At risk for language disorders? Correlates and course of language disorders in preschool children born at risk

The language abilities of 324 children of an at-risk population were investigated at age 2 and 4.5 y. Modified research criteria of the ICD-10 for specific developmental disorders of speech and language were applied. Frequencies between 4% and 7%, depending on age and type of disorder, were diagnosed among children whose performance on the language measure was only 1 instead of ICD-10's 2 SD below group mean, but the discrepancy measure of 1 SD between non-verbal language score and language measure was retained. Psychosocial aspects of a child's environment proved to be better predictors of later language disorders than obstetric complications. Stability of specific language disorders was on the whole fairly low, but children who perform below age level on language measures remained at risk. Gender differences are almost compensated by the age 4.5 y.

Mutagenic properties of 1,2,3,4-tetrahydronaphthaline-1-hydroperoxide, a model compound for organic peroxides in Diesel exhaust

The genotoxicity of the organic peroxide 1,2,3,4-tetrahydronaphthaline-1-hydroperoxide (or tetraline-1-hydroperoxide, THP) was investigated in the Ames assay without a metabolic activating system using Salmonella typhimurium strains TA 98, TA 100, and TA 102. THP served as a model compound for higher organic peroxides, which can arise from autoxidation of hydrocarbons, e.g. in Diesel exhaust. While THP induced no mutagenic response in S. typhimurium TA 98, it was directly mutagenic in strains TA 100 and TA 102. These data, along with findings on mutagenic properties of other alkyl hydroperoxides, suggest that such compounds deserve further investigation regarding their genotoxic potential and occurrence in the environment.

[Risks and protective factors in early childhood development: empirical findings]

A common result of many studies of children at risk for developmental disorder is the heterogeneity of individual reactions to adversity. One attempt to explain the differential outcome of children at risk lies in the assumption of protective factors. In a prospective study of 362 infants the significance of pre- and perinatal complications (early biological risks) and of adverse family living circumstances (early psychosocial risks) on child development at 4 1/2 years was examined. Additionally, to study the interplay between risk and protective factors a number of mother-child and family characteristics potentially favourable to early development were assessed. Results indicated that early risk factors made a significant contribution to child development at preschool age. Using multiple risk indices, between 10 and 20% of the variance of the developmental outcome at 4 1/2 years was explained. Significant predictors of later developmental disorders were neonatal seizures and very low birth weight among the biological risks and low educational level of the parents, early parenthood and unwanted pregnancy among the psychosocial risks. The contribution of early protective factors to developmental outcome, however, was only limited. The high overlap with risk factors, the low specific predictive power and the lack of a moderator effect question the theoretical usefulness of a global concept of protective factors. However, when interactions between specific risk and protective factors were studied, there was evidence of a buffer effect of a successful early mother child interaction.

[Mannheim Rating Scales for the analysis of mother-child interaction in toddlers]

As part of a prospective study on child development from birth to age 11 the Mannheim Rating Scales for the Analysis of Mother-Child Interaction in Toddlers was constructed. Ten-minute interactions of 352 mothers and their toddlers were videotaped in the laboratory and evaluated with micro- and macroanalytic techniques. The instrument consists of a combination of second-by-second codings and dimensional ratings of 5-second to 1 minute periods. Interrater reliability, assessed by having two raters analyze 16 mother-child dyads, proved satisfactory. Psychosocial risk showed different patterns from those at low risk. Interactions of mothers and daughters seemed to be more harmonious than interactions of mothers and sons.

Developmental outcome of infants born with biological and psychosocial risks

The significance of prenatal and perinatal complications (biological risk) and of family adversity (psychosocial risk) on early child development was examined in a prospective study. Developmental outcome of 350 infants was assessed by measures of motor, cognitive, and social-emotional functioning at 3, 24, and 54 months. Results indicated a differential impact of risk factors on specific outcomes. Whereas psychosocial risks became more prominent with growing age and were related to poorer child outcome in all areas of functioning, biological risks decreased in influence and predominantly resulted in poorer motor development. The contributions of biological and psychosocial risks on outcomes were additive. A number of individual risk factors emerged as significant predictors of later maladaptation.

Psychiatric disorders in adult patients with early-treated phenylketonuria

OBJECTIVE

To determine psychiatric disorders in patients with phenylketonuria (PKU) and to test whether biochemical control, intellectual functioning, white matter abnormalities visible on magnetic resonance imaging (MRI), and/or style of parenting influence psychopathology.

DESIGN AND SUBJECTS

This cross-sectional study consisted of 35 PKU patients 17 to 33 years of age (mean: 22.2). From a total of 67 patients, 3 patients were selected because of other causes of possible brain damage. Then 35 patients were randomly drawn with comparison with a control sample (n = 181) from an epidemiologic study.

