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This reprinted article originally appeared in American Journal of Orthopsychiatry, 1979, Vol. 49, No. 2, 240-245. (The following abstract of the original article appeared in record 2013-43131-006.) The fourth follow-up study of adolescent delinquent boys treated in a community-based program that combined job placement, remedial education, and psychotherapy indicates that the better overall adjustment of the treated group, compared to untreated controls, is maintained well into adulthood. It reaffirms the importance of developing sound, innovative means of reaching adolescents in crisis, and suggests the value of a fullscale replication of the original program.

Allogeneic bone marrow transplantation in the E.U. is a routine treatment which requires specific legal procedures to protect under-aged donors. The European Council (5/29/1978) decreed the guidelines concerning organ transplantation for the Member Countries. These guidelines included obtaining written consent from the donor or his/her guardian. The International Convention on children s rights (New York 11/20/1989, art. 12) stated that the minor has the right to give his/her opinion, which must be taken into consideration. Currently, though legal guidelines vary among Member Countries, all require the parents or guardian s written consent. In France, an ethics committee (L. 76-1181/1976) must inform the minor about the consequences of the procedure, respect his/her will and obtain consent. In Luxembourg, the Department of Health requires written consent as well as authorization by three experts, including two physicians. In Spain an ethics committee must obtain the minor s consent which is then approved by a government authority and counter-signed by a physician. In UK an N.H.S. directive (1st Aug. 1993) states that as of 16 years of age donors must give consent. In Germany minors over 14 are allowed to give consent. A legal guarantee is required when the recipient is a parent to avoid conflict of interest. In Belgium minors between 15 and 18 require witnessed written consent, counter-signed by the guardian and approved by a physician. Married donors below 21 need the consenting adult s approval. In Portugal verbal consent by the minor and the guardian is sufficient. In Denmark the guardian s written consent is needed. In Italy a law is being prepared to best protect minors. In conclusion it would be useful for the European Council to decree the detailed legal guidelines and require greater uniformity among the E.U. Countries.

Central Venous Catheter (CVC) allows the administration of drugs, parenteral nutrition and blood sample taking for laboratory tests, avoiding continuous damage to the peripheral veins. Most of the psychological traumas caused by crude treatments also decrease and therefore CVC may initially be experienced as the end of continuous physical injuries. Nevertheless, it often happens that other sorts of psychological trauma, due to fantasies and fears elicited by the CVC, arise in children and their families. The CVC is often felt as a dangerous and invasive "foreign body". Moreover after it has been used for a long time it may create a psychological state of dependency and it frequently becomes the only means of salvation. This makes removal particularly difficult and it is felt as a "cutting" of the CVC at the end of the therapy. Young patients elaborate complex fantasies about the starting point, the route and the end point of the catheter. Their parents are often unknowing accomplices of these fears, partially because they project their own experience and also because they are conditioned by the way they have elaborated the information provided by the assistance staff. Since the handling of CVC is under the parent's responsibility when the child is not in Hospital, we should be able to help the patients and their families to cope with this experience in the most suitable way. This makes it possible to avoid both excessive worries and the tendency to underestimate the risk of infection. This is why we consider that submitting children and their family members to interviews, surveys and spontaneous drawing is wise in order to evaluate the existence, nature and extent of the fantasies. This helps to modify possible distortions both of perception and behavior.

