Child health professionals are keen to understand the origins of antisocial behaviour. Ben Lahey and colleagues, in this issue's Annotation, remind us of the evidence that it may reflect individual propensities to be impulsive, to have high activity levels with greater than average physical strength, coupled with low intelligence and a sense of daring. Youths with an earlier age of onset, before adolescence, are more likely than those with later onset to meet criteria for ADHD, but whether ADHD as such predisposes boys to engage in antisocial acts is unclear. Oppositional Defiant Disorder may be the more relevant influence. They discuss the role of “intelligence” in protecting against the development of antisocial behaviour, in particular the importance of reasonably good verbal abilities. Interestingly, Lahey et al. take the view that we are not yet in a position to be sure whether specific cognitive deficits are important predisposing factors for antisocial behaviour. They suggest that a more parsimonious way of looking at cognitive influences is to consider the global trait of intelligence without being more specific until better evidence emerges. For clinicians who wish to identify children who may be at high risk of antisocial behaviour, it is also important to think about parenting variables that may predispose to its development. These include the use of harsh discipline, lack of parental supervision, and antisocial parental attitudes. Finally, they note there is increasing interest in the influence of gender on the development of antisocial behaviour. This article is concerned exclusively with boys, and there is so far no truly convincing explanation for the remarkable differences in prevalence of such behaviour between the sexes. Girls appear to be easier to socialise, and boys have poorer communication skills in the preschool period. This aspect of sexual dimorphism is worthy of further investigation, perhaps from the perspective of gender differences in social cognitive development.

Helen Rushforth offers a Practitioner Review whose purpose is to offer guidance to practitioners who are responsible for communicating with hospitalised children. She presents not only a literature review, which is derived from the theories pertaining to children's conceptualisation of health and illness, but her paper also gives guidance to practitioners on how to communicate effectively with children of different ages, and in different clinical situations. The paper focuses on a range of contemporary issues including pre-procedural preparation, children's health promotion, and the need to convey health promotion messages to young children. She discusses the competence of children to give consent for surgery, and the criteria by which their competence to gain contraceptive advice without parental consent may be judged.

This annotation presents an integrative model of the origins and development of antisocial behavior during childhood and adolescence. Like all theoretical models, it both summarizes what is known and states hypotheses that go beyond the current data. Our goal is to add to the impetus created by other theories to conduct the critical studies necessary to test models and advance knowledge. The present model offers some new hypotheses regarding precursors to antisocial behavior but seeks primarily to integrate antisocial propensity theories (Gottfredson & Hirschi, 1990) and developmental theories (Loeber, 1988; Moffitt, 1993; Patterson, Reid, & Dishion, 1992). Our model focuses on enduring propensities to antisocial behavior but also places antisocial propensity within a developmental perspective. Like Loeber (1991) and Sroufe (1997), we posit that changing manifestations of problem behavior over the course of the development result from successive transactions of the growing child with changing social environments. As such, roles for person variables, developmental variables, and environment variables are specified, as are interactionsWe use the term "interaction" broadly in discussing the interplay between predisposing variables and social experiences. We have not advanced hypotheses at this point that distinguish between additive, multiplicative, or other joint effects of these classes of variables, but joint effects beyond additive combinations would be most consistent with the intent of our model (cf. Pennington & Bennetto, 1993). among these classes of variables. The age of onset of antisocial behavior is a key element of the present model as the levels of influences from the multiple causal factors vary with the age of onset of antisocial behavior. Because much more is known about antisocial behavior in boys than girls, the present model may be applicable only to boys. As discussed in this annotation, there may be important gender differences that will require different models for girls and boys. Therefore, when sufficient data are available, it will be important to test the applicability of the model to girls.

