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Objective: This study examined (1) the effects of type of malformation, sex of ratee, and sex of rater on facial attractiveness and facial impairment ratings, and (2) the reliability of judgments on facial attractiveness and facial impairment and the association between these two constructs., Setting: A university hospital for children., Participants: Raters were eight volunteers from the student population in a university, four men and four women., Main Outcome Measures: Raters judged frontal and lateral view slides of children with various types of craniofacial malformations both on a 5-point facial attractiveness scale and on a 5-point facial impairment scale., Results: Main effects were found for type of malformation, sex of ratee, and sex of rater. No interaction effects were found among type of malformation, sex of ratee, and sex of rater. Interrater reliability was moderate to high, both for attractiveness ratings and for impairment ratings. The correlation between facial attractiveness and facial impairment was also moderate to high. CONCLUSIONS; Both condition parameters (type of malformation) as well as social parameters (sex of rater and sex of ratee) seem to influence judgments on attractiveness and impairment. Facial attractiveness and facial impairment can be rated reliably in children with (cerebro)craniofacial dysplasias. Raters consider these concepts to be very similar but not identical.

Behavioural, cognitive, and affective aspects of social functioning of 107 children with a chronic illness were studied. The aim of the study was twofold: (1) to describe peer interaction of children with a chronic illness in comparison with normative data of healthy children; (2) to examine whether peer interaction was related to the illness characteristics physical restrictions and pain. Peer interaction was assessed with measures of social activities (CBCL), parent-reported social skills (CABS), child-reported social skills (MESSY), social self-esteem (SPPC), and social anxiety (SASK). Results showed no differences between diagnosis groups, suggesting that the social consequences of chronic illness are not diagnosis specific. Compared with healthy norms, chronically ill children reported less aggressive behaviour. The parent-report measures suggested a similar trend. Children with chronic illness also tended to display more submissive behaviour than healthy norms, as perceived by their parents. With regard to illness characteristics, both physical restrictions and pain were associated with restricted social activities, but not with other measures of social peer interaction. Children who display submissive behaviour and children who are restricted in their social activities should receive extra attention because they are especially vulnerable for problems in their social development.

Unlabelled: In the Netherlands a case control study into cot death was undertaken as part of the European Concerted Action on sudden infant death syndrome. Children between 1 week and 2 years of age who died suddenly and unexpectedly were reported. Non cot death cases were excluded after a consensus by three pathologists. The study comprised 73 cot death cases and two controls per case, matched for date of birth. Compared to national data, the coverage was 91%. We investigated whether in the Netherlands new risk or preventive factors might have emerged. The present report focuses on the relative risks of dummy use, thumb sucking, breast versus bottle feeding, and sleeping with the mouth open., Conclusion: Dummy use seems to be an important preventive factor for cot death in the Netherlands, independent of other risk factors such as prone sleeping and bedding. We recommend dummy use at least for bottle-fed infants. We found no indication that dummies influence the frequency or duration of breast feeding but more data are needed. Mouth breathing appears to be associated with an increased risk for cot death, but again further research is needed.

This study aimed to assess whether previously established risk factors for sudden infant death syndrome (SIDS) are still valid now that the incidence in the Netherlands has dropped to 0.26 per 1000 liveborn infants. A distinction was made between immutable and mutable risk factors. This case-control study (part of the European Concerted Action on SIDS) comprised 73 SIDS cases and 146 controls and lasted from March 1995 to September 1996. Adjustments were made for sleeping position and bedding factors by treating them as covariables. Apart from these factors, well known risk factors that remain of importance in the Netherlands are: male sex, young maternal age, twins, and low socioeconomic status. These factors are largely immutable. Other well known risk factors which might reflect attitudes to child care and could possibly be mutable are: smoking, alcohol consumption by the mother, bottle feeding, and change of babycare routine. Intervention strategies should focus on early signalling, thereby assisting parents in changing these unfavourable parenting attitudes. Information on optimal child care and extra support by public health nurses specifically aimed at families at risk could help to decrease further the incidence of SIDS in the Netherlands.

