Editorial
Editorial
- Fred Volkmar
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- Published online by Cambridge University Press:
- 01 January 1998, p. 1
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It again has been my pleasure to work with an outstanding group of contributors in the production of this, the 9th Annual Research Review. In inviting contributions, the intention is that authors provide selective reviews that will serve to update the readership on current research and emerging research trends. As always I am grateful to the authors for agreeing to undertake these reviews, as well as to the referees whose thoughtful and detailed comments to the authors enrich each of the papers. As noted in last year's Editorial, this, and future issues, will begin to revisit some of the topics addressed in previous reviews.
In this issue Susan Gathercole has provided a thoughtful discussion of the issue of development of memory in children. As she notes, many changes take place in the development of children's capacities for memory, particularly in the pre-school years. These topics are of interest to clinicians and researchers working with children. Jan Wallander and James Varni have undertaken a review of the effects of chronic physical disorder on the development of children and their families. As noted, recent research has helped to identify risk and protective factors although evaluations of interventions, sadly, remain lagging. Three papers in this issue are more directly focused on clinical disorders. Maria Kovacs and Bernie Devlin review the topic of internalising disorders in children. This paper focuses on aspects of predictive validity, comorbidity, onset, and family history. Rosemary Tannock reviews recent advances in our understanding of the neurobiology of attention deficit hyperactivity disorder; her review highlights the range of problems observed in this condition and the need for interdisciplinary research perspectives. Leslie Jacobsen and Judith Rapoport provide a most helpful summary of recent work on childhood schizophrenia. Although this condition is very rare, its tremendous cost in human terms as well as its significance for research lends considerable interest to this review. Research on both these conditions has considerable potential in helping understand aspects of syndrome pathogenesis and mechanisms of disorder. Finally, Edmund Sonuga-Barke has undertaken a review of the issue of categorical approaches to classification of childhood disorders with particular focus on the implications for clinical practice and diagnosis that arise as alternative models for such classification schemes are assessed.
For the 10th edition of the Annual Research Review, we anticipate that the following topics will be covered: effects of trauma on children, advances in the genetics of childhood psychiatric disorders, effects of divorce on children, comorbidity of mental health disorders, the development of language, and neuroimaging.
Editorial
- David Skuse
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- 01 February 1998, pp. 135-136
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When the wife of the president of the United States has recently been on a lecture tour warning about the dangers of domestic violence we know the subject has at last entered public consciousness. As the authors of our annotation, Terrie Moffitt and Avshalom Caspi, put it “Research on partner violence has struggled to gain scientific legitimacy”. Moffitt and Caspi discuss the topical issue of adult partner violence and its possible consequences for the health and well-being of children. A disturbing number of detrimental consequences for children could arise from their exposure to violence between adult partners in the home. The authors suggest clinical practice with children should take into account those parental influences that children carry forward with them into their own adult family life. They make the point that violence between couples may begin during dating in adolescence, and is as often perpetrated by females as males. They point out that an important but hitherto unappreciated link has been found, from the results of longitudinal epidemiological investigations, between childhood conduct problems and adult partner violence. That link has probably been missed in former retrospective studies of adults who are abusive to their partners, asked about their own upbringing. Interventions for conduct problems in adolescence and beforehand are clearly of importance if the cycle of intergenerational violence is to be broken. Questions we all need to address, as clinicians, include: “What is the impact on young children of violence within the home between adults, to which they may repeatedly be exposed? How is such experience likely to affect their attitudes to violence, especially when in a similar relationship themselves?” Partner violence is concentrated among young men and women who cohabit but are not married, and who bear children at a young age, especially if they have a history of conduct problems themselves. How often is domestic violence a subject of enquiry when drawing up the initial formulation of a new clinical referral?
Editorial
- Frank C. Verhulst
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- 01 July 1998, pp. 607-608
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It is a great honour to assume the role of joint editor of the Journal of Child Psychology and Psychiatry, and inspiring to be part of an enthusiastic and supportive team. The Association for Child Psychology and Psychiatry has shown its open-mindedness and international orientation by electing, for the first time in its history, a joint editor who is not a native speaker of English. I appreciate the trust placed in me, and I hope I will come up to the expectation that, together with my fellow editors, this Journal will maintain, or even strengthen, its high standards and influential position in this rapidly changing field of research in child psychology and psychiatry. I follow in the footsteps of Dorothy Bishop, who I got to know when she was a joint editor and I was an author who had submitted an article to this Journal, anxiously awaiting the editor's decision. I remember I was struck by the skilful scrutiny and supportiveness of her editorial work and I wondered if I would be able to do equally well if I would be an editor, not knowing that years later I would be in a position to take up this challenge.
