Executive Function and Emotional,Behavioral, and Social Competence Problems in Children with Epilepsy

Many researchers have reported elevated rates of emotional, behavioral, and social competence problems (EBSP) in children with epilepsy. Although executive function has been found to be associated with EBSP in children with typical development, almost no research has looked at the individual components of executive function as potential predictors of EBSP in children with epilepsy. This is surprising given the deficits in executive function in children with epilepsy. We investigated EBSP and executive function in 42 children with epilepsy, aged 6.0 to 18.1 years and found, as expected, that EBSP were associated with executive function in these children even after epilepsy-related variables, such as seizure type, were accounted for. However, different components of executive function were related to different emotional, behavioral, and social competence problems in these children. Shifting of mental sets was a significant predictor of emotional, behavioral, and social competence problems whereas inhibition was a significant predictor of behavioral problems. This suggests that different executive function profiles in children with epilepsy may place them at-risk for developing different types of emotional, behavioral, and social competence problems. These results may help researchers and clinicians develop new techniques to identify and treat emotional, behavioral, and social competence problems in children with epilepsy.     

Cognitive and neuropsychological outcomes: more than IQ scores

Improved survival in preterm infants has broadened interest in cognitive and neuropsychological outcomes. The incidence of major disabilities (moderate/severe mental retardation, neurosensory disorders, epilepsy, cerebral palsy) has remained consistent, but high prevalence/low severity dysfunctions (learning disabilities, ADHD, borderline mental retardation, specific neuropsychological deficits, behavioral disorders) have increased. The follow-up literature contains methodologic problems that make generalizations regarding outcome difficult, and these are discussed. Although mean IQs of former VLBW infants generally are in the low average range and are 3-9 points below normal birth weight peers, these scores mask subtle deficits in: visual-motor and visual-perceptual abilities, complex language functions, academics (reading, mathematics, spelling and writing), and attentional skills. There is an increased incidence of non-verbal learning disabilities, need for special educational assistance, and behavioral disorders in children born prematurely. Males have more problems, and there is a trend for worsening outcome over time, due to emergence of more subtle deficits in response to increased performance demands. In addition to IQ and achievement testing in follow-up, there should be evaluation of executive functions and attention, language, sensorimotor functions, visuospatial processes, memory and learning, and behavioral adjustment.     

SEPARATE AND COMBINED EFFECTS OF METHYLPHENIDATE AND A BEHAVIORAL INTERVENTION ON DISRUPTIVE BEHAVIOR IN CHILDREN WITH MENTAL RETARDATION

We investigated the separate and combined effects of a behavioral intervention and methylphenidate (Ritalin®) on disruptive behavior and task engagement in 3 children with severe to profound mental retardation. The behavioral intervention involved differential reinforcement of appropriate behavior and guided compliance. All 3 children demonstrated decreased disruptive behavior and improved task engagement in response to the behavioral intervention. Two of the 3 children demonstrated similar improvement in response to methylphenidate. Although both interventions were highly effective for these 2 participants, the relative efficacy of the interventions varied between the 2 children. There was no evidence of an additive or synergistic effect of the two interventions, but the high efficacy of each intervention alone limited our ability to detect such effects.     

Siblings of children with mental retardation: Family characteristics and adjustment

Siblings of children with mental retardation may be at greater risk for adjustment problems because of family stress related to the needs of the child with mental retardation. Family dimensions were investigated to determine their relationship to sibling adjustment. Adjustment of 12 siblings of children with mental retardation was examined in relationship to family dimensions. These relationships were compared to those for children from families without a disabled child. For both groups, self concept was positively associated with family cohesion, and social competence was positively associated with family promotion of independence. For only the siblings of the mentally retarded children, family conflict was inversely related to social competence, and family organization was positively related to sibling self concept. Our results suggest that family conflict and disorganization appear to have a more negative effect in families with a child with mental retardation.     

Treatment of epilepsy in the multiply handicapped

The medical management of epilepsy in the multi-handicapped patient requires careful evaluation, classification, and pharmacologic treatment. It is estimated that 20-40% of patients with mental retardation and cerebral palsy have epilepsy. This review reports the clinical trial data and personal experience related to the use of newer AEDs in the chronic management of epilepsy syndromes in children and adults, as well as information available on the treatment of seizures in individuals with mental retardation and associated handicaps. Furthermore, clusters of seizures, prolonged seizures and status epilepticus are more commonly seen in the multiply handicapped and mentally retarded population and require special attention. The new antiepileptic drugs felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide show specific advantage in some multiply handicapped patients, be it for seizure control or medication tolerance. Furthermore, new modalities of treatment for prolonged seizures allow better efficacy both outside of hospital and within hospital facilities. The treatment of epilepsy in multi-handicapped and retarded adults and children has significantly advanced in the past few years, and much of this improvement can be attributed to improved knowledge and monitoring of new antiepileptic drugs. Conventional anticonvulsants remain first line therapy for most clinicians, but newer AEDs must broaden the therapeutic option and do allow improved therapy for some multiply handicapped patients.     