Unlabelled: In the Netherlands an 18 months case control study into cot death was undertaken as part of the European Concerted Action (ECAS) on sudden infant death syndrome to determine the relative risk of prone sleeping and other sleep practices. Physicians in the Netherlands were asked to report to the study centre all sudden and unexpected deaths of children between 1 week and 2 years of age. Non cot death cases were deleted from further analysis after a consensus was reached by three pathologists, not primarily involved in the post mortem diagnosis. A positive response of families was achieved in 91% of cases registered in the Central Bureau of Statistics. The study comprised 73 cot deaths and 146 controls, two for each case and matched for date of birth. All families were visited at home for completion of a questionnaire. The cot death rate has dropped considerably over the past 10 years after the recommendations on supine sleeping to a low of 0.26 per 1000 live born infants. In addition to the ECAS objective, we wanted to establish whether previously found risk factors are still valid in the present situation or that new factors might have emerged, some of them possibly protective., Conclusion: Placing an infant prone or on side on last occasion, secondary prone position (not placed prone but turned to prone), inexperienced prone sleeping and use of a duvet, leading to head and body being covered, were shown to be risk factors. Preventive factors were using a cotton sleeping-sack and a dummy. Even in a low incidence country, such as the Netherlands, there are indications that further prevention is possible.

Objective: To inventory the reasons adolescents give for their perceptions of events, thoughts, and feelings in the last days and hours before and during the attempt., Method: A semistructured interview also included the administration of an instrument that contained the formulation of reasons., Results: The most frequently mentioned reasons for attempting suicide concerned the cessation of (an unbearable) consciousness. The motivation most frequently named for "crossing the bridge" between thinking about and attempting suicide involved an escalation of frustration and tension., Conclusions: Special emphasis should be given to family relationships, relationships with peers and friends, frustration tolerance, and the way in which adolescents handle their problems.

Differences in social support, behavioral characteristics and life events between four groups of adolescents were investigated, one group consisting of suicide attempters and depressed adolescents showing problematic psychological scores and high risk for attempting suicide, and three other groups with lower risk and other (combinations of) psychological characteristics. The high-risk group distinguished itself from the psychologically most "normal" group by reporting less support and understanding from siblings and relations outside the family, more changes in living situation (life-time), more changes in caretaker and physical abuse during childhood, more changes in living situation and sexual abuse during adolescence, and more siblings leaving home during the preceding year. On a behavioral level, they reported consuming more alcohol and running away more often. The only exception to this was support and understanding from other relations: high-risk adolescents experienced more, especially in the last year. A possible explanation is that these subjects, due to the turmoil in their families, relied more on persons outside their families. Differences between the high-risk group and the other two groups are described in terms of the relation between the dependent variables and the psychological characteristics. Implications for assessments in emergency rooms is discussed.

An empirical classification of 203 adolescent suicide attempters (mean age 17.3) was achieved using multiple correspondence analysis. The characteristics upon which the classification is based concern sociodemographic as well as psychological variables. Two groups are identified: the first is predominantly characterized by recent problematic behaviors, whereas the second group is primarily characterized by problematic circumstances. Analyzing related variables, the first group seems to have special clinical and preventive interest, because of its high risk for recidivism. The second group seems to have a satisfactory level of functioning.

Using a semistructured interview, psychological characteristics were gathered from three groups of adolescents: 48 suicide attempters, 66 depressed, and 43 nondepressed adolescents who never attempted suicide. Various characteristics reported in literature discriminated the attempters from the normal group but not from the depressed group. These characteristics probably are not specific for adolescent suicide attempters. Even when a discriminant analysis was applied, the suicide attempters showed many similarities with the depressed adolescents, although both these groups could be separated from the normal group. Using follow-up data, the quadrants created by the axes appeared to have more implications for prevention than for the a priori group membership.

