Recent investigations have highlighted associations between maternal smoking in pregnancy and antisocial behaviour in offspring, and suggested the possibility of a causal effect. We used data from the 1970 British birth cohort study (BCS70) to examine these links in a large, population-based sample studied prospectively from birth to age 16. We found a strong dose-response relationship between the extent of pregnancy smoking and childhood-onset conduct problems, but no links with adolescent-onset antisocial behaviours. Effects on childhood-onset conduct problems were as marked for girls as for boys, and were robust to controls for a variety of social background factors and maternal characteristics. Controls for mothers' subsequent smoking history modified this picture, however, suggesting that the prime risks for early-onset conduct problems may be associated with persistent maternal smoking—or correlates of persistent smoking—rather than with pregnancy smoking per se.

The aim of this study was to assess prospectively the long-term outcome in a representative sample of teenage-onset anorexia nervosa (AN) in respect of psychiatric disorders and overall outcome. Fifty-one AN cases, recruited by community screening, with a mean age of onset of 14 years, was contrasted with 51 matched comparison cases at a mean age of 24 years (10 years after AN onset). All 102 cases had been examined at ages 16 and 21 years. At 24 years all probands were interviewed regarding psychiatric disorders (SCID-I) and overall outcome (Morgan-Russell assessment schedule, the GAF). There were no deaths at 10-year follow-up. One in four in the AN group had a persisting eating disorder (ED), including three who still had anorexia nervosa. Lifetime diagnoses of affective disorders and obsessive-compulsive disorder were over-represented in the AN group. Outcome according to Morgan-Russell was poor in 27%, intermediate in 29%, and good in 43%. According to the GAF, half the AN group had a poor psychosocial functioning. These were subjects with either a persisting ED or lifelong problems with social interaction or obsessive-compulsive behaviour. Ten-year outcome of teenage-onset AN is favourable in the majority of cases; most individuals have recovered from their ED and have no other axis I disorder. However, half the AN group reported poor psychosocial outcome, in most cases explained by a persisting ED or chronic obsessive-compulsive behaviour/social interaction problems.

The goal of the study was to ascertain the factor structure and prevalence of psychiatric disability in children and adolescents in relation to demographic variables and diagnosis. A representative sample of 1420 children (9–13 years) from 11 countries in North Carolina was followed for up to 6 years. Children and caretakers were interviewed with the Child and Adolescent Psychiatric Assessment, which generates DSM-IV diagnoses and includes a measure of disability secondary to psychological symptoms. Three broad areas of disability were identified (relating to family, school, and peers). School disabilities were more common in boys than girls, while the reverse was true of family disability. Effects of age were complex, and partially gender-differentiated. Children from minority ethnic groups had a higher overall prevalence of school disabilities, and were more prone than Whites to the disabling effects of disruptive behavior disorders. Anxiety disorders were as likely to result in disability as depressive disorders, and oppositional defiant disorders were more strongly associated with disability in some areas than was conduct disorder. The areas where disability is manifested are different depending on race, gender, age, and the type of disorder suffered. The implications of these findings for nosology and prevention are discussed.

Social phobia is a common psychiatric problem in children and adolescents that has recently gained serious attention in clinical practice and research. This article describes the clinical presentation of social phobia and reviews several emergent areas of related research to social phobia in children and adolescents. We begin with a summary of research regarding the developmental pathways of childhood social anxiety into social phobia, highlighting normative developmental factors, behavioral inhibition, pathophysiology, genetics, and parenting/environmental factors. This is followed by a critical review of findings from studies providing evidence for and against the existence of subtypes of social phobia. Common comorbid disorders and sequelae of social phobia in children and adolescents are discussed, bringing to attention the critical need for effective treatments, the current status of which is reviewed in the final section. In sum, this review demonstrates that through research in multiple disciplines, scientists are now developing a better understanding of the risk and protective factors of social phobia in children and adolescents, ultimately leading to improvements in primary prevention and intervention efforts for children at serious risk for long-term problems with education, employment, social relationships, and independent adult functioning.