This issue is especially voluminous, since we wanted to reduce the number of articles in the pipeline awaiting publication. By temporarily increasing the number of pages, we wanted to ensure that the information the reader reaches is up to date and not obsolete by the time it is published.
Editorial
- Frank C. Verhulst
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- 01 November 1998, pp. 1057-1058
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Epidemiological research has shown that the majority of children who need professional mental health care do not receive it. Factors other than the level of the child's problem behaviour are involved in the help-seeking process, and are co-determinants of whether or not the child receives help. Longitudinal general population studies have shown that child psychopathology can persist and may lead to later serious adjustment problems, even in adult life. Consequently, it seems important that child psychologists and child psychiatrists should not wait passively until the patient steps into the office, but should actively trace high-risk children and apply the most effective intervention programmes. But how can children most in need of professional interventions be selected accurately? The central question addressed in the Annotation by Bennett et al. in this issue concerns externalising problems. The authors give an account of the most relevant epidemiological measures needed for the assessment of the predictive accuracy of externalising behaviours. They reviewed studies and tested the accuracy with which measures of externalising behaviours in children from the general population predict later antisocial behaviours. Selecting only those studies that pertained to kindergarten and grade one children, they came to the sobering conclusion that the predictive accuracy of externalising symptoms at that age has been overestimated and is, at best, modest. However, as they point out, targeted intervention programmes, in which high-risk children are selected, may still offer some advantages, because even with far from accurate predictive measures the number of children who receive unnecessary interventions can still be substantially reduced. The authors rightly note the risk of labelling due to false positive errors. They also claim that, when the same method is used to detect the presence of externalising behaviours in both females and males, a higher rate of false positive errors in females will occur, with a consequently greater risk for labelling for females. However, they seem to have overlooked that it is possible to select different morbidity or high-risk criteria for each sex separately; by using norm-based measures of problem behaviour, we can use the distributions of problem behaviours in the norm population for each sex separately to determine which cut-off separates high- from low-risk boys and girls. Even if we have improved our means to select accurately those children that run a high risk for later problems, we still have to determine which preventive intervention strategies work best, and who is going to treat all the high-risk children thus selected.
Editorial
- Jim Stevenson
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- 01 March 1998, pp. 289-290
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Autism is not a condition that I have studied and at times I have been concerned that this Journal may have published a disproportionate number of studies on a condition that is relatively rare and primarily determined by genetic factors, and for these reasons, perhaps of less relevance to most clinicians. Having read Pat Howlin's Practitioner Review I realise just how wrong I have been on both counts! Not only are autism, autism spectrum disorders, and Asperger syndrome far more common than I realised (the prevalence estimate of Wing for autism spectrum disorders of just under 1 per 1000 is quoted) but it is also clear that the recent research effort focused on these children has paid dividends in the development of approaches to treatment for the disorders. As Howlin emphasises, these advances have not led to a cure for autism, as claimed by some proponents of therapies such as holding therapy and facilitated communication, and even those producing some change may require an unacceptable burden of commitment for families, for example the home-based behavioural programmes of Lovaas and colleagues. However, as she clearly indicates, we have learned how to guide the management of challenging behaviour and have methods both to enhance communication and to reduce obsessional behaviour in children with autism. A recurrent theme running through this Practitioner Review is the value of early intervention with these children. This, in turn, gives new impetus to both the research concerned with the basic deficits experienced by children with autism and the studies on the detection of early signs of the disorder by, amongst others, Baron-Cohen and colleagues. An example of the former is the paper in this issue by Leevers and Harris into the ability of the child with autism to conceptualise and image “impossible” entities, for example a man with two heads. This study showed that the imagination of children with autism is not as impaired as once thought. Care should be taken not to interpret poor performance on such tests as reflecting lack of creativity or imagination when a problem with understanding the nature of the task or with certain task demands, such as planning, may be responsible.