A pilot-study was carried out on support measures chosen by 40 families having a subsequent child after their experience with a cot-death infant. Cardio-respiratory monitors were used in one group and weighing scales in the other. General support measures given to both groups included the keeping of symptom charts and weekly visits by health-nurses. Parents who used a home-monitor relied upon the medical-technical approach of the problem, while parents using scales were mainly given confidence by the personal attention of the health-nurse. Monitor-parents more often called the paediatrician for advice than parents using weighing-scales. Especially parents who used weighing-scales commented on the great value of the symptom diary and the weekly home-visit of the health-nurse.

Most of the characteristics differentiating between adolescent attempters and nonattempters do not have discriminative power in comparing 48 adolescents who recently attempted suicide with 66 depressed adolescents. These characteristics may probably be attributed to an affective disorder that is present in most of the suicide attempters. However, suicide attempters, compared with the depressed group, live in more problematic circumstances (such as family disruption or sexual abuse) and have a cognitive style that promotes a more negative evaluation of events and situations. Their depressive symptoms are distinguished from the depressed group by withdrawal and isolation, besides maintaining a hopeless and negative expectation of the future. Furthermore, there are reasons to accept the idea that suicidal behavior is a serious alternative within their behavioral repertoire. Based on these findings, a psychological interpretation is given concerning the dynamics leading to a suicide attempt. Also, intervention strategies are discussed.

Objective: Although the relationship between experience of problematic life events and adolescent suicidal behavior has frequently been recognized during the past decade, few studies of life events have been initiated that discriminated between adolescent suicide attempters and depressed adolescents. Therefore, the authors compared adolescent suicide attempters with both depressed and nondepressed adolescents who never attempted suicide with respect to life events that happened in two periods: childhood (defined as the period up to age 12 years) and adolescence (age 12 and older)., Method: Using a semistructured interview, the authors gathered life event data about childhood and adolescence from three groups of adolescents: 48 suicide attempters, 66 depressed adolescents who had never made a suicide attempt, and 43 nondepressed adolescents who had never made a suicide attempt., Results: The group of adolescents who attempted suicide differed from both of the other groups in that they had experienced more turmoil in their families, starting in childhood and not stabilizing during adolescence. During adolescence, they were more often sexually abused. During the last year before the attempt, further social instability, such as changes in residence and having to repeat a class, occurred., Conclusions: For suicidal adolescents, the suicide attempt seems embedded not just in the problems every adolescent has to deal with but in greater turmoil in their families, rooted in childhood and not stabilizing during adolescence, in combination with traumatic events during adolescence and social instability in the year preceding the attempt.

A group of 48 adolescents who recently attempted suicide and 66 depressed adolescents were compared on sociodemographic, behavioural, psychological and relational variables. The variables which proved significant were used in different combinations in stepwise logistic regression analyses, resulting in seven variables which served as the content of an index of risk. The sensitivity of the index was 90% and the specificity 83%. At one-year follow-up the occurrence of a suicide attempt correlated with score on the instrument.

The subject of this study is the effects of transcultural sojourn and culture shock on the psycho-social development and school achievement of Dutch children. One hundred and three Dutch children in the age range 6-17 years who stayed abroad with their parents for at least two years and returned to Holland were compared with 81 Dutch classmates of the same age and sex. The class teacher and parent(s) were the informants. The transcultural group showed more behavioural problems on the Dutch version of the Child Behavior Checklist developed by Achenbach. Parents of the transcultural group regarded their children on a modified Graham & Rutter questionnaire as less happy than the control parents. However, no differences were found for academic achievement or problem behaviour at school as assessed by the teacher version of the CBCL, the 'Teacher's Report Form' (TRF). Organizations which send their employees abroad should direct more attention to employees' children. Attention given by parents and teachers to language problems and school performance should not pre-empt close attention to the psycho-social development of children.

