This issue starts with an overview of what we know from MRI neuroimaging of children and adolescents with psychiatric disorders. As is often the case in child psychopathology, accomplishments in adult psychiatry serve as the model for the study of childhood conditions. Thus Eliez and Reiss, in their clear overview of neuro-imaging studies, emphasise the results pertaining to child/adolescent onset schizophrenia, with its main conclusion that childhood-onset schizophrenia is not distinct from adult-onset schizophrenia from the standpoint of neuroanatomical variation. The use of the new imaging techniques in the search for neurobiological substrates of the more common psychiatric disorders in children and adolescents is still in its infancy. This can be concluded from the fact that only a few studies are available on children with ADHD, autism, or Tourette's disorder, with no neuroimaging studies yet available on childhood conditions such as depression, conduct disorder, anxiety disorders, or pervasive developmental disorders other than autism. A rather crude finding that stands out is the relationship between total brain volume and intelligence. The authors point out that studies that did not take IQ into account erroneously interpreted differences between groups of children to be specific for a certain condition, whereas in fact the differences could have been explained by differences between the groups in IQ. Reading this annotation, one is struck by the many contradictory findings of the neuroimaging studies that are reviewed. These discrepancies may be due to variations in neuro-imaging methodology and variations in the definition and measurement of neuroanatomical regions. Also, the large etiological heterogeneity, as well as the lack of precision with which we can define and measure behavioural phenotypes, will influence the variability in findings. The authors give an example of how one MRI study looked at children with ADHD without comorbid conditions whereas another study looked at children with ADHD of whom the majority had a comorbid diagnosis of conduct disorder or oppositional defiant disorder. It is not surprising, then, that neuroimaging studies on children with very different behavioural phenotypes, despite claiming that they studied the same phenomenon, end up with contradictory results. Instead of treating childhood conditions such as ADHD as diagnostic categories that are either present or absent, it may be advantageous for MRI studies to retain more diagnostic information by studying the covariation between brain morphology and behavioural phenotypes as continuous measures. Now that some experience with neuroimaging of child/adolescent psychiatric disorders is available, it is hoped that studies using larger sample sizes, advanced techniques such as functional MRI, longitudinal designs, and more precise diagnostic assessment techniques, will shed light on the still somewhat inconsistent findings on brain morphology of psychiatric conditions in children and adolescents.

Over the past 10 years, innovations in physics and computer science have promoted magnetic resonance imaging (MRI) as an essential tool for investigating the biological substrates of psychiatric disorders. Requiring no radiation exposure, MRI is now the preferred imaging technique for pediatric populations. However, the rapid technical advances in MRI pulse sequences, data processing, and analysis have made it increasingly complex for clinicians to compare and critically evaluate MRI research studies. This paper selectively reviews MRI research on five psychiatric conditions occurring in childhood or adolescence: ADHD, autism, childhood-onset schizophrenia, Tourette syndrome, and early-onset depression. The selection of papers reviewed was based on four criteria: the originality of the idea underlying the paper, the quality of the sample and methodologies used, the presence of controversial findings in the paper, and whether the paper was a clear illustration of specific methodological strengths or weaknesses. The two goals of this review paper are to update clinicians on morphometric brain imaging in child psychiatry and the methodological issues pertaining to image acquisition and analysis, and to promote critical reading of future MRI studies.

Children are both the direct and indirect targets during wars. They are directly affected by violence aimed at them and their families; they are indirectly affected by the distress caused to their families; they may be internally displaced or find themselves crossing borders as asylum seekers. Their experiences during and immediately after war militate against their developing in a safe, secure, and predictable environment. Their human rights are compromised and their mental health put at risk.

Whether in the country at and after war, or in the country that offers refuge, children's mental health needs have to be properly assessed and met. In many cases, children may only require a sense of safety and support via their family and school. In other cases, they require more complicated psychosocial interventions that address the various stress reactions they manifest.

This paper addresses these issues against the context of a major community-based programme in Mostar in Bosnia during the recent civil war there. It argues that we have reasonably good screening measures to identify children at high risk of developing mental health problems. It presents an hierarchical model of support and intervention whereby psychosocial help is delivered primarily through schools with only a small proportion of more complex needs being met by specially trained mental health professionals. There is a strong need to evaluate various methods of delivering help and to develop new ways of reaching needy children in a nonstigmatising way.

