There is an urgent need to pay attention to the mental health of children in developing countries. Professionals confronted with this task face a number of challenges. Services have to be planned in a rational way, keeping in mind the needs of local populations. These needs will often exceed the available resources, and it will be necessary to set priorities. Feasible and cost-effective models of service delivery then have to be developed to meet these needs. This annotation provides a framework within which mental health needs of children can be assessed, priorities established, and services organised. This is illustrated with examples of relevant activities undertaken in low-income developing countries over the last two decades.

Severe retardation in a child surely has an effect on all family members. Studies of nondisabled siblings in these families have indicated both emotional risks and perceived benefits. Little is known about how out-of-home placement of the child with retardation affects the siblings. Adolescent siblings of children with retardation living at home (N=25) or in residential placement (N=20) were contrasted with siblings of children without retardation (N=28), on measures obtained from their mothers and themselves. Despite their different situations, these siblings were highly similar on measures of psychological adjustment, self-esteem, and family environment. Sibling relationships, however, were less intense, with less warmth but also lower conflict, in families where the child lived out of the home. Most siblings of children with retardation reported positive personal growth experiences while also expressing realistic concerns about the future. Siblings of children with retardation had beliefs and attitudes about placement that were highly consistent with the child's current living situation.

In this study, we explored relations among negative life events, negative attributional style, avoidant coping, and level of fear in 99 children who had survived residential fires. Overall, negative life events, negative attributional style, and avoidant coping were found to be predictive of levels of fear. However, the relation between negative life events and fear was moderated by mother's level of education such that this prediction was obtained only for those children whose mothers were low in education level. Age, ethnicity, and sex did not moderate these relations. In addition, negative attributional style and avoidant coping were related to levels of fear in those children whose mothers were high in education levels but not those whose mothers were low in education level. Results are discussed within a stress and coping framework.

The last decades have shown a rapid increase in nonresponse rates. For this reason it is important to study nonresponse and think about it critically. In this article we investigated whether nonresponse affected estimates of the levels of adjustment problems in children and the correlations between these outcomes. The nonresponse was caused by parents who refused permission to interview their children at school, parents who did not return a questionnaire, teachers who did not complete the questionnaire, and parents who refused to participate in an in-depth study, with nonresponse rates of 9%, 69%, 25%, and 46% respectively. The sample consisted of 1282 children aged 4–5 years and the dependent measures were peer-rated sociometric status, self-rated wellbeing at school, and teacher-rated behaviour problems. Despite considerable nonresponse in some conditions our results showed hardly any evidence for bias. This suggested that bias cannot simply be inferred from the amount of nonresponse and that standard rules such as ‘‘nonresponse rates higher than 50% are not acceptable’’ lack a scientific basis. Instead, we argue that to assess nonresponse bias the specific conditions and analyses of the study will need to be considered and special measures may be required.

The relationship of atopic and behavioral symptoms in a community sample of 66 monozygotic and 141 dizygotic twin pairs, ages 4–11 years, was investigated via mother report questionnaires. Within-person correlation between atopic symptoms and Child Behavior Checklist internalizing symptoms (CBCL-INT) was .21 (p<.001) for the total sample. Cross-correlations between atopy and CBCL-INT were .26 for monozygotic and .04 for dizygotic twins. A common and specific factor model applied to the data revealed that the cross-correlation between atopy and CBCL-INT was mainly due to genetic influences (77% of the covariance). This study supports the hypothesis that there is a shared genetic risk for atopy and internalizing symptoms.

In a study of a total high-school population, 2300 students aged 16–17 years were screened for depression (BDI, CES-DC). Those with a self-evaluation indicating depression, together with controls matched for sex, age, and class were interviewed (DICA-R-A). The 177 pairs, where both individuals were interviewed and the control had no lifetime diagnosis of depression, were analysed in the form of paired differences for psychosocial factors and compared within diagnostic groups. The psychosocial factors were measured with the ISSI subscales and six attitude questions about family climate (KSP). Adolescents with an episode of major depression during part of the last year did not differ from their controls. Those with long-lasting depressive symptoms, i.e. dysthymia with or without episodes of major depression, had a more limited social interaction and were not satisfied with it. They also evaluated their family climate and attachment network as being more inadequate than did their controls. Depressed adolescents with comorbid conduct disorder had a more negative evaluation of availability and adequacy of both social interaction and attachment network than their controls. This group had a very negative view of their family climate. Since this is a case-control study conclusions cannot be drawn about cause and effect.

