Changing patterns of neuropsychological functioning in children living at high altitude above and below 4000 m: a report from the Bolivian Children Living at Altitude (BoCLA) study

The brain is highly sensitive to environmental hypoxia. Little is known, however, about the neuropsychological effects of high altitude residence in the developing brain. We recently described only minor changes in processing speed in native Bolivian children and adolescents living at approximately 3700 m. However, evidence for loss of cerebral autoregulation above this altitude (4000 m) suggests a potential threshold of hypoxia severity over which neuropsychological functioning may be compromised. We conducted physiological and neuropsychological assessments in 62 Bolivian children and adolescents living at La Paz (～3700 m) and El Alto (～4100 m) in order to address this issue. Groups were equivalent in terms of age, gender, social class, schooling, parental education and genetic admixture. Apart from percentage of hemoglobin saturated with oxygen in arterial blood (%SpO(2)), participants did not differ in their basal cardiac and cerebrovascular performance as explored by heart rate, mean arterial pressure, end-tidal carbon dioxide, and cerebral blood flow velocity at the basilar, anterior, middle and posterior cerebral arteries. A comprehensive neuropsychological assessment was administered, including tests of executive functions, attention, memory and psychomotor performance. Participants living at extreme altitude showed lower levels of performance in all executive tests (Cohen effect size = -0.91), whereas all other domains remained unaffected by altitude of residence. These results are compatible with earlier physiological evidence of a transitional zone for cerebral autoregulation at an altitude of 4000 m. We now show that above this threshold, the developing brain is apparently increasingly vulnerable to neuropsychological deficit.     

Human behaviour and development under high-altitude conditions

Although we are far from a universally accepted pattern of impaired function at altitude, there is evidence indicating motor, perceptual, memory and behavioural deficits in adults. Even relatively low altitudes (2500 m) may delay reaction time, and impair motor function. Extreme altitude exposure (>5000 m) may result in more pronounced impairment that can persist after returning to the lowlands. Research into the effects of altitude exposure earlier in development is lacking by comparison. Un-acclimatized children can suffer from acute mountain sickness, and, in native populations born at altitude, subtle cognitive and behavioural deficits suggest incomplete adaptation to hypoxia. The study of neurobehavioural functioning at altitude may provide important information about the effects of clinical hypoxia on the human brain and behavioural development.     

Emotional and Behavioural Problems Among Refugee Children and Adolescents Living in South Australia

While there is a growing body of literature on the mental health status of adult refugees, children have been relatively neglected in research, particularly in Australia. This study investigated the prevalence of emotional and behavioural problems and patterns of service utilisation among 530 refugee children and adolescents aged 4–17 years living in South Australia. Parents and teachers of children aged 4–17 years and adolescents aged 13–17 years completed the appropriate versions of the Strengths and Difficulties Questionnaire. Of the 11.0% of children and adolescents found to have borderline or abnormal emotional and behavioural problems, only 13.0% accessed professional help. The study has practical implications for policy and practice.     

Is knowledge of family history related to psychosocial functioning? Comparison of adolescents living in institutional care and adolescents living with their biological families

We tested adolescents growing up in institutional care and adolescents living with their birth families using the ‘Do you know?’ scale and other measures of psychosocial functioning. We found that children living in group homes knew significantly less of their family history, exhibited more behavioural problems and had a more external locus of control. Moreover, the correlations between self-esteem and knowledge of family history were significantly different between the groups. This may suggest that the contribution of the knowledge of family history to self-esteem is different depending on the quality of family history. We also found a significant correlation between locus of control and behavioural problems for the children in institutional care, but not children living with their birth families, which may indicate that their behavioural problems may partially stem from the sense of lack of control over their lives.     

Neurobehavioral Assessment of Children Presenting Diverse Congenital Cardiopathologies

Brain maturation in 1–36 month old children suffering from congenital cardiopathologies was assessed after a study of psychomotor development. The Rogers’ test (Rogers et al., Developmental programming for infants and young children. Volume 2. Early intervention developmental profile, Revised edition, ESL/ELT Michigan, Ann Arbor, 1981) was applied to 65 children, of whom 21 presented with simple cardiopathologies (CpS) and 22 with complex cardiopathologies (CpC). All children were matched by age, sex and socioeconomic status to 22 healthy children in a control group (C). Mean differences between the three groups were established by applying the Kruskal–Wallis test, and mean differences between the C and CpS/CpC groups were determined using the Mann–Whitney test. The proportion of cases evaluated as “low” in each group was calculated by applying the Rogers’ test, and a test of proportion differences was applied between the C and CpS/CpC groups. CpS children performed similarly to the C, whereas CpC children scored significantly lower than C children on all variables. It is highly likely that the suboptimal psychomotor performance observed in CpC children was due to compromised hemodynamics and related to subclinical immaturity of cerebral development.     