Inpatient care is expensive and should ideally be provided for children and adolescents with the most serious psychiatric disorders. However, only little is known about inpatient treatment, e.g. the factors influencing hospital admission, the content of care in the hospital, the appropriate norms for the duration of inpatient stays, the inpatient arrangements that result in the best outcomes, or connection with necessary aftercare services. There are many methodological problems with existing research. However, it can cautiously be concluded that psychiatric hospitalisation of children and adolescents is often beneficial, particularly if special aspects of treatment are fulfilled (e.g. good therapeutic alliance, treatment with a cognitive-based problem-solving skills training package, or planned discharge) and aftercare services are available. The continuum-of-care model is promising because it provides opportunities to achieve better integration between inpatient interventions and aftercare services.

Fifty children aged 7–14 years with a principal diagnosis of social phobia were randomly assigned to either child-focused cognitive-behaviour therapy (CBT), CBT plus parent involvement, or a wait list control (WLC). The integrated CBT program involved intensive social skills training combined with graded exposure and cognitive challenging. At post-treatment, significantly fewer children in the treatment conditions retained a clinical diagnosis of social phobia compared to the WLC condition. In comparison to the WLC, children in both CBT interventions showed significantly greater reductions in children's social and general anxiety and a significant increase in parental ratings of child social skills performance. At 12-month follow-up, both treatment groups retained their improvement. There was a trend towards superior results when parents were involved in treatment, but this effect was not statistically significant.

This paper reports the results of a randomised treatment trial of two forms of outpatient family intervention for anorexia nervosa. Forty adolescent patients with anorexia nervosa were randomly assigned to “conjoint family therapy” (CFT) or to “separated family therapy” (SFT) using a stratified design controlling for levels of critical comments using the Expressed Emotion index. The design required therapists to undertake both forms of treatment and the distinctiveness of the two therapies was ensured by separate supervisors conducting live supervision of the treatments. Measures were undertaken on admission to the study, at 3 months, at 6 months and at the end of treatment. Considerable improvement in nutritional and psychological state occurred across both treatment groups. On global measure of outcome, the two forms of therapy were associated with equivalent end of treatment results. However, for those patients with high levels of maternal criticism towards the patient, the SFT was shown to be superior to the CFT. When individual status measures were explored, there were further differences between the treatments. Symptomatic change was more marked in the SFT whereas there was considerably more psychological change in the CFT group. There were significant changes in family measures of Expressed Emotion. Critical comments between parents and patient were significantly reduced and that between parents was also diminished. Warmth between parents increased.

We analysed results from seven American and British studies that compared groups of mothers with and without clinically diagnosed depression, and assessed the attachment category of their infants (under 3 years) using the Strange Situation. The samples were predominantly middle-income and free of risk factors other than maternal depression. Meta-analysis using loglinear modelling and standardised residuals showed that the effect of depression on the distribution of infants' attachment was statistically heterogeneous. However, after removing one outlier study, the effect of depression was homogeneous across the remaining six studies. Infants of depressed mothers showed significantly reduced likelihood of secure (B) attachment and marginally raised likelihood of avoidant (A) and disorganised (D) attachment. The first two effects varied considerably in magnitude between studies, whereas the increase in disorganised attachment, from 17% to 28% on average, was consistent.

This longitudinal study is part of a series examining the relationships between maternal mood, feeding practices, and infant growth and development during the first 6 months of life in 226 well-nourished mother-infant dyads in Barbados. In this report, we assessed maternal moods (General Adjustment and Morale Scale and Zung Depression and Anxiety Scales), feeding practices (scales describing breast-feeding and other practices associated with infant feeding in this setting), and infant cognitive development (Griffiths Mental Development Scales). Multivariate analyses, with and without controlling for background variables, established significant relationships between maternal moods and infant cognitive development. Infants of mothers with mild–moderate depression had lower Griffiths scores than infants of mothers without depression. Maternal depressive symptoms and lack of trust at 7 weeks predicted lower infant social and performance scores at 3 months. Maternal moods at 6 months were associated with lower scores in motor development at the same age. Although no independent relationships emerged between feeding practices and infant cognitive development, the combination of diminished infant feeding intensity and maternal depression predicted delays in infant social development. These findings demonstrate the need to carefully monitor maternal moods during the postpartum period, in order to maximize the benefits of breast-feeding and related health programs to infant cognitive development.

This study on children with a Pervasive Developmental Disorder (PDD; N = 32), children with developmental language disorder (N = 22), and normally developing children (N = 28) sought to answer questions concerning attachment and autistic behaviour. We could replicate the finding that children with a PDD are able to develop secure attachment relationships to their primary caregiver. Children with PDD who had an insecure attachment showed fewer social initiatives and responses than children with PDD who had a secure attachment, even when the insecurely and securely attached PDD children were matched on chronological and mental age. Children with both a PDD and mental retardation were more often classified as disorganised.