There is growing recognition amongst child health care practitioners of children's rights to be informed about their condition and treatment, and to be actively involved in decisions pertaining to their care. In order to facilitate such understanding, there is a need to explore the ways in which such concepts can best be communicated, in particular to younger children whose conceptual ability may be regarded as limited. Consideration of the literature on how children's conceptualisation of health and illness develops reveals diverse perspectives, with seminal work heavily influenced by the work of Piaget (1929), and a belief that the understanding of younger children may be minimal. However, more contemporary theorists refute such beliefs, suggesting that children may have far more potential to understand complex illness concepts than they have previously been given credit for. The work of Carey (1985) and Vygotsky (1962) offers alternative developmental theories congruent with this perspective, which might more appropriately underpin current practice. A variety of clinical situations are then explored in the light of this debate, including preparation of children for hospitalisation, their competence to consent, their views of pain and death, and approaches to child health promotion. Guidelines are offered to practitioners throughout, with the aim of enhancing children's understanding of their conditions, and their active participation in care, which in turn has the potential to optimise care delivery.

The purpose of the current study was to examine whether types of discourse deficits were associated differentially with psychiatric disorders (PD) and with language impairments (LI) in children. Discourse analyses examining the occurrence of different types of discourse deficits in language structure, information structure, and flow of information were performed on the spoken narratives of 111 children aged 7 to 12 years who comprised 4 groups: (1) psychiatrically referred children with LI (PD+LI), (2) psychiatrically referred children with normally developing language (PD), (3) nonreferred children with language impairments (LI), and (4) nonreferred children with normally developing language (controls). Discourse deficits in language and information structure characterized children with LI, whereas disruptions in the flow of discourse characterized children with PD. Children with the comorbid condition exhibited deficits associated with both LI and PD; in addition, they displayed distinct deficits related to pronominal reference and causal cohesion. The findings provide a preliminary understanding of the associations among language, discourse, and psychopathology in children.

Two studies were conducted to examine executive function skills in siblings of children with autism. In Study 1, four computerised tasks (three executive tasks: the ID/ED set-shifting task; a spatial working memory task; and the Tower of London planning task; and a control spatial span task) from the CANTAB battery were used to compare 31 siblings of children with autism with 32 siblings of children with developmental delay and 32 children from unaffected families. In Study 2, the two sibling groups were compared on two manually administered executive tasks (verbal fluency and list recall). As a group, autism siblings showed superior spatial and verbal span, but a greater than expected number performed poorly on the set-shifting, planning, and verbal fluency tasks. There were no group differences in working memory performance. The implications of these findings for the broader phenotype of autism is discussed.

The association between, and stability of, clinical diagnosis and diagnosis derived from the Autism Diagnostic Interview-Revised (ADI-R; Lord, Rutter, & Le Couteur, 1994) was examined in a sample of prospectively identified children with childhood autism and other pervasive developmental disorders assessed at the age of 20 months and 42 months. Clinical diagnosis of autism was stable, with all children diagnosed with childhood autism at age 20 months receiving a diagnosis of childhood autism or a related pervasive developmental disorder (PDD) at age 42 months. Clinical diagnosis of childhood autism was also reasonably sensitive, with all children who went on to receive a clinical diagnosis of childhood autism at 42 months being identified as having autism or PDD at 20 months. However, clinical diagnosis for PDD and Asperger's syndrome lacked sensitivity at 20 months, with several children who subsequently received these diagnoses at 42 months receiving diagnoses of language disorder or general developmental delay, as well as in two cases being considered clinically normal, at the earlier timepoint. The ADI-R was found to have good specificity but poor sensitivity at detecting childhood autism at 20 months; however, the stability of diagnosis from 20 to 42 months was good. In addition, the ADI-R at age 20 months was not sensitive to the detection of related PDDs or Asperger's syndrome. The continuity and discontinuity between behavioural abnormalities identified at both timepoints in the three domains of impairment in autism was examined, both in children who met final clinical criteria for an autistic spectrum disorder, and for children with language disorder who did not, as well as for a small sample of typically developing children.

