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Background: Controversy exists about the efficacy of psychotherapy for the mental health problems of sexually abused children.Aims: To compare the relative efficacy of focused individual or group therapy in symptomatic sexually abused girls, and to monitor psychiatric symptoms for persistence or change.Method: A multi-centre psychotherapy outcome study recruited 71 sexually abused girls aged 6-14 years who were randomly assigned to focused individual psychotherapy (up to 30 sessions) or psychoeducational group therapy (up to 18 sessions). Changes over the course of the study were monitored.Results: Both treatment groups showed a substantial reduction in psychopathological symptoms and an improvement in functioning, but with no evident difference between individual and group therapy. However, individual therapy led to a greater improvement in manifestations of post-traumatic stress disorder (PTSD).Conclusions: The beneficial effects on PTSD support the use of individual therapy. However, the small sample size and lack of a control group limit conclusions about changes attributable to treatment. [ABSTRACT FROM AUTHOR]

Background: There is widespread belief in a 'cycle' of child sexual abuse, but little empirical evidence for this belief.Aims: To identify perpetrators of such abuse who had been victims of paedophilia and/or incest, in order to: ascertain whether subjects who had been victims become perpetrators of such abuse; compare characteristics of those who had and had not been victims; and review psychodynamic ideas thought to underlie the behaviour of perpetrators.Method: Retrospective clinical case note review of 843 subjects attending a specialist forensic psychotherapy centre.Results: Among 747 males the risk of being a perpetrator was positively correlated with reported sexual abuse victim experiences. The overall rate of having been a victim was 35% for perpetrators and 11% for non-perpetrators. Of the 96 females, 43% had been victims but only one was a perpetrator. A high percentage of male subjects abused in childhood by a female relative became perpetrators. Having been a victim was a strong predictor of becoming a perpetrator, as was an index of parental loss in childhood.Conclusions: The data support the notion of a victim-to-victimiser cycle in a minority of male perpetrators but not among the female victims studied. Sexual abuse by a female in childhood may be a risk factor for a cycle of abuse in males. [ABSTRACT FROM AUTHOR]

This article presents an interview with behavioral scientist Michael Rutter. He explains the factors that have contributed to his creativity. When asked whether there are any particular individuals who influenced his life course, he mentioned his teachers and George Gorman in the Quaker youth groups outside school. When asked about whether he speaks Arabic because he lives in the Middle East, he pointed out that he spoke Arabic when he was in Lebanon but this ability is now completely gone.

The article profiles behavioral scientist Michael Rutter, who has focused on the field of child mental health over the past 50 years. A brief review of the psychology of creativity is presented and then the nature and origins of Michael Rutter's creativity are examined. It is observed that Rutter combines many off the qualities and factors that shape a creative individual, such as early family stimulation, intellectual nourishment in school, and scientific stimulation.

Background: There is evidence that exposure to social and family disadvantages in childhood are a risk factor for adult depression.Aims: To explore the effects of multiple adversity in early childhood on adult depression, and the relative effects of the different adversities.Method: This study utilises data from the Newcastle Thousand Family Study. Information on childhood disadvantages was collected when the participants were 5 years old, and information on mental health was gathered when they were 33 years old. Mental health data were scrutinised blind to the evidence of early disadvantage, and best-estimate diagnoses of major depressive disorder were made according to DSM-III-R criteria.Results: Multiple family disadvantages in childhood substantially increase the risk of suffering a major depressive disorder in adulthood. Such disadvantages include family or marital relationship instability, a combination of poor mothering and poor physical care, and a combination of dependence on social welfare and overcrowding. For females major depression was linked in particular to the quality of parenting in early life.Conclusions: Social and family (especially multiple family) disadvantages during childhood predispose individuals to an increased risk of major depression in adulthood. [ABSTRACT FROM AUTHOR]

The article discusses the physical, psychological and social care of children living on the Island of Leros in Greece. The Children's Care Institution on the island was established in 1962. It is attached to PIKPA, the largest child welfare organization in Greece. Mental health services in Leros has been criticized locally and internationally. However, the situation has improved through the influence of public opinion and the European Economic Community's support of intervention programs.

