Search

The purpose of this paper is threefold: (a) to report an unusually high prevalence of encopresis in a sample of boys in psychiatric residential treatment; (b) to explore the possible relationship of sexual abuse to the development of encopresis in these cases; and (c) to discuss the diagnostic and treatment implications of our findings.

This article reviews the diagnoses with which dissociative identity disorder/multiple personality disorder (DID/MPD) is often confused, and it reviews ways to distinguish DID/MPD from these conditions. The article suggests techniques for tapping dissociative symptoms in children. It also provides figures to illustrate the way writing samples and drawings produced prior to evaluations can be used to confirm the diagnosis of DID/MPD.

Adults with dissociative identity disorder/multiple personality disorder often describe having had very vivid imaginary companions in childhood. Little is known, however, about the phenomenon of imaginary companions in children with dissociative disorders. This article explores differences in the number, nature, and functions of imaginary companions of abused, severely dissociative boys and of normal school boys.

There is a consensus in the literature that early, severe maltreatment antedates dissociative identity disorder/multiple personality disorder (DID/MPD). Most data on maltreatment, however, are gathered retrospectively from the patient only. This article presents the cases of six violent, incarcerated men with DID/MPD. It documents from records and family interviews their childhood and adult dissociative symptoms and signs and their abusive childhood experiences.

Anecdotal evidence points to a tendency for dissociative identity disorder/multiple personality disorder (DID/MPD) to run in families. This article reports on the prevalence of dissociation and other psychopathology in the families of 11 children with DID/MPD and dissociative disorder not otherwise specified. It describes the perpetuation of violent behaviors and dissociative defenses from one generation to the next.

In a follow-up study of incarcerated Connecticut youth, 66 subjects participated in extensive personal interviews. This paper documents discrepancies between early data regarding abuse and retrospective self-reports of abuse given at the time of follow-up. It describes the development of an interview protocol in which inquiries regarding medical history, the general temperament of caretakers and their behaviors when intoxicated, and instruments and methods of punishment used in the home enabled subjects to describe abusive experiences not disclosed in response to direct questions about maltreatment. The paper also discusses the use of explicitly worded probes to flesh out a clear picture of subjects' experiences. The conflicts that underlie denial or minimization of abuse are discussed, along with interviewing strategies for overcoming them.

This paper reviews the psychophysiological literature related to violent behaviors. It explores the interactions of environmental influences, pain, stressors, hormones, and neurotransmitters. It presents ways in which maltreatment in the form of abuse or neglect exacerbates preexisting psychobiological vulnerabilities. It proposes that whatever forces increase impulsivity and irritability, engender hypervigilence and paranoia, diminish judgment and verbal competence, and curtail the recognition of pain in the self and others, will enhance violence, and presents evidence that maltreatment has all of these effects.

Eighteen males condemned to death in Texas for homicides committed prior to the defendants' 18th birthdays received systematic psychiatric, neurologic, neuropsychological, and educational assessments, and all available medical, psychological, educational, social, and family data were reviewed. Six subjects began life with potentially compromised central nervous system (CNS) function (e.g., prematurity, respiratory distress syndrome). All but one experienced serious head traumas in childhood and adolescence. All subjects evaluated neurologically and neuropsychologically had signs of prefrontal cortical dysfunction. Neuropsychological testing was more sensitive to executive dysfunction than neurologic examination. Fifteen (83%) had signs, symptoms, and histories consistent with bipolar spectrum, schizoaffective spectrum, or hypomanic disorders. Two subjects were intellectually limited, and one suffered from parasomnias and dissociation. All but one came from extremely violent and/or abusive families in which mental illness was prevalent in multiple generations. Implications regarding the ethics involved in matters of culpability and mitigation are considered.

Objective This paper describes the adult adaptation of a group of 97 formerly incarcerated male delinquents. Method Follow-up clinical interviews were administered to subjects, approximately 9 years after discharge from uvenile corrections. The records of the correctional school, state police, FBI, state psychiatric hospitals, and state health department also were reviewed. Results All but six had adult criminal records, most for violent crimes. Only 10% were graduated from high school; 30% received minimal job training; most worked sporadically at unskilled jobs. Few married. Although 35 had fathered children, only 5 were living with them. Psychiatric treatment for identified vulnerabilities was negligible. Upon discharge, the most neuropsychiatrically impaired and violent subjects tended to be placed in adult corrections; the most intact were placed in special schools and psychiatric hospitals. Numbers of vulnerabilities continued to contribute most significantly to violent outcome regardless of placement. Placement in families was associated with fewer adult aggressive offenses than was institutional placement, even while controlling for vulnerabilities and early juvenile violence. Conclusions Based on their well-documented early vulnerabilities and needs, this sample of delinquents did not obtain the kinds of supports subsequent to juvenile incarceration that might have enabled them to function independently in society.

Twenty-one female delinquents, neuropsychiatrically evaluated while in a juvenile correctional facility, were followed up to 7 to 12 years later. Compared with a matched sample of male delinquents, they committed fewer and less violent offenses. Unlike the males, early biopsychosocial variables were not predictive of adult criminality; however, most females were seriously impaired neuropsychiatrically. Mortality rates were high. Having come from abusive households, the female delinquents became suicidal, alcoholic, drug addicted, enmeshed in violent relationships, and unable to care for their children.