In 1982, the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) started its third-generation study, aiming to improve previous results obtained by AIEOP '79 study and to deliver a standardized treatment to most Italian children with acute lymphoblastic leukemia (ALL).We treated 902 children (older than 1 year and younger than 15 years of age) with newly diagnosed ALL in multicenter studies of risk-directed therapy (111 low risk [LR] from Study 8201; 570 average risk [AR] from Study 8202; and 117 and 104 high risk [HR] from Studies 8303 and 8503, respectively). Induction therapy was composed of vincristine, prednisone, and asparaginase for LR or AR patients and these agents plus daunorubicin, (Study 8503) or vincristine, prednisone, cytarabine, and intermediate-dose methotrexate (Study 8303) for HR patients. Central nervous system (CNS) preventive therapy consisted of intrathecal methotrexate only (LR), intrathecal methotrexate plus 18 Gy cranial irradiation (AR and HR Study 8503), or high-dose (HD) cytarabine (HR Study 8303). Reinduction therapy was vincristine/prednisone/daunorubicin for AR patients with cyclophosphamide added for HR patients in Study 8303 and HD asparaginase in Study 8503. LR patients did not receive intensification therapy. Continuation therapy comprised 6-mercaptopurine plus methotrexate and monthly pulses with vincristine plus prednisone for all patients, except for HR patients in Study 8303 who also received teniposide plus cytarabine. Weekly HD asparaginase was also given in Study 8503. Duration of treatment was 24 months for Studies 8201 and 8202, 15 months for Study 8303, and 22 months for Study 8503. The overall complete remission (CR) rate was 94.7% (97.3% for LR, 94.9% for AR, and 93.2% for HR).Overall 7-year event-free survival (EFS) was 53.6% (standard error [SE], 1.8). EFS was 60.8% in LR (SE, 4.7), 60.6% in AR at 7 years (SE, 4.7), and 18.5% in Study 8303 (HR) at 5 years (SE, 3.8). Because of the poor result in HR patients, a successor study (8503) was developed that yielded a 5-year EFS of 46.1% (SE, 5.1). Site-specific relapse rates were 18.5% (LR), 13.4% (AR), 35.1% (HR on 8303), and 18.3% (HR in Study 8503) for bone marrow and 9.2%, 7.9%, 17.5%, and 19.3%, respectively, for the CNS (isolated). Isolated testicular relapse was observed in 3.9% of male patients.This risk-directed therapy cured at least 50% of patients with ALL with relatively nonintensive therapy. The 80% overall survival rate for LR and AR patients at 7 years suggested that the total cure rate may be higher than 50% because of the significant salvage rate for patients who received antimetabolite-based therapy initially.

A follow-up study of the adolescent delinquent boys participating in a new comprehensive, vocationally-oriented psychotherapy program reported earlier revealed that two to three years following termination the treated boys continued to show major improvement in ego functioning, though at a slower rate than during treatment. An untreated group deteriorated during that time. The results are of significance in planning programs of intervention, especially with lower socioeconomic groups.

In the present study, 15 children with non-Hodgkin lymphoma have been immunologically evaluated by the following parameters on peripheral blood (PB) lymphocytes: phytohemagglutinin responsiveness (PHA-r); non-immune rosette formation with sheep red blood cells (RF-L) as T-cell marker; presence of surface immunoglobulins (sIg-L) as B-cell marker; serum immunoglobulins levels (IgA, IgM, IgG). Our patients (pts) have been divided in two groups: the first one includes 10 children without PB involvement; the second one includes 5 pts with bone-marrow and PB invasion. From our data it appears that: 1) the majority of pts of the first group presented normal values of membrane markers; PHA-r was impaired in 4/8 pts; 2) in pts with PB invasion absolute number of B and "null" cells was always abnormal and PHA-r altered; 3) in the second group of pts, a "null" cell origin can be suggested by the high percentage and absolute number of cells without surface markers. In our opinion, the high incidence of "null" cells represents the most relevant question: whether they are cells deprived of specific markers, or endowed with markers not identifiable by our current techniques, remains to be established.

This is the second in a continuing series of followup studies of adolescent delinquent boys successfully treated in an experimental program five years ago. Few legal difficulties, stable employment, and personal growth were shown in those treated. On the other hand, three of the untreated youth were in adult correctional institutions, employment was irregular, personal rewards few. Contact with usual rehabilitative agents of society seemed unable to reverse the deterioration in the untreated group.

Traditional approaches to the treatment of adolescent delinquent boys have frequently been unsuccessful. A vocationally oriented psychotherapeutic program, administered by a single practitioner and utilizing job placement, remedial education and intensive psychotherapy in a concrete and individualized manner, brought about significant improvement in learning, personality structure and overt behavior.

The third in a series of follow-up studies of adolescent delinquent boys successfully treated in a community-based program that combined job placement, remedial education, and psychotherapy shows significantly better overall adjustment in the treated group when compared with untreated controls. The lack of any major change in direction over a decade seems to confirm the significance for later development of identity formation during adolescence, and the need for priority to be given to innovative means of reaching adolescents during the crises that arise in that developmental period.

Many previous studies on the relationship between inhibition of expression of hostility in thematic stories have focused on the severity of the punishment rather than the quality of the guilt expressed. Using a more subtle approach, it was found that an increase in the level and quality of guilt expressed in TAT stories was significantly associated with a reduction in unsocialized behavior. The results suggest that an analysis of guilt along dimensions of internalization, the concern for others, and the desire to change offers a way of dealing with thematic productions that is more consistent with our clinical observations and understanding.