Risk factors for psychopathology among Chinese children

The present study was designed to examine the family environment and child characteristics associated with psychopathology among Chinese children. A large epidemiological sample of 1695 children aged 6-11 was drawn from 12 elementary schools in Linyi Prefecture of China. Parents completed the Child Behaviour Checklist, the Family Environment Scale, and a self-administered questionnaire including a number of items with regard to family, parental, and child characteristics. Results indicated that the overall prevalence of child psychopathology was 17.2%. Logistic regression analyses showed that a number of family and parental, as well as prenatal, perinatal and postnatal risk factors had significant association with child psychopathology. The most notable risks were derived from poor parental rearing with regard to the child's misbehaviour, low birthweight, and poor marital relations of the parents after controlling for other factors. These findings are consistent with previously reported risk factors for child psychopathology, highlighting the importance of family and early childhood intervention as a measure to prevent child psychopathology in China.     

Changing views: New perspectives in child psychiatric research

Research in child and adolescent psychiatry has remarkably changed during the last two decades. In general, there is a strong trend towards empirically based research in all relevant areas, including basic research as well as psychotherapy and prevention. Important contemporary research fields are: epidemiology, developmental psychopathology, family psychopathology, electrophysiology, neuropsychology, genetics, and the application of the new imaging techniques in child psychiatric disorders. Several methods applied in these fields have been developed in non-medical disciplines so that it has been and will be an interdisciplinary task to integrate them into child psychiatry as a medical discipline. New journals, most of them using an interdisciplinary approach, have substantially contributed to the spread of knowledge and have improved the quality of scientific contributions worldwide. Nevertheless, there are also deficits and shortcomings: In general, there is not enough support for research in the field of child psychiatry and developmental psychopathology. In many countries, there is also a deficit with regard to education and training of young researchers. There are not enough positions for senior researchers within departments of child and adolescent psychiatry, and there is also a deficit of research departments in the field without an overload of clinical tasks. However, in many places the given resources are not adequately used, and very often, there is also a lack of interdisciplinary cooperation. Besides these general shortcomings, there are also deficits with regard to conceptualization and evaluation of treatment methods and measures of prevention. To overcome these deficits and shortcomings will be an important task for the future.     

The one-child family and violent criminality: a 31-year follow-up study of the Northern Finland 1966 Birth Cohort

OBJECTIVE: Serious defects in social skills acquired during childhood may be associated with aggressive behavior in later life. The authors studied whether being an only child was associated with criminality in adulthood and, secondly, if parental factors increased the putative risk. METHOD: The authors used an unselected, prospectively collected large birth cohort. Data on crimes were linked with being an only child as well as with perinatal risk and maternal and paternal psychological risk factors among male subjects. RESULTS: The risk for violent crimes later in life was elevated among the only children. If perinatal or parental risks were combined with being an only child, the odds ratios for violent offending increased four-fold to eight-fold. A corresponding risk increase between being an only child and nonviolent offending was not detected. CONCLUSIONS: These results support the hypothesis that growing up as an only child is associated with violent criminality among male subjects.     

Predictors of Program Use and Child and Parent Outcomes of A Brief Online Parenting Intervention

Web-based parenting interventions have the potential to increase the currently low reach of parenting programs, but few evidence-based online programs are available, and little is known about who benefits from this delivery format. This study investigated if improvements in child behavior and parenting, following participation in a brief online parenting program (Triple P Online Brief), can be predicted by family and program-related factors. Participants were 100 parents of 2–9-year-old children displaying disruptive behavior problems. Regression analyses showed that higher baseline levels of child behavior problems, older parental age and more intense conflict over parenting pre-intervention predicted greater improvement in child behavior at 9-month follow-up. Improvement in parenting was predicted by higher pre-intervention levels of ineffective parenting. Family demographics, parental adjustment and program related factors did not predict treatment outcomes. Younger child age and lower disagreement over parenting pre-intervention predicted completion of the recommended minimum dose of the program.     