The dexamethasone suppression test was carried out on 44 children to assess agreement with diagnosis of depression. No significant association was found between suppression of plasma cortisol and depression diagnosed clinically or by cluster analysis. [ABSTRACT FROM AUTHOR]

A comparison was made of the reliability and validity of two self-rating scales, the Children's Depression Inventory (CDI) and Depression Self-Rating Scale (DSRS), in the diagnosis of depression in 93 children (aged 8-1 6 years) attending a university child psychiatry department. The two scales were of comparable merit but had only moderate discrimination between depressed and non-depressed children, with each scale having a misclassification rate of 25%. Better agreement was obtained in more verbally intelligent children, irrespective of age. Girls scored higher on the instruments than boys. No significant relationship was found between teacher assessment of classroom behaviour and the two self-rating depression instruments. [ABSTRACT FROM AUTHOR]

This paper examines the family background, premorbid personality traits and adverse life events preceding childhood depression. The non-depressed group proved more likely to have experienced pre-school bereavement and familial disturbance, and to come from the more deprived background; there was also an excess of premorbid anxiety and hysterical personality traits in this group. School phobia and premorbid obsessional traits were associated with the depressed group. Although there was an association between depression and the total number of adverse life events, this was more substantial when the perceived impact of the events was taken into account. Of the individual classes of life event, only illness and a change in social relationships were associated specifically with depression. [ABSTRACT FROM AUTHOR]

The extent of the similarities and discrepancies in the reporting of depressive symptomatology by children and their mothers was examined. Child-parent agreement was not always impressive, particularly for more subjective symptoms. It is suggested that direct psychiatric assessment of children provides a more accurate picture of their mental state regardless of presenting disorder, but particularly where depression is suspected. [ABSTRACT FROM AUTHOR]

A tota of 275 successive referrals to a university child psychiatry unit out-patient department were examined using the Child Depression Inventory. Of these, 95 children were examined further by a structured clinical interview, and the relationship between different instruments for the assessment of depression in childhood was investigated. Just over one-third of the children (35%) had significant depression, and it was found that depression may be missed unless children with other psychiatric diagnoses are examined closely. Multivariate analyses of the clinical data provided factorial validation of diagnoses when employing different clinical diagnostic schemas. [ABSTRACT FROM AUTHOR]

A rare opportunity to study deprivation and criminality across generations arose from the follow-up of the families who participated in the Newcastle Thousand Family Survey. The data on these families had been preserved and it was possible, using criminal records, to examine longitudinally whether children who grew up in 'deprived' rather than 'non-deprived' families were more at risk of offending during later childhood and beyond. The results of this study suggest that this is indeed so. [ABSTRACT FROM AUTHOR]

The timing and number of recent stressful life events occurring in the year before onset of emotional or behavioural disorder was examined in a consecutive sample of children. Overall, events increase the relative risk of psychiatric disorder by 3-6 times. Events occur throughout the 12 months, but tend to cluster in the 16 weeks nearest onset of symptoms. The number of events influences the onset of disorder: cases with multiple events are more likely to have an event within 16 weeks of onset; cases with single events are more likely to have the event 36-52 weeks before onset. Cases whose onset occurs within 4 weeks of an event may have experienced single or multiple events. The results support the concept of additivity of recent stressful events in some cases of emotional and behavioural disorders in childhood. [ABSTRACT FROM AUTHOR]

As part of a larger study, a brief rating-scale was developed which focuses on the mid-adolescent phase of development. Completed by teachers, the questionnaire has an inter-rater reliability of 0.78, with a test-retest correlation of 0.82. When the performances of various screening instruments were compared it became clear that no single questionnaire was obviously more efficient than the others at detecting potential disturbance in an urban adolescent population. Indeed, different questionnaires seemed to highlight particular facets of functioning. The Newcastle Adolescent Questionnaire proved to be a reliable and valid screening measure. [ABSTRACT FROM AUTHOR]

A sample of children and adolescents (n = 157) attending a child psychiatry outpatient clinic with conduct or emotional disturbance were compared with community controls (n = 76) for the number and type of recent life events. A Life Events Schedule for children and adolescents was developed and used as a semi-structured interview. Four clinical groups were identified according to their predominant presenting symptoms (conduct, mild mood, severe mood, or somatic). An excess of events carrying a severe degree of negative impact was found for all four groups, compared with matched controls. Eleven classes of events were examined: there is a suggestion that two classes (martial/family, accident/illness) may be more important for conduct and mild mood disorders, and that a further class (permanent separations, termed exits) may be more important for somatic and severe mood disorders. [ABSTRACT FROM AUTHOR]

