Twenty-five adolescents referred to an outpatient clinic because of school refusal in 1985-1986 were followed up after an average of 5 years. DSM-III diagnoses and scores on the Maudsley Symptom Checklist were obtained at initial contact and a follow-up. At follow-up, information was also gathered on psychosocial adjustment, and subjects completed self-ratings of anxiety and depression. At initial contact, school refusal was associated mainly with anxiety symptoms, and to a lesser extent with depressive and somatoform disorders. No specific relationships were found between diagnoses at baseline and at follow-up. About half of the sample still had a psychiatric disorder at follow-up. Outcome was negatively associated with a history of previous psychosocial or psychiatric treatment and a small family size, and positively with a history of frequent somatic complaints.
An important issue in current research on dyslexia is to what extent the reading deficits of dyslexic children are related to processing deficits at the sensory-visual level, at the cognitive-linguistic level or at both levels. Event-related potential mapping distinguishes the split-second processing stages during reading as brief brain-electric micro-states and can address this issue directly. Previously, conventional studies have yielded inconsistent patterns of event-related potential differences between dyslexic and control children, but most of these discrepancies could result from the widely differing methodologies. We used event-related potential mapping during silent reading of correct and incorrect sentence endings to examine the neurophysiology of sensory and cognitive processes in dyslexic and control children (n = 12/group). Selected findings from spatio-temporal analyses of map strength (global field power), map latency and map topography measured in three dimensions are presented. Both sensory-visual processes in a P110 micro-state and cognitive-linguistic processes in an early N400 micro-state were affected in dyslexic children, and processing delays, as well as qualitatively different patterns of neural activation, were found. Our findings also indicated that the use of specific cognitive tasks and of appropriate spatio-temporal analyses of event-related map series are critical factors for successful identification of specific processing deficits in brain mapping studies.
According to Boder, there are two processes involved in reading: visual-gestalt and analytic-phonetic. The gestalt process is activated for known words, forming part of the child's "sight vocabulary", and it enables him/her to recognize words even when they are exposed for a very short time. The analytic-phonetic process involves the auditory channel when the words are not part of the "sight vocabulary" and require a spelling process. At first, neither the English version nor the Italian adaptation of the Boder test included a control of word exposition time (ET) and reading time (RT). Both parameters are necessary for a check of the gestalt and phonetic processes. The aim of this paper was the assessment of minimum ET for the words belonging to the "sight vocabulary" and of RT for a word read through a gestalt process. Seventy-five primary schoolchildren from the first to the fifth class were presented with 100 meaningful words (MF) and 100 meaningless (ML) words, using ETs ranging from 150 to 650 ms. The results showed that, at the age of 7 years, the gestalt process was completely developed. Of MF words, 95% were correctly read and it did not change significantly with longer ETs. The RT for MF words did not change with different ETs and remained stable after the age of 7 years. Finally, the RT for ML words was always longer than the RT for MF words, and the difference was significant in 8-, 9- and 10-year-old children.
In a prospective epidemiological longitudinal study of children (n = 399) from age 8 to 18 years, children with specific reading retardation (n = 37) were identified by the modified Research Diagnostic Criteria of ICD-10. The group with specific reading retardation was compared with a group with other specific developmental disorders (n = 62), a group of children with normal intelligence (n = 285) and a group of children with below average intelligence (n = 15). No correlation was found between reading retardation and pre- and perinatal complications. Children with reading retardation suffered from environment-related stress factors in early childhood and adverse familial conditions at 8 years and the educational level of the mother was significantly lower. The number of additional psychiatric symptoms was increased at ages 8, 13 and 18. Conduct disorders, in particular, were more frequent in children with specific reading retardation and the rate of juvenile delinquency was increased (25%). The non-verbal intelligence remained constant between ages 8 and 13, and spelling performance developed parallel to the control group with normal intelligence. Only one out of three showed a significant improvement in spelling ability.