Evaluation of an online training program to improve family routines,parental well-being,and the behavior of children with autism

BackgroundParents of children with autism spectrum disorder (ASD) are at an increased risk for stress, and their children often display high rates of problem behavior. There is a robust literature base showing that training parents to implement applied behavior analytic (ABA) interventions helps reduce their child’s challenging behavior. However, some parents continue to report high rates of stress that may interfere with implementation. Adding cognitive-affective strategies such as ACT and optimism training to ABA may be beneficial. Telehealth models have the potential to reach parents who may not otherwise be able to access parent training, making evidence-based programs more readily available.MethodTwenty-three parents (with 16 completing posttest assessments) of children with autism (ages four to eight) participated in a three-week online training program. Topics covered included instruction in ABA principles as well as stress reduction strategies and mediation practice based on ACT principles. The intervention included weekly synchronous online meetings with other parents and two parent educators, as well as supplemental assignments completed between sessions.ResultsWe found that after the intervention parents reported: (1) decreases in parental stress, (2) increases in relevant knowledge, (3) increases in child prosocial behavior, (4) decreases in hyperactive behaviors, and (5) high levels of satisfaction with the intervention.ConclusionsThis online program, combining ABA and stress reduction practices, resulted in positive outcomes for children with autism and their families. Although this was a small sample size, this early investigation offers promise for delivering this combined intervention approach effectively online. Training small groups of parents in an online format may be a feasible, efficient service delivery method.     

Prenatal and postnatal psychological symptoms of parents and family functioning: the impact on child emotional and behavioural problems

Although relations of various parental psychological problems and family functioning with child development are well documented, it remains unclear whether specific prenatal or specific postnatal risk factors are independently associated with child emotional and behavioural problems, or whether observed associations can be explained by general parental psychopathology. Using a stepwise approach, we examined the effects of prenatal and postnatal parental depressive symptoms, prenatal and postnatal hostility of the parents, as well as prenatal family functioning on the risk of child emotional and behavioural problems. This study was embedded in Generation R: a population-based cohort from foetal life onwards. Mothers and fathers of 2,698 children provided information about depressive symptoms, symptoms of hostility and family functioning during pregnancy and 3 years after birth. Mother and father each reported on child behaviour when the child was 3 years old. Parental depressive symptoms increased the risk of child emotional and behavioural problems, but this increase was explained by postnatal parental hostile behaviour. Postnatal symptoms of hostility of mothers (OR = 1.34, p value <0.001) and postnatal symptoms of hostility of fathers (OR = 1.30, p value <0.001) each contributed independently to the risk of child emotional and behavioural problems. Postnatal parental hostility is associated with an increased risk of child emotional and behavioural problems, independent of parental depressive symptoms. These findings suggest that prevention and intervention strategies should focus on psychological symptoms of both mothers and fathers, in particular on hostile behaviour, in families with young children.     

Families and intellectual disability

PURPOSE OF REVIEW: This review includes recent research pertaining to family functioning when there is a child or adult offspring with intellectual disability. The purpose was to broaden the examination of families research from an adjustment/coping perspective to consideration of more contextual factors (environment, culture, service delivery). RECENT FINDINGS: Studies continue to focus on parental well being, with parents of children with intellectual disability still showing evidence of stress and depression. Increasing evidence is accruing, however, that child behavior problems or specific syndrome more directly relate to poorer parental well being. On the other hand, parenting behaviors also contribute to child behaviors, with studies highlighting the importance of parenting context and dynamics. Interventions focus on child behaviors as well as on stress reduction for parents. Finally, the continued involvement of parents across the lifespan of their young adult with intellectual disability is apparent from studies of quality of life and living arrangements. SUMMARY: The well being of family members continues to be an area of interest, with special emphasis on siblings and cultural context. Methodological rigor in families research also continues to increase, with diverse methodologies represented. There is still a need, however, for the development of theoretical models within which to frame future research on topics such as siblings, as well as both negative and positive impact on families.     

Parental Reaction to Early Diagnosis of Their Children’s Autism Spectrum Disorder: An Exploratory Study

This study explores parental reactions subsequent to receiving their child’s autism spectrum disorder (ASD)-diagnosis. Seventy seven parents of recently diagnosed children participated in the Reaction to Diagnosis Interview. Within this group, associations between parental reaction to diagnosis, parental and child characteristics and prediagnostic circumstances were analysed. In a sub-sample, the stability of reaction to diagnosis was examined. The majority of parents were classified as ‘resolved’ regarding their child’s diagnosis. Conversely, parents of children with more severe ASD symptoms or non-Dutch parents were more likely to be classified as ‘unresolved’. Sub-sample analysis revealed stability of reaction to ASD-diagnosis. The majority of parents adapted well to the circumstances and the care for their child. Autism severity and parental nationality were significant factors affecting parental reactions. Thus, early identification of parental reaction to children’s ASD-diagnosis may aid in providing more tailored parental support programs.     