Psychometric Properties of the Mental Health Continuum-Short Form: A Study of Portuguese Speaking Children/Youths

The development of measures of children and adolescents’ subjective well-being is crucial to the conceptualization and evaluation of positive mental health. The aim of this study was to investigate the factorial structure and invariance of the Mental Health Continuum-Short Form (MHC-SF—adolescents) across children and youths. Participants were from two different samples: 208 elementary school children (sample 1) and 216 middle school youths (sample 2). Results confirmed the three-dimensional structure of subjective well-being in both samples. The three sub-scales of the MHCSF yielded high internal consistency and results from the HTMT85 indicated discriminant validity. Measurement invariance testing across three different age groups (7–8, 9–10 and 11–14 years) confirmed the full metric and approximate scalar invariance of the MHC-SF. Full scalar invariance was achieved across gender. The study also compared the latent means for mental well-being in the three age groups, and found that the younger groups showed significantly higher levels of wellbeing. The present research study strongly suggests that the MHC-SF (adolescents) is an appropriate instrument to measure the positive mental health and well-being of children and pre-adolescents as multidimensional construct.     

Comprehensive Trail Making Test performance in children and adolescents with traumatic brain injury

The sensitivity of the Trail Making Test to brain damage has been well-established over many years, making it one of the most commonly used tests in clinical neuropsychological evaluations. The current study examined the validity of scores from a newer version of the Trail Making Test, the Comprehensive Trail Making Test (CTMT), in children and adolescents with traumatic brain injury (TBI). Participants included 242 children and adolescents, 121 with sustained TBI and 121 normal control participants, who were matched to the individuals with TBI on age and sex. Receiver operating characteristic analysis indicated that the CTMT composite index provided the best overall classification, with a correct classification rate of 79%. Differences between the TBI and control groups remained stable across age. These findings indicate that the CTMT is sensitive to TBI and overall demonstrates classification rates that are comparable with some other versions of the Trail Making Test. Whether the CTMT will exhibit similar classification accuracy in adults with TBI and for other neurological disorders awaits further investigation.     

A Comparison Between Comprehensive System and an Early Version of the Rorschach Performance Assessment System Administration With Outpatient Children and Adolescents

For many years, the effects of variability in the length of Rorschach records has been debated, and a new administration procedure aimed at reducing the proportion of short and long records has recently been introduced. Using an outpatient sample of children and adolescents, this study explored the impact of an early version of the Rorschach Performance Assessment System (R–PAS) administration, on the central tendencies of Rorschach variables. Specifically, the mean values of 51 variables in 142 Comprehensive System versus 99 R–PAS collected records were compared with each other. Results found comparable mean values across CS and R–PAS administration methods for the variables that guide interpretation with children and adolescents. Both methods produced a comparable number of long (> 27 responses) records. The only relevant difference that emerged is that the early R–PAS administration version yielded significantly fewer short (14–16 responses) records and lower variability in the number of responses.     

Behavioural problems in adolescents who are in adoption, residential care, and grandparent fostering

The aim of this research is to identify the severity and type of behavioural problems found in a sample of 181 Spanish adolescents, aged 11 and 18, who have been, or still are in the protective system and to provide give up-to-date figures about behavioural problem situations of children are living under protective measures, and to determine the existence of diverse behavioural problems concerning the kind of care the adolescents are receiving (adoption, residential care, or with grandparent fostering). The Child Behavior Checklist (CBCL) was used in this study. The results show that most of the adolescents scored within the normal range and only a small percentage of them had important behavioural problems and were therefore situated within the clinical range of the trial. The adopted adolescents scored higher than the adolescents who were either fostered by their extended families or in residential care. The main problems identified in each section are discussed, along with the results, in the context of modernising the Spanish protection system.     