Editorial
- Jim Stevenson
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- 01 October 1998, pp. 941-942
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Recently the editors of the JCPP were challenged that there must be a policy within the Journal creating a bias against a particular topic which, it was claimed, was under-represented in the Journal. Our response to this was that there is indeed no editorial policy on specific topics to be included or excluded from the Journal. It is only the scientific merit of the individual papers that determines what gets accepted and what is rejected. The topics of the papers that appear in the Journal are primarily a reflection of the range of papers that are submitted. The editors of the Journal act autonomously in deciding, in the light of referees' comments, whether to accept a paper or not. In a similar manner, the Associate Editors and Corresponding Editors have independence in making decisions about papers to appear in the Annual Research Reviews and in the Practitioner Reviews and Annotations.
One consequence of this autonomy is that, as an editor, it is only when an issue is collated that material processed by the other editors comes to your attention. This usually creates a number of pleasant surprises and this issue is no exception. It was not until I received the collection of papers to appear in this issue that I was aware of the Annotation provided by Weiss. These editorials are intended to draw to the reader's attention aspects of the papers appearing in each issue that are of particular salience to clinicians. This annotation by Weiss should be required reading for all clinicians.
Editorial
- Jim Stevenson
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- 01 May 1998, pp. 437-438
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A number of the papers in the present issue have clinical implications related to the role of families in child development. The first paper by Rutter and his colleagues from the English and Romanian Adoptees study team concerns the impact of gross early privations on subsequent development. The adoption into English families of children from Romanian institutions constituted a most informative natural experiment because horrendous early experiences were followed by placement into rather better than average family circumstances. The paper documents the poor state of most children at the time of coming to the U.K. and the spectacular degree of cognitive, as well as physical, catch-up. The findings attest to the remarkable resilience shown by many individuals, even after quite extreme privation. However, they also show that recovery was not always complete, especially if the privation lasted beyond the early months of life. Because the privation in Romanian institutions was so severe and pervasive it proved difficult to isolate the key element leading to lasting deficits, but the pattern of findings suggests that psychological privations may have been more damaging than nutritional ones. The results highlight the need for clinicians to be alert to the sequelae of serious neglect, but also to be aware that provision of a good rearing environment in a supportive family can do much to alleviate the damage.
Editorial
- David Skuse
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- 01 September 1998, pp. 795-796
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We have a particular interest in the development of interpersonal communication in this issue, and in some of the problems that are seen when the system goes awry. Subtle deficits of communication are far more common among children referred to child psychiatric facilities than is generally appreciated. It is arguable that they are probably detected rather more easily by other children than by clinicians or even parents. Subtle disorders of language, particularly the higher-order features of language such as pragmatics, may contribute to the social difficulties faced by many children presenting to psychiatrists and psychologists. Unfortunately, until very recently we did not have any really good measures for detecting and measuring these subtle disorders, which may have profound consequences for children's behavioural and emotional adjustment, and may also contribute to educational failure.
A common clinical problem is the appropriate diagnosis to apply to a child who presents with a mixture of communicative and social impairments. Diagnostic difficulties are compounded by the lack of suitable assessment tools for evaluating how children use language in relation to a given social context. We refer to this issue as pragmatics. Bishop presents data on a new checklist for detecting pragmatic deficits, which is designed for completion by teachers or other professionals who are in daily contact with the child. Her instrument represents an important development. Careful evaluation of the checklist has shown that it can be rated reliably. Information obtained from it is intended to complement that from more formal language assessments, which are for the most part insensitive to children's pragmatic skill deficits. Bishop argues that diagnostic difficulties in the field of communication deficits are not uncommon, and her assertion will find echoes in the experience of many clinicians.
Research Article
The Development of Memory
- Susan E. Gathercole
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- 01 January 1998, pp. 3-27
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This article reviews recent advances in understanding the changes in memory function that take place during the childhood years. Development of the following aspects of memory are considered: short-term memory, comprising phonological memory, visuospatial memory, and executive function; autobiographical memory; episodic memory, including eyewitness memory; and metamemory. Each of these aspects of memory function shows substantial qualitative change from infancy, through the preschool period, to the early school years. Beyond about 7 years of age, however, memory function appears adult-like in organisation and strategies, and shows only a gradual quantitative improvement through to early adolescence.
