This paper reviews the treatment of obsessive-compulsive disorder (OCD) in children and adolescents. Focusing on clinical features of the disorder and its treatment particular to pediatric onset, diagnosis, assessment, and behavioral, pharmacological, as well as new investigative treatments are covered. Adaptation of cognitive-behavioral therapy for children and adolescents, use of augmenting agents in drug treatment, and subtyping of OCD cases are developments relevant for current practice.

The assessment and treatment of somatisation in childhood require explicit recognition that many families frequently hold strong belief in the presence of physical disorders. Engaging the family, recognising and focusing on their beliefs and concerns, and paediatric/psychiatric liaison are usually required. Our knowledge on the management of children with somatisation is largely based on clinical reports but a number of open trials and methodologically increasingly stronger studies show that somatisation can respond to family treatments involving cognitive-behavioural techniques as well as to sensitive, psychologically sound advice by paediatricians. Antidepressants should be considered when there are comorbid mood disorders.

This report attempts to give nontechnical readers some insight into how a multilevel modelling framework can be used in longitudinal studies to assess contextual influences on child development when study samples arise from naturally formed groupings. We hope to achieve this objective by: (1) discussing the types of variables and research designs used for collecting developmental data; (2) presenting the methods and data requirements associated with two statistical approaches to developmental data—growth curve modelling and discrete-time survival analysis; (3) describing the multilevel extensions of these approaches, which can be used when the study of development includes intact clusters or naturally formed groupings; (4) demonstrating the flexibility of these two approaches for addressing a variety of research questions; and (5) placing the multilevel framework developed in this report in the context of some important issues, alternative approaches, and recent developments. We hope that readers new to these methods are able to visualize the possibility of using them to advance their work.

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.

The present study assesses the effects of demographic risk factors on children's exposure to violence (ETV) and how these effects vary by informants. Data on exposure to violence of 9-, 12-, and 15-year-olds were collected from both child participants (N = 1880) and parents (N = 1776), as part of the assessment of the Project on Human Development in Chicago Neighborhoods (PHDCN). A two-level hierarchical linear model (HLM) with multivariate outcomes was employed to analyze information obtained from these two different groups of informants. The findings indicate that parents generally report less ETV than do their children and that associations of age, gender, and parent education with ETV are stronger in the self-reports than in the parent reports. The findings support a multivariate approach when information obtained from different sources is being integrated. The application of HLM allows an assessment of interactions between risk factors and informants and uses all available data, including data from one informant when data from the other informant is missing.

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.

On the basis of Gray's theory, Quay suggested that conduct disorder (CD) is associated with a Behavioural Activation System (BAS) that dominates over the Behavioural Inhibition System (BIS), whereas attention deficit hyperactivity disorder (ADHD) is characterised by an underactive BIS. Two studies were conducted to test the hypothesis that the dominance of the BAS over the BIS is more pronounced in CD comorbid with ADHD (CD/ADHD) than in CD alone. First of all, a response perseveration task was used, i.e. the door-opening task (Daugherty & Quay, 1991). In this game, the subject chooses either to open the next door or to stop playing; there is a steadily increasing ratio of punished responses to rewarded responses and a large number of doors opened is indicative of response perseveration. As expected, a steady increase in the number of doors opened was found across normal control (NC) boys, CD boys, and CD/ADHD boys (NC<CD<CD/ADHD). Second, the dominance of the BAS over the BIS was examined by observing the social behaviour of the child in interaction with a research assistant who alternately activated the BAS and the BIS while a game was played. The behaviour of the children was analysed according to ethological methods. Group differences in the frequencies of three out of five behavioural categories were in line with the results of the door-opening task (NC<CD<CD/ADHD).