Phonological skills, language ability, and literacy scores were compared for four groups: 19 children with mild-to-moderate sensorineural hearing loss (SNH), 20 children with specific language impairment (SLI), 20 controls matched on chronological age to the SNH group (CA), and 15 controls matched on receptive vocabulary level to a subset of the SLI group (CB). In common with the SLI group, mean scores of children with mild-to-moderate hearing loss were significantly poorer on tests of phonological short-term memory, phonological discrimination, and phonological awareness than CA controls. No differences between group means were observed in SNH and CA control groups on vocabulary, digit and sentence recall, sentence comprehension, and literacy scores. However, there was considerable individual variation within the SNH group. Nearly 50% of the SNH group showed phonological impairment associated with poorer expressive and receptive vocabulary and higher hearing thresholds than remaining children without phonological impairment. Nonword repetition deficits were observed in SNH subgroups with and without phonological impairment and were of a similar magnitude to those observed in children with SLI. Indeed, poorer repetition in children with SLI could only be differentiated from children with SNH on phonologically complex nonwords. Overall, findings suggested major problems in nonword repetition and phonological impairment occurred without clinically significant deficits in wider language and literacy abilities in children with mild-to-moderate sensorineural hearing loss. Implications for theories of SLI are discussed.

The phenotypic and genetic interrelationships underlying ADHD symptomatology assessed by various instruments were examined on a sample of 735 male and 819 female same-sex twin pairs, aged 8 to 16 years, participating in the first phase of the Virginia Twin Study of Adolescent Behavioral Development (VTSABD). Multivariate analyses were applied to parental and teacher ratings from an investigator-based interview, the CAPA, and three questionnaires (the CBCL and the Rutter Parent and Teacher Scales). Results from patterns of intercorrelations and factor analyses of maternal measures suggested that at the phenotypic level, these assessed the same underlying behavioural construct, which differed from other emotional and behavioural constructs. However, genetic analyses showed that in addition to a common factor underlying the expression of ADHD as assessed across the range of measures, additional genetic factors were identified that were method- and rater-specific. The findings suggest that although the investigator-based interview and the behavioural checklists tap similar aspects of ADHD behaviour, there is additional rater-specific variance.

In light of recent reports of episodic memory difficulties linked to early childhood hypoxia (Isaacs et al., 2000; Vargha-Khadem et al., 1997), preliminary findings of everyday memory function are reported for 20 children born at or before 32 weeks gestation, compared to 20 children born at term. Memory skills were assessed using the Rivermead Behavioural Memory Test for Children (Wilson, Ivani-Chalian, & Aldrich, 1991) at 5 years of age. Everyday memory problems were not found to be a general feature of children born prematurely, and performance was closely linked to receptive language ability but not general cognitive ability in both groups of children. Three children in the preterm group did obtain scores in the impaired range of the RBMT, and in two of these children memory impairment could not be predicted from their receptive language ability. This suggests an increased risk of everyday memory difficulties in populations of preterm children that may be enhanced in further studies by sampling children with greater risk of hypoxic insult.

The main aim of this study was to combine two research approaches to hyperactivity: the behaviour genetic approach and the testing of psychological theories of hyperactivity. For a sample of 268 twin pairs aged 7–11 years we obtained ratings on the Conners' scales from both teachers (CTRS-28) and parents (CPRS-48). Forty-six hyperactive twin pairs (pairs in which at least one twin was pervasively hyperactive) and 47 control twin pairs were assessed on a psychological test battery. Confirming findings from previous twin studies, a substantial proportion of the variance in hyperactivity considered as a dimension was due to genetic effects. There was significant evidence of genetic effects also on extreme hyperactivity, although the present group heritability estimates were somewhat lower than those reported in most previous studies. We investigated the possibility that the psychological mechanisms we reported to be associated with hyperactivity (Kuntsi, Oosterlaan, & Stevenson, 2001) share common genetic factors with hyperactive behaviour. The data produced significant evidence of such shared genetic effects only on hyperactivity and the variability of reaction times. Given that the high variability in speed of responding would indicate a state-regulation problem, this is the psychological mechanism that could possibly be the “link” between genetic effects and hyperactive behaviour.