Physiological correlates of intellectual function in children with sickle cell disease: hypoxaemia, hyperaemia and brain infarction

Lowered intelligence relative to controls is evident by mid-childhood in children with sickle cell disease. There is consensus that brain infarct contributes to this deficit, but the subtle lowering of IQ in children with normal MRI scans might be accounted for by chronic systemic complications leading to insufficient oxygen delivery to the brain. We investigated the relationship between daytime oxyhaemoglobin saturation (SpO2), cerebral blood flow velocity (CBFV) and intellectual function (IQ) using path-analysis in 30 adolescents with sickle cell disease (mean age 17.4 years, SD 4.2). Initial analyses revealed that the association between SpO2 and Full Scale IQ (FSIQ) was fully mediated by increased CBFV, whereby SpO2 was negatively correlated with CBFV and CBFV was negatively correlated with FSIQ, i.e. decreases in oxygen saturation are associated with increases in velocity, and increased velocity is associated with lowered IQ scores. The mediated relationship suggests that lowered IQ may be a function of abnormal oxygen delivery to the brain. Further analyses showed that the association between CBFV and IQ was significant for verbal but not for performance IQ. The pathophysiology characteristic of SCD can interfere with brain function and constrain intellectual development, even in the absence of an infarct. This supports the hypothesis that lowered intellectual function is partly explained by chronic hypoxia, and has wider implications for our understanding of SCD pathophysiology.     

Acetylcholine esterase activity and behavioral response in hypoxia induced neonatal rats: effect of glucose, oxygen and epinephrine supplementation

Brain damage due to an episode of hypoxia remains a major problem in infants causing deficit in motor and sensory function. Hypoxia leads to neuronal functional failure, cerebral palsy and neuro-developmental delay with characteristic biochemical and molecular alterations resulting in permanent or transitory neurological sequelae or even death. During neonatal hypoxia, traditional resuscitation practices include the routine administration of 100% oxygen, epinephrine and glucose. In the present study, we assessed the changes in the cholinergic system by measuring the acetylcholinesterase (AChE) activity and the behavioral responses shown by hypoxia induced neonatal rats and hypoxic rats supplemented with glucose, oxygen and epinephrine using elevated plus-maze and open-field test. The acetylcholine esterase enzyme activity showed a significant decrease in cerebral cortex, whereas it increased significantly in the muscle of experimental rats when compared to control. Hypoxic rats supplemented with glucose, glucose and oxygen showed a reversal to the control status. Behavioral studies were carried out in experimental rats with elevated plus-maze test and open-field test. Hypolocomotion and anxiogenic behavioral responses were observed in all experimental rats when compared to control, hypoxic rats supplemented with glucose, glucose and oxygen. Thus, our results suggest that brain damage due to hypoxia, oxygen and epinephrine supplementation in the neonatal rats cause acetylcholine-neuromuscular-defect leading to hypolocomotion and anxiogenic behavioral response. Glucose and glucose with oxygen supplementation to hypoxic neonates protect the brain damage for a better functional status in the later life.     

Specific aspects of psychological disorders of performance in children with epilepsy

We examined 49 normal intelligent epileptic and parallelised in sex, age and intelligence just as much healthy and 14 minimal cerebral damaged children without seizures. Using a psychological test battery psychic/psychomotor speed, flexibility/preservation proneness, memory span and memory and concentration were registrated. Besides reduced memory performances we found a deceleration of psychic/psychomotor speed as primary basic disorder within the performance structure of epileptic children analogous to our previous examined adults. The tridimensional comparison suggests remarkable psychopathological differences among the two groups of patients.     

Social and individual risk factors for suicide ideation among Chinese children and adolescents: A multilevel analysis

The objective of this study was to investigate the prevalence and predictors of suicide ideation among primary, middle and high school students. We used multilevel modelling to investigate suicide ideation among 12,733 Chinese children and adolescents aged 9–18 years from wide range of areas across China. Approximately, 32.09% of children and adolescents reported suicide ideation, with females were more likely to report suicide ideation than males (38.09% vs. 29.95%). Our results showed that the risk factors in primary school students were different from middle and high school student groups, whereas significant risk factors for middle and high school students were similar. The city's standard of living as indicated by the Engel coefficient and the city's divorce rate were positively associated with the prevalence of suicide ideation; in contrast, the school's pupil‐to‐teacher ratio was negatively correlated with elevated suicide ideation. Significant risk factors for suicide ideation included study anxiety, self‐accusation tendency, impulsive tendency, terror tendency and physical symptoms. These results have important implications for the prevention of suicide, suggesting that both contextual (city‐level) and compositional (individual‐level) factors could be important targets for prevention and intervention for children and adolescents at risk of suicide ideation.     