This study was designed to examine the classification performance of diagnostic rules for pervasive developmental disorder not otherwise specified (PDD-NOS) and multiple complex developmental disorder (McDD), with clinical diagnosis as the gold standard. McDD is an heuristic concept of a developmental disorder characterised by social impairments, affective dysregulation, and thought disturbance. Detailed information on the symptoms, reliably extracted from the charts of 103 children with PDD-NOS and McDD, 32 with autistic disorder, and 96 with non-PDD disorders, was used to determine the presence of the DSM-IV criteria of autistic disorder and the criteria of McDD. A scoring rule for PDD-NOS based on a short set of seven DSM-IV criteria with a cut-off point of three items and one social interaction item set as mandatory had the best balance between high sensitivity and high specificity. The most effective and simple rule based on McDD criteria had a cut-off of three items, out of six items of anxieties and thought disturbance.

Infantile autism is a heterogenous disorder with unknown aetiology. Evidence from the relatively few family and twin studies suggests a genetic component. Co-occurrence or cosegregation between infantile autism and chromosomal abnormalities may identify candidate regions, which could be tested in linkage or association studies.

The purpose of this study was to use the Danish Cytogenetic Central Register in order to detect autosomal chromosome abnormalities associated with infantile autism, and to review the literature for cases of autism associated with autosomal chromosome abnormalities to identify candidate chromosomal regions.

The register-based study identified possible candidate regions on chromosome 7q21 and 10q21.2, which have not previously been reported.

A few interesting candidate regions, 15q11–13, 16q23, and 17p11.2 were found in the literature survey.

Fears and phobias are relatively common in childhood. Both environmental and genetic theories have tried to explain the etiology behind these conditions. However, data supporting the different theories are sparse. To investigate the relative importance of genetic and environmental influences on specific phobias and fears, parental reports of animal, situational, and mutilation fears and phobias were completed for 1106 pairs of 8- to 9-year-old Swedish twins. The prevalence of specific phobias was 7.3% for boys and 10.0% for girls. Genetic, shared environmental, and nonshared environmental effects contributed to individual differences in fears and phobias in young children, but the magnitude of the effects differed between sexes. Shared environmental effects contributed to a general susceptibility for fearfulness. Genetic and nonshared environmental effects, on the other hand, contributed both to the general susceptibility and specific fearfulness, even though these effects primarily were fear specific. These results indicate that both heritable factors as well as environmental factors such as trauma, vicarious learning, and/or negative information are important for differences in fearfulness and phobias—at least in children.

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.

The present study utilised a cognitive paradigm to investigate attentional biases in clinically depressed children and adolescents. Two groups of children and adolescents—clinically depressed (N = 19) and normal controls (N = 26)—were asked to complete a computerised version of the attentional dot probe paradigm similar to that used by MacLeod, Mathews, and Tata (1986). Results provided no support for an attentional bias, either toward depression-related words or threat words, in the depressed group. This finding is discussed in the context of cognitive theories of anxiety and depression.

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).

In adolescence, antisocial and depressive symptoms are moderately stable and modestly correlated with each other. We examined the genetic and environmental origins of the stability and change of antisocial and depressive symptoms and their co-occurrence cross-sectionally and longitudinally in a national sample of 405 adolescents. Monozygotic (MZ) and dizygotic (DZ) twins and full, half, and unrelated siblings 10–18 years of age from nondivorced and stepfamilies were studied over a 3-year period. Composite measures of adolescent self-reports, parent reports, and observational measures of antisocial and depressive symptoms were analysed in multivariate behavioural genetic models. Results indicated that the majority of the stability in and co-occurrence between dimensions could be accounted for by genetic factors. Nonshared environmental risks and, for antisocial symptoms, shared environmental risks also contributed to the stability. Genetic influences on change were observed, but only for antisocial behaviour. In addition, the longitudinal association between antisocial behavioural and later depressive symptoms was also found to be genetically mediated, but this effect was nonsignificant after controlling for stability. Results are discussed in light of the potential contributions of developmental behavioural genetic research in understanding individual differences in the stability and change of maladjustment.

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.

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.