From nearly 10,000 secondary education students in The Netherlands, aged 14-20, data were collected on the prevalence of suicide attempts and recent thoughts about suicide and death. In this sample, 3.3% of the girls and 1.3% of the boys indicated that they had attempted suicide. The youngest students already reported as many attempts as the eldest, which is remarkable. Differences between boys and girls and between various types of schools were not substantial. We also found that 5.2% of the girls and 2.2% of the boys currently had thoughts of suicide. Again, there was no substantial difference as regards sex, type of school, and age. There was, however, a (small) difference between boys and girls concerning thoughts of death--namely, 9.3% of the girls versus 4.8% of the boys.

The characteristics of suicide attempters were ascertained in a sample of 9393 Dutch students aged 14-20. Broken homes and use of drugs and alcohol were found more often among attempters. Attempters more frequently lived with a single parent, in children's homes or foster homes, were disproportionately of female sex, reported more deaths of friends or relatives, and more often had an unemployed father. Thoughts of suicide and of death were reported more frequently, they were more depressed and hopeless, and had less self-esteem. They were less rational and perceived relationships with parents as poor.

In this article the results of a study to determine the degree of somatopsychic vulnerability in children with encopresis are discussed. A checklist was constructed for the registration of somatic and functional data relevant to encopresis. Twenty-five children with encopresis were compared with a control group. The expectation of the authors that a number of somatopsychic phenomena would occur more frequently among encopretics than among non-encopretics could not be confirmed. It appeared that somatic and psychic diseases were more frequent in the families of the children with encopresis than in the control group.

This article deals with the care and treatment of the adolescent in hospital. As a result of changes in society and alterations in the biological and psychological patterns of growth adolescents are being increasingly regarded as a distinct and separate group. In the authors' opinion medical care in the Netherlands is still not sufficiently adapted or geared to the needs of the adolescent. The authors propose that special facilities be created for adolescents in hospitals and out-patient departments, along the lines of those currently available in the U.S.A. The establishment of special adolescent units in children's hospitals and general hospitals requires considerable organisation and the recruitment of suitably qualified staff; in addition, medical students and nurses must be given factual and scientifically accurate information about adolescence during their training courses.

In the Netherlands home-monitoring of infants has been used since 1978, although not as widely as in other countries. For years it has been discussed whether a cardio-respiratory monitor can prevent SIDS. Controversies still exist about the criteria for home-monitoring and the reliability of the device. In this article, the history of debates on home-monitoring since 1972 is reviewed as well as current opinions and controversies.

433 medical and mental health institutions in the Netherlands took part in an investigation into the incidence of suicide and suicide attempts in children. The investigation is also concerned with the form that suicidal behaviour takes and an attempt is made to identify demographic and social characteristics of the children involved. The results show that suicide attempts do not constitute a very large problem in children aged 5-14; attempts hardly occur at all in children under the age of 11, but the incidence increases with age. It is also clear that children who make suicide attempts live in a problematic background situation.

With the help of a questionnaire and the study of 25 cases of child abuse from 1973 to 1976, the course of assistance given by various services and social workers involved was followed and the extent of the coordination between them was assessed. The starting point was the fact that when child abuse has reached the crisis stage many different bodies give immediate assistance to both the child and his parents. Later on, however, as help continues, it is not clear which of the persons or bodies concerned is really in charge of the case. The following conclusions were drawn: Abused children came from multiproblem families who often already have had contact with care or welfare services though no steps had been taken to intervene before ill-treatment was verified. Many parents confessed to ill-treatment of their child and desired help. Abused children were subjected to longer than usual hospital stays due to lack of reception facilities outside the hospital. Most ill-treated children abused enough to be hospitalized, were placed away from home although half of the parents did not agree with that decision. Of those later returned to their parents, over half had to be removed later for renewed ill-treatment and neglect. The need for one body to coordinate and be responsible for execution of plans for treatment was stressed.