Children with a diagnosis of autism and typically developing children were given two variations of the Navon task (Navon, 1977), which required responding to a target that could appear at the global level, the local level, or both levels. In one variation, the divided attention task, no information was given to children regarding the level at which a target would appear on any one trial. In the other, the selective attention task, children were instructed to attend to either the local or the global level. Typically developing children made most errors when the target appeared at the local level whereas children with autism made more errors when the target appeared at the global level in the divided attention task. Both groups of children were quicker to respond to the global target than the local target in the selective attention task. The presence of normal global processing in the children with autism in one task but not in the other is discussed in terms of a deficit in mechanisms that inhibit local information in the absence of overt priming or voluntary selective attention to local information.

In the present study, copying tasks were used to assess hierarchical aspects of visual perception in a group of 10 nonsavant autistic individuals with normal intelligence. In Experiment 1, the hierarchical order of graphic construction and the constancy of this order were measured for the copying of objects and nonobjects. In comparison to control participants, autistic individuals produced more local features at the start of the copying. However, they did not differ from controls with respect to graphic constancy. Experiment 2 measured the effect of geometrical impossibility on the copying of figures. Results revealed that autistic individuals were less affected by figure impossibility than were controls. Therefore, these experiments seem to support the notion of a local bias for visual information processing in individuals with autism. Two interpretations are proposed to account for this effect. According to the hierarchical deficit hypothesis, individuals with autism do not manifest the normal global bias in perceiving scenes and objects. Alternatively, the executive function hypothesis suggests that autism brings about limitations in the complexity of information that can be manipulated in short-term visual memory during graphic planning.

Whereas many young children show initial wariness on meeting a stranger, shyness that lasts into middle childhood may be indicative of concurrent problems and subsequent disorder. Adjustment problems of an internalising nature, such as low self-esteem, loneliness, and anxiety may occur. Special significance has, however, been ascribed to preadolescent friendships as a means of validating self-worth and buffering against loneliness and anxiety. The main aim of the present study is to examine associations between shyness, perceptions of friendship quality, and indices of adjustment related to internalising problems.

The study involves a sample of 8.4–10.6-year-olds (N=50), preselected at 4.5 years to include a high proportion of shy children. Ratings of shyness to an unfamiliar adult had been made by different observers at 4.5 and 7 years, and at the present ages by another observer, mothers, and teachers. Observer-rated shyness was highly consistent over time and was significantly correlated with mothers' and teachers' ratings, although both significantly underestimated children's shyness relative to observer ratings. Compared with the younger children (mean age of 9 years), observed shyness (a composite over all three age points) increased in salience for the older children (mean age of 10 years), becoming significantly correlated with trait anxiety as well as low global self-worth. Indeed, global self-worth took on a central role for the older children, showing significant correlations not only with observed shyness and internalising problems (loneliness and anxiety), but also with perceptions of social acceptance and classmate support as well as friendship quality, with a named “best friend”. Thus by 10 years of age, aspects of peer relationships may influence and be influenced by global self-worth, with a possible buffering effect on any potential detrimental effects of shyness.

The aim of this longitudinal sibling adoption study was to estimate genetic and environmental components of variance in parent- and child-reported measures of the family environment (parental negative affect, negative control, and achievement orientation). Participants included 85 adoptive and 106 nonadoptive sibling pairs from the Colorado Adoption Project. Parents and children completed annual assessments of the family environment when the children were 10, 11, and 12 years old, and genetic and environmental parameter estimates were derived. Genetic influences were found for parent-reported negativity and warmth and child-reported achievement orientation, suggesting child genetic effects on these measures of the family environment. Shared environmental influences were found for parent-reported negativity, inconsistent discipline, warmth, and child-reported positivity. Nonshared environmental variance was substantial for children's ratings, but modest for parents' ratings.