Epilepsy in childhood may alter family relationships but the relevance of these changes for the increased rates of psychopathology has been little investigated. This study uses maternal expressed emotion (EE) to examine family relationships of children with epilepsy and the association with high risk for psychiatric disorder. EE was assessed using the Camberwell Family Interview carried out with the mothers of 22 schoolchildren with chronic epilepsy who were attending a general hospital outpatient clinic. Sixteen of these children had similarly aged healthy siblings who served as controls. High risk for psychiatric disorder in the children and mothers was assessed using behavioural, mood, and self-esteem questionnaires completed by mothers, teachers, and children. It was found that mothers showed significantly more emotional overinvolvement and a trend for more hostility towards their children with epilepsy than towards sibling controls. For the 22 children with epilepsy, maternal emotional overinvolvement was not associated with child behavioural deviance. High levels of criticism and, to a lesser extent, hostility did show associations with child behavioural deviance, and the strongest links were between maternal criticism and maternal rated antisocial and overactive behaviour in the child. Fewer positive comments by mothers towards the children were associated with child emotional symptoms and lower self-esteem in a number of areas. This study suggests that further research could consider the appropriateness of psychological intervention for families in which mothers are critical and hostile and whose children show antisocial behaviour.

The purpose of the present study was to explore patterns of mother–child interaction, children's private speech use, and behavioral self-regulation among a sample of preschool children identified by their preschool teachers as evidencing behavior problems. Forty preschoolers were classified into two groups (behaviorally at-risk and a matched comparison group) on the basis of teacher ratings of impulsivity, inattention, and hyperactivity. Children completed a magnet board puzzle task once in collaboration with their mother and once individually, and maternal and child speech and behavior were coded from videotapes. Although there were no group differences in children's behavior or speech during the collaborative session, nor were there differences in children's individual task performance or on-task attention, mother–child interaction involving behaviorally at-risk children was characterized by more other-regulation, negative control, less praise, and less physical withdrawal over time, compared to interactions involving comparison children. Behaviorally at-risk children, compared to controls, used more overt, task-relevant private speech during individual problem solving. Partially internalized private speech use among at-risk preschoolers was positively associated with task performance. Group differences rather than similarities prevailed in terms of the relations between maternal behavior, child speech, and child performance.

ADHD is a familial disorder with high rates of comorbidity with conduct disorder in childhood and antisocial personality and substance use disorders in adulthood. A growing literature suggests that ADHD with antisocial comorbidity may be nosologically distinct from other forms of ADHD. Previously, we proposed a family-based stratification that defined Antisocial families as those with either conduct disorder or antisocial personality disorder in the probands or relatives. To provide predictive validity for that stratification, we assessed psychopathology in these families 4 years after their initial assessment. Results show that the probands and siblings from Antisocial families had higher rates of psychopathology during the 4-year follow-up period compared with siblings from Non-antisocial and control families. They also had more deviant ratings on the Child Behavior Checklist (especially for anxious/depressed, delinquent, and aggressive behavior). We found fewer group differences in the academic, psychosocial, and intellectual correlates of ADHD. These results confirm and extend previous work indicating that Antisocial ADHD may be a nosologically and clinically meaningful subform of ADHD.

This study examined the parenting and family life correlates of childhood hyperactivity in a community sample of London school children. Twenty-eight boys with pervasive hyperactivity were compared to 30 classroom control children on a range of parenting and family functioning measures. Results showed that poor parent coping and the use of aggressive discipline methods were significantly associated with hyperactivity after adjusting for the effects of conduct disorder and parent mental health. The best parenting predictor of hyperactivity was disciplinary aggression. Findings suggest that the quality of parenting provided for hyperactive children may contribute to their behavioural difficulties, and highlights the need to examine more closely the role of parenting attitudes and behaviour in shaping the course, prognosis, and treatment outcomes for children with hyperactivity.

Abbreviations: BPVS: British Picture Vocabulary Scale; CRPR: Child-Rearing Practices Report; DAS: Dyadic Adjustment Scale; GHQ: General Health Questionnaire; PACS: Parental Account of Children's Symptoms Interview; SOS: Significant Others Scale.