Fifty-one school phobic children, aged nine to fourteen years, were assessed for psychiatric diagnosis; this revealed the presence of two clinically meaningful sub-groups--depressed and residual school phobic. A wide range of symptoms were studied to identify those which might prove useful in diagnosing adult-type depression in childhood and early adolescence, both in terms of frequency of symptoms in the depressed group and the extent of the distinction between the two groups. Eleven such key symptoms were identified and based on these, a formula for diagnosing adult-type depression was evolved. The validity of several different ways of classifying the above cases were explored; these covered: kind of disorder; type of onset; adolescence versus pre-adolescence; and sex of the child. However, on only one dichotomy--depression versus absence of depression--were there many significant discriminants. Affective symptomatology of more recent onset was contrasted with pre-morbid personality traits, usually associated with school phobia. There was no evidence to support the concept of 'masked depression' in childhood. [ABSTRACT FROM AUTHOR]

A double-blind trial failed to demonstrate any significant short-term effects of clomipramine in doses recommended for use in general practice (in addition to the usual range of psychotherapeutic help) in the treatment of children with school refusal and neurotic disorder. Patterns of improvement were also studied for the sample as a whole irrespective of treatment. Neither age nor sex were significantly related to improvement, except on one behavioural measure where girls initially did better than boys. In addition, it was found that there was a rapid relief of depression but neurotic symptomatology tended to persist. [ABSTRACT FROM AUTHOR]

Junior schoolchildren were screened for high risk of emotional and educational disorder. The information was gathered from the school, using standard and objective tests. The multiple criterion screen employed, comprised: (a) classroom behaviour scale (Rutter B Scale), rated by teachers; (b) sociometric tests; choice of companions by classmates. From these, lack of positive choices was taken as a measure of isolation and a high rate of negative choices, as a measure of rejection; (c) Reading quotient of 75 or below on the Young Reading Test; (d) Absence from school for reasons considered by teachers to be trivial. The number of cases identified by the screening was found to be 322 children per thousand. They may be seen as representing a high risk rate. Using extreme scores as indicative of high risk, approximately 17 per cent of children were identified on the basis of the behaviour test; 12 per cent by the reading test; 9 per cent by the isolation test; 8 per cent by the rejection test and 3 per cent by the absenteeism test. Seventy per cent of the identified children were rated clinically as disturbed. Absenteeism identified the smallest percentage of cases and made the smallest independent contribution of identification. Isolation was not impressively related to neurotic or antisocial behaviour. The three important criteria, therefore, were behaviour, rejection and reading. Corrected disturbance rates for our population of 7-8-year-old children, including those not identified by the screen, were 6-8 per cent markedly maladjusted and 33-7 per cent somewhat maladjusted. [ABSTRACT FROM AUTHOR]

The article presents a study on the dimensions of behavior among infant school children based on the reports of their parents. The study employed a questionnaire that asks questions about children's behavior, its frequency and its severity. Some of the behavior features classified in the questionnaire are absence of guilt, infantilism, restless sleep, relationships with siblings, bedwetting and obsessionality. It indicated that the behavior of infant school children can be related to conduct disorder and neurotic disorder.

The article presents a study of various symptomatic, physical and social aspects of 47 cases of infantile psychosis and 33 cases of late onset psychosis, focusing on the cognitive development of the psychotic children admitted at the Park Hospital for Children, Oxford, and the Newcastle Child Psychiatry Unit. The study used the Welchsler Intelligence Scale for Children on older, more accessible and brighter children in a routine psychological testing and in other cases the Merrill-Palmer was utilized. Findings revealed that in the first three years of life, onset of psychosis was associated with major intellectual deficit and later onset was linked with only moderate deficit. Moreover, low intelligence quotients tended to be associated with cumulative cerebral dysfunction in early onset.

The article presents a study of cerebral dysfunction of 46 children suffering from infantile psychosis (IP) and in 33 suffering from late onset psychosis (LOP). Child psychoses were divided into three groups, those beginning before the age of three; those between the age of three and five; and those beginning after the age of five. They were studied in terms of anomalies in perinatal life and by neurological and electroencephalogram (EEG) examinations. Findings revealed that 46 percent of IP cases and 69 percent of LOP cases had not been found any evidence of the dysfunction. In addition, the research showed evidence that more of the pure IP cases came from the first and second levels of the social class.

The article presents a study which tests the common assumption in child psychiatry that the personality and attitudes of parents is a fundamental influence on the developing child. Researchers aims to examine it relative to aberrant personality and undeniable psychiatric disorder in childhood. Researchers studied the personalities of the mothers of 79 children with infantile psychosis (IP) and long onset psychosis (LOP) and were administered with Maudsley Personality Inventory (MPI). MPI revealed that 42 percent of the mothers of 32 children with LOP were considered as introverted, but only 13 percent of the mothers of 46 children with IP. Also, those parents with IP children were overprotective.