Review Article
Annotation: Do Measures of Externalising Behaviour in Normal Populations Predict Later Outcome?: Implications for Targeted Interventions to Prevent Conduct Disorder
- Kathryn J. Bennett, Ellen L. Lipman, Yvonne Racine, David R. Offord
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- 01 November 1998, pp. 1059-1070
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Mental health professionals involved with the care of children and adolescents are frequently confronted with questions about the risk of later troublesome outcomes. Of particular concern is whether the presence of certain risk factors warrants the provision of an intervention. The presence of externalising behaviour symptoms is regarded by many as the single best predictor of risk for future conduct disorder and antisocial behaviour (Loeber, 1991; Lynam, 1996; Moffitt, 1993; Patterson, 1993; Yoshikawa, 1994). These symptoms include aggression against others, destruction of the personal property of others, temper tantrums, and noncompliance, to name but a few. The evidence suggests that when these behaviours are present in childhood there is an increased risk for persistent, life-long psychosocial problems (Loeber, 1982; Loeber & Dishion, 1983; Moffitt, 1993; Olweus, 1979; Yoshikawa, 1994). For example, a link between the early onset of externalising behaviours and the later development of conduct disorder, antisocial behaviour, and substance abuse has been documented in both longitudinal and retrospective studies (Caspi, Moffitt, Newman, & Silva, 1996; Farrington, 1990; Robins, 1978; Tremblay, Pihl, Vitaro, & Dobkin, 1994; White, Moffitt, Earls, Robins, & Silva, 1990; Zoccolillo, Tremblay, & Vitaro, 1996).
The risks associated with externalising symptoms and the relatively modest effectiveness of treatment for established cases of conduct disorder and antisocial behaviour (Kazdin, 1997; Offord, 1989; Offord & Bennett, 1994) have led to an increased emphasis on the provision of preventive interventions (Institute of Medicine, 1994; Reiss & Price, 1996). It has been argued that intervention should be provided to high-risk children as early as possible. Claims have been made that even in nonclinic populations of children as young as 4 and 5 years of age, 50% or more of those with troublesome externalising symptoms will develop persistent psychosocial problems (Campbell, 1995; Coie, 1996; Reid, 1993; Reid & Patterson, 1991).
Annotation
Day and Night Wetting in Children — A Paediatric and Child Psychiatric Perspective
- Alexander von Gontard
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- 01 May 1998, pp. 439-451
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Involuntary wetting is one of the most common symptoms of childhood, affecting 10% of all 7-year-olds at night and 3% during the day (Hellström, Hanson, Hansson, Hjälmas, & Jodal, 1990). It comprises a heterogeneous group of disorders that differ regarding aetiology, pathophysiology, clinical symptoms, and therapy. Day wetting was last reviewed in the Journal of Child Psychology and Psychiatry in 1979 (Berg, 1979). In the past two decades a wealth of information on the pathophysiology of nocturnal enuresis, as well as of diurnal wetting, has been won. This annotation will review clinically relevant aspects of both forms of wetting and will concentrate on findings from paediatric urology, paediatric nephrology, genetics, endocrinology, child psychiatry, and epidemiology. Medical and technical terms are explained in the Glossary. Specific child psychological aspects will not be dealt with, as these have been excellently reviewed elsewhere, especially for nocturnal enuresis (Butler, 1987, 1994).
Genetic Research, Family Life, and Clinical Practice
- Martin Richards
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- 01 March 1998, pp. 291-305
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Human interest in and concern about inheritance is very far from new. It is reasonable to assume that ideas about physical resemblances and behavioural characteristics running in families are as old as concepts of family and kinship. We can be rather more certain that from the dawn of agriculture selective breeding has been used to change the characteristics of plant crops and domesticated animals. Indeed, selective breeding may well be viewed as the first step required to create agriculture. However, a knowledge of genetics is not required to apply selective breeding to animals or plants (or humans). All that is needed is the assumption that parental characteristics are likely to be passed to offspring. Then one can breed from superior stock, or those which have desired characteristics, and avoid breeding from inferior stock.