Child and adolescent internalizing and externalizing problems 12 months postburn: the potential role of preburn functioning,parental posttraumatic stress,and informant bias

Adjustment after pediatric burn injury may be a challenge for children as well as their parents. This prospective study examined associations of internalizing and externalizing problems in children and adolescents 12 months postburn with preburn functioning, and parental acute and chronic posttraumatic stress symptoms (PTSS) from different perspectives. Child, mother, and father reports of 90 children (9–18 years), collected within the first month and 12 months postburn, were analyzed. Results indicated that overall, child and parental appraisals of pre- and postburn behavioral problems were not significantly different from reference data. Rates of (sub)clinical postburn behavioral problems ranged from 6 to 17 %, depending on the informant. Pre- and postburn behavioral problems were significantly related, but only from the parents’ perspective. Path models showed an association between parental PTSS 12 months postburn and parental reports of child internalizing problems, as well as a significant indirect relationship from parental acute stress symptoms via PTSS 12 months postburn. Notably, no associations between parental PTSS and child reports of postburn behavioral problems were found. In conclusion, parental observations of child externalizing problems appear to be influenced by their perspectives on the child’s preburn functioning, while parental observations of internalizing problems are also related to long-term parental PTSS. However, these factors seem of no great value in predicting behavioral problems from the child’s perspective, suggesting substantial informant deviations. To optimize adjustment, clinical burn practice is recommended to adopt a family perspective including parent perception of preburn functioning and parental PTSS in assessment and intervention.     

Programming for generalization to high and low risk parenting situations in families with oppositional developmentally disabled preschoolers

This study examined the generalization effects of a training program for parents of oppositional, mildly developmentally disabled preschool children. Specifically, the study sought to determine the possible differential generalization effects of treatment to high and low risk parenting settings. Treatment comprised child management and planned activities training procedures specifically designed to enhance generalization effects. A multiple baseline design across subjects that incorporated a non-treatment control subject was employed. Dependent measures included deviant child behavior, accuracy of parent implementation of treatment procedures, and specific measures of aversive and non-aversive parent behaviors. Three of the treated families showed marked reductions in levels of deviant behavior, as well as increases in parental implementation of treatment procedures in both the training setting and the low risk generalization setting. Two of these three families showed comparable improvements in the high risk setting. The control subject showed little improvement in either generalization setting. It was concluded that the treatment program was effective in producing generalization effects in parent training.     

The impact of parental status on the risk of completed suicide

BACKGROUND: Although some studies suggest that parenthood is associated with a reduced suicide risk, the impact of children on parental suicide has rarely been documented. METHODS: This study investigates the impact of parental status on the risk of completed suicide in the context of other risk factors. A nested case-control design is used, matching for age, sex, and calendar time. The study is based on 4 Danish longitudinal registers, including 18 611 suicides of individuals aged 18 to 75 years from January 1, 1981, to December 31, 1997, and 372 220 matched control subjects. Information about children and subject's individual background is retrieved and merged. Data are analyzed using conditional logistic regression, yielding odds ratios interpreted as incidence rate ratios. RESULTS: The presence of children is protective against suicide in parents in terms of having children and, to a higher degree, having a young child; these effects exist even when adjusted for marital, socioeconomic, and psychiatric status; and their influences are much stronger in women than in men. At the same time, parents of children with a hospitalized psychiatric disorder and parents of children who have died are at an increased risk for suicide. A child dying during early childhood has a strong effect on suicide in parents, and a suicidal death of a child increases the risk of parental suicide more than a nonsuicidal death. The suicide risk is particularly high in the first month after losing a child. CONCLUSIONS: The impact of children on parental suicide can be protective because of having children. It can also be negative, for example, when losing a child, particularly if the child dies during early childhood; the risk is particularly high during the first month after the loss.     

