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The interindividual varying cognitive performance in female patients with Turner's syndrome has usually been attributed to the interindividual varying mosaicism with a consecutive variable loss of X-chromosome DNA or to secondary risk factors such as estrogen deficiency owing to ovarian failure. The aim of our study was to determine the specific impact of X chromosome-related features and associated risk factors, on the one hand and familial influences, on the other hand on the interindividual variation in the cognitive phenotype. One hundred and one subjects with Turner's syndrome and 53 sisters as controls for familial influences were examined by comparing the cognitive information processing abilities (Kaufmann Assessment Battery for Children [K-ABC]). Subjects with Turner's syndrome performed at a significantly lower level than sisters on all subscales (eg, Mental Processing Composite: Turner's syndrome 86.4 [SD 15.0] versus sisters 99.3 [SD 10.6]; P < .001). For the neurocognitive phenotype in subjects with Turner's syndrome, a significant correlation was found only with the sisters' cognitive abilities (Mental Processing Composite: r = .38, P < .05). In contrast, neither the individual mosaic status nor the known associated risk factors predicted the neurocognitive phenotype in Turner's syndrome. These results are corroborated in the regression analyses in those subjects with Turner's syndrome with a sister (Simultaneous Processing[subsister] for Simultaneous Processing[subTurner's syndrome]: β = -346, P < .05, corrected R² = .049; and Mental Processing Composite[subsister] for Mental Processing Composite[subTurner's syndrome]: β = .354, P < .05, corrected R² = .033). The interindividual variation of intellectual abilities in Turner's syndrome seems to be primarily related to familial coinfluences and not to the interindividual varying loss of X-chromosome DNA in terms of hidden mosaicism or potential associated risk factors. (J Child Neurol 2004;19:183-190). [ABSTRACT FROM AUTHOR]

Doctors and especially paediatricians in clinics and private practices are often the first professionals to be confronted with the suspicion of a child endangerment (sexual abuse, physical abuse, neglect, Munchausen-by-proxy syndrome). They thus play a key role in the early assessment and clarification of suspicion and setting the course for the further interdisciplinary procedure.The clinical investigation of a suspicion is a diagnostic and communicative challenge. The procedure includes biomedical diagnostics, structured medical history based on standardized questionnaires and a forensic (investigative) interview of caregivers and especially of the affected child.The child's statements are subject to various risks of bias. The mental processing of events can modulate and distort the scope and quality of the report in many ways. Expectations on how the professionals will use this information and the consequences that may arise for the family as well as the resulting conflicts of loyalty are superimposed on the child's willingness to talk and to provide valid statements. On the part of the interviewer too, motivational, affective and cognitive processes pose risks for a suggestive influence on the child as well as for the objectivity in carrying out the interview and the interpretation of the findings. Complex pitfalls endanger the validity and forensic usability of the interview results. In order to assure the quality of their findings, interviewers are therefore required to carefully register and reflect on their own motivational tendencies and implicit hypotheses, to know and avoid suggestive question formulations and to make use of standardized interview protocols whenever possible.

Psychodynamic findings based on the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) in patients with Anorectal Malformations (ARM) in comparison to psychiatric patients were presented focussing the psychic structure. Patients with ARM had significant better psychic structure especially with regard to coping with conflicts and communication of affects. Furthermore typical findings were generated: Patients with ARM had better treatment conditions and more positive relationships. Still they had fewer hypotheses about their disease and greater living burden. Structural strengthes facilitate acceptance and integration of the disease. Nonetheless more attention should be paid to child-oriented psychoeducation for development of age-appropriate hypotheses about the disease. Facing living burden, psychological-psychiatric support should be offered to patients with ARM., (© Georg Thieme Verlag KG Stuttgart · New York.)

Anorectal malformations are inborn developmental defects that are associated with multiple functional Impairments (especially incontinence) and psychosocial burden with a major impact on body schema and self-esteem. Child psychology and psychiatry research begin to identify disorder-dependent and -independent risk and protective factors that predict the outcome of psychological adaptation and quality of life. The present paper analyses the interference of structural and functional disease parameters with the achievement of regular developmental tasks, presents a hypothetical conceptual framework concerning the development of psychological adaptation and quality of life in ARM, integrates findings from empirical research with the framework presented and outlines strategies of psychological support from a cognitive-behavioural perspective within a multidisciplinary treatment approach to enhance medical, functional, and psychosocial quality of life.

Similar to the adult patient, a child or adolescent may actively feign or produce artificial symptoms (synonymous: Munchausen syndrome). The more frequent case is that the child suffers from being an object of symptom fabrication induced by a close person caring for the child, regularly the mother (Munchausen syndrome by proxy). This review focuses on psychopathological aspects of the clinically more relevant factitious disorder by proxy. Typical behaviour and personality characteristics are presented that can be taken as clinical warning signs. Doctor-mother-interaction is affectively challenging due to conflicting tasks imposed on the physician. Complementary to pediatric exclusion of genuine disease, psychopathological assessment is required to exclude other sources of deviant illness behaviour. Factious disorder shares particular features (active violation of the child, false report of history, aggravated symptom presentation and increased doctor-hopping, difficulties in conforming maternal report in biomedical data) with other psychopathological entities (child abuse, simulation, dissociative disorders, somatoform disorders including hypochondria, variants of maternal overprotection and infantilization, psychosis or delusion in the mother). Criteria for differentiation are presented. Three concepts on the psychopathological etiology of factitious disorder by proxy are relevant: In some cases, it may be conceived as secondary manifestation of a primary psychopathological entity or personality disorder. Learning theory emphasises operant rewards received from vicarious sick role. Attachment theory provides possible explanations concerning the traumatic impact on the child, early sources of psychopathology in the fabricating mother and risks for intergenerational transmission of factitious disorders.