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Nous presentons une etude des antecedents pre- et post-natals de certains indices aux âges de 6 a 24 mois du developpement mere-enfant et du developpement socio-emotionnel de l'enfant. Les hypotheses suivantes ont guide notre etude: 1. Une mere qui est secure avant la naissance de son enfant sera plus impliquee dans le travail de l'intervention a domicile, et, lorsque son enfant aura 24 mois, sera plus receptive aux besoins de son enfant, encouragera l'autonomie de son enfant, et utilisera des formes de controle verbales et positives. Dans ce contexte de relation, on s'attend a ce que les enfants de deux ans soient soignes, fassent preuve de plus d'autonomie, et repondent plus positivement au controle de la mere. 2. Dans un mode regressif d'analyse, les cinq antecedents qui suivent seront des facteurs supplementaires de prediction du resultat a deux ans: a) la reaction de la mere quand l'enfant a un mois et l'irritabilite du nourrisson, b) le partenaire de la mere quand l'enfant a six mois et le soutien familial, c) l'implication de la mere dans le travail de l'intervention durant la periode de 7 a 12 mois. Des analyses de mesure repetees de la variance et des analyses de regression ont demontre que l'etat secure/autonome de la mere avant la naissance de l'enfant etait lie au resultat durant la periode de 6 a 24 mois et a son implication dans le travail de l'intervention, et que ce dernier constituait de maniere consistente un antecedent important pour le resultat a 24 mois. Les implications du resultat etant anticipees a la fois par les caracteristiques familiales et par l'implication de la mere dans l'intervention sont discutees.

Acute Abdominal Pain and Peritonitis: Pathophysiology and Therapeutic Concepts The understanding of pathomechanisms is of utmost importance for diagnosis and treatment of acute ab

Il a ete demontre que le groupe d'intervention a domicile mere-nourrisson de l'Universite de Californie a Los Angeles avait eu un impact positif durant les deux premieres annees de l'enfant sur deux indices du soutien de la mere et sur trois domaines de developpement mere-enfant et de developpement de l'enfant: (1) La receptivite de la mere aux besoins de son enfant et le developpement qui y est lie de la securite de l'attachement chez l'enfant; (2) l'encouragement a l'autonomie de son enfant que prodigue la mere et le developpement de son autonomie qui y est lie chez l'enfant; (3) l'encouragement a participer a des tâches que prodigue la mere a son enfant et le developpement de sa participation a completer des tâches qui y est lie chez l'enfant. Lorsque les enfants avaient deux ans, les meres faisant l'objet de l'intervention, compare a celles qui n'avaient pas fait l'objet de l'intervention, utilisaient aussi des methodes de controle verbalement persuasives et non coercitives et importunes, et leurs enfants reagissaient de facon plus positive a ces controles. Les meres qui n'avaient pas connu l'aide de l'intervention avaient bien plus de difficultes a controler leur enfant si c'etait un garcon, par rapport a une fille. Elles utilisaient des methodes de controle moins appropriees et lse garcons reagissaient plus negativement a ces controles. La nature du developpement de l'utilisation que fait la mere de controles appropries et de la reaction de l'enfant a ce controle fut elucidee en determinant, a partir de l'echantillon total, quels antecedents constates a l'âge de 12 mois influencerent les indices de controle soit independamment de ou en interaction avec le statut d'intervention. L'endurance de l'enfant dans la situation de test fut un indicateur independant de controle maternel approprie et la reaction positive de l'enfant a ce controle en l'absence d'intrusion maternelle mit mieux en valeur l'impact de l'intervention sur ce controle.