METHODS

We used a standardized, highly structured, face-to-face interview; intelligence quotient (IQ) test; cranial MRI (n = 26); and monitoring of plasma phenylalanine.

RESULTS

The overall rate of psychiatric disorders was 25.7% in PKU patients and 16.1% in controls. This difference was not statistically significant. The pattern of psychiatric disturbances was different for PKU patients and controls (Fisher's exact test): in PKU patients, externalizing disorders were reduced (PKU: not present, controls: 7.8%), whereas internalizing disorders (PKU: 25.7%, controls: 8.3%) were increased. International Classification of Diseases, version 10, diagnoses were predominantly those of the depressive category and more frequent in women (8 of 18 females and 1 of 17 males). A correlation between IQ and both biochemical control up to 12 years of age and school education of parents was confirmed. No correlation was found between the severity or pattern of psychiatric disturbances and school education of parents, biochemical control, IQ, or the extension of MRI-visible, white matter abnormalities. It was found that a restrictive controlling style of parenting is a risk factor for the development of psychiatric symptoms.

CONCLUSIONS

Our results support a psychological perspective for the development of psychiatric symptoms in PKU. Thus, optimizing medical treatment necessary to prevent brain damage should be accompanied by psychiatric monitoring and psychological support for the families.

[4 1/2 years later: Mannheim risk children of preschool age]

The present investigation was concerned with the impact of prenatal and perinatal complications (biological risks) and of family adversity (psychosocial risks) on developmental status at age 4 1/2. In a prospective study the developmental course of 362 children (including 210 high-risk children) was followed from birth to age 4 1/2 years. A multilevel approach was used to assess all relevant domains of functioning (i.e. motor, cognitive and social-emotional development). The goal was to obtain information about the effects of biological and psychosocial risks alone and together on outcome in the different domains of functioning. The results show that psychosocial risk factors posed the greatest threat to normal development. Children with psychosocial risks were significantly behind those without such risks in all areas of functioning. Biological risks mainly affected motor development, their negative effects on cognitive and social-emotional functioning having been largely compensated for by age 4 1/2. The extent of an adverse outcome was related to both the degree of risk load and the number of risk factors, whereas interactions among risks were of only minor relevance. An adverse outcome is not inevitable, however: Despite the risks most of the at-risk children showed normal development at age 4 1/2.

The management of chronic tinnitus--comparison of a cognitive-behavioural group training with yoga

Two non-medical treatment strategies for chronic idiopathic tinnitus were evaluated in a randomized control group design. A cognitive-behavioural tinnitus coping training (TCT) was developed and compared to yoga and a self-monitoring control condition. Forty-three chronic tinnitus patients, were assessed at baseline, directly after therapy, and at 3 months follow-up. For evaluation, differential psychoacoustic variables were registered, a tinnitus diary as well as the Tinnitus Questionnaire and different measures of general well-being were used. Statistical analyses showed effects favouring the TCT treatment in comparison to the control and yoga treatment. The TCT-treated patients reported more satisfaction with the training than the yoga group. Participants in the self-monitoring control group were treated either by TCT or yoga after a waiting period. The outcome in this group was even better than in the experimental groups while yoga again showed rather poor effects.

[Category system for microanalysis of early mother-child interaction]

As part of a prospective longitudinal study on the pathogenesis of neuropsychiatric disorders in children at biological and psychosocial risk, a system of categories was developed for the assessment of early mother-child interaction. A computer program for recording observational data in synchrony with video images by online coding was developed for this purpose. It permits second-by-second recording of basic categories and complex interactional behavior of mother and child. An evaluation of instrumental validity, interrater reliability and the validity of the system with 48 mother-child dyads yielded positive results. Measures of interaction (synchrony, reciprocity, elicit) and of disturbed interactions were defined.

Contrasting infant predictors of later cognitive functioning

The predictive power of early visual attention in terms of later cognitive functioning was compared to standard developmental test scores and further early predictors of later development. In a longitudinal study of 226 infants at risk visual attention in a habituation-dishabituation paradigm was assessed at 3 months and cognitive development was measured at 3, 24 and 54 months. The results indicated that response decrement and response recovery measures are related to cognitive outcome in later childhood, but failed to support their superiority over standard developmental test scores or early biological and psychosocial predictors of later IQ. Methodological shortcomings of previous studies and theoretical weaknesses of the habituation concept were discussed as a possible explanation.

