Current emphasis on intriguing gains in our understanding of child psychopathology, though of major importance, should not weaken our attention as mental health professionals to “old” issues that tend to be ignored both because they render us helpless despite our increasing knowledge and because they seem so hard to remedy. I refer to those children who are subjected to severe disadvantaged conditions, both materially and psychologically, with parents who provide grossly inadequate or severely abusive care to them. These children may be considered for placement in foster care. Although there have been arguments against long-term foster care and in favour of short-term care, long-term foster care remains a persistent and important form of substitute care. The question must then arise as to whether permanent foster care can provide adequate alternatives. Practitioners are sometimes confronted with the detrimental effects of “oscillation” of children in and out of care, and reluctance as to the decision to place the child into permanent foster family care. Minty, in this issue's Annotation, provides an overview of the outcomes of long-term foster family care. Contrary to much current prejudice, Minty shows that there is ample evidence that long-term foster family care can provide a satisfactory upbringing for most children who lack adequate care in their birth families—provided that foster care begins early in life and continues at least until the late teens. Large-scale longitudinal studies have found that where psychosocial development is disturbed and educational progress deficient, these inadequacies are largely attributable to the social factors impinging on children before admission to, and discharge from, family foster care. Nevertheless, there is room for much improvement in the educational attainments of foster children, and there needs to be better training in the safe caring of children who have previously been seriously abused. Also, it is clear from Minty's overview that more methodologically sound research is needed to unravel the mechanisms that hamper or facilitate the healthy development of these children.

Fifty years ago the Children Act (1948) created the modern child care service in England and Wales. Then, as now, the preferred form of state-provided care for children was foster, rather than residential, care. However, the nature of foster family care has changed considerably over the past 50 years and, in some respects, so have the children fostered. Then the predominant form of foster care was long-term care, in keeping with the prevailing ideology of “rescuing” children from intolerable home conditions. Now, by contrast, foster care is a much more diverse service, and the commonest form is short-term care, which is generally understood as care intended to last less than roughly 3 months. This is in keeping with a strong ideology in both the U.S.A. and the U.K. that foster care is not parenting, and that almost all children are best off with their biological parents.

Developments in the assessment and treatment of school refusal have often been hampered by a failure to recognise its essentially heterogeneous nature. This paper provides a review of major conceptual complexities that have helped to undermine developments in clinical practice. In particular, it considers the distinction between school refusal and truancy, and school phobia and separation anxiety. Common approaches to the assessment and treatment of school refusal are outlined. Although behavioural and cognitive behavioural approaches are now widely accepted as central to treatment, it is increasingly recognised that individually tailored programmes, utilising a range of approaches, are most likely to prove successful. An approach focusing upon the functions, rather than the symptoms, of school refusal is advocated as having most promise for assessment and the subsequent formulation of individual prescriptive treatment.

The associations between maternal labour force participation and child academic achievement were examined in a birth cohort of New Zealand children who have been studied from birth to age 18. The results of this analysis suggested the presence of small associations between the extent of maternal labour force participation and scores on standardised tests of word recognition, reading comprehension, and mathematical reasoning. Similar associations were found between maternal labour force participation and success in school leaving examinations. These associations arose predominantly because children whose mothers worked had better performance than children whose mothers who had not worked in paid employment. However, patterns of maternal labour force participation were also related to a series of family and child factors including: maternal education, family socioeconomic status, race, birth order, family composition, early mother–child interaction, and child IQ. Adjustment for these factors reduced associations between maternal labour force participation and academic achievement to the point of practical and statistical nonsignificance. These results were found to be robust and similar conclusions were found for (1) a range of measures of maternal labour force participation, and (2) subgroups of the cohort defined by gender, socioeconomic status, ethnicity, or family type.

Links between sibling relationships, mother–partner, and parent–child relationships were studied in a longitudinal community sample of 3681 sibling pairs. Individual differences in sibling relationship quality were related to mother–partner affection and hostility assessed 4 years earlier, to contemporary parent–child negativity, and to indices of social adversity. Evidence for both direct and indirect pathways (via parent–child relations) linking mother–partner and sibling relations were found. Comparisons of prediction for non-stepfamilies and stepfather families showed similarities in patterns of association, but also differences: In stepfather families, mother–partner hostility was unrelated to parent–child negativity and sibling relationship quality. Both positivity and negativity towards young siblings decreased with the age of older siblings, and older sisters were more positive than older brothers.