32 formerly monosyndromatic enuretic patients who had been treated for this condition between 1980 and 1992 were compared with a matched control group from the general population in respect of sociobiography, psychopathological and dimensional factors (depressiveness, satisfaction with life, global functioning). Most of the former patients did not fulfil diagnostic criteria for an ICD- 10 diagnosis at follow-up, although there was a 37% vs. 9% difference between former patients and controls in this respect - without a clear diagnostic pattern of such disorders. Furthermore, former patients had slightly higher depression scores and slightly lower global functioning than controls at follow-up. These results confirm that childhood enuresis has a low negative predictive value concerning the development of psychiatric disorders, although it may constitute a vulnerability factor.

Une comparaison de groupe effectuee a deja demontre que dans les familles faisant l'objet de l'intervention du Projet de Developpement Familial de l'Universite de Californie a Los Angeles (par opposition a un groupe qui n'avait pas fait l'objet de cette intervention), les meres reagissaient particulierement bien aux besoins de leurs nourrissons et les nourrissons etaient plus stables dans leur attachement a leur mere. L'etude que nous presentons examine si les variations trouvees dans ces resultats a la suite de la participation a une intervention basee sur la relation sont anticipees par la participation maternelle a l'intervention, le soutien du partenaire, les dimensions de la personnalite, et les interactions mere-nourrisson qui ont ete evaluees au debut du processus d'intervention. L'echantillon consiste en quarante cinq meres a risque pour un parentage inadequat, egalement pauvres et dans l'ensemble sans soutien. Nous avons trouve que, a l'âge de 12 mois, les variations de la reaction positive de l'enfant a la separation, le fait qu'il ou elle s'attende a ce que l'on prenne soin de lui (avait un sentiment de securite), et la reaction de la mere au besion de l'enfant sont anticipees par des variations dans la participation de la mere aux visites d'intervention a domicile durant la periode de 6 a 12 mois, ainsi que la qualite du soutien offert par son partenaire, mesure a l'âge de 6 mois, et sa propre confiance, sa capacite a former des relations stables et son manque de doute de soi. Les parents qui, a un mois, reagissaient aux besoins des bebes les plus apaises avaient bien plus de chance d'avoir des enfants stables a l'âge de 12 mois, mais ces associations n'etaient pas aussi solides que celles resumees ci-dessus.

Cette etude montre qu'une intervention basee sur une relation de visites a domicile, telle qu'elle est definie par le Projet de Developpement de la Famille a l'Universite de Califomie a Los Angeles. affecte certains domaines du fonctionnement familial au moment ou l'enfant atteint l'âge de douze mois. Nous avons compare deux echantillons (pris au hasard) de m'ageres etant identifiees comme etant a risque de parentage inadequat durant le troisieme trimestre de leur grossesse pour leur premier enfant. Les caracteristiques essentielles de risque etaient la pauvrete et le manque de soutien. Trente et une de ces meres ont eu une intervention et trente trois n'en ont pas eu. Les meres ayant recu l'opportunite de developper une relation positive de confiance et de travail avec un visiteur a domicile hebdomadaire ainsi qu'avec un groupe mere-nourrisson ont bien mieux reussi aux mesures. L'intervention a aussi eu un impact significatif sur trois transactions critiques socio-emotionnelles mere-bebel durant la premiere annee des enfants. Ainsi, sur un eventail d'indices (comprenant les reactioins a la Situation Anormale Ainsworth), les enfants du groupe d'intervention etaient plus cofiants et leurs meres plus attentives a leurs besoins. Les enfants ayant eu l'experience de l'intervention etaient aussi plus autonomes et plus portes a effectuer des tâches, et y etaient encourages par leurs meres.