Psychoanalytically Based Treatment for Traumatized Children and Families

A psychoanalytic orientation provides an important perspective for developing community-based prevention and intervention programs for traumatized children and their families. In New Orleans, the Violence Intervention Program for Children and Families is designed to reduce the risk of exposure to violence, mental health problems following exposure, interference with normal developmental progression, academic performance, family functioning, onset of behavioral and conduct disturbances, later psychopathology, and subsequent violence. The program includes an unusual focus on work with police officers as first responders to increase their sensitivity and responsiveness to traumatized children. A psychoanalytic perspective helps a therapist or interventionist understand a person's strengths and weaknesses, frustrations, and conflicts as well as those within a chaotic environment and social situation. The psychoanalytic approach allows for more effective therapeutic approaches as well as more flexible problem-solving strategies.     

The reliability of the ICD‐10 and the DC 0–3 in an epidemiological sample of children 1½ years of age

The aims of this study were to investigate the reliability of ICD‐10 and DC 0–3 in the diagnostic classification of mental health problems in 1½ ‐year‐old children from the general population. The reliability study was conducted as a part of an epidemiological survey of psychopathology in 1½ ‐year‐old children from the general population. In this survey, the children were assessed and diagnosed according to the ICD‐10 and the DC 0–3 after a 2‐hr session including standardized and clinical methods and videorecordings. The case records and video material of 18 children were rediagnosed by the three child psychiatrists, who had diagnosed children in the epidemiological survey. In general, the reliability in diagnostic classification of mental health problems in 1½‐year‐old children was improved with the DC 0–3 compared to the ICD‐10. In the classification of psychopathology at Axis I, the interrater reliability and test‐retest reliability kappas were 0.66 and 0.57, respectively, with the ICD‐10, and 0.72 and 0.74, respectively, with the DC 0–3. The reliability of the classification of relationship disturbances at Axis II with the DC 0–3 was high, corresponding to κ = 1. A high agreement among raters in the differentiation between psychopathology and normal variations was found. Given experienced clinicians and standardized assessment methods, it is possible to reliably identify and diagnose psychopathology in 1½‐year‐old children from the general population.     

Intelligence Testing and its Implications for Disability Evaluation in Individuals with Mental Retardation

Disability evaluation in mental retardation, which is done through assessment of intelligence, has certain inherent problems. The situation gets more complex if the person has additional disabilities, which is very likely in mental retardation. As an initiative, this study aims to study problems faced in intelligence testing in persons with mental retardation. The study included 88 randomly selected files of the individuals with mental retardation registered at the National Institute for the Mentally Handicapped (NIMH) Regional Centre, Kolkata during 2007-08. Each file was reviewed for information on diagnosis mental retardation, associated conditions and the intelligence testing reports. The results indicated that specific factors including both the characteristics of mental retardation and the nature of the tests available were interfering with intelligence testing. The problems are discussed in the context of current constructs related to mental retardation, diagnostic systems and legislation.     

A Systematic Review of Psychiatric and Psychosocial Comorbidities of Genetic Generalised Epilepsies (GGE)

Psychiatric disorders and associated poor psychosocial outcomes are recognised to be a common sequelae of epilepsy. The extent to which this is true of genetic generalised epilepsies (GGE), particularly syndromes other than juvenile myoclonic epilepsy (JME) is unclear. This systematic review synthesises findings regarding psychiatric and associated comorbidities in adults and children with GGE. Systematic review yielded 34 peer-reviewed studies of psychiatric and psychosocial outcomes in adults and children with GGE. Clinically significant psychiatric comorbidity was reported in over half of all children and up to a third of all adults with GGE. There was no evidence to support the presence of personality traits specific to JME or other syndromes; rather rates mirrored community samples. A small number of studies report poor psychosocial outcomes in GGE, however the interpretation of these findings is limited by paucity of healthy comparison groups. Some evidence suggests that anti-epileptic drug polytherapy in children and seizure burden at all ages may constitute risk factors for psychopathology. Findings highlight the importance of early screening so as not to overlook early or developing symptoms of psychopathology.     