In this study the factorial validity and the reliability of DSM-IV related ADHD symptom ratings made by care professionals working in residential treatment centres were determined in a sample of 412 residential youngsters. Three concurrent models of the ADHD disorder were investigated, a one-factor model comprising all 18 symptoms, a two-factor model with the Inattention and Hyperactivity/Impulsivity symptoms, respectively, combined and a three-factor model comprising Inattention, Hyperactivity, and Impulsivity symptoms, respectively. An analysis of the covariance structure shows acceptable fits for both the two-and the three-factor models, slightly favouring the three-factor model. The internal consistencies, the test-retest reliabilities, and the inter-rater reliabilities turned out to be good to excellent for all scales based on each of the three concurrent models.

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.

We report several studies developing a parent-rated measure of emotional distress for children in Singapore, with the key objectives being to derive a very brief valid measure of global distress. The refined item set comprised behaviourally expressed broad manifestations of emotional distress. Three developmental studies were undertaken, with the first two involving parental ratings on the measure for validation against clinician-rated distress levels, while also testing two rating options for the measure. We established clear comparative advantages to the rating anchors used in the Revised Rutter Scales. High inter-rater agreement was established across parental ratings, with the latter finding supporting objectives for the measure. Paternal scores correlated more strongly than maternal scores with clinician-generated distress scores. Additional properties of the measure were tested in a large community sample of nearly 2000 Singapore schoolchildren in their last 2 years of primary school, allowing prevalence estimates and mean scores to be derived for each item. Here, girls and boys received identical total scores, scores were also independent of the number of children in the family and of ordinal position, and mothers returned higher scores than fathers.

The effects of postnatal depression on cognitive test scores at 20 months and 4;8 years of age as well as the timing (onset in the early postnatal period versus later), severity, number of episodes, duration of longest phase, recency, and chronicity of material depression on children's cognitive scores at 6;3 years was investigated. In South Bavaria, Germany, 1329 mothers of singletons were screened when the children were 6;3 years of age for the presence of depressive symptoms since the birth of their infant. A standard interview (SADS-L) was used to ascertain DSM-IV diagnosis and details of depressive episodes. Ninety-two mothers were diagnosed as having suffered DSM-IV defined depression (7%). Seven hundred and twenty-one mothers had no depressive episodes or symptoms from their children's birth until 6;3 years and were used as control group. The children had been assessed with the Griffiths Scales of Babies' Abilities (20 months), the Columbia Mental Maturity Scales (CMM) at 4;8 years, and the Kaufman Assessment Battery for Children (K-ABC) at 6;3 years. No significant main effects of severity, timing of onset, duration, or chronicity of depression of the child's cognitive development were found. Significant interactions of gender with chronicity of maternal depression (i.e. early-onset major and repeated episodes) were detected. Low SES boys or boys born at neonatal risk of mothers with chronic depression had lower Achievement Scores in the K-ABC at 6;3 years than children of mothers with less severe depression or controls. It is concluded that maternal depression per se has negligible effects on children's cognitive development. Long-term effects may be found when maternal depression is chronic, the child is a boy and neonatal risk-born, or the family suffers other social risks.