Contrary to the current assumption that there are no specific correlates of dyslexia in the standard clinical EEG, we have often noted a spontaneous "intermittent left parietal alpha desynchronization" (ILPAD) when visually evaluating the standard EEGs of children with delayed speech and language development and/or dyslexia. Visual evaluations of EEGs, as well as computer-assisted frequency analysis of three pairs of matched groups (healthy and hyperkinetic children with vs. without relatively "low levels" of verbal performance, as well as children with other child psychiatric disorders with vs. without dyslexia), revealed that healthy children did not display the ILPAD phenomenon. It was seen neither in healthy children with a homogeneous performance profile ("high level" of verbal performance) nor in those with a relatively "low level" of verbal performance. However, the ILPAD phenomenon was evident mainly in children with psychiatric disorders who suffered from dyslexia. Its intermittent occurrence prevented its detection by means of the usual computer-supported analyses of EEG power spectra. Nevertheless, auditory cognitive loading was accompanied by a decrease in alpha power in both healthy and hyperkinetic children with "high" or "low" levels of verbal performance. In a further group of 8-year-old children with dyslexia, but otherwise healthy, the ILPAD phenomenon was also observed if their CNS maturation as reflected in the EEG was normal for their age. These results seemed to indicate at least a deficit-specificity of the ILPAD phenomenon, which is interpreted as an electrophysiological correlate of a "brain-electrical developmental deviation" with regard to the "functions of communication": speech, language, reading and spelling.
The initial assumptions as to the existence of neurodevelopmental disorders have been confirmed by almost a century of studies focused on the nature and causes of reading disability. Dyslexia is an umbrella term for the various manifestations of reading disabilities, each of which is related to its own complex of neuropsychological dysfunctions, sometimes accompanied by neurological symptoms that can be indicative of the specific location involved. Electro-physiology and neuro-imaging in relation to metabolic activity have also confirmed that, to some extent, there is dysfunction in various cerebral areas, more frequently in the left than in the right hemisphere, less often between the hemispheres (corpus callosum) and outside the classical language areas. The rather rare subtype referred to as visual dyslexia and the inter-modal disconnection type resembling alexia are eclipsed by dyslexias related to spoken language: the dysphonemic (auditory-phonological) subtype and the subtypes that are concerned with the production of speech (fluency, word-finding, syntax, sequences), semantics (language comprehension) and linguistic memory. Although it is considered that there are basic brain dysfunctions in dyslexics such as deficits in sequential information processing, there is no "grand unified theory" of dyslexia. There are some new insights as regards the aetiology. In addition to indications of such possible causes as perinatal brain damage, genetic or chromosomal anomalies that manifest themselves in the substrate in an unclear manner, there is also the possibility that the cortical language areas can be disturbed in their development (migration disorders and abnormal asymmetry) due to genetic or epigenetic hormonal and/or immunological factors, so that the normal left hemispheric dominance does not develop. The diagnosis and treatment of dyslexia should begin at an early age and should be acknowledged as being of great social importance.
We studied testicular growth and psychosexual development in 41 young males who had survived malignancies in childhood. The focus of the study was evaluation of the connection between the possible pathologies of these two phenomena. The size of the testicles was measured in millilitres and compared with reference values. The psychosexual development was evaluated using three approaches: the interviewer's evaluation, the patient's subjective assessment and information gained by specific questions. On the basis of the developmental theory of adolescence described by Blos, the appropriate development in each criterion was defined. Our results indicated that both psychosexual and somatic development were impaired. A significant relationship existed between testicular size and three criteria assessed by the patients: the patients who felt that their pubertal development was different from that of their peers, those who felt that their developmental failures were related to their personal medical histories, and those who did not feel that they had the ability to have sexual intercourse and/or children. The last group had significantly smaller testicles than the others. We speculate that the perception of the small size of testicles may trigger the psychological experiences of failed development, leading to narcissistic problems in adolescent development. In order to prevent these harmful consequences it will be necessary for different specialists to work together with the families and patients.
