Research issues in child abuse

Research into child abuse and its interpretation has been bedevilled by controversy over questions of definition and appropriate approaches. It is suggested in this paper that different questions require different approaches, and that the use of both sociological and medical models may be justified depending on the nature of the research issue. Possible future social science research activity based on this distinction is described in relation to definition, the acceptability of violence in society, the perception of punishment, the establishment of standards of care and decision-making by professionals. Specific recommendations concerning future research into prevention and treatment using a more medical approach are also outlined.

Epidemiological Study of Psychiatric Disorder in Adolescent Girls: Preliminary Communication

A two-stage general population study of affective disorder and problems of eating control in 15–19-year-old girls is in progress, the sample being identified by the use of general practitioners' age-sex registers. So far, 244 girls and their mothers have been interviewed and have independently completed questionnaires relating to mood and appetite control. The girls completed questionnaires both on themselves and on their mothers, and their mothers on themselves and on their daughters. Significant correlations between self-rating and rating of the other person were obtained in all cases, with agreement on the daughters' mood being higher in non-manual couples.

A study of hypoallergenic diets and oral sodium cromoglycate in the management of atopic eczema

Twenty-nine atopic children aged 3-12 years were given elimination diets for 3 weeks, individual groups of foods being then reintroduced over 6 weeks. Most children improved whilst dieting and relapsed on return to normal food intake. In all but 4 cases some food group which caused exacerbation of symptoms was identified, fruits and colourings proving more of a problem than milk and eggs. Taking into account these suspected food allergens, tailored diets were designed for each child. Using these diets the group participated in a double-blind crossover trial of oral sodium cromoglycate (SCG) versus placebo. Twenty-two patients completed the trial. The results indicated that tailored diets were of value in the management of eczema but SCG did not produce a significant additional effect. At follow-up 1 year later most children were adhering to their diet; thirteen were better and only three worse. Children who had initially continued using SCG had stopped it; no accompanying change in their eczema was noticed. A considerable reduction in the use of topical steroids was observed, in marked contrast to previous requirements. Sequential measurements of total serum IgE (PRIST) showed variable changes apparently unrelated to recent SCG therapy. There was little agreement between skin prick tests and specific IgE (RAST) to corresponding foods. Correlation between RAST and food challenge was poor for positive results (r = 0.39) but good for negative results (r = 0.99).

Long-term effects of treatment in a pre-school day centre: a controlled study

A five-year follow-up of 25 children who attended a psychiatric day centre for pre-school children is described. This group was compared at eight years of age with two matched control groups who had not received intensive treatment. There were few differences between the treated and untreated groups. Possible reasons for the findings are discussed and some methodological issues involved in carrying out evaluation studies are raised.

Evaluation of CSF shunt patency by means of technetium-99m DTPA

Evaluation of 192 cerebrospinal fluid shunts was performed using 1 mCi of technetium-99m DTPA which was injected into the shunt tubing. This was found to be a safe, simple method of evaluating shunt patency. No complications were noted with this procedure, nor was there any documented case of infection related to the injection of the isotope. The sensitivity of the test for evaluation of patency was 97%, specificity 90%, and accuracy 93%. Various patterns of tracer clearance are noted and discussed. The role on this test as an aid in making management decisions is detailed.

Glycosylation of apolipoproteins by cultured rat hepatocytes. Effect of tunicamycin on lipoprotein secretion

Cultured rat hepatocytes were used to measure hepatic synthesis of rat plasma glycoproteins. [3H]Glucosamine was progressively incorporated into the protein of hepatocyte culture media very-low-density lipoprotein, low-density lipoprotein, high-density lipoprotein and the p greater than 1.21 g/ml fraction after 3.5 and 6.5 h incubation. Apolipoproteins B, E and C, as well as transferrin, were identified as glycoproteins. The association of radioactivity with apolipoprotein C of hepatocyte very-low-density and high-density lipoproteins suggests that apolipoprotein C-III-3, the only C apoglycoprotein in the rat, is synthesized de novo by the hepatocytes. Treatment of hepatocytes with tunicamycin, a specific inhibitor of protein glycosylation, resulted in a substantial decrease in [3H]glucosamine incorporation into hepatocyte very-low-density, low-density and high-density lipoproteins and p greater than 1.21 g/ml protein, but had little or no effect on secretion. In the rat, hepatic secretion of lipoproteins and transferrin does not appear to be dependent on prior protein glycosylation.

How much child psychiatry does a general practitioner do?