In this prospective study of divorce in the first 4 years of life we have shown that previous marital patterns anticipate the occurrence of divorce and influence the response to that event. Most of the divorces occurred in marriages that were consistently low in satisfaction or decreased in satisfaction from birth on. The family response to the event differed. The continuing effort at conflict resolution and the fact that differing levels of adjustment are reached at different time points are suggested by these reactions. For couples with an unsatisfactory marriage from late pregnancy through the first 2 years (consistently low), the immediate and sustained impact of divorce was to enhance the parent's responsiveness to the needs of their infant and the infant's expectation of being cared for. This was not true for couples decreasing from high to lower satisfaction in their adaptation. However, by child age 4, when all families had been divorced for 1 year, divorce versus no divorce was associated with a differential positive effect on teacher Q-sort ratings of the children for both marital patterns. Children who were from families where the parents were in conflict but did not divorce were more likely to externalize control, were more often uncontrolled, and were more anti- as opposed to prosocial. The implication of these findings are discussed. © 1997 Michigan Association for Infant Mental Health

Cet article consiste en une etude de l'impact du niveau prenatal de l'individuation parentale et conjugale au cours du developpement parent-nourrisson et du developpement du nourrisson durant la premiere annee apres la naissance. On a trouve de quoi soutenir la premiere hypothese, c'est-a-dire que le profil d'individuation composite d'un couple, en prenant en consideration la separation-individuation du pere, de la mere et leur mariage avant la naissance, seraient associe a un developpement du nourrisson positif et que les transactions parent-nourrisson serait liees a la separation-individuation et a la mutualite durant la premiere annee apres la naissance. Une seconde hypothese selon laquelle l'individuation maternelle predirait plus fortement le developpement du nourrisson et le developpement parent-nourrisson a six mois, alors que l'individuation paternelle emergerait a l'âge d'un an en tant que fort facteur de prediction, n'a pas ete soutenue. L'on a decouvert a la place que l'individuation maternelle et l'individuation paternelle avant la naissance etaient des facteurs de prediction tout aussi forts a l'âge de six mois, alors que l'individuation maternelle etait le facteur de prediction primaire a 12 mois. D'autres resultats sur les associations directes et indirectes entre l'individuation pre-parentale et conjugale avant la naissance et les transactions parent-nourrisson apres la naissance suggerent que les processus precoces de separation-individuation resultent d'une configuration complexe de transactions triadiques mere-pere-nourrisson.

De tres nombreuses recherches viennent soutenir la declaration generale selon laquelle les couples qui, avant la naissance de leur premier ne, sont caracterises par une mutualite positive, l'autonomie de chaque partenaire et l'aptitude a confronter les problemes et a reguler l'affect negatif reagissent bien aux besoins de leurs nourrissons, encouragent leur autonomie et ont des enfants plus autonomes et plus tranquilles, comme on le voit durant les quatre premieres annees de l'enfant (Heinicke, 1995). Les implications pour la sante mentale infantile sont profondes, mais il est necessaire d'en apprendre plus et d'etablir quelles sont au juste les qualites prenatales specifiques qui interviennent dans le fonctionnement conjugal et le fonctionnement de l'enfant apres la naissance et la maniere dont elle les anticipent. Nous presentons ici l'etude de l'association entre la nature de l'interaction prenatale du couple et l'adaptation conjugale durant les deux premieres annees de l'enfant. Etablissant un lien entre le fonctionnement conjugal prenatal et postnatal, la frequence de l'affect negatif et l'incapacite a resoudre leurs problemes dans l'interaction conjugale d'avant la naissance etaient des facteurs de prediction d'une adaptation conjugale d'apres la naissance diminuee ou immanquablement faible.

Previous research has shown considerable stability in the quality of the husband-wife adaptation from prebirth to 2 years of age as well as a consistency in the mutual influence of the positive marital relationship and the positive parent-child relationship. This study examines if within this overall consistency there are different patterns of marital adaptation and interaction with the infant during the first 2 years of life. Using child expectation of being cared for, parent responsiveness to need, child sense of separate self, and parent's encouragement of effective autonomy as the indices of the positive parent-child relationship, it was found that by 24 months, three marital patterns were associated with a more positive family development: couples consistently high in their adaptation, those showing an initial decrease followed by an increase, and those showing an increase. It was also found that the optimal patterns of marital adaptation to the firstborn were anticipated by prebirth measures of the mother's capacity for positive relationships and adaptation-competence. The optimal patterns in turn anticipated the positive 48-month development of parent-child mutuality and psychological separateness.