The abilities of children with mental retardation to remember personal experiences: implications for testimony

Investigated the abilities of children with mental retardation to remember the details of a personally experienced event. A simulated health check was administered to 20 children with mental retardation and 40 normally developing children, half matched on mental age (MA) and half matched on chronological age (CA) with the children with mental retardation. The children's memory was assessed immediately after the health check and 6 weeks later. Overall, the children with mental retardation accurately recalled the health check features, provided detail, and resisted misleading questions about features that did not occur. The group with mental retardation performed similarly to the MA matches on virtually all of the memory variables. The children with mental retardation performed worse than the CA matches on most of the memory variables, although they were able to recall a similar number of features. The findings are discussed in terms of the ability of children with mental retardation to provide accurate testimony.     

GENERALIZED LANGUAGE LEARNING BY CHILDREN WITH SEVERE MENTAL RETARDATION: EFFECTS OF PEERS' EXPRESSIVE MODELING

In this study, we investigated the conditions that contribute to observational learning of generalized language in children with severe mental retardation. Matrix-training strategies were used to teach 6 children with mental retardation to combine known words into two- or three-word utterances consistent with syntactic rules. Subsequently, the children learned two or more unknown words concurrently, inducing word-referent relations consistent with these word order rules. Generalized learning of responses not taught directly was shown to be under experimental control using a multiple baseline design across submatrices. Expressive modeling of only four or five responses was sufficient to promote recombinative generalization in the expressive and receptive modalities. Thus, 95% to 98% of subjects' learning was attributed to generalization processes. This study demonstrates how the efficiency of language training with children with mental retardation might be enhanced by coupling observational learning and matrix-training strategies.     

Long-Term Follow-Up of Children with Mental Retardation/Borderline Intellectual Functioning and ADHD

Fifty-two children (ages 7 to 14 years) with moderate mental retardation to borderline intellectual functioning were recontacted 12 to 65 months following participation in a double-blind, placebo-controlled trial of methylphenidate (MPH). Sixty-nine percent of subjects continued to be prescribed medication for behavior control at follow-up. While 72% of the sample evidenced improvement, over two-thirds continued to be rated at or above the 98th percentile on the Hyperactivity Index of the Parent Conners. In fact, 22% of subjects had received inpatient psychiatric treatment between the time of the initial MPH trial and follow-up. Finally, subjects with high initial ratings on the Parent Conners Conduct Problems scale were more likely to be suspended from school or receive inpatient psychiatric treatment than subjects with low initial ratings. The results suggested that children with ADHD and mental retardation or borderline intellectual functioning continued to exhibit significant symptoms associated with attention deficit hyperactivity disorder (ADHD) at follow-up and that early conduct problems were predictive of continuing behavioral difficulties.     

Mental Health Diagnostic Considerations in Racial/Ethnic Minority Youth

Misdiagnoses of racial/ethnic minority youth’s mental health problems can potentially contribute to inappropriate mental health care. Therefore, we conducted a systematic review that focuses on current theory and empirical research in an attempt to answer the following two questions: (1) What evidence exists that supports or contradicts the idea that racial/ethnic minority youth’s mental health problems are misdiagnosed? (2) What are the sources of misdiagnoses? Articles were reviewed from 1967 to 2014 using PsychINFO, PubMed, and GoogleScholar. Search terms included “race”, “ethnicity”, “minority”, “culture”, “children”, “youth”, “adolescents”, “mental health”, “psychopathology”, “diagnosis”, “misdiagnosis”, “miscategorization”, “underdiagnosis”, and “overdiagnosis”. Seventy-two articles and book chapters met criteria and were included in this review. Overall, evidence was found that supports the possibility of misdiagnosis of ethnic minority youth’s emotional and behavioral problems. However, the evidence is limited such that it cannot be determined whether racial/ethnic differences are due to differences in psychopathology, mental health biases, and/or inaccurate diagnoses. Cultural and contextual factors that may influence misdiagnosis as well as recommendations for research and practice are discussed.     

Parent-Reported Behavioral and Emotional Responses of Children to Disaster and Parental Psychopathology

Child disaster mental health research has been largely limited by investigation of one disaster at a time and inconsistent methods across different studies. This study assessed 160 survivors of 3 disasters with structured diagnostic interviews, asking about the behavioral and emotional disaster reactions of their 266 children, ages 3–17. Most children had ≥1 postdisaster behavior change or disaster-related posttraumatic stress symptom. The children’s postdisaster behavioral and emotional problems were associated with parental postdisaster psychopathology. The results underscore the importance of asking disaster survivors about their children’s disaster reactions and considering parental disaster experiences and reactions in addressing their children’s reactions.     