The current study examines the link between the experience of divorce in childhood and several indices of adjustment in adulthood in a large community sample of women. Results replicated previous research on the long-term correlation between parental divorce and depression and divorce in adulthood. Results further suggested that parental divorce was associated with a wide range of early risk factors, life course patterns, and several indices of adult adjustment. Regression analyses indicated that the long-term correlation between parental divorce and depression in adulthood is explained by quality of parent–child and parental marital relations (in childhood), concurrent levels of stressful life events and social support, and cohabitation. The long-term association between parental divorce and experiencing a divorce in adulthood was partly mediated through quality of parent–child relations, teenage pregnancy, leaving home before 18 years, and educational attainment.

The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire that asks about children's and teenagers' symptoms and positive attributes; the extended version also includes an impact supplement that asks if the respondent thinks the young person has a problem, and if so, enquires further about chronicity, distress, social impairment, and burden for others. Closely similar versions are completed by parents, teachers, and young people aged 11 or more. The validation study involved two groups of 5–15-year-olds: a community sample (N=467) and a psychiatric clinic sample (N=232). The two groups had markedly different distributions on the measures of perceived difficulties, impact (distress plus social impairment), and burden. Impact scores were better than symptom scores at discriminating between the community and clinic samples; discrimination based on the single “Is there a problem?” item was almost as good. The SDQ burden rating correlated well (r=.74) with a standardised interview rating of burden. For clinicians and researchers with an interest in psychiatric caseness and the determinants of service use, the impact supplement of the extended SDQ appears to provide useful additional information without taking up much more of respondents' time.

This study aimed to identify the prevalence and associations of childhood psychiatric disorder in Calicut District, South India. Among 1403 children aged 8 to 12 years selected by random cluster sampling, a projected prevalence of 9.4% (95% CI 7.9–10.8%) was found. Associations of disorder with male sex, the Muslim religion, lower social class, less parental education, school failure, and impaired reading and vocabulary were found, but not with malnutrition or perinatal problems. The similarity to associations of disorder in Western studies was noted. The discussion focuses on the validity of comparisons of prevalence across cultures.

Do cultural values and traditions influence the development of coping styles? To address this question, we compared self-reports of coping by 6–14-year-olds in Thailand and the U.S. One hundred and forty-one children were interviewed about six common stressors: separation from a friend, injection in a doctor's office, adult anger, peer animosity, school failure, and physical injury. Children's self-reported coping methods were coded as overt or covert. Coping goals were coded as reflecting primary control (attempts to influence objective conditions), secondary control (attempts to adjust oneself to objective conditions), or relinquished control. Although findings revealed numerous cross-national similarities, there were also multiple main and interaction effects involving culture, suggesting that sociocultural context may be critical to our understanding of child coping. Consistent with literature on Thai culture, Thai children reported more than twice as much covert coping as American children for stressors involving adult authority figures (i.e. adult anger, injection in doctor's office). Thai children also reported more secondary control goals than Americans when coping with separation, but American children were five times as likely as Thais to adopt secondary control goals for coping with injury. The findings support a model of coping development in which culture and stressor characteristics interact, with societal differences most likely to be found in situations where culture-specific norms become salient.

In order to examine the mechanism whereby stunted children have poor developmental levels, we compared the behaviour of stunted (N=78) and nonstunted (N=26) children aged 12 to 24 months, and examined the relationship of their behaviour to their developmental levels. The effect of nutritional supplementation with or without psychosocial stimulation on the stunted children's behaviour was also examined. The children were observed at home during 4 days over a period of 6 months. The stunted children showed significantly more apathy, and less enthusiasm and variety in exploring, were less happy and more fussy. Caretakers' vocalisations to them were less warm or instructive. Stunted children's activity level, exploratory and happy behaviours were predictive of change in developmental levels measured on the Griffiths Scales, from enrolment to 12 and 24 months later. Supplementation predicted mental age at 12 and 24 months after enrolment, however, it had no significant effect on behaviour.