Paternal Alcohol Abuse: Relationship Between Child Adjustment, Parental Characteristics, and Family Functioning

This study examines possible risk factors associated with child adjustment in a sample of children with alcohol abusing fathers in Norway (N = 37). Factors included are socio-economic status, severity of the fathers' alcohol abuse, parental psychological problems, and family functioning. Children of alcohol abusing fathers were found to have more adjustment problems assessed by CBCL compared to a general population sample. The findings further suggest that child adjustment in families with paternal alcohol abuse is the result of an accumulation of risk factors rather than the effects of the paternal alcohol abuse alone. Both general environmental risk factors (psychological problems in the fathers, family climate, family health and conflicts) and environmental factors related to the parental alcohol abuse (severity of the alcohol abuse, the child's level of exposure to the alcohol abuse, changes in routines and rituals due to drinking) were related to child adjustment. The results indicate the need to obtain both parents' assessments of child adjustment, as the fathers' assessment was associated with different risk factors compared to the mothers'.     

Psychiatric disorders in children and family dysfunction

Summary Children and families of Greek and Turkish migrant workers were compared with two samples of German subjects in West Berlin. One sample contained lower class subjects only, while the other was representative with regard to social class composition based on local census data. All four samples were matched with regard to age and sex of the children. While the Greek sample was based on epidemiological screening procedures of the total population of 8- to 11-year-old children, the Turkish subjects came from one primary school situated in an area densely populated by Turks. The study was based on parental interviews covering the areas of child psychopathology and family functioning. With regard to psychiatric disorders in children, the Turks had the highest frequency and the Greeks the lowest. The frequency of family-functioning disorders was distributed similarly. Although there were clear correlations between the severity of the child's disturbance and certain indicators of disturbed family functioning, migration factors did not have the same impact. It is hypothesized that different degrees of cultural pressure and family organization account for these findings.Supported by a grant from the Stiftung Volkswagenwerk     

Rehabilitation of the pediatric patient with a neuromuscular disease

A rehabilitation program for a patient with a neuromuscular disease can be developed only after an accurate diagnosis has been established. The diagnosis and its ramifications should suggest a natural course of disease which, it is hoped, can be improved upon with a rational and realistic program. The program is best developed by an interdisciplinary team, including a pediatric neurologist, who should have the greatest understanding of the patient's problem and should ultimately be responsible for the implementation and monitoring of the program. A child with cerebral palsy commonly requires the services of physical and occupational therapists as well as knowledgeable orthopedists. Is the program appropriate? Does it consider the child's potential as well as his limitations? A child with a traumatic brain injury requires, in addition to the above, psychological intervention and an intensive educational program. Will the child and family need help from mental health professionals? A child with a motor unit disease such as Duchenne's muscular dystrophy requires, in addition to the above services, a "philosophy" of care. Will the child ever ambulate independently? If so, at what cost? What will be necessary for the child to reach this potential, including items such as orthoses and adaptive equipment? Will respirator care become necessary? What issues must be addressed for this form of care to be established? There is no one program for all children. The programs must be individualized to meet the needs of the patient and the family. This point cannot be overemphasized.     

Cooperation and networking in early prevention and intervention and child protection: the importance of evidence-based methods

Prevention, intervention and child protection in early childhood essentially need well-established interdisciplinary systematic networking. Individual, heterogeneous and complex needs of families cannot be met by one profession alone. Successful cooperation of various institutions and professions is based on fixed arrangements and cooperation pathways. Networking has to be systematically established in everyday routine to be able to work in difficult emergency cases of child protection. Only well established cooperation is experienced as a support for the participants of the network and not as an additional complication. Prerequisite for such a development of favorable conditions is an evidence-based knowledge of the impact of different structures of cooperation, relations and conditions. This requires data collection with the aim of further empirically based development of local network structures. Three tools for such surveys have been developed and tested in the field.     

Symposium on ethics and morals related to antenatal treatment of pediatric neurosurgical disorders

In Austria, there is no need for treatment of defective fetuses in utero. First of all, the possibilities known so far are limited their effectiveness is debatable. Second, knowledge about fetal therapy is limited to a few specialists but so far is not practiced. The problems to be encountered in this new field and are discussed with regard to the ethical impact on the physician, the parents, and society, as well as the costs involved. The answer to this controversial subject is proposed using clear, irrevocable diagnostic procedures. Indication for surgery should cover the benefits to the child and parents and the benefits for society as well; justification of antenatal surgery should lead to a better understanding of the whole problem; all identical cases should be treated under identical circumstances; finally, justification for antental surgery or preterm delivery should not contradict or subvert our notion of fundamental and equal human rights. Progress in this field should be observed very critically.Presented at the 10th Annual Meeting of the European Society for Pediatric Neurosurgery in Aalborg, 1986     