Many children suffer an injury to the head at some time, but relatively few of these cause major problems. However, in a few cases the sequelae can be far reaching. This review considers how to evaluate the significance of a head injury. Factors to consider are (1) injury variables: cause, severity and type of injury; (2) child variables: premorbid functioning, age, and developmental level of the child both at injury and at assessment; and (3) the cognitive, behavioural, and emotional problems that may arise. Parental beliefs and knowledge about the injury as well as the overall effect of an injury on the family as a whole are also considered.

This paper examines the cognitive and neuropsychological functioning of children who were in utero to age 15 months at the time of the Chornobyl disaster and were evacuated to Kyiv from the 30-kilometer zone surrounding the plant. Specifically, we compared 300 evacuee children at ages 10–12 with 300 non-evacuee Kyiv classmates on objective and subjective measures of attention, memory, and school performance. The evacuee children were not significantly different from their classmates on the objective measures (grades; Symbolic Relations subtest of the Detroit Test; forms 1 and 2 of the Visual Search and Attention Test; Benton Form A; Trails A; Underline the Words Test) or on most of the subjective measures (the attention subscale of the Child Behavior Checklist completed by mothers; the attention items of the Iowa Conners Teacher's Rating Scale; mother and child perceptions of school performance). The one exception was that 31.3% of evacuee mothers compared to 7.4% of classmate mothers indicated that their child had a memory problem. However, this subjective measure of memory problems was not significantly related to neuropsychological or school performance. No significant differences were found in comparisons of evacuees and classmates who were in utero at the time of the explosion, children from Pripyat vs. other villages in the 30-kilometer zone, and children manifesting greater generalized anxiety. For both groups, children with greater Chornobyl-focused anxiety performed significantly worse than children with less Chornobyl-focused anxiety on measures of attention. The results thus fail to confirm two previous reports that relatively more children from areas contaminated by radiation had cognitive deficits compared to controls. Possible reasons for the differences in findings among the studies are discussed.

Alcohol use and nicotine use were investigated in a representative sample of 1110 study participants aged 10 to 17 years. In addition to questions on substance use, the participants responded to questionnaires covering behavior and emotions, life events, self-related cognitions, coping capacities, perceived parental behavior, perceived school environment, and the social network. The gender gap in substance use tended to close with increasing age. Parental substance use served as a model for substance use in the participants. Substance users had more abnormal scores on almost all variables as compared to abstaining controls. Lack of acceptance and control, pressure to achieve at school, and life events significantly predicted substance use. The latter served as a moderating risk variable for delinquent behavior under stress.

To examine the possibility that there is an early sensitive period for the effects of malnutrition on cognitive development, three groups of children (N = 197) were recruited from a birth cohort with known growth characteristics in south-west Ethiopia (N = 1563). All had initial weights [ges ]2500g. Early growth falterers dropped in weight below the third centile (z<−1·88) of the NCHS/WHO reference population in the first 4 months. Late growth falterers were children not in the first group whose weights were below the third centile at 10 and 12 months. Controls were a stratified random sample with weights above the third centile throughout the first year. All children were tested blind at 2 years using the Bayley Scales of Infant Development, adapted for use in Ethiopia. Mean (SD) scores on the psychomotor scale were 10·2 (3·7) in the controls, 6·6(4·2) in the early growth falterers, and 8·5(4·3) in the late growth falterers. For the mental scale they were 28·9(5·8), 22·6(6·2), and 26·6(6·1) respectively. Both overall differences were statistically significant at p<·001, and planned comparisons between the control and the combined growth faltering groups, and between the early and later growth faltering groups, showed that each difference was statistically significant for both scales. However, early weight faltering was associated with weight at the time of testing (r = .33), which was associated with scores both on the psychomotor (r = .53) and the mental scale (r = .49). After taking weight at the time of testing into account there was no additional effect attributable to the timing of growth faltering. In this population, therefore, early malnutrition does not have specific adverse effect beyond the contribution that it makes to enduring malnutrition over the first 2 years.