The article presents a study which aims to explore whether the family and social background distinguishes childhood psychoses. The study involves 47 infantile psychoses cases and 33 long onset psychoses cases. Findings suggest that the different childhood psychoses are associated to social class, with the strong possibility that IP is common in the fist and second levels of the social class. In addition, a trend was shown in the mothers of LOP children towards a degree of social isolation, attributed to their personalities. It also found out that parent of IP children had a low rate of schizophrenia while parents of the LOP children had a significantly high rate which reflects a genetic association between childhood LOP and adult schizophrenia.

The article presents a study which analyzes the clinical picture of eighty psychotic children at Oxford or Newscastle, classified as suffering from infantile psychosis (IP) or from late onset psychosis (LOP). Researchers observed that LOP children showed disorder of form and stream of thought and disordered thought content while IP group was characterized by severe speech delay and many speech anomalies. The study also discussed the problems of accurately evaluating the presence of LOP and IP phenomena. Moreover, authors remarked that LOP cases with a simple schizophrenic picture maybe confused with IP cases of the same age if a clear medical history is not shown.

The article presents a study which discusses the division of childhood psychoses. They can be grouped into: (1) children with early onset and a slow chronic course; (2) children age three to five years with an acute course followed by regression; and (3) children aged over 5 years with a late onset and a fluctuating subacute course. Details of the researchers' ascertainment criteria in the study, the infantile psychosis and late onset psychoses are also discussed. Meanwhile, the study reported in the paper evaluates the value of distinction by age onset and creates the frequency of occurrence of the different signs in the different clinical groups.

A letter to the editor is presented in response to a commentary on the article about depression in school phobia, published in the March 1986 issue.

Over the recent past, reports have argued that there has been a decline in the mental health of children and young people in Western societies. This is said to have occurred gradually over the second half of the last century and possibly longer. This view is based on evidence of a progressively declining peak age for adult type depressive disorders, and an apparent increase in adolescent disturbance such as substance abuse, attempted and completed suicide, perhaps eating disorders, and behaviour disorders. These phenomena have been attributed to the major changes in social values and behaviour, with their impact on child rearing and family life that gathered pace over the course of the last century.

Objectives: This paper explores the relationship of hyperactivity (HA), conduct disorder (CD) and combined hyperactivity and conduct disorder (HACD) with certain environmental and biological stresses and vulnerabilities., Method: It is based upon a large epidemiological database from the North of England., Results: The findings suggest that CD is uncommon and strongly related to environmental stresses. This is true to a lesser extent of HACD. While both CD and HACD were related to family adversity and adverse styles of parental discipline, subtly different patterns of associations are also evident. In particular, CD is linked with poverty, parental violence and contact with child care social agencies. These findings are consistent with the hypothesis that HA contributes to a pattern of confrontation and punishment associated, in some cases, with the emergence of a more complex combination disturbance. However, CD occurs against a background of family conflict and poor child-care., Conclusions: Most apparent cases of conduct disorder are in fact hybrid conditions including symptoms of HA and CD. True CD should be diagnosed not only by positive symptomatology but also by the absence of hyperactivity symptoms.

The 4th- and 5th-year pupils of four large comprehensive schools, which were broadly typical of the schools serving an urban population, were screened using a multiple criterion approach. The screen results were compared with those found in a younger population drawn from the same area, and a similar rate of efficiency was found. However, in the adolescent age group the screen was more accurate at detecting true negative cases (specificity) but less able to identify true positive cases (sensitivity). Overall, the multiple criterion screen proved more efficient than a variety of single screen criteria, and the findings also suggest that certain screen measures used in adolescence may be more effective at identifying disturbed girls while others are more effective at identifying disturbed boys. This confirms the principle that the choice of screening instruments must be made with reference to their proposed use.

A multiple criterion screen was developed as part of a study which was designed to assess different types of intervention for school children with psychiatric disorder. The foremost requirement was that false positives be kept to a minimum, with selected children being unequivocally disturbed. Children were identified for treatment by the following measures: (a) teacher rating on the Rutter B2 Scale, giving a total score and subscores for neurotic and antisocial behaviour; (b) peer ratings on a sociometric measure, yielding isolation and rejection scores; and (c) self ratings on the Junior Eysenck Personality Inventory, specifically the neuroticism dimension. A weighting system was developed so that children could be selected on the basis of extreme scores on either teacher or self-rating measures alone, or by a combination of less extreme scores on more than one measure. The results are presented and discussed.