This study reports the high prevalence (42%) of physical abuse in the histories of 166 psychiatrically hospitalized children and adolescents and identifies those characteristics of abused patients that distinguish them from their nonabused counterparts. Although psychiatric symptoms were similar in abused and nonabused patients, injury to the central nervous system was more prevalent in the abused patients. The abused were significantly more violent and their parents were more psychiatrically impaired. Implications of these findings for identification and treatment are discussed.

This paper reports results of a study of medical histories of black and white delinquents and a matched sample of nondelinquents. Medical records were analyzed in terms of numbers and timing of hospital contacts, nature of services used, and reasons for contacts. Black delinquents made somewhat more hospital visits than white delinquents. White delinquents had significantly more hospital contacts and accidents, injuries, illnesses, and psychiatric problems than white nondelinquents. Findings are discussed in terms of the relevance of particular medical events to the development of maladaptive behaviors, the tendency of clinicians to dismiss as culturally expectable certain medical and psychological factors in black children and their families, and the failure of physicians to recognize the existence of severe family disorganization in black children with multiple hospital contacts.

Antisocial behavior in childhood is one of the most ominous predictors of future serious psychopathology (Robins, 1966). The purpose of this section is to present some of the current ways in which investigators are exploring the subject of antisocial behaviors in children. Unless we are able to increase our understanding of the etiology, treatment, and prevention of delinquency, it is a certainty that many of the children seen presently in child guidance clinics because of antisocial behaviors will be psychiatrically hospitalized or living marginal existences as adults (Robins, 1966). The psychobiological exploration of childhood deviance comes after a long period of time when psychoanalytic and social theories dominated the field of delinquency. Aichhorn (1925), Healy and Bronner (1936), Bowlby (1944, 1951), Anna Freud (1949), Johnson (1949), Glueck and Glueck ( 1950), Greenacre (1950), and others focused on the effect of intrapsychic mechanisms and parental attitudes on children’s deviant behaviors. Simultaneously, and perhaps in reaction to the failure of psychiatrists to pay sufficient attention to social influences on behavior, sociologists called attention to environmental factors contributing to delinquency. They encouraged the examination of cultural biases affecting the interpretation of deviance (Becker, 1963; Shaw and McKay, 1942). Sociological

This paper reports the results of a comparison of degrees of violence in adolescents psychiatrically hospitalized in the late 1960s and adolescents hospitalized 10 years later. The authors studied a random sample of 51 adolescents, including 26 boys and 25 girls in the late 1960s, and a random sample of 51 adolescents matched for sex and race 10 years later. Psychiatrically hospitalized girls in the 1970s were significantly more violent than psychiatrically hospitalized girls in the 1960s. The implications of these findings are discussed.

This study compares the neuropsychiatric, intellectual, and educational status of extremely violent and less violent incarcerated boys. The more violent children were more likely to demonstrate psychotic symptomatology (paranoid ideation and rambling, illogical associations) and to have major and minor neurological abnormalities. They were also more likely to have experienced and witnessed extreme physical abuse. The contribution of these factors to violent delinquency is discussed and implications for therapeutic intervention are suggested.

This paper hypothesizes that a linkage exists between some delinquency and the schizophrenic spectrum of disorders. Data from retrospective studies, follow-up studies, family studies, and our clinical and epidemiologic studies are presented to support this hypothesis.

This paper reports the neuropsychiatric status of a sample of incarcerated white female juvenile offenders and compares their status to a sample of incarcerated white male juvenile offenders. Males and females had a similar prevalence of psychiatric and neurological impairment. More violent males were significantly more impaired than less violent males. There was a tendency for more violent females to have greater impairment than less violent females. The paper questions the prevailing literature indicating greater psychopathology in female offenders than male offenders. It explores issues of sex and race bias in the assessment of the neuropsychiatric status of offenders. Journal of the American Academy of Child Psychiatry , 21, 2:190–196, 1982.

A follow-up study of 51 children who had previously been in residential treatment for an average of 25.5 months revealed that the majority had a poor outcome in terms of subsequent psychopathology and social adaptation. Differences in age, nature of psychopathology, and parental psychiatric illness were found between good-outcome and poor-outcome children. Numbers of prior placements did not distinguish the groups. Independent rating and documentation of life events were found to be more accurate measures of outcome than clinical assessments. Implications of the findings are discussed.

Of 56 school age children admitted over a 1 year period to an urban inpatient psychiatric ward serving primarily lower socioeconomic class children, 12 were signed out against medical advice. These children were significantly more likely to have been seriously physically abused. They were more likely to have had previous psychiatric hospitalizations or residential placement. There was also a tendency for fathers to have had psychiatric treatment, be alcoholic and be drug abusers, and for the children to have higher IQs and be more violent. In addition, four particular characteristics of parents and one of children appeared clinically to be associated with these ill-advised discharges.

The neuropsychiatric status and reading grade level of 59 adolescent incarcerated male delinquents were studied. Contrary to expectation, there were no significant neurological differences between the severely reading-disabled subjects and the better readers, although abnormal EEGs, choreiform movements, and inability to skip were somewhat more characteristic of the poorer readers. The most striking differences were psychiatric in that paranoid ideation, illogical thought processes, and visual hallucinations were significantly more prevalent in the group of especially poor readers. They also had problems with calculation and short-term memory. Poor readers were more violent than better readers. The findings of severe behavior problems and reading disability are considered in relation to Piagetian cognitive theory.