Two general hypotheses relating to studies of early family intervention are discussed: (1) Pervasive and sustained gains in family development are correlaries of changes in the multi-risk mother's adaptation-competence and partnership quality, and (2) Efforts to change this functioning are most likely to be successful if the mother can develop a sustained and working relationship with the intervenor. The paper reviews sources which support these hypotheses: (1) Eight controlled follow-up intervention studies assessing and attempting to intervene in different family domains; and (2) Current ongoing studies focussing on the nature of the mother's relationship to the intervenor.

Generic principles governing the outcome and process of the treatment of children and their families can be generated from both research on the psychotherapy of school-aged children and early family intervention. Evidence indicates that the amenability of the child or parent to treatment and the comprehensiveness, duration, and intensity of the helping process are significant parameters. Definition of significant early family intervention roles allows linkage to various therapeutic roles with school-aged children and forces the recognition that most treatment situations involve more roles than are officially recognized. This articulation of the profile of intervention roles among poverty level, first-time parents at risk for neglecting their infant drew on several bodies of theory: psychoanalytic, cognitive, behavioral, social cognitive, and positive reinforcement principles, and advocacy and direct assistance as used in clinical social casework.

In spite of extensive preoperative investigation, surgical exploration is often the only way to determine whether a pancreatic cancer is curatively resectable. If curative resection is not possible, palliation of cholestasis and eventual duodenal obstruction is mandatory. This is best achieved by construction of a bilio-digestive double bypass. Many different techniques have been described but considerable rates of delayed gastric emptying have added high morbidity to the procedure. We propose a retrocolic construction technique combining an omega loop with a Roux-en-Y reconstruction which to our knowledge has not been published before.

32 formerly monosyndromatic enuretic patients who had been treated for this condition between 1980 and 1992 were compared with a matched control group from the general population in respect of sociobiography, psychopathological and dimensional factors (depressiveness, satisfaction with life, global functioning). Most of the former patients did not fulfil diagnostic criteria for an ICD-10 diagnosis at follow-up, although there was a 37% vs. 9% difference between former patients and controls in this respect--without a clear diagnostic pattern of such disorders. Furthermore, former patients had slightly higher depression scores and slightly lower global functioning than controls at follow-up. These results confirm that childhood enuresis has a low negative predictive value concerning the development of psychiatric disorders, although it may constitute a vulnerability factor.

Down-regulation of KAI1 expression has been shown to be associated with formation of metastases or disease progression in prostate and pancreatic cancer. In the present study we analyzed the expression pattern of KAI1 in metastatic and nonmetastatic hepatocellular carcinomas (HCCs) in comparison with normal livers to evaluate whether alteration of KAI1 also facilitates the metastatic ability in this malignancy. Thirty-nine primary HCCs and 10 normal liver tissue samples were studied for KAI1 messenger RNA (mRNA) expression with use of Northern blot analysis and in situ hybridization. By Northern blot analysis, moderate to strong KAI1 mRNA expression was present in normal liver samples. In contrast, KAI1 mRNA expression in tissue samples of primary HCCs was markedly decreased compared with normal controls. The normal/tumor ratio of KAI1 mRNA expression was 2.6:1 (P.01). Primary HCCs that gave rise to metastasis showed significantly lower KAI1 mRNA levels than nonmetastasized HCCs (P. 05). As seen by in situ hybridization, moderate to strong cytoplasmic KAI1 mRNA staining was present in almost all normal hepatocytes. Bile ducts, blood vessels, and connective tissue showed no or only faint KAI1 mRNA expression in the normal liver samples. In nonmetastatic HCCs, the cancer cells exhibited in situ hybridization signals that were similar to the normal controls. In contrast, most of the primary HCC cells in samples with metastases showed only faint or moderate KAI1 mRNA expression predominantly in the perinuclear regions. When KAI1 mRNA expression of primary hepatocellular cancer cells was compared with metastasized cancer cells in lymph nodes, with intrahepatic satellite metastasis, or with peritoneal metastasis in the same patients, significantly lower (P.01) KAI1 mRNA levels were present in the metastasized HCC cells. Reduced KAI1 mRNA in HCC cells seems to influence their metastatic ability and thereby enhances the malignant potential of HCC.