Age‐related differences in subjective recollection: ERP studies of encoding and retrieval

The ability to mentally re‐experience past events improves significantly from childhood to young adulthood; however, the mechanisms underlying this ability remain poorly understood, partially because different tasks are used across the lifespan. This study was designed to address this gap by assessing the development of event‐related potential (ERP) correlates associated with subjective indices of recollection. Children, adolescents, and adults performed Tulving's ( 1985 ) remember/know paradigm while ERPs were recorded during memory encoding (Experiment 1) and retrieval (Experiment 2). Behaviorally, children recognized fewer items than adolescents and adults. All age groups reliably made subjective judgments of recollection, although the ability to make these judgments improved with age. At encoding, the ERP effect associated with recollection was present and comparable across age groups. In contrast, the ERP effect associated with recollection at retrieval differed as a function of age group; specifically, this effect was absent in children, topographically widespread in adolescents, and, consistent with previous literature, maximal over left centro‐parietal leads in adults. These findings suggest that encoding processes associated with the subsequent subjective experience of recollection may be similar among children, adolescents, and adults and that age‐related improvement in recollection may be primarily attributable to the development of processes that follow the initial encoding of stimuli (i.e., consolidation, storage, retrieval).     

Knowledge and causal attributions for mental disorders in HIV-positive children and adolescents: results from rural and urban Uganda

Increasing availability of antiretroviral treatment (ART) has led HIV to be considered a chronic disease, shifting attention to focus on quality of life including mental wellbeing. We investigated knowledge and causal attributions for mental disorders in HIV-positive children and adolescents in rural and urban Uganda. This qualitative study was nested in an epidemiological mental health study among HIV-positive children and adolescents aged 5–17 years in rural and urban Uganda. In-depth interviews were conducted with caregivers of HIV-positive children (5–11 years) and adolescents (12–17 years) in HIV care. Interviews were audio recorded with permission from participants and written consent and assent sought before study procedures. Thirty eight participants (19 caregivers, 19 children/adolescents) were interviewed. Age range of caregivers was 28–69 years; majority were female (17). Caregivers had little knowledge on mental disorders ;only 3 related the vignette to a mental problem and attributed it to: improper upbringing, violence, poverty and bereavement. Five adolescents identified vignettes as portraying mental disorders caused by: ill-health of parents, bereavement, child abuse, discrimination, HIV and poverty. Caregivers are not knowledgeable about behavioural and emotional challenges in HIV-positive children/adolescents. Mental health literacy programmes at HIV care clinics are essential to enhance treatment-seeking for mental health.     

Parent–adolescent communication in foster,inter‐country adoptive,and biological Italian families: Gender and generational differences

There is a paucity of studies aimed at comparing how parents and children in different family structures cope with the challenges posed by the adolescence transition; in particular, there are few studies aimed at comparing adoptive and foster families. In order to partially fill this gap, the principal aims of the present study were to verify whether there are differences in parent–child communication among foster, intercountry adoptive, and biological families according to the adolescents' gender, and to compare the perceptions of parents and adolescents concerning parent–child communication. Data were elaborated on two levels: a generational level (adolescent's and his/her parents' perceptions among the three family groups) and a dyadic level (mother–child and father–child perceptions). The sample was composed of 276 Italian families with adolescents aged between 11 and 17 (81 foster, 98 international adoptive, and 97 biological families). Subjects (mothers, fathers, and children) filled out a questionnaire including the Parent–Adolescent Communication Scale (Barnes & Olson, 1985 ). Results highlighted that in foster families, parent–child communication showed more difficulties from both the adolescent's and the parents' point of view. Adoptive adolescents, however, reported a more positive communication with both their parents than did their peers living in biological and foster families. At a dyadic level, some differences emerged among the three groups. In biological families, a more pronounced distance emerged between parents and children. In adoptive families, father and adolescent shared more similar perceptions, whereas a significant discrepancy emerged between mother and child. A higher level of perceptual congruence between adolescents and parents was found in foster families. Gender differences were also seen: Mothers experienced a more open communication with their children than did fathers, and adolescents, and above all females, communicated better with their mothers than with their fathers in all three family groups.     