This study examined patterns of comorbid/associated diagnoses and associated problems in a population sample of children with and without DSM-III-R attention-deficit hyperactivity disorder (ADHD). Half (N = 409) of a mainstream school population of Swedish 7-year-olds were clinically examined, and parents and teachers were interviewed and completed questionnaires. The children were followed up 2–4 years later. Eighty-seven per cent of children meeting full criteria for ADHD (N = 15) had one or more—and 67% at least two—comorbid diagnoses. The most common comorbidities were oppositional defiant disorder and developmental coordination disorder. Children with subthreshold ADHD (N = 42) also had very high rates of comorbid diagnoses (71% and 36%), whereas those without ADHD (N = 352) had much lower rates (17% and 3%). The rate of associated school adjustment, learning, and behaviour problems at follow-up was very high in the ADHD groups. We concluded that pure ADHD is rare even in a general population sample. Thus, studies reporting on ADHD cases without comorbidity probably refer to highly atypical samples. By and large, such studies cannot inform rational clinical decisions.

It is difficult to study the contribution of fathers' antisocial behaviour to children's development because fathers with behavioural problems are often absent or reluctant to participate in research. This study examines whether mothers' reports about their children's fathers' antisocial behaviour can be substituted for interviews with fathers. Both members of 67 couples (N = 134) were interviewed separately and independently about the men's lifetime antisocial behaviour. There was strong relative agreement: the women's reports about men's antisocial behaviour and the men's self-reports about the same behaviour were highly correlated. However, there was poor agreement about absolute level: compared to men's self-reports, women reported fewer of the men's antisocial behaviours. Women's reports provide a reliable index of men's relative standing in a distribution and can be used in research about their children's fathers, but should not be used to make diagnostic decisions about men's antisocial disorders.

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.

This study aimed at testing whether there were different types of dysfunctional schemas and cognitive distortions that could help to differentiate three emotional/behavioural problems, i.e., anxiety, depression, and aggression, from each other. Five hundred and eighty-one Chinese adolescents from five mainstream high schools in Hong Kong were recruited and completed several self-report questionnaires. Bivariate correlation showed an indiscriminate pattern of association between dysfunctional schemas, cognitive distortions, and the three emotional/behavioural problems. However, when the effects of the confounding correlated emotional/behavioural problems were controlled in regression analysis, different problems did show some specific association with different types of dysfunctional schemas and/or cognitive distortions. Despite some inconsistency, these findings generally supported a specificity hypothesis. Cognitive variables were thus not only relevant in understanding psychopathology, but their different patterns of association with anxiety, depression, and aggression also supported the separability of these three emotional/behavioural problems, despite their significant correlation.

Several studies have found a relationship between attention-deficit hyperactivity disorder (ADHD) and substance use, primarily in the context of co-occurring conduct disorder (CD). However, very few have examined the associations between the individual dimensions of ADHD (hyperactivity-impulsivity and inattention) and substance use, even though these dimensions reflect distinct symptom groupings, both by clinical definition (DSM-IV, American Psychiatric Association, 1994) and through empirical demonstration (Lahey et al., 1988; McBurnett et al., 1999). This longitudinal study examines the relationship between dimensions of ADHD (as described by DSM) and substance use, accounting for other psychopathology and factors potentially related to substance use. Participants were 177 clinic-referred boys (initially between ages 7 and 12) followed up over nine annual phases until all participants had reached age 15. Annual assessment included structured clinical interviews with parent and child and self-report questionnaires of substance use, as well as questionnaires related to family factors and parenting behaviors. Seventy-eight per cent of participants reported use of tobacco, alcohol, marijuana, or other illicit drugs during adolescence, with 51% reporting any tobacco use. The inclusion of CD rendered all bivariate relationships with the full diagnosis of ADHD nonsignificant. However, adolescent inattention, considered independently, was associated with a 2·2 times greater risk for concurrent tobacco use, even after controlling for CD. Even when other factors, selected based on their associations with tobacco use in adolescence, were included in a regression model (concurrent adolescent CD odds ratio [OR] = 6·08), duration of tobacco use by age 12 (OR = 5·11), poor parental communication in childhood (OR = 2·9), African-American ethnicity (inversely predictive; OR = 0·15), inattention (OR = 2·3) remained significantly associated with tobacco use in early adolescence. These findings highlight the importance of considering the risks for comorbid substance use separately by individual dimensions of ADHD.