Endoluminal sonography is an excellent technique in preoperative staging of rectal carcinoma. This minimally invasive technology makes individual planning of therapy possible and is a very good tool in postoperative follow-up and documentation. In comparison with the techniques of CT and MRI it is less expensive and the mobile unit can easily be moved e.g. into the operating theatre. There are no contraindications for this examination, postoperative tissue scars and metal implants will not disturb the imaging. We think that endoluminal sonography will be able to facilitate individual decision making in the treatment of rectal carcinoma.

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. Bleeding of the diverticulum from a peptic ulcer due to ectopic gastric mucosa makes up 25% of all complications in the disease. We report a case of a 20 year old male with chronic anemia, severe hematochezia and perforation due to Meckel's diverticulum. Segmental small bowel resection was performed. Difficulty of preoperative diagnosis is discussed, indication for incidental diverticulectomy is established and the literature reviewed.

Generic principles governing the outcome and process of the treatment of children and their families can be generated from both research on the psychotherapy of school-aged children and early family intervention. Evidence indicates that the amenability of the child or parent to treatment and the comprehensiveness, duration, and intensity of the helping process are significant parameters. Definition of significant early family intervention roles allows linkage to various therapeutic roles with school-aged children and forces the recognition that most treatment situations involve more roles than are officially recognized. This articulation of the profile of intervention roles among poverty level, first-time parents at risk for neglecting their infant drew on several bodies of theory: psychoanalytic, cognitive, behavioral, social cognitive, and positive reinforcement principles, and advocacy and direct assistance as used in clinical social casework.

As a set, the reports included in this Monograph seek to expand the conceptualization and study of attachment. The editors and authors have indeed done an excellent job of presenting the "new growing points" within this field. My comments will focus on three of the issues that they raise: (1) How do we continue the study and conceptualization of secure-base behavior? (2) How do we take into account the multiple-relationship context of attachment? (3) How do we expand our conceptualization of attachment to include variations in individual adaptations and the development of relationships? Two statements that John Bowlby made during our many exciting conversations serve as an introduction to these comments. When I expressed discomfort with the reduction of attachment to five behavioral responses, he answered that the scientific study of essential phenomena requires some simplification; later conceptualization and further research involve revision and a better fit. He also often joked with me: "Jimmy Robertson, you, Miss Freud, and I can pretty much agree on how children respond to being separated from their mothers. It is when we come to interpret these responses that we get into difficulty."

This research describes the development of a semantic differential technique for rating nonverbal style of expressiveness in a population of expectant mothers. Nonverbal features (facial expression, gesture, voice quality) were emphasized as uniquely valid indices of emotional reactions towards parenthood and as the principal forms of interpersonal stimulation to which preverbal infants would be exposed. In the final trimester of pregnancy 46 primiparous mothers, representing a range of age, ethnic, and social-class backgrounds, were interviewed on videotape discussing childhood, marital adjustment, and expectations about parenthood. Interview selections were then presented to judges under three stimulus conditions: total videotape, videotrack, or audiotrack. Each mother's expressive style was rated on 12 bipolar adjective scales pertaining to affective tone, energy level, and involvement. Analyses demonstrated significant associations between nonverbal expressive style variables and measures of parent and child functioning over the first 2 years of life.