In order to investigate the possible causal relationships between hyperactivity and educational underachievement that might account for their frequent co-occurrence, four groups of boys, defined by the presence or absence of hyperactivity and specific reading retardation, were identified in an epidemiological study of 7–8-year-old children. They were examined in detail by means of parental interviews and psychological tests and reassessed 9 years later at the age of 16–18 years on a similar range of measures. The findings provided little support for the idea that persistent reading disabilities either lead to the development of hyperactivity de novo or increased the likelihood that hyperactivity, when present, would persist. Similarly, although features of hyperactivity persisted to follow-up, there was little evidence that they either lead to the development of reading disabilities or increased the likelihood that reading disabilities, when present, would persist. Socioeconomic adversity and a history of speech therapy were more common in the group with both hyperactivity and reading disability, but the strength of these associations made it unlikely that these factors could account for the frequent co-occurrence of the two conditions.

This report describes the evaluation methodology of the Tri-Ministry Study—a school-based trial evaluating the effectiveness of three universal programs: (a) a classwide social skills program (SS), (b) a partner reading program (RE); and, (c) a combination of both (SS & RE), to reduce and prevent behavioural maladjustment among children in the primary division (up to grade 3) of Ontario schools. The trial was done between 1991 and 1995. Sixty schools in 11 boards of education took part and were assigned randomly to program(s) during the study. Contributing to the evaluation database are detailed follow-up assessments (observations, ratings, and standard tests) on 2439 children. Three-level growth trajectory models are used to evaluate program effects. The analysis presented for illustration in this report focuses on reading achievement measured by the Wide Range Achievement Test. A companion paper presents the results of the study and discusses important methodological and programmatic issues applicable to this and other prevention studies in the field.

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.

One hundred and seventy children attending a hospital accident and emergency department following everyday trauma were interviewed and completed the Post-traumatic Stress Disorder (PTSD) screening battery suggested by Yule and Udwin (1991). Diagnostic interviews (CAPS-C) confirmed that 39 (22.9%) fulfilled the DSM-IV criteria for PTSD. There were significant differences between children with and without PTSD on each individual component of the screening battery. Various criteria for caseness were evaluated and at 6 weeks post trauma the screen identified up to 90% of children diagnosed with PTSD and 73% with borderline conditions. A subset of 36 children were reassessed 8 months post trauma and all children with persistent PTSD were correctly identified by initial screen scores. The limitations of the study and the role of screening for PTSD in the absence of proven psychological interventions are discussed.

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 construct representation of the cross-informant model of the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF) was evaluated using confirmatory factor analysis. Samples were collected in seven different countries. The results are based on 13,226 parent ratings and 8893 teacher ratings. The adequacy of fit for the cross-informant model was established on the basis of three approaches: conventional rules of fit, simulation, and comparison with other models. The results indicated that the cross-informant model fits these data poorly. These results were consistent across countries, informants, and both clinical and population samples. Since inadequate empirical support for the cross-informant syndromes and their differentiation was found, the construct validity of these syndrome dimensions is questioned.

In a case-control study of cognitive performance, tests of intelligence, reading, spelling, and pragmatic language were administered to the parents and siblings of 90 community-ascertained probands with autism (AU group) and to the parents and siblings of 40 similarly ascertained probands with trisomy 21 Down syndrome (DS group). The two samples were comparable for age and parents' education; both groups were well-educated and had above-average intelligence. AU parents scored slightly but significantly lower on the WAIS-R Full Scale and Performance IQ, on two subtests (Picture Arrangement and Picture Completion), and on the Word Attack Test (reading nonsense words) from the Woodcock-Johnson battery. There were no differences between AU and DS siblings. As in earlier studies, AU parents, more often than DS parents, reported a history of early language-related cognitive difficulties; we were not able to replicate this in siblings. AU parents who reported such difficulties scored significantly lower on Verbal IQ, spelling, and the nonsense reading test. AU parents without a history of early language-related cognitive difficulties often had a Verbal IQ that exceeded Performance IQ by more than one standard deviation. AU siblings with early language-related difficulties had similar findings: lower Verbal IQ, poorer spelling, and poorer reading scores, compared to AU siblings without such a history. Parents with a positive history also scored worse on a measure of pragmatic language,the Pragmatic Rating Scale, but not on measures of social-related components of the broader autism phenotype. We propose that cognitive differences in a subset of autism family members are manifestations of the language-related component of the broader autism phenotype, and separate from the social-related component. This is consistent with the hypothesis that there are several genes that may interact to cause autism which segregate independently and have distinguishable manifestations in family members. The hypothesis would be further supported by finding different patterns of genetic loci linked to autism in families where one or both parents has language difficulties.

In this single case study, paintings by a visually impaired and cognitively handicapped savant artist are evaluated. He paints his pictures exclusively from memory, either after having looked at a natural scene through binoculars, or after studying landscape photographs in brochures, catalogues, and books. The paintings are compared with the models from which they were derived, and the resulting generative changes are accounted for by an interaction between impaired visual input and memory transformations.