Repressive defense style, characterized by low levels of self-reported distress and high levels of defensiveness, has been well studied in adult patients. This study identified four adaptive styles (repressor, impression manager, low anxious, and high anxious) in an adolescent psychosomatic patient sample (n = 120) by standardized psychometric examination. Adolescents with an active medical diagnosis on DSM III-R axis III or with an axis I diagnosis associated with physical symptoms (conversion disorder, somatization disorder, and psychological factors affecting physical condition) were more likely to be repressors. Those with affective disorders were more likely to be impression managers. Implications for pediatric and psychiatric management are discussed.
The Kiddie-Infant Descriptive Instrument for Emotional States (KIDIES), a new instrument that uses affective and behavioral dimensions for categorization, was compared with DSM-III-R criteria to assess diagnostic reliability in childhood pervasive developmental disorder (PDD). Forty-two children with PDD and other developmental disorders were evaluated. Their diagnoses were based on DSM-III-R criteria. Subjects were videotaped during interviews with three different partners and rated using the KIDIES. Cluster analysis of KIDIES ratings revealed a significant correlation with DSM-III-R diagnostic categories, demonstrating the potential reliability of the KIDIES dimensional approach for diagnosing PDD in preschoolers.
We recently presented the theory that parents should be intensively involved in the treatment of adolescents with anorexia nervosa during the acute re-feeding period and during follow-up. Thirteen anorectic patients with a mean age of 14.6 years (range: 12.6-16.5 years) were being treated in our pediatric day-care unit in Israel according to this treatment model when the Gulf War broke out. Because of the war, treatment was abruptly interrupted for approximately 6 weeks. Immediately after the war the patients were re-evaluated. We found that all of them maintained their weight, and two had even continued to gain weight. These results encouraged us to assume that our treatment model, based on intensive parental involvement especially during the acute re-feeding period, was effective.
Out of a collection of 121 child and adolescent psychiatric or psychological recommendations in family court cases, some 60 opinions were subjected to retrospective study. All the cases studied involved a single child to be recommended. In a retrospective analysis, the aim was to identify dangerous psychological constellations in the separating families, in particular typical behavioral and coping patterns of the parents in the process of separation and the typical reactive patterns of the children caught in the process. The study is designed as a descriptive analysis with the aim of sensitizing the helping-systems involved to better perception of such problem constellations. Thus it offers recommendations for parents, lawyers, judges and social-workers in the separation process.
A neurophysiological approach to developmental studies of childhood autism has revealed major cognitive and sensori-motor disturbances which are associated with impairment in social relationships. This new approach suggests the existence of underlying cerebral dysfunction, signs of which are revealed by functional exploration and cerebral imaging.
By the end of the nineteenth century, anorexia nervosa had acquired a certain amount of recognition in the medical literature in many countries. In Norway, however, little attention had been paid to this eating disorder. Some anorexic-like conditions can be found in case reports on "hysteria" in children, of which the article by Selmer, from 1891, is quoted in extenso.
This article is part of a special section on 'self-injurious behaviour and autism' and is mainly based on a book edited by Luiselli, Matson and Singh (1992) addressing empirical data on self-injurious behaviour and mental retardation from a behavioural perspective. Within the overview of the book some information on autism is also presented and critically discussed. Self-injurious behaviour is a poorly understood phenomenon and problematic in many ways; its definition is not easy; little is known about the causes and neuroscientific models. Demographic data are scarce and functional analysis and interventions (behavioural techniques, medication, education) need to be further developed, under the protection of human rights committees.
All means of exploring the psychological and environmental antecedents of murder by a child should be used toward preventing lethal outcomes in future. The authors present the case of a ten year old girl who killed her sister with details of the sisters' relationship, the perpetrator's psychological characteristics and the family situation. Sibling-rivalry, family stressors, and the perpetrator's compulsive and narcissistic traits and preoccupation with a violent television fantasy are discussed. A literature review and suggestions for future research are provided.