Routine Monitoring of the Effectiveness of Child Psychotherapy
- Bahr Weiss
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- 01 October 1998, pp. 943-950
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Outcome studies of child psychotherapy have sometimes been categorized into two broad types of studies. Ideally, psychotherapy outcome investigators first conduct “efficacy studies”, where internal validity is at the forefront and where considerable control is exercised over and within the experimental design (Hoagwood, Hibbs, Brent, & Jensen, 1995). In efficacy studies, often: (a) specific inclusion and exclusion criteria will be defined in order to restrict the sample to children exhibiting only the specific behavioral/emotional problem area upon which the treatment focuses; (b) the sample will be randomly assigned to treatment and comparison groups; (c) in order to allow for assignment to a no-treatment control group, the sample will not be seeking treatment (i.e. not clinic-referred); and (d) the investigators will exercise a high degree of control over the intervention (e.g. spend several months training therapists who are hired specifically for the project, see, e.g., Lewinsohn, Clarke, Hops, & Andrews, 1990).
“Effectiveness studies” are conducted where the focus is more on external validity and generalizability. In contrast to efficacy studies, effectiveness studies generally: (a) take place in naturalistic settings, where the mental health treatment of children actually occurs (e.g. in clinics); (b) use heterogeneous samples that are actually seeking services; (c) involve practitioners rather than research therapists; and (d) allow therapists more control over the intervention (see, e.g., Weisz & Weiss, 1989).
Review Article
Annotation: Class Size and the Quality of Educational Outcomes
- Neville Bennett
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- 01 September 1998, pp. 797-804
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There has, over the last few years, been a keen and contentious debate surrounding the interpretation and implications of an inexorably upward trend in class sizes in Britain, focusing particularly on the primary sector. This has been played out against a backcloth of such diverse influences as the continued diminution in public sector spending, low teacher morale, changes in school management and budgeting incorporating a market approach to school enrolment, the enhanced role of parents in school governance, the publication of league tables, and disputes about differential funding of schools. Day, Tolley, Hadfield, Parkin, and Watling (1996) characterise the resultant polarisation of view as being between education pressure groups on the one hand and the government on the other, i.e. the “critical” versus the “official” view. However, this is probably too narrow a characterisation because all parties with a legitimate interest in education have been involved, from parents and teachers through to national pressure groups such as teacher unions and the National Commission on Education. Several independent surveys have been undertaken, which show both the wide consensus about the effect of increasing class sizes among these groups, and the strength with which they hold their views.
Research Article
Annotation: Implications of Violence between Intimate Partners for Child Psychologists and Psychiatrists
- Terrie E. Moffitt, Avshalom Caspi
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- 01 February 1998, pp. 137-144
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Violence between adult intimate partners has increasingly attracted the concern of the general public (Hunt & Kitzinger, 1996), medical professionals (Skolnick, 1995), and mental health practitioners who treat adults (Danielson, Moffitt, Caspi & Silva, in press). Yet, it may seem surprising to find an article about adult partner violence in a journal focused on children. We prepared this article because research suggests that adult partner violence has some important consequences for the health and well-being of children. We present four reasons why practitioners who treat children and adolescents should be knowledgeable about adult partner violence:
(1) Partner violence is not confined to adults; it is a feature of adolescents' earliest intimate experiences.
(2) The strongest developmental risk factor for adult partner violence is childhood conduct problems.
(3) Young children are adversely affected by witnessing violence between the adults in their homes.
(4) Adult partners who are violent toward each other are also at increased risk of abusing their children.
Abbreviations: CTS: Conflict Tactics Scale.
Annotation
The Psychological Development and Welfare of Children of Opiate and Cocaine Users: Review and Research Needs
- Diane M. Hogan
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- 01 July 1998, pp. 609-620
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Parental dependence on illicit drugs is a growing concern across a number of disciplines. It has implications that are at once medical, political, social, and psychological. In recent years, researchers from the U.S.A. (Austin & Prendergast, 1991; Deren, 1986; Johnson, 1991) and the U.K. (Burns, O'Driscoll, & Wason, 1996) have called for greater attention to be paid to social and psychological, rather than solely physical, effects of parental drug use on children. In Ireland, against the backdrop of an intractable and escalating intravenous opiate problem, the issue of how children are affected by parental drug dependence is emerging as a new social and clinical concern. A recent government report, for example, recognises that children of drug users may be in need of clinical interventions and special care arrangements (Rabitte, 1996). But what form should such services take? Are these children at greater risk than other children from similar socioeconomic backgrounds for experiencing social and psychological problems? Is the nurturing environment provided to children whose parents are dependent on illicit drugs less adequate than that provided to children whose parents do not use drugs? At present research does not provide conclusive answers to these questions. Research that focuses on the effects of postnatal parental drug use on children's social and psychological well-being is strikingly scarce, with the majority of child-oriented research concentrating instead on the effects of prenatal exposure to drugs. The small amount of research that has been conducted on the caregiving environments of children of drug users has produced largely inconclusive findings.