Parallel development of ERP and behavioural measurements of visual segmentation

Visual segmentation, a process in which elements are integrated into a form and segregated from the background, is known to differ from adults at infancy. The further developmental trajectory of this process, and of the underlying brain mechanisms, during childhood and adolescence is unknown. The aim of the study was to investigate the developmental trajectory of ERP reflections of visual segmentation, and to relate this to behavioural performance. One hundred and eleven typically developing children from 7 to 18 years of age were divided into six age groups. Each child performed two visual tasks. In a texture segmentation task, the difference in event‐related potential (ERP) response to homogeneous (no visual segmentation) and checkered stimuli (visual segmentation) was investigated. In addition, behavioural performance on integration of elements into contours was measured. Both behavioural and ERP measurements of visual segmentation differed from adults in 7–12 year‐old children. Behaviourally, young children were less able to integrate elements into a contour than older children. In addition, a developmental change was present in the ERP pattern evoked by homogeneous versus checkered stimuli. The largest differences in behaviour and ERPs were found between 7–8‐ and 9–10‐, and between 11–12‐ and 13–14‐year‐old children, indicating the strongest development between those age groups. Behavioural as well as ERP measurements at 13–14 years of age showed similar results to those of adults. These results reveal that visual segmentation continues to develop until early puberty. Only by 13–14 years of age, children do integrate and segregate visual information as adults do. These results can be interpreted in terms of functional connectivity within the visual cortex.     

Mental health help‐seeking and refugee adolescents: Qualitative findings from a mixed‐methods investigation

There is general agreement in Australia and other Western resettlement countries that many refugee adolescents with social, behavioural, and mental health problems are not accessing mental health care. There is, however, a paucity of research on refugee adolescent mental health service utilisation and help‐seeking. Most research to date has centred on adolescents in the general population, and even then is still very limited. This paper presents the findings of 13 focus groups held with 85 refugee adolescents aged 13–17 years from Afghanistan, Bosnia, Iran, Iraq, Liberia, Serbia, and Sudan. The study was part of a wider investigation of mental health service utilisation by refugee parents of children aged 4–17 years, and by adolescents aged 13–17 years. With respect to adolescents, the focus group findings indicate that most are very reluctant to venture beyond their close friendship networks for help with their psychosocial problems due to a range of individual, cultural, and service‐related barriers. Implications for mental health policymakers, service planners, and service providers are discussed.     

Anxiety and depression as correlates of self-reported behavioural inhibition in normal adolescents

In a previous study, Muris, Merckelbach, Wessel, and Van de Ven [Psychopathological correlates of self-reported behavioural inhibition in normal children. Behav. Res. Ther. 37 (1999) 575-584] found that children who defined themselves as high on behavioural inhibition displayed elevated levels of psychopathological symptoms compared to children who defined themselves as low or middle on behavioural inhibition. The present study further examined the relationship between self-reported behavioural inhibition and anxiety disorders and depression symptoms in a large sample of adolescents aged 12-18 years (N=968). Adolescents completed a measure of behavioural inhibition and questionnaires of anxiety and depression. Results indicated that adolescents who classified themselves as high on behavioural inhibition had higher scores of anxiety and depression than adolescents who classified themselves as low or middle on behavioural inhibition. Structural equations modelling was employed to test hypothetical models on the role of behavioural inhibition in childhood anxiety and depression. It was found that a pathway in which behavioural inhibition results in anxiety, which in turn leads to depression, provided the best fit for the data.     

Adolescent maternity: A risk factor in poverty situations?

This paper describes the psychosocial characteristics of adolescent mothers living in poverty in urban communities of Uruguay, whose children are now 0 to 5 years old. A sample of 965 mothers representative of the poor urban communities in the entire country was studied. One hundred thirty-six of these mothers were adolescents, 19 years old or younger. Six major areas were explored: socioeconomic status and social support, family characteristics, child-rearing practices, maternal and paternal availability, and characteristics of the child. In the group of children 2 to 5 years of age, psychomotor development was explored using the Test de Desarrollo Psicomotor (TEPSI). Psychosocial risk and child development were compared for adolescent and nonadolescent poor urban mothers. Children in both groups showed negative effects. It was not found that children of adolescent mothers did worse than those of nonadolescent mothers. Therefore, it was concluded that adolescent maternity is a complex phenomenon that cannot be viewed in isolation from the social environment in which it takes place. The results indicated that in poor communities the poverty-related risk factors may obscure the effect of the age-related ones.