的稳定性

采用实验室观察法研究了儿童行为抑制性发展的稳定性特征。被试为追踪样本,随机选取北京市124名儿童,经家长同意参加本项追踪项目。2岁时,有124名儿童参加本实验,在不同的陌生情景下对儿童行为进行录像观察,每次一对儿童和母亲。4岁时,有103名儿童参加实验室观察,21名儿童由于搬迁、失约或中途退出而没有数据;在观察室,每次邀请四名过完四岁生日不久的同龄、同性别、但父母评价害羞程度不同的、彼此陌生的儿童同时来到实验室作观察。结果表明：就整体而言,儿童在2岁时的行为抑制性特征与其4岁时的行为抑制性特征相关显著,但稳定性程度较低(0．294);通过对极端组和非极端组儿童的行为抑制性的稳定程度的比较发现,极端组儿童,无论是极端非抑制儿童还是极端抑制儿童,其行为特征的保持程度要好于非极端组;对儿童4岁时行为抑制性的性别差异检验虽然没有达到显著性水平(t＝-1．776,p＝0．079),但男孩总体上有非抑制性倾向(抑制性的平均分数为-0．2420),女孩有抑制性倾向(女孩的平均抑制性分数为0．2035)。     

震后18个月都江堰地区青少年负性生活事件、父母教养方式与焦虑性情绪的关系

以1021名高中生为被试,于震后18个月用儿童焦虑性情绪筛查量表、父母教养方式问卷、青少年自评生活事件量表等进行评估,探索震后继发的负性生活事件、父母教养方式对青少年焦虑的影响。结果发现:震后18个月都江堰地区青少年焦虑问题仍较为严重;青少年的父亲、母亲过度保护和父亲关怀对震后焦虑问题有直接影响;负性生活事件对青少年焦虑影响显著,母亲过度保护和父亲自主性对这种关系调节作用显著。     

困境儿童孤独与社交焦虑对抑郁的影响——自尊的中介作用

为探讨困境儿童孤独、社交焦虑、抑郁和自尊的现状、特点、关系以及自尊在其中的中介作用,进而为困境儿童心理帮扶及救助提供依据。本研究使用儿童抑郁障碍自评量表、儿童孤独量表、儿童社交焦虑量表和自尊量表对重庆市17个区县1733名困境儿童进行调查。结果发现:(1)抑郁、社交焦虑和自尊存在性别差异,抑郁、孤独、社交焦虑和自尊存在年龄差异;(2)孤独和社交焦虑与抑郁呈显著正相关并显著预测抑郁,自尊与抑郁呈显著负相关并显著预测抑郁。(3)困境儿童的自尊在孤独和抑郁之间,社交焦虑和抑郁之间起中介作用。结果表明:困境儿童的孤独、社交焦虑既可直接影响其抑郁水平,也可通过自尊的中介作用间接影响其抑郁水平。     

Anxiety disorders in 8–11‐year‐old children: Motor skill performance and self‐perception of competence

Ekornås, B., Lundervold, A. J., Tjus, T. & Heimann, M. (2010). Anxiety disorders in 8–11‐year‐old children: Motor skill performance and self‐perception of competence. Scandinavian Journal of Psychology, 51, 271–277. This study investigates motor skill performance and self‐perceived competence in children with anxiety disorders compared with children without psychiatric disorders. Motor skills and self‐perception were assessed in 329 children aged 8 to 11 years, from the Bergen Child Study. The Kiddie‐SADS PL diagnostic interview was employed to define a group of children with an anxiety disorder without comorbid diagnosis, and a control group (no diagnosis) matched according to gender, age, and full‐scale IQ. Children in the anxiety disorder group displayed impaired motor skills and poor self‐perceived peer acceptance and physical competence compared with the control group. Two‐thirds of the anxious boys scored on the Motor Assessment Battery for Children (MABC) as having motor problems. The present study demonstrated impaired motor skills in boys with “pure” anxiety disorders. Anxious children also perceived themselves as being less accepted by peers and less competent in physical activities compared with children in the control group.     

Predicting toddler anxiety/depressive symptoms: Effects of caregiver sensitivity on temperamentally vulnerable children

This research examines whether maternal sensitivity in early childhood reduces later anxiety/depressive symptoms for children with more temperamental vulnerability, and whether these effects are different for boys and girls. Data from the National Institute of Child Health and Human Development Early Child Care study with 1,226 subjects (631 boys, 595 girls) were analyzed. Mothers and other caregivers rated children's difficult temperament at 1 and 6 months. Trained observers scored maternal sensitivity when children were 6 and 15 months. Child anxiety/depressive symptoms were rated by mothers and other caregivers when children were 2 and 3 years of age. Maternal sensitivity in early childhood significantly predicted decreased 2‐ and 3‐year‐old anxiety/depressive symptoms. Children with more difficult temperament were significantly more likely to show decreased anxiety/depressive symptoms at 2 years of age if their mothers had been more sensitive. Maternal sensitivity also was a significant predictor of decreased anxiety/depressive symptoms for more temperamentally difficult boys, and temperamentally difficult boys with more sensitive mothers were found to be significantly more likely than girls to show decreased anxiety/depressive symptoms at 3 years of age. The findings of this pilot research suggest that facilitating and supporting increased sensitivity for mothers with more temperamentally difficult children could be beneficial. ©2005 Michigan Association for Infant Mental Health.     