儿童行为抑制性与心理障碍关联的认知神经过程

行为抑制型儿童相较于普通儿童更容易在童年中期和青春期出现心理障碍, 具有更高的发展风险性。此类儿童比非抑制型儿童表现出更多的退缩动机、更长的预期过程与前注意过程、更少的注意控制、对负性信息更多的注意偏向、异常活跃的反应监控过程和更慢的习惯化过程。这些与心理障碍患者相似的认知神经过程是儿童行为抑制性与心理障碍间的重要联系途径, 并能作为预测指标筛选有更高发展风险性的个体。除儿童本身的特质外, 环境因素也能通过塑造认知神经过程, 进而影响儿童的发展结果。因此在未来的研究中, 可以考虑不同文化背景下的儿童行为抑制性与心理障碍关联的认知神经过程差异。进而从个体特质和环境因素两方面寻找行为抑制型儿童发展的保护性因素。     

Memory impairment and Benign Epilepsy with centrotemporal spike (BECTS): A growing suspicion

Benign Epilepsy with centrotemporal spikes (BECTS) is considered a benign type of epilepsy; nevertheless a significant number of children present clear and heterogeneous cognitive deficits such as memory disturbances. Thus far, evidence about memory impairment has been less than conclusive. To clarify the quality of memory functioning in BECTS children, an analysis of existing findings has been conducted trying to identify the type of memory deficits and their underlying factors. Short- and long-term declarative memory are impaired in BECTS children, with both verbal and non-verbal material; co-occurrence of attentional, linguistic and behavioral disturbances is reported. In children with continuous spikes and waves during the slow-wave sleep pattern the normal downscaling of slow-wave activity is absent, disrupting plastic brain processes of sleep-related memory consolidation. In BECTS children, NREM sleep interictal epileptiform discharges (IED) may interfere in the dialogue between temporal and frontal cortex, causing declarative memory deficits: the role of NREM sleep IED acquires a special importance, leading to methodological guidance and suggesting aims for future researches in the field of childhood neuroscience.     

Maternal mental health,child care quality,and children's behavior

Moderating effects of non-parental preschool child care quality on the impact of maternal mental health risks on children's behavioral and mental health outcomes were examined. The paper presents data both on the concurrent buffering effects on children at the age of 4 ½ while they are in child care as well as on the longitudinal effects on the children two years later in the first grade. Study participants included 294 mothers, fathers, their children, their children's non-parental caregivers in preschool child care programs and their children's first grade teachers from the Wisconsin Study of Families and Work. Using regression models to examine moderation, we found that in low quality child care, children exposed to elevated maternal depressive symptoms and anger showed more behavioral problems and worse prosocial functioning. In contrast, children in high quality child care did not present higher symptoms in relation to elevated mother mental health risks. Significant moderating effects were found in both concurrent and longitudinal analyses. Results point to potential buffering effects of high quality care for children faced with adverse family factors.     

Sexual Abuse Prevention for Individuals with Mental Retardation: Considerations for Genetic Counselors

It is now widely recognized that children, adolescents, and adults with mental retardation are especially vulnerable to sexual abuse. Because at least 10% of genetic conditions are reported to include mental retardation as a feature, the provision of services to individuals with mental retardation represents a substantial portion of the case load for many genetic counselors. Our objective is to educate genetic counselors and other health professionals about this vulnerable population in order to enhance the frequency and efficacy of inquiry into sexual education and sexual abuse prevention training for patients with mental retardation. The following review article is intended to assist genetic counselors by increasing their knowledge of factors that lead to sexual abuse and provides recommendations for integrating this information into the counseling interaction.     

Narrow and broad definition of mixed-handedness in male psychiatric patients.

Differences in assessment and classification procedures of many mixed-handedness studies have made comparison of findings difficult. In the present study, "narrow" and "broad" definitions of mixed-handedness were investigated using the Annett Handedness Questionnaire in patients with schizophrenia (n=68), panic disorder (n=62), borderline personality disorder (n=35), heroin addiction (n=54), and mental retardation (n=33) in comparison with 944 controls. According to the "narrow" definition of mixed-handedness, an excess of mixed-handedness was observed in patients with borderline personality disorder and mental retardation. An excess of nonmixed-handedness was found in patients with panic disorder. According to the "broad" definition of mixed-handedness, an excess of mixed-handedness was observed in patients with mental retardation, in the total sample of psychiatric patients (n=252), and in the schizophrenic patients. Thus, we can conclude that different mixed-handedness definitions can be associated with different results. Furthermore, we suggest that the neurotic part of the present psychopathology spectrum tends to be related to an excess of normal or nonmixed-handedness, and the psychotic as well as the organic portion is associated with an excess of mixed-handedness, regardless of the definition of mixed-handedness used.