Importance of nonshared environmental factors for childhood and adolescent psychopathology

It is a family affair: individual experiences and sibling exposure to emotional, physical and sexual abuse and the impact on adult depressive symptoms

BACKGROUND

Childhood abuse and neglect often occurs within families and can have a large influence on mental well-being across the lifespan. However, the sibling concordance of emotional abuse and neglect (i.e. together referred to as emotional maltreatment; EM), physical abuse (PA) and sexual abuse (SA) and the long-term impact on the context of siblings' maltreatment experiences are unclear. To examine the influence of EM, PA and SA on adult depressive symptoms within the family framework we differentiate between (a) the family-wide (mean level of all siblings) effects and (b) the individual deviation from the mean family level of maltreatment.

METHODS

The sample (N = 636) consists of 256 families, including at least one lifetime depressed or anxious individual and their siblings. Multilevel modeling was used to examine the family-wide and relative individual effects of childhood maltreatment (CM).

RESULTS

(a) Siblings showed most similarity in their reports of EM followed by PA. SA was mostly reported by one person within a family. In line with these observations, the mean family levels of EM and PA, but not SA, were associated with more depressive symptoms. In addition, (b) depression levels were more elevated in individuals reporting more EM than the family mean.

CONCLUSIONS

Particularly in the case of more visible forms of CM, siblings' experiences of EM and PA are associated with the elevated levels of adult depressive symptoms. Findings implicate that in addition to individual maltreatment experiences, the context of siblings' experiences is another crucial risk factor for an individuals' adult depressive symptomatology.

Maternal behavior predicts infant neurophysiological and behavioral attention processes in the first year

We apply a biopsychosocial conceptualization to attention development in the 1st year and examine the role of neurophysiological and social processes on the development of early attention processes. We tested whether maternal behavior measured during 2 mother-child interaction tasks when infants (N = 388) were 5 months predicted infant medial frontal (F3/F4) EEG power and observed attention behavior during an attention task at 10 months. After controlling for infant attention behavior and EEG power in the same task measured at an earlier 5-month time point, results indicated a significant direct and positive association from 5-month maternal positive affect to infant attention behavior at 10 months. However, maternal positive affect was not related to medial frontal EEG power. In contrast, 5-month maternal intrusive behavior was associated with infants' task-related EEG power change at the left frontal location, F3, at 10 months of age. The test of indirect effects from 5-month maternal intrusiveness to 10-month infant attention behavior via infants' EEG power change at F3 was significant. These findings suggest that the development of neural networks serving attention processes may be 1 mechanism through which early maternal behavior is related to infant attention development in the 1st year and that intrusive maternal behavior may have a particularly disruptive effect on this process. (PsycINFO Database Record

Associations Between Mother-Child Relationship Quality and Adolescent Adjustment: Using a Genetically Controlled Design to Determine the Direction and Magnitude of Effects

This study used a genetically controlled design to examine the direction and the magnitude of effects in the over-time associations between perceived relationship quality with mothers and adolescent maladjustment (i.e., depressive symptoms and delinquency). A total of 163 monozygotic (MZ) twins pairs (85 female pairs, 78 male pairs) completed questionnaires at ages 13 and 14. Non-genetically controlled path analyses models (in which one member of each twin dyad was randomly selected for analyses) were compared with genetically controlled path analyses models (in which MZ-twin difference scores were included in analyses). Results from the non-genetically controlled models revealed a) child-driven effects in the longitudinal associations between adolescent perceived maternal support and depressive symptoms, and b) parent-driven and child-driven effects in the longitudinal association between perceived maternal negativity and adolescent delinquent behaviors. However, results from the genetically controlled models revealed only child-driven effect, suggesting that, purported parent-driven effects were a product of error arising from potential gene-environment correlations (rGE).

Toward a Bioecological Model of School Engagement: A Biometric Analysis of Gene and Environmental Factors

School disengagement is associated with poor academic achievement, dropout, and risk behaviors such as truancy, delinquency, and substance use. Despite empirical research identifying risk correlates of school disengagement across the ecology, it is unclear from which domain these correlates arise. To redress this issue, the current study used intraclass correlation and DeFries-Fulker analyses to longitudinally decompose variance in three domains of engagement (academic, behavioral, and emotional) using data from the National Longitudinal Study of Adolescent Health. Findings suggest that nonshared environmental factors (that is, environmental contexts and experiences that are unique to each sibling) account for approximately half of the variance in indicators of school disengagement when controlling for genetic influences, and that this variance increases as adolescents grow older and rely less on their immediate family. The present study contributes new evidence on the biosocial underpinnings of school engagement and highlights the importance of interventions targeting factors in the nonshared environment.

Chronic bullying victimization across school transitions: the role of genetic and environmental influences

We investigated the antecedents and consequences of chronic victimization by bullies across a school transition using a genetically sensitive longitudinal design. Data were from the Environmental Risk Longitudinal Twin Study (E-Risk), an epidemiological cohort of 2,232 children. We used mothers' and children's reports of bullying victimization during primary school and early secondary school. Children who experienced frequent victimization at both time points were classed as "chronic victims" and were found to have an increased risk for mental health problems and academic difficulties compared to children who were bullied only in primary school, children bullied for the first time in secondary school, and never-bullied children. Biometric analyses revealed that stability in victimization over this period was influenced primarily by genetic and shared environmental factors. Regression analyses showed that children's early characteristics such as preexistent adjustment difficulties and IQ predicted chronic versus transitory victimization. Family risk factors for chronic victimization included socioeconomic disadvantage, low maternal warmth, and maltreatment. Our results suggest that bullying intervention programs should consider the role of the victims' behaviors and family background in increasing vulnerability to chronic victimization. Our study highlights the importance of widening antibullying interventions to include families to reduce the likelihood of children entering a pathway toward chronic victimization.