The Contribution of Temperamental and Cognitive Factors to Childhood Anxiety Disorder Symptoms: A Closer Look at Negative Affect,Behavioral Inhibition,and Anxiety Sensitivity

This study examined the role of anxiety sensitivity as an explanatory variable in the link between two temperamental dimensions (i.e., behavioral inhibition and negative affect) and anxiety disorder symptom severity in a sample of children with anxiety disorders. Forty-four children (52?% African American) between 8 and 12 years of age and their mothers participated in this study. An assessment battery consisting of diagnostic interviews, questionnaires, and behavioral assessment of behavioral inhibition was administered. Findings revealed that anxiety sensitivity was a significant explanatory variable linking child self-reports of behavioral inhibition and negative affect to anxiety disorder symptom severity. For parent-completed measures, only direct effects of behavioral inhibition on anxiety disorder symptom severity were found. The clinical implications of our findings, including the importance and feasibility of anxiety sensitivity and behavioral inhibition assessments as part of routine clinical care of children with anxiety disorders are discussed, along with the limitations of our study.     

A Multifactorial Model for the Etiology of Anxiety in Non-Clinical Adolescents: Main and Interactive Effects of Behavioral Inhibition, Attachment and Parental Rearing

There has been limited research examining the additive and interactive effects of multiple factors on the development of anxiety symptoms and anxiety disorders in youths. This study was an attempt to examine the reciprocal connections among temperament, attachment, and rearing style, and their unique and interactive relations to anxiety symptoms. Six hundred forty-four non-clinical children aged 11–15 years (mean age = 12.7 years) completed questionnaires measuring behavioral inhibition, attachment, parental rearing behavior, and anxiety symptoms. Results indicated that there were small to moderate positive correlations among various risk factors. Furthermore, modest but significant positive correlations were found between behavioral inhibition, attachment quality, and anxious and controlling rearing behaviors on the one hand, and anxiety scores on the other hand. That is, higher levels of behavioral inhibition, insecure attachment, and parental control and anxious rearing were associated with higher levels of anxiety symptoms. Finally, behavioral inhibition, attachment quality, parental control and anxious rearing each accounted for a small but unique proportion of the variance of anxiety disorders symptomatology. Little support was found for interactive effects of these vulnerability factors on childhood anxiety.     

Selective Mutism in Children: Comparison to Youths With and Without Anxiety Disorders

Fifteen children with selective mutism (SM), 15 children with anxiety disorders (AD) without selective mutism, and 15 children without anxiety disorders or selective mutism (CN) were compared to examine the relationship between selective mutism and anxiety. Data were collected from children (age 4–10 years), parents, teachers, and clinicians. Results indicated that children with SM closely resemble children with AD. All children with SM received a diagnosis of social anxiety disorder and 53% received a diagnosis for an additional anxiety disorder. In addition, the SM and AD groups differed substantially from controls with respect to parent- and teacher-rated internalizing behavior problems. No differences among the groups were found with respect to parent-and teacher-reported externalizing behavior problems. The results are consistent with prior research emphasizing the association between selective mutism and anxiety disorders, and suggest that selective mutism may be conceptualized, assessed, and treated as an anxiety-related problem.     

Attachment,Behavioral Inhibition,and Anxiety in Preschool Children

This study examined the association between insecure attachment, behavioral inhibition, and anxiety in an at risk sample of preschool children. The relationship between maternal anxiety and child anxiety was also assessed. Participants were 104 children aged 3–4 years who were assessed for behavioral inhibition and mother–child attachment (using the Strange Situation procedure). DSM-IV criteria were used to assess childhood anxiety disorders. Insecure attachment and behavioral inhibition were both independently associated with child anxiety, even after controlling for the effect of maternal anxiety. Maternal anxiety was also associated with child anxiety. This study identified both constitutional and environmental factors associated with the expression of anxiety in young children. Furthermore, the highest levels of anxiety were shown by children who were behaviorally inhibited and insecurely attached and whose mothers were also anxious.     

Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex.

Examined the impact of childhood psychiatric disorders on the prevalence and timing of substance use and abuse and tested for sex differences. A representative population sample of 1,420 children, ages 9, 11, and 13 at intake, were interviewed annually. American Indians and youth with behavioral problems were oversampled; data were weighted back to population levels for analysis. By age 16, more than half the sample reported substance use, and 6% had abuse or dependence. Alcohol use began by age 9, and smoking in the 13th year. Mean onset of dependence was 14.8 years, and mean onset of abuse was 15.1 years. Substance use began earlier in boys, but not girls, who later developed abuse or dependence. Disruptive behavior disorders and depression were associated with a higher rate and earlier onset of substance use and abuse in both sexes, but anxiety predicted later onset of smoking. Family drug problems were the strongest correlate of early onset. Despite differences in prevalence of psychopathology, boys and girls showed more similarities than differences in the course of early substance use and abuse, and its associations with psychopathology.