Entwicklungspsychologische Beziehungstherapie (EBT) 4–10 – Ein bindungsorientiertes psychotherapeutisches Modul zur Förderung der Beziehung zwischen Eltern und ihren Kindern im Vor- und Grundschulalter

In this paper a therapeutic module is described, which aims at enhancing the parent-child-relationship during the kindergarten and primary school years. Its focus is on sensitizing the parent for the child?s perspective and experience, and by this to improve the quality of the relationship. Two methods are used both for diagnostics and for intervention: The German Attachment Story Completion Procedure (GEV-B) for middle childhood and new scales to assess parental sensitivity from observations of interactions. Systematic video-feedback using short episodes from both diagnostic assessment methods serves as the basic intervention procedure, which is embedded into a structured therapeutic session with the parent. The well established GEV-B proved to be appropriate for considering the increasing autonomy of the child within the parent-child-relationship and complementing standardized observations of parental sensitivity. A manualized curriculum is being prepared to train experienced psychotherapists. In this contribution the structure and first impressions on the feasibility are reported on how the model can be applied in families with a risk constellation. An example of a particular family intends to illustrate this.     

Violent behavior in children and youth: preventive intervention from a psychiatric perspective. Group for the Advancement of Psychiatry, Committee on Preventive Psychiatry

ObjectiveTo outline causative factors for the epidemic of violence among children and youth in North America and suggest roles for child and adolescent psychiatry in preventive intervention.MethodThe committee used literature searches to identify biological, psychological, and sociocultural factors associated with violent behavior.ResultsChildren and youth are both victims and perpetrators of violence. Risk factors include socioeconomic status, difficult temperament, chronic illness, psychiatric comorbidity, and parental psychopathology. Access to firearms in a culture of violence presents a particularly serious risk. Protective factors include intact family structures, prosocial peer groups, and supportive communities. Preventive interventions include the following: universal, addressed to total population groups; selective, for atrisk populations; and indicated, for children and youth developing violent behavior. Universal interventions including gun control and improved perinatal care are helpful, and selective interventions such as gun-free zones around schools may be successful. Indicated programs such as gun confiscation and conflict resolution for youth at serious risk may be useful, but only when embedded within well-funded, clinically based, and community-focused programs. Single-emphasis programs such as “Boot Camps” have intuitive appeal, but their utility is doubtful.ConclusionsViolent behavior can be prevented, and child and adolescent psychiatrists must be more active in community preventive interventions.     

Language of perfectionistic parents predicting child anxiety diagnostic status

Previous research has identified parental perfectionism as a risk factor for child anxiety. Yet few studies investigated why parental perfectionism may play such a role. Based on research suggesting parental verbal information and language use are associated with increased child fear beliefs and anxiety, the current study investigated the linguistic style of perfectionistic mothers and its relation to child anxiety. Participants were 71 mother–child dyads. Children were 3–12 years old, 57.7% female, and 30 were diagnosed with an anxiety disorder. Analyses showed that parental perfectionism was associated with increased second person pronouns, decreased adverbs, negative emotion words, and anger words. Second person pronouns and negative emotion words predicted child anxiety diagnostic status and mediated the relation between maternal perfectionism and child anxiety. These findings suggest that parental perfectionism may be associated with a specific language style that is related to child anxiety. Implications and future directions are discussed.     

Practice parameter: treatment of the child with a first unprovoked seizure: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society

The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence regarding risks and benefits. This parameter reviews published literature relevant to the decision to begin treatment after a child or adolescent experiences a first unprovoked seizure and presents evidence-based practice recommendations. Reasons why treatment may be considered are discussed. Evidence is reviewed concerning risk of recurrence as well as effect of treatment on prevention of recurrence and development of chronic epilepsy. Studies of side effects of anticonvulsants commonly used to treat seizures in children are also reviewed. Relevant articles are classified according to the Quality Standards Subcommittee classification scheme. Treatment after a first unprovoked seizure appears to decrease the risk of a second seizure, but there are few data from studies involving only children. There appears to be no benefit of treatment with regard to the prognosis for long-term seizure remission. Antiepileptic drugs (AED) carry risks of side effects that are particularly important in children. The decision as to whether or not to treat children and adolescents who have experienced a first unprovoked seizure must be based on a risk-benefit assessment that weighs the risk of having another seizure against the risk of chronic AED therapy. The decision should be individualized and take into account both medical issues and patient and family preference.