Genetic origin of the relationship between parental negativity and behavior problems from early childhood to adolescence: a longitudinal genetically sensitive study

Little is known about how genetic and environmental factors contribute to the association between parental negativity and behavior problems from early childhood to adolescence. The current study fitted a cross-lagged model in a sample consisting of 4,075 twin pairs to explore (a) the role of genetic and environmental factors in the relationship between parental negativity and behavior problems from age 4 to age 12, (b) whether parent-driven and child-driven processes independently explain the association, and (c) whether there are sex differences in this relationship. Both phenotypes showed substantial genetic influence at both ages. The concurrent overlap between them was mainly accounted for by genetic factors. Causal pathways representing stability of the phenotypes and parent-driven and child-driven effects significantly and independently account for the association. Significant but slight differences were found between males and females for parent-driven effects. These results were highly similar when general cognitive ability was added as a covariate. In summary, the longitudinal association between parental negativity and behavior problems seems to be bidirectional and mainly accounted for by genetic factors. Furthermore, child-driven effects were mainly genetically mediated, and parent-driven effects were a function of both genetic and shared-environmental factors.

[Characteristics of smoking and secondhand smoke exposure in monozygotic and dizygotic twins: results from an international twin study]

INTRODUCTION

Zygosity differences in smoking exposure are unclear in twins.

AIMS

To assess smoking and secondhand smoke exposure characteristics in twins.

METHODS

151 monozygotic and 62 dizygotic Hungarian and American adult twin pairs (age 43.8±16.5 years, mean±SD) participated in the study.

RESULTS

Monozygotic twins started smoking 1.8 years earlier compared to dizygotic twins (p = 0.08). Dizygotic twins smoked longer (p<0.01) and suffered more parental smoke exposure during childhood (p<0.05). Monozygotic twins reported stricter smoking restrictions at home and workplaces (p<0.005) and less smoke exposure in indoor public places (p<0.01). 85.7% of monozygotic twins were ex or active smokers, while only 69.5% of the dizygotics (p<0.01). Lesser difference was observed in the self-reported smoke exposure rate in monozygotic compared to dizygotic pairs concerning restaurants and cafés (p<0.05) which was not present regarding bars, pubs and transportation facilities.

CONCLUSIONS

Different psychological family orientation may be present across zygosity. Preventive parental care is warranted in twin families exposed to smoking.

"Attenuated psychotic symptoms syndrome" as a risk syndrome of psychosis, diagnosis in DSM-V: The debate

Schizophrenia is a common disorder, affecting approximately 1 out of every 100 people, with a typical onset during adolescence and early adulthood. The personal and societal costs of schizophrenia are extremely high. Prevention of schizophrenia, would offer substantial benefits to patients, their family members, and the community at large. The prodromal phase of schizophrenia has been recognized since the 19th century. At-risk individuals for psychosis and schizophrenia are the subjects who can provide information for intervention prior to development of frank psychosis. This approach is currently being investigated. The question remains, however, whether it can be a diagnostic category by itself. The proposal for including the risk syndrome is one of the recommendations by the working group on schizophrenia and psychotic disorders for the forthcoming DSM-V. There are differing views in academia regarding this proposal. Prior to becoming fully psychotic, a consistent literature demonstrates that patients generally had suffered from accelerating attenuated symptoms and distress. It is important that the prodromal phase be accurately recognized in order to accomplish the goal of prevention. We can then purposefully engage in early intervention aiming toward prevention. A recent strong resurgent interest in this area stems largely from two developments: First, the identification of the neurobiological deficit processes associated with the severity and chronicity of schizophrenia, and second, the development of reliable criteria for diagnosis. Although the general at-risk construct appears to offer great potential to advance both the treatment and research dealing with psychotic illnesses, it seems premature to many researchers to include the syndrome as an established entity in the text of the new DSM-V. It would be far more appropriate to include this proposed syndrome in the appendix and evaluate the many contemporary issues in future studies. The main issues involved in this discussion are the clinical validity of the syndrome, concern about stigma and unnecessary treatment, and need for responding to patients' distress in addition to the ethical dilemma. In this review we examine the issue of inclusion of the risk syndrome as a diagnosis.

The emerging modern face of mood disorders: a didactic editorial with a detailed presentation of data and definitions

The present work represents a detailed description of our current understanding and knowledge of the epidemiology, etiopathogenesis and clinical manifestations of mood disorders, their comorbidity and overlap, and the effect of variables such as gender and age. This review article is largely based on the 'Mood disorders' chapter of the Wikibooks Textbook of Psychiatry http://en.wikibooks.org/wiki/Textbook_of_Psychiatry/Mood_Disorders.

Anxiety, mood, and substance use disorders in parents of children with anxiety disorders

Examined the prevalence of anxiety, mood, and substance use disorders in the parents of anxiety disordered (AD) children relative to children with no psychological disorder (NPD). The specificity of relationships between child and parent anxiety disorders was also investigated. Results revealed higher prevalence rates of anxiety disorders in parents of AD children relative to NPD children. Specific child-mother relationships were found between child separation anxiety and panic disorder and maternal panic disorder, as were child and maternal social phobia, obsessive compulsive disorder, and specific phobias. Findings are discussed with reference to theory, clinical implications, and future research needs.

Parenting practices as potential mechanisms for child adjustment following mass trauma

Trauma research has identified a link between parental adjustment and children's functioning and the sometimes ensuing intergenerational impact of traumatic events. The effects of traumatic events on children have been demonstrated to be mediated through their impact on children's parents. However, until now, little consideration has been given to the separate and more proximal mechanism of parenting practices as