Antidepressant treatment of children: clinical relapse is unrelated to tricyclic plasma concentrations

Plasma concentrations of imipramine and amitriptyline and their desmethylated metabolites were measured in 20 children being treated for major depressive illness 2 wk. and 5 to 10 wk. after achieving drug dosages of 2.25 mg/kg body weight. At 2 wk. all children had exhibited clinical improvement, but by 10 wk. 4 of the 10 children treated with imipramine and 5 of the 10 children treated with amitriptyline had experienced clinical relapse of depressive symptoms. Tricyclic antidepressant plasma concentrations and ratios were comparable in the subgroups of children who maintained their clinical improvement and those who relapsed. There was no evidence of a systematic decline in plasma tricyclic antidepressant concentrations in those children who relapsed.     

Frequency of neurologic-psychiatric findings in the late phase following minor and medium severe blunt craniocerebral injuries

The authors present a short review of the pertinent literature and report on their own neuropsychiatric findings following internal craniocerebral injuries, at the same time drawing attention to the necessity of psychological examination. Statistical comparisons with the international literature are complicated owing to the different classifications used for craniocerebral injuries.     

Conditioned and unconditioned caloric compensation: Evidence for self-regulation of food intake in young children

The purpose of these two experiments was to determine (a) whether young children can be responsive to caloric density cues in regulating their food intake, (b) whether such cues can be associatively conditioned to organoleptic cues in foods, and (c) to obtain evidence regarding which of the many cues available are involved as conditioned stimuli. In Experiment 1 participants were eighteen 3- to 5-year-old children, who were seen for a series of pairs of conditioning trials, followed by extinction test trials. Each trial consisted of a two-part snack: approximately 100 ml of a pudding preload (chocolate or vanilla; high or low caloric density) followed after a delay by ad-lib consumption of snack foods (cookies and crackers). In extinction trials, flavors previously paired with high- or low-caloric density preloads during conditioning were presented in isocaloric intermediate density preloads. Results indicated that 14 of 18 children showed unconditioned caloric compensation on the first pair of conditioning trials; 16 of 18 children showed compensation following the second pair of trials, and 12 of these 16 subjects continued to show this consumption pattern during extinction. Consumption was significantly greater following the low calorie paired flavor than following the high calorie paired flavor during extinction. Experiment 2 (N = 10) replicated these findings, and uncorrelating preload and snack food flavors indicated that flavor cues in the preloads can serve as conditioned stimuli. Children showed both initial responsiveness to caloric density and evidence for associative conditioning of food cues to the physiological consequences of eating. These results provide initial evidence for a mechanism allowing the child to learn to anticipate the caloric consequences of familiar foods and regulate food intake accordingly.     

Infant hypotonia, obesity, hypogenitalism and oligophrenia--new viewpoints on the etiology and symptoms of Prader-Willi syndrome

We present four cases of Prader-Willi syndrome. Two of them have an abnormality of a chromosome 15, the other both show different chromosomal abnormalities. Translocations or deletions were found recently in the bands 15q11/12 in about 60% of the cases of Prader-Willi syndrome. The consequences for diagnosis, symptomatology and genetic counselling of the syndrome are discussed.     

Clauses and the semantic representation of words

When a sentence with more than one clause is processed, words of the first clause become less available for recall or recognition once the clause boundary has been passed. One common interpretation of this observation is that the representation of a given word shifts from a predominantly surface form (e.g., phonological or lexical) to a semantic form, after the clause boundary. Two experiments that test that interpretation are reported. In the first experiment, two-clause spoken sentences were followed by spoken word or picture probes. Pictures were intended to provide a fast semantic match to probed words, but a slow surface match. Although response times exhibited a robust main effect of the clause position of the probe, no interaction with probe type was found. Similar results were obtained in a second experiment that compared pictures with written word probes. The faster response to picture than to word probes in the second experiment indicates that subjects did not covertly name the picture, but made a semantic match (as intended). These observations suggest the following reinterpretation of earlier sentence memory experiments: Words in the most recent clause of a sentence are more available than words in an earlier clause because their semantic representations are more active, not because their surface representations are more active.     

The interaction of pronunciation rules and lexical representations in reading aloud

Two experiments examined the role of pronunciation rules and of lexical information in pronouncing letter strings. In Experiment 1, subjects pronounced pseudowords varying in the strength of the rules needed to pronounce them, as well as in the availability of a lexical model. In Experiment 2, the stimuli were words varying in rule strength and in usage frequency. The pronunciation times from both experiments displayed an interaction between rules and lexical information: When the rules necessary were strong, the relative availability of lexical information was less important than when the rules were weak. The results were discussed with respect to both traditional dual-process models of pronunciation and models proposing the use of lexical analogies.     

Recent stressful life events and young children's school adjustment

A group of 211 first-to fourth-grade children who had experienced one or more recent stressful life events were compared to a demographically matched sample of 211 children who had not experienced such events on measures of school adjustment problems and competencies. Stressful life events were found to be associated with the presence of more serious school adjustment problems and fewer competencies. Those associations were strongest for children who had experienced multiple recent stressful events. The importance of preventive interventions for this at-risk group was emphasized and future research steps in the area were considered.     

Changes in self-stimulatory behaviors with treatment

For four of six autistic children who underwent intensive behavioral treatment, the nature of their self-stimulatory behavior changed from initial lowlevel motor behaviors (such as rocking, spinning, twirling) to differing kinds of higher-level behaviors (such as lining of objects, echolalic speech, and preoccupation with spelling and numerical values). The children who changed to the highest levels of self-stimulatory behavior also showed the largest gains in treatment (as determined by IQ scores, school placement, etc.). The changes in self-stimulatory behaviors were attributed to the intense teaching of appropriate social behaviors and the explicit therapeutic suppression of low-level, self-stimulatory behaviors. The long-term therapeutic effects of changing from lower-to higher-level forms of self-stimulatory behavior were discussed.This study was supported by a grant from the National Institute of Mental Health (grant MH 11440). We want to express our thanks to the parents who allowed us to study their children. We gratefully acknowledge the assistance of Maria Audero with the design of the weighted measure, and Tracee Parker with the collection of the data.