We look at the awareness of grammatical distinctions in children with reading difficulties, and at their ability to use this awareness in order to learn about the conventional spellings for morphemes like “ed” at the end of past verbs. Using longitudinal methods we show that, initially, children who are to become poor readers are actually better in this aspect of spelling and also in grammatical awareness tasks than younger children of the same reading level: but they are worse than these other children in tasks that tax their knowledge of phonologically based letter-sound correspondences. Later on, however, the poor readers lose their initial advantages in the conventional spelling of morphemes. We conclude that poor readers are initially held back by a failure to learn about letter-sound correspondences, and that this deprives them of successful reading experience, which in turn hampers the growth of their grammatical awareness and their learning how to spell morphemes.

Boys identified as hard-to-manage at age 4 and age-matched controls were assessed on laboratory measures of inattention, impulsivity, and hyperactivity at ages 4, 6, and 9. Hard-to-manage boys still exhibited some behavioral difficulties at age 9, but were not more inattentive or impulsive than controls. Boys with Attention Deficit Disorder (ADD) at age 9 showed performance deficits in each symptom-related domain relative to problem boys without ADD and controls. However, hard-to-manage problem boys with and without ADD did not differ on most earlier measures of inattention, impulsivity, and hyperactivity, suggesting that symptoms specific to ADD emerged more clearly between ages 6 and 9.

Using a longitudinal sample of children, this study examined the relation between maternal Expressed Emotion (EE) and mother–child attachment disorganization at age 6 years. A nonclinical sample of 33 children (at ages 12 months and 18 months) from Berlin, Germany participated with their mothers in Ainsworth's Strange Situation. Thirty-two children were again observed with their mothers at age 6 years in a standard laboratory attachment observation. At the time of the 6-year assessment, maternal EE was assessed based on a Five-Minute Speech Sample. Mothers also completed the Life Events Questionnaire, a measure of family stress, and the Present State Examination, a measure of maternal depression.

Maternal Expressed Emotion was significantly linked to mother–child attachment security at age 6 years. Further analyses revealed that High EE was most closely linked to the disorganized attachment pattern at age 6 years, an at-risk attachment pattern that has been associated with intrusive and hostile maternal behavior. The relationship was upheld when other relevant variables, including infant attachment disorganization and a measure of perceived family stress, were simultaneously considered. The study provides independent validation of Expressed Emotion as a measure of relationship quality in early childhood. It also provides a basis for the further investigation of the nature of the relation between maternal Expressed Emotion and attachment disorganization.

The relationship between age of asthma onset and behavioral adjustment was analyzed using data from a longitudinal prospective investigation of 150 children identified prenatally as at genetic risk for developing asthma (the W. T. Grant Asthma Risk Study). The children's development and asthma status were monitored regularly for 6 years. Mothers were interviewed yearly using the Behavioral Screening Questionnaire (BSQ). Children who had an early onset of asthma (by 3 years of age) had significantly more behavior problems at age 4 than children who developed asthma later (between 3 and 6 years of age). Furthermore, the early-onset group had significantly more problems at age 6 than both children who developed asthma later and children who never developed asthma. Children with early asthma onset were compared to children who were asthma free on individual problem items of the BSQ, revealing a profile of behavior problems that included waking at night, depressed mood, and some indication of increased fearfulness. This profile is consistent with an earlier report of behavior problems among severely asthmatic preschool children (Mrazek, Anderson, & Strunk, 1984), who displayed the same internalizing behavior problems on the BSQ. These results suggest that early asthma onset may have predictable negative influences on behavioral adjustment over a wider range of asthma severity than has previously been reported.

Abbreviations: BSQ: Behavioral Screening Questionnaire.

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.

There is increasing interest regarding electroconvulsive therapy (ECT) in young persons but limited information about its optimal use. This paper reviews the indications, effectiveness, and side effects of the treatment in the teenage population and their implications for everyday clinical practice. There is particular reference to factors influencing the clinician to recommend or advise against convulsive therapy, steps in the assessment of patients, and consent issues. Practical aspects of ECT administration are also examined, including treatment locale, anaesthesia, electrode position, stimulus characteristics, EEG monitoring, and use of psychotropics during and after the ECT course.