The general hypothesis guiding this research is that certain preschool behaviors such as sustained attention are predominantly anticipated by pre-birth parent and early infant characteristics, whereas other behaviors such as positive parent-child mutuality are shaped by both earlier and concurrent influences. It was found that variations in the child's 36-month attention, 36-month verbal expressiveness, and 48-month verbal IQ all correlated significantly with the concurrent parent stimulation of cognitive and verbal experiences, but that when the influence of certain pre-birth and early postnatal variables was allowed in a path analysis, the concurrent correlations were no longer significant. For all three of these preschool behaviors, the mother's pre-birth verbal IQ was a significant influence. By contrast, for the child's 48-month modulation of aggression, the significant correlation with the concurrent parent transaction remained even after the pre-birth and postnatal characteristics had been allowed in the path analysis.

A framework for understanding the effect of early intervention on family structure and functioning is presented. The framework uses five sets of variables to characterize families: Their ecology; and the values, roles, personalities, and interactions of family members. Twenty research studies that met criteria of having comparison/control groups, beginning intervention either prenatally or during the first 3 months of infancy, and directing intervention to family functioning are abstracted and examined in detail. Successful and unsuccessful studies are compared as to population and nature of intervention. Two criteria of success are used: (1) The commonly used criterion of any positive change; (2) a more rigorous criterion of change in at least three areas of family functioning, based on the assumption that more pervasive change will have more lasting influence on child development. Application of the first criterion found that 75% of early family focused intervention studies showed a successful outcome. Application of the latter criterion found that 50% showed a successful outcome. Further, there were no significant differences between successful and unsuccessful studies as to target group or type of intervention. The review suggests that early intervention targeted at family functioning is effective and that a more pervasive and sustained effect is likely if the intervention includes at least 11 or more contacts over at least a 3-month period.

Two main questions are addressed: What is the impact of frequency of psychotherapeutic session on the rate of improvement in reading of children referred for a learning disturbance, and do children seen more frequently as opposed to once a week, show a differential development on a number of indices of personality functioning? It was found that children seen more frequently as opposed to once a week, showed a greater rate of improvement in reading in the year after the end of treatment and were in particular characterized by being more flexible in their adaptation and having a greater capacity for relationships at both the end and a year after the end of treatment.

A psychoanalytic social work approach to family intervention is described, and data on its impact on parents and their children are presented. Program parents, especially those in an open-ended approach, were rated as more positive both as persons and as parents; their children scored higher on IQ and other developmental and adaptational measures.

In designing early intervention studies, it is important to consider how the nature of pre-birth parent personality and marital characteristics influence family and child development. Descriptions of the development of three families show the specific impact of these pre-birth characteristics on the quality of the parent-infant transaction of infant soothability-responsiveness to need. Further focus is provided by linking the parent's responsiveness to the infant's need to the emergence and resolution of ambivalent feelings about caring for the infant. The variations in the resolution of ambivalent feelings and the parental personality and marital context of that resolution are explored. Three such configurations are illustrated: a competent mother whose ambivalence appeared in the context of difficulty with intimacy; a mother who struggled with intensely loving and hostile feelings generally; and the description of the emergence of maternal ambivalence in the context of difficulty in achieving psychological separation from her child. Finally, quantitative indices are used to compare these three instances of difficulty in resolving ambivalence with two families whose resolution of the ambivalence was optimal.

(1975). On Termination in Child Analysis. The Psychoanalytic Study of the Child: Vol. 30, No. 1, pp. 443-474.