This study investigated predictors of attachment security in a play context using a sample of 71 mothers and their 6-month-old infants. We sought to rethink the concept of maternal sensitivity by focusing on mothers' ability accurately to read the mental states governing infant behaviour. Five categories were devised to assess this ability, four of which were dependent on maternal responses to infant behaviours, such as object-directed activity. The fifth, mothers' Appropriate mind-related comments, assessed individual differences in mothers' proclivity to comment appropriately on their infants' mental states and processes. Higher scores in this fifth category related to a secure attachment relationship at 12 months. Maternal sensitivity and Appropriate mind-related comments were independent predictors of attachment security at 12 months, respectively accounting for 6·5% and 12·7% of its variance. We suggest that these findings are in line with current theorising on internal working models of attachment, and may help to explain security-related differences in mentalising abilities.

This study's aim was to estimate the prevalence and describe the clinical characteristics of Tourette syndrome (TS) in 13–14-year-old schoolchildren attending mainstream secondary schools. A three-stage ascertainment procedure was used to identify those who had TS. First, all 1012 Year 9 pupils were screened for tics using validated self-report questionnaires, which were completed by parents, teachers, and pupils. Data were available from at least one informant for 918 (90·7%) subjects. Tics were identified in 189 (18·7%) pupils. Second, families were contacted and a semistructured interview was carried out to determine whether they had TS. Finally, to ensure that the diagnosis of TS was correct, all those assessed as having TS were systematically assessed by an expert clinician in the field of TS.

Seven young people were identified as fulfilling the criteria for TS, giving a minimum prevalence rate amongst 13–14-year-olds of 0·76% (95% CI 0·31 to 1·57) and a more realistic estimate of 1·85% (95% CI 1·00 to 2·95). Behavioural problems, in particular hyperkinetic disorder, were frequently associated with the TS group. These findings lend further support to the contention that the prevalence of TS in the community has hitherto been underestimated, though the symptoms may be generally milder than cases of TS presenting to clinics. This study supports the need for vigilance for TS in school-age children in primary care and in educational settings, so that children with this potentially serious disorder can be identified and assessed and effective management packages can be formulated to address their needs, when necessary.

Child Behavior Checklist questionnaires (Achenbach, 1992), filled in separately by mothers and fathers, were collected for an effective sample of 3501 Dutch 3-year-old twin pairs. To disentangle the child's phenotype from that of the rater, two contrasting models were fitted to the data. One model, called a Rater Bias model, is based on the assumption that both parents assess exactly the same behaviors in the child. A weaker alternative of this model, called a Psychometric model, assumes that apart from these common behavioral views, each parent also assesses a unique aspect of the child's behavior. A Psychometric model fitted the data of both Internalizing and Externalizing scales significantly better than a Rater Bias model. This implied that each parent provided unique information from his or her own perspective, apart from the common behavioral view. Using this best fitting model, the etiology of both the Internalizing and Externalizing scales was studied. Common factors (influencing behaviors similarly assessed by both parents) were more important than unique factors (influencing behaviors uniquely assessed by one parent). Common genetic factors explained about 50% of the variance of both scales, indicating a possible inborn vulnerability to childhood psychopathology. Common environmental factors not shared between twins (free of unreliability and error) explained around 14% of both scales, suggesting the importance of pure idiosyncratic experiences even for children as young as 3 years. Common environmental factors shared between twins (unconfounded by rater bias) were only found for the Externalizing scale, explaining 18% of the variance. Rater bias and unreliability, if present in the data, were included in the estimates of the unique factors. Unique genetic, shared, and nonshared environmental factors each explained around 8% of the variance for both scales. These small effects could be detected because of the large sample of twin pairs used.