This paper examines the effects of living in a stepfamily during childhood and adolescence on a range of psychosocial outcomes at age 18 years. Data collected during an 18-year longitudinal study were used to examine a sample of 907 children with respect to: exposure to living in a stepfamily during the period from age 6 to 16 years; measures of psychosocial outcomes including mental health, antisocial behaviour, substance use, restricted life opportunities, and sexual risk-taking at age 18 years; and measures of prospectively collected confounding factors. The analyses revealed that children exposed to living in a stepfamily for the first time between ages 6–16 years had elevated risks of a range of psychosocial outcomes at 18 years. These included elevated risks of: (1) juvenile offending; (2) nicotine dependence; (3) abuse or dependence on illicit substances; (4) leaving school without qualifications; (5) early onset of sexual activity; and (6) multiple sexual partners. However, these risks were reduced substantially when psychosocial outcomes were adjusted for the confounding effects of antecedent factors such as: family socioeconomic characteristics; family history of instability, adversity, and conflict; mother's age, religiosity, and smoking; child gender; and preexisting child conduct and attentional problems. After adjustment, the odds ratios between exposure to a stepfamily and adolescent outcomes were nonsignificant. Additional analysis revealed that there were no significant differences in outcomes for boys and girls exposed to stepfamilies. It was concluded that although young people exposed to living in a stepfamily had increased risks of poor psychosocial outcomes, much of this association appeared to be spurious, and arose from confounding social, contextual, and individual factors that were present prior to the formation of the stepfamily.

This report describes program effects of the Tri-Ministry Study—a school-based, longitudinal trial carried out over a 5-year period to assess the effectiveness of classwide social skills training (SS), partner reading (RE), and a combination of both (SS & RE) to reduce maladjustment among children in the primary division (up to grade 3) of Ontario schools. It also places these effects in the context of other school-based prevention studies and discusses them in view of important methodological and programmatic issues. The incremental effects attributable to the intervention programs were small and sporadic. There were statistically significant increases in prosocial behaviour observed in the playgrounds of intervention schools with no differentiation by program type. Furthermore, there was some evidence—a reduction in teacher and parent-rated externalising problems—that the combination of SS & RE and SS alone may have had modest beneficial effects. A review of nine other school-based studies, which evaluated universally delivered mental health prevention programs in general populations of students, revealed similar mixed results. There are both methodologic and programmatic issues implicated in the weak findings that have been reported to date. These issues need to be addressed to advance knowledge about the potential impact of mental-health prevention initiatives delivered universally through school-based programs. A companion paper gives the specific details on the programs, randomisation of schools, selection of subjects, measurements, and analysis.

Recognition is increasing that suicide in young people poses an important public health challenge. Suicide in prepubertal children is very rare, but it increases for both genders in each of the adolescent years (McClure, 1994). In England and Wales, for example, the 1990 suicide rates per million for males and females aged 15 to 19 years were 57 and 14 respectively (McClure, 1994). Mortality rates in this age group were higher only for accidents. Since the Second World War, there has been an increase in male youth suicide rates in most European countries and in North America. In England and Wales, the suicide rate of males aged 14 to 24 years increased by 78% between 1980 and 1990! (Hawton, 1992). This increase is particularly striking when seen in comparison to the stable rates for other age groups and for young females (Diekstra, Kienhorst, & De Wilde, 1995).

Based on hospital statistics, it is estimated that the rate of nonfatal suicide attempts is 50 to 100 times higher than fatal attempts (Flisher, Ziervogel, Chalton, Leger, & Robertson, 1993). Evidence is emerging that the increase in rate of completed suicide is accompanied by an increase in the rate of attempted suicide (Hawton, Fagg, Simkin, Bale, & Bond, 1997). The rates of 15–24-year-olds presenting at the general hospital in Oxford with deliberate self-harm increased by 194% for males and 36% for females between 1985 and 1995 (Hawton et al., 1997).

Data from the National Child Development study (NCDS) were used to examine predictors of attainment among adoptees, nonadopted children from similar birth circumstances, and other members of this national birth cohort. Adoptees performed more positively than nonadopted children from similar birth circumstances on childhood tests of reading, mathematics, and general ability, and retained this advantage in school-leaving and later adult qualifications. In addition to family SES and material circumstances, measures of the educational environment of the home and of parental interest in education emerged as central predictors of these variations. Further analyses suggested possible differences in the mode of operation of these variables between boys and girls, and at different stages of young people's educational careers.