The aims of the present paper are to review and analyse existing research on the social environments provided to children of drug users, and on the developmental outcomes for this group. A further aim is to provide pointers to gaps and shortcomings that need to be addressed in future research. The focus is on parental addiction to “hard drugs”, namely opiates (primarily heroin and methadone) and cocaine. Studies dealing exclusively with the impact on children of prenatal exposure to drugs and of parental alcohol use are excluded, as are studies of a primary addiction to amphetamines and other illicit substances, although it is recognised that these are frequently used in addition to opiates and cocaine.
Practitioner Review
Psychological and Educational Treatments for Autism
- Patricia Howlin
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- 01 March 1998, pp. 307-322
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The review discusses various interventions that have been used in the treatment of children with autism. It concludes that no single mode of treatment is ever likely to be effective for all children and all families. Instead, intervention will need to be adapted to individual needs and the value of approaches that involve a functional analysis of problems is explored. It is suggested that many so called “challenging” behaviours result from the child's fundamental difficulties in communication and social understanding, or from the ritualistic and obsessional tendencies that are also characteristic of autism. Possible ways in which parents and teachers might deal with problems in these areas are discussed. The importance of early diagnosis, and with it early, practical advice for families is stressed.
Annotation
Night Wetting in Children: Psychological Aspects
- Richard J. Butler
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- 01 May 1998, pp. 453-463
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von Gontard's annotation (1998) on day- and night-wetting children takes a paediatric perspective on these prevalent and distressing conditions. This review addresses some of the major psychological issues relevant to nocturnal enuresis. Daytime wetting, which encapsulates a number of conditions each with separate aetiologies, distinct presentations, and specific treatment interventions, has been the focus of two recent reviews (Edens & Surwit, 1995; Robson, Leung, & Bloom, 1996) and will thus not be discussed in this annotation.
Research Article
Targets and Cues: Gaze-following in Children with Autism
- Susan R. Leekam, Emma Hunnisett, Chris Moore
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- 01 October 1998, pp. 951-962
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Children with autism are known to have difficulties in sharing attention with others. Yet one joint attention behaviour, the ability to follow another person's head turn and gaze direction, may be achieved without necessarily sharing attention. Why, then, should autistic children have difficulties with it? In this study we examined the extent of this difficulty by testing school-aged autistic children across three different contexts; experiment, observation, and parent interview. We also tested whether the ability to orient to another person's head and gaze could be facilitated by increasing children's attention to environmental targets and social cues. Results for experiment and observation demonstrate that a sizeable proportion of children with autism did not have difficulties with following another's head turn. There was a difference between children with high and low verbal mental ages, however. Whereas children with higher mental ages (over 48 months) were able to orient spontaneously to another person's head turn, children with lower mental ages had difficulties with this response. When cues were added (pointing, language) or when feedback from targets was given, however, their performance improved. Parent interview data indicated that children with autism, whatever their mental age, began to follow head turn and gaze direction years later than typically developing children. Developments in attention and language are proposed as possible factors to account for this developmental delay.
Review Article
Practitioner Review: Treatment of Schizophrenia in Childhood and Adolescence
- Andrew F. Clark, Shôn W. Lewis
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- 01 November 1998, pp. 1071-1081
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This paper reviews the management of schizophrenia occurring during childhood and adolescence. It considers the clinical features of the disorder particular to its early onset before providing a practical framework for assessment and treatment based upon a critical review of the available literature. A multi-modal approach to treatment encompassing the individual and their family is adopted with the roles of pharmacological, psychological, and environmental interventions all considered. The place of the newer “atypical” antipsychotic agents and the likelihood that they will soon become the first-line drugs of choice is particularly discussed.