A predictive method involving the assessment of prebirth functioning and the anticipated quality of parenting is described and developed in order to facilitate identifications of family at risk for future parenting. The association between these predictions and selected outcome criteria was studied in a representative sample of 46 US families, who were followed from mid-pregnancy to infant age of 2 years. Both the quantitative and qualitative results support the hypotheses that those families where mother and father were both characterized during the prebirth assessments as above average on adaptation-competence, capacity for relationships, and their positive view of their marriage, and who were expected to provide an optimal parent care environment, did in fact enhance a mother-infant relationship charcterized by positive mutuality and responsiveness. The most efficient predictor of positive mother-infant mutuality was the father's positive experience of the marriage. The mother's verbal I.Q. correlates significantly with maternal adaptation-competence, which in turn correlates with positive mother-infant mutuality. It is assumed that the prebirth assessments and predictions, even though global in nature, effectively reflect a profile of family system and individual characteristics that are likely to enhance the development of positive mother-infant mutuality. The authors stress "enhance" because the characteristics of the infant, such as his or her irritability, are also going to influence the quality of the emerging transaction.

SUMMARY The pineapple stem is an excellent source of two acid phosphatases. Although the enzymes are stable between pH 4.0 and 8.5 and are not readily surface-denatured, yet the assay values are not too reproducible. Micelle formation may account for the erratic results. The enzyme shows optimum activity at pH 6.0 and requires no metal cofactor. Certain metals, such as magnesium, stabilize the enzyme. Molybdate and hydrogen peroxide are the most potent inhibitors. Dibasic phosphate is about three times as potent an inhibitor as dibasic arsenate.

The proteolytic enzymes in this plant product, not yet in commercial production, may find application, as do similar agents from other sources, in the bating of hides, tenderizing of meat, chill-proofing of beer and other directions suggested in this article.

(1965). Frequency of Psychotherapeutic Session as a Factor Affecting the Child's Developmental Status. The Psychoanalytic Study of the Child: Vol. 20, No. 1, pp. 42-98.

Day care services organized to contribute to mental health must consider: 1) criteria for the evaluation of day care; 2) models for interrelating family and day care based on the concept of an extended family and implemented by support of family resources; and 3) delivery systems focusing on children's needs.

Preschool task orientation and certain parent-child variables assessed during infancy predict school-age task orientation and academic achievement. There is, however, limited evidence of direct association between task-orientation variables in infancy and those assessed later. Research on attachment suggests one possible explanation of the link between variations in early parent-child interaction and later task orientation. Thus, a certain profile of mother-infant interaction is associated with the child's secure attachment to the mother in infancy and his or her ego resiliency, task orientation, and capacity for peer relations from 2 to 5 1/2.

This document contains annotated abstracts of 149 selected papers from the literature on simulator training devices and programs. The abstracts are organized into two sections: abstracts of 83 empirical articles and abstracts of 66 theoretical articles. Each abstract is organized according to a standardized format, with the following headings: Authors; Title; Source; Topic keywords; Short summary; Device; Institution; Type of article. The purpose of these annotated abstracts is to effectively summarize, and not merely to describe or identify, the contents of the papers under review. The abstract will be entered into a computerized data base for future analyses.

• Attitudes toward preventive mental health activities with high-risk children in clinical practice were surveyed in 316 pediatricians. Although generally positive attitudes were expressed regarding appropriateness and efficacy of such activities, uncertainty was expressed regarding the ethical issues and knowledge on which such activities rest. Pediatricians perceived serious barriers to preventive activities related to financial, educational, and time factors. Pediatricians whose personal health beliefs favored an internal locus of control were more positively inclined toward preventive activities. Studies relating reported attitudes and beliefs to actual practice patterns are necessary. Pediatricians also require additional training in mental health—related preventive activities. ( AJDC . 1989;143:1087-1090)

In 1957, Levitt concluded from a review of research that “there is no evidence to indicate that child psychotherapy is effective” (Eysenck, 1965; Levitt, 1957a). In 1988, Tuma, reviewing a set of studies published from 1953 to 1986, concluded that “two-thirds of the studies [reviewed] find treatment effects showing that treated children achieve positive changes over control children” (Tuma, 1988). The first task of this chapter will be to elucidate these different conclusions and to suggest that both are based on the review of incomplete data. As Tuma (1988) indicated, there are too few well-described and executed studies to group them in a manner that allows generalization.