Estimating the change of carbon in the terrestrial biosphere from 18 000 BP to present using a carbon cycle model

The authors used a global High Resolution Biosphere Model (HRBM), consisting of a biome model and a carbon cycle model, to estimate the changes of carbon storage in the major pools of the terrestrial biosphere from 18 000 BP to present. The climate change data to drive the biosphere for 18 000 BP were derived from an Atmospheric General Circulation Model. Using the AGCM anomalies interpolated to a 0.5 degrees grid, the HRBM data base of the present climate was recalculated for 18 000 BP. The most important processes which influenced the carbon storage include (1) climate-induced changes in biospheric processes and vegetation distribution, (2) the CO(2) fertilization effect, (3) the inundation of lowland areas resulting from the sea level rise of 100 m. Two scenarios were investigated. The first scenario, which ignored the CO(2) fertilization effect, led to total carbon losses from the terrestrial biosphere of -460 x 10(9) t. Scenario 2, which assumed that the model formulation of the CO(2) fertilization effect as used for preindustrial to present could be extrapolated to the glacial 200 microl litre(-1) (ppmv, parts per million per volume), gave a carbon fixation in the terrestrial biosphere of +213 x 10(9) t. The two scenarios were compared with CO(2) concentration data and isotopic ratios from air in ice cores. The results of Scenario 1 are not in agreement with the data. Scenario 2 gives realistic delta(13)C shifts in the atmosphere but the biospheric carbon storage at the end of the glacial period seems too large. The authors suggest that the low atmospheric CO(2) concentration may have favoured the C-4 plants in ice age vegetation types. As a consequence the influence of the low CO(2) concentration was eventually reduced and the glacial carbon storage in vegetation, litter, and soil was increased.

[Effect of timing and chronicity of stressors on the emotional development of children and adolescents. Results of a prospective epidemiologic longitudinal study of 8 to 18 years]

In a prospective epidemiological study with assessments at ages 8, 13 and 18 it could be demonstrated that if all risk factors are analyzed at the same time recent stressors are more important than stressors and disturbances in early childhood. But from a chronological point of view early stressors were found to be at least as important as later ones because the early stressors play a role in the development of some of the later ones. The effects of stressors were sex-specific to some extent: Boys were more seriously affected when of elementary school age, whereas girls were more affected in early childhood and in adolescence. Chronic stress proved to be more important than acute life events, the later being not only a cause but also a consequence of emotional disturbances. Children with early disturbances sometimes even had lower rates of disorders in adolescence if they had been brought up in an overprotective manner.

[Diagnosis and therapy of functional encopresis]

Males clearly dominate within this diagnostic category with an overall prevalence rate between 1 and 2%. Functional encopresis is often connected with other emotional and behavioural problems. After excluding an organic incontinence the main aim of the diagnostic procedure is to search for stressors that may have caused the encopresis and now contribute to the stability of the disturbance. Usually indications of an early disturbed parent-child relation are found. Techniques of behavioural therapy are superior to psychoanalytical methods that do not surpass the rate of spontaneous remissions. The therapeutic approach by Wright and Walker is recommended, which comprises systematic rewards, glycerine suppositories and enemas. 78% of the such treated children showed a lasting remission. The connection of numerous other psychic disorders with encopresis is demonstrated by a case report.

[Prevalence and follow-up of psychiatric disorders in childhood and adolescence. Results of a prospective epidemiologic longitudinal study from ages 8-18 years]

In a prospective longitudinal epidemiological study with assessments at age 8, 13 and 18 the prevalence rate for psychiatric disorders remained constant at about 16%. The sex ratio for severe disorders was male dominated even in adolescence, which was a consequence of the high rate of unsocialized disturbances of conduct in boys. Persistence of psychiatric disorders between age 13 and 18 was about 50%, as had previously been the case between age 8 and 13. One child in four suffered from a psychiatric disorder for at least 10 years. In childhood, conduct disorders had a very poor prognosis and emotional disorders a very good one. In adolescence, the course of disorders depended on an interaction between diagnosis and gender. Boys with unsocialized disturbances and girls with emotional problems had a poor prognosis.

["Risk children": the importance of biological and psychosocial risks for child development in the first two years of life]

In a prospective longitudinal study the development of N = 362 children will be followed over four time points (T1-T4) from birth to school age utilizing a comprehensive battery of instruments. Aims of the study are the description of the developmental course of children born at differing degrees of biological and psychosocial risk, the identification of early predictors of developmental disorders and their compensation, as well as the analysis of the processes and mechanisms underlying differential developmental patterns. The results of waves 1 and 2 show that early development from 3 to 24 months is quite unstable. Depending on the examined domain of development up to 3/4 of the disturbances of infancy have remitted by the later age, whereas nearly a fifth of the hitherto well children developed new disturbances. Both risks have a marked negative effect on development. While biological risks go hand in hand with impaired motor functioning, psychosocial risks adversely affect cognitive and social-emotional competence. However, the relative weight of risk factors changes during the first two years with biological risks becoming less important and psychosocial risk factors gaining influence. Single risk factors identified as being prognostically very unfavourable are very low birth weight and neonatal seizures. Of the psychosocial risks a pattern of unfavourable family characteristics such as low educational level, history of broken home or mental health problems of parents and chronic difficulties is related most strongly to poor outcome.

[The effect of life change events on cognitive and socio-emotional development in early childhood]

The present study investigates the role of life events of differing durations in the cognitive and social-emotional development of infants. A total of 354 children were examined at the ages of 3 and 24 months and the children's parents were interviewed about the occurrence of live events in this interval. The total number of life events was a significant predictor of changes in the level of cognitive and social-emotional functioning. Changes in the caregiver and marital discord were the best predictors of a child's social-emotional development, and serious illness in the child and changes in the caregiver were the best predictors of a child's cognitive development.

[Marital disharmony of the parents and child development in infancy and early childhood]

As part of a prospective study currently being conducted in the Mannheim-Heidelberg region of Germany on the neuropsychiatric development of 362 children born at varying degrees of organic and psychosocial risk, the effect of marital discord on the cognitive and social-emotional development of 315 children born into two-parent households was investigated. Both the children and the quality of the parental relationship were evaluated when the children were 3 months and two-years of age. Assessment of the children included performance on the Bayley Scales of Infant Development, observed and reported temperament characteristics and measures of infant and child psychopathology. Evaluation of the relationship was based on pertinent information provided by the parents about their marriage within a standardized interviews as well as on the basis of a questionnaire. Results show that marital discord at 3 months does not effect child performance at 3 months, nor at 24 months. Marital discord at 2 years does affect the emotional well-being of the two-year-old i.e. is accompanied by a significant rise in psychopathological symptoms. When the effect of the stability of marital strife from the first assessment to the second was studied a significant increase in behavior problems and decrease in Bayley performance was found in the group of children whose parents' marital situation had deteriorated and failed in the meantime but surprisingly not in the group with chronic discordant relationships. Conversely, poor child performance and emotional adjustment improved with a positive change in the parental relationships. An increase, although not significant, was also found among the children whose parents' marriage had deteriorated but had not lead to separation.

[Behavioral disorders in infants and young children: a contribution to psychopathology of early childhood]

In a study on the psychological development of children born at biological and psychosocial risk adverse temperamental characteristics and psychopathological symptoms of 362 children were determined at the ages of 3 and 24 months. Adverse temperamental characteristics were measured with the help of behavioral observations in standardized situations. Symptoms were assessed in a highly structured parent interview. The results showed a higher-than-average rate of disturbed children, which increased from 15.5% at the age of 3 months to 19.5% at two years. Hyperkinesis was the most prevalent disturbance. Whereas no sex effect was found among infants, the 2-year-old boys manifested more symptoms and had more adverse temperamental characteristics than the 2-year-old girl. Sex differences in symptom patterns were similar to those seen in later childhood. The course of early disturbances was characterized by low persistence and stability. Four fifths of all infant disturbances had remitted by the age of two years. A small number of early problems (i.e. eating disorders) turned out to be predictive of later disorders.

Familial adversities and child psychiatric disorders

The well known association between child and adolescent psychiatric disorders and chronic adversities was proved in a field sample. Children (356) were investigated at the ages of 8 and 13 years. The association between child psychiatric disorders and chronic adverse conditions in the familial environment--measured by the FAI--was analysed with respect to the variables: age, sex, psychiatric diagnoses, and course (stability) of disorder. The FAI proved to be predictive of psychiatric disorder, in particular of early onset disorder, of disorders in boys, and of conduct disorders. According to the results, the common assumption that chronic adversities cause child psychiatric disorders must be viewed cautiously.

[Early recognition of partial learning disorders]

The long-term outcome of learning disabilities (lower school performance, higher rates of unemployment and unskilled jobs, secondary psychic disorders and juvenile delinquency) requires their early recognition even at pre-school age. The concept of learning disabilities should be adapted to the concept of specific developmental disorders (ICD-10, F80-F83). The diagnosis of specific developmental disorders at pre-school age shows many difficulties due to the drawbacks of the available psychological tests. A highly economic and reliable battery of tests is presented as an alternative, which enables us to diagnose general intelligence and specific developmental disorders. The diagnostic procedure was standardised on 657 children of four and five years of age.

Behaviour problems and developmental status of 3-month-old infants in relation to organic and psychosocial risks

In a prospective longitudinal study starting at birth 384 infants and their families were investigated. The subjects were distributed across the nine cells of a two-factorial design (3 x 3), factor 1 representing the degree of organic, factor 2 the degree of psychosocial risk. At age 3 months there was a significant influence of organic risk factors on all developmental parameters. Psychosocial risks were only relevant for cognitive development and behaviour problems. Organic high-risk children who adapted quickly after birth showed an especially good development status.