Eleven general practitioners recorded information on relevant psychological and social factors on 1,127 consecutive attendances of children and adolescents under the age of 18 years. The proportion of 'pure' psychological problems was low (3.5 per cent of all attendances), but in 25.7 per cent of attendances a psychological component to the presenting problem existed. Non-specific 'emotional' problems were the most frequent psychological symptoms noted, but management problems in infancy and early childhood were also common. There were significant differences between practitioners in the proportion of 'purely physical' diagnoses made and in action taken at the time of attendance. The findings suggest that paediatric training of general practitioners should contain a considerable child psychiatric component.

A controlled evaluation of the therapeutic effectiveness of a psychiatric day centre for pre-school children

The progress over one year of 25 children aged 2 1/2 to 3 1/2 years attending a psychiatric day centre was compared with that of 25 similarly disturbed 3-year-old children identified in a total population study. There were few differences in outcome, and thost that were found did not particularly favour either group. Implications for the organization of treatment servides are discussed in terms of the need to lay down clear objectives and to pursue systematic controlled evaluation.

Research report: Isle of Wight Studies, 1964-1974

The Isle of Wight Studies began in 1964–65 with a series of epidemiological studies of educational, psychiatric and physical disorders in 9- to 11-year-old children. These early studies were financed by the Department of Education and Science and the Foundation for Child Development (then the Association for the Aid of Crippled Children). The findings were fully reported in two books (Rutter, Tizard & Whitmore, 1970; Rutter, Graham & Yule, 1970) and only brief details are included here.

Organic brain dysfunction and child psychiatric disorder

The total population of 11,865 children of compulsory school age resident on the Isle of Wight was studied to determine the prevalence of epilepsy, cerebral palsy, and other neurological disorders. With the use of reliable methods, children selected from screening of the total population were individually studied by means of parental interviews and questionaries, neurological examination and psychiatric assessment of each child, information from school teachers, and perusal of the records of hospitals and other agencies. The association between organic brain dysfunction and psychiatric disorder was studied by comparing the findings in the children with epilepsy or with lesions above the brain stem (cerebral palsy and similar disorders) with those in (1) a random sample of the general population, (2) children with lesions below the brain stem (for example, muscular dystrophy or paralyses following poliomyelitis), and (3) children with other chronic physical handicaps not involving the nervous system (for example, asthma, heart disease, or diabetes).Psychiatric disorders in children with neuro-epileptic conditions were five times as common as in the general population and three times as common as in children with chronic physical handicaps not involving the brain. It was concluded, on the basis of a study of factors associated with psychiatric disorder, that the high rate of psychiatric disorder in the neuro-epileptic children was due to the presence of organic brain dysfunction rather than just the existence of a physical handicap (though this also played a part). However, organic brain dysfunction was not associated with any specific type of disorder. Within the neuro-epileptic group the neurological features and the type of fit, intellectual/educational factors, and socio-familial factors all interacted in the development of psychiatric disorder.

The reliability and validity of the psychiatric assessment of the child: II. Interview with the parent

The importance of diagnostic procedure in child psychiatry does not need emphasis. In most clinics dealing with the emotionally disturbed child a substantial proportion of children referred are not seen again after the initial appraisal (Rogers, 1939), and on the basis of information obtained at this single appearance decisions may need to be made about the nature and severity of the child's disorder and the suitability of the child for treatment. Certainly with children taken on for treatment, elements of the diagnostic process enter into the therapy situation, yet even here a programme affecting the child's life will often have been laid down after the first session.

The reliability and validity of the psychiatric assessment of the child: I. Interview with the child

Surprisingly little has been written on the interview with the child as a diagnostic tool, in contrast to the voluminous literature on the therapeutic interview. Whereas standard texts on child psychiatry usually include a discussion of the physician-child relationship and of the use of play situation, it is rare for there to be any systematic account of the interview with the child as a diagnostic procedure.

Histamine formation in the tuberculin reaction of the rat

The histamine forming capacity and histamine content of tuberculin skin reactions have been studied in the rat. An increase in HFC and a concomitant decrease in histamine content occur. Both changes are maximal 12 hours after injection of antigen. The results suggest that histamine may play a role, although a minor one, in the tuberculin reaction of the rat.

Reliability of a procedure for measuring and classifying "present psychiatric state"

It is generally agreed that psychiatric illnesses can fairly reliably be categorized into four broad groups—organic psychoses, functional psychoses, neuroses and personality disorders. Cases are assigned with greatest confidence to the first group and with least confidence to the fourth. The reliability of specific diagnoses within these classes is much less secure and decreases in the same order. The best recent reviews of the literature are by Kreitman (1961) and Foulds (1965).

An investigation of a group of patients who have attended both the child and adult departments of the same psychiatric hospital

The relationship between child and adult psychiatric illness, though of fundamental importance, has received scant attention, perhaps because of the split which exists between the study and treatment of children and of adults.