Three findings suggested that a disorganised attachment does not merely reflect the presence of “autistic” behaviour: (1) children with PDD did not reveal higher rates of a disorganised attachment than matched comparison children; (2) having a PDD diagnosis and having a disorganised attachment were found to be associated with opposite effects on an ethological measure of level of behavioural organisation; and (3) a disorganised attachment but not a PDD diagnosis was associated with an increase in heart rate during parting with the caregiver and a decrease in heart rate during reunion.

This study explored the claim that individuals with autism and Asperger's disorder tend to process locally rather than holistically. Participants observed a large or “global” number composed of smaller or “local” numbers. The response was contingent upon the identification of either the large stimulus or the small stimuli. Relative to age, sex, and IQ matched controls, global processing in children and adolescents with autism (N = 12) and Asperger's disorder (N = 12) was more vulnerable when the local stimuli were incongruent. The autism group made more global errors than their matched control group, regardless of whether there was local incongruence. In contrast, the Asperger's disorder group made a similar number of global errors as their respective control group. These results were discussed in relation to an “absence of global precedence” notion, “weak central coherence” theory, and right-hemisphere dysfunction. The neurobiological significance of these findings were discussed in the context of a fronto-striatal model of dysfunction.

This paper examines the extent to which conduct problems at age 13 are associated with a range of educational, psychosocial, and sexual outcomes at age 18 in a birth cohort of 488 young women. Significant associations were found between early adolescent conduct problems and later risks of educational failure, juvenile crime, substance abuse, mental health problems, and adverse sexual outcomes by late adolescence. These elevated risks were explained, in part, by social, family, and personal disadvantages associated with adjustment at age 13. In addition, there was evidence of a causal chain process in which early adolescent conduct problems were associated with a series of adolescent risk-taking behaviours, including delinquent peer affiliations, early-onset sexual behaviour, substance use, and school problems that were, in turn, associated with increased risks of later adverse outcomes.

The goal of this study was to investigate the variables that best predict functional impairment in children and adolescents. Two hundred and eight psychiatric and 129 pediatric children aged 7 to 17 years were assessed with measures of psychopathology, functional impairment, temperament, marital discord, educational style, coping, developmental milestones, stressful life events, medical history, school information, and family history of psychopathology. Multiple regression models adjusted by psychopathology were estimated. The global model, which included all the significant variables in partial models, revealed the following predictors of impairment: receiving review lessons, chronic disease or handicap, the presence of problems the child interpreted as stressful, late onset and long duration of psychopathological problems. These indicators could be useful for the proper identification of children with severe difficulties, in order to provide them with adequate psychological services.

Objective: To evaluate sleep and alertness and to investigate the presence of possible underlying sleep/wake disorders in children with attention-deficit/hyperactivity disorder (ADHD). Method: After 3 nights of adaptation in a room reserved for sleep studies in the department of child psychiatry, children underwent polysomnography (PSG) followed by the Multiple Sleep Latency Test (MSLT) and reaction time tests (RT) during the daytime. Thirty boys diagnosed as having ADHD (DSM-IV), aged between 5 and 10 years, and 22 age- and sex-matched controls participated in the study. All children were medication-free and showed no clinical signs of sleep and alertness problems. Results: No significant differences in sleep variables were found between boys with ADHD and controls. The mean latency period was shorter in children with ADHD. Significant differences were found for MSLT 1, 2 and 3 (p<.05). Mean reaction time was longer in children with ADHD, with significant differences in all tests (p<.05). Number and duration of sleep onsets measured by the MSLT correlated significantly with the hyperactivity-impulsivity and inattentive- passivity indices of the CTRS and CPRS. Conclusion: Children with ADHD were more sleepy during the day, as shown by the MSLT, and they had longer reaction times. These differences are not due to alteration in the quality of nocturnal sleep. The number of daytime sleep onsets and the rapidity of sleep-onsets measured as MSLT were found to be pertinent physiological indices to discriminate between ADHD subtypes. These results suggest that children with ADHD have a deficit in alertness. Whether this deficit is primary or not requires further studies.

Emeritus Professor Colin Hindley of the Institute of Education, University of London died on 12 May following surgery for lung cancer, aged 76. He will be remembered by many colleagues not only for his research on child development and individual differences but also for his personal support to individuals and organisations concerned with child development, both in this country and abroad. He was a founding Committee Member of the International Society for the Study of Behavioral Development and Advisory Editor for the Journal of Human Development. His work as a founding member of the Association of Child Psychology and Psychiatry and Allied Disciplines from 1958 onwards ensured its strong interdisciplinary base and a highly productive future. Perhaps even more significantly, many would wish to emphasise his particularly distinguished contribution as the founding Psychology Editor of the Journal of Child Psychology and Psychiatry and Allied Disciplines from 1959–1969. In recognition of his long service to the Association at so many levels, he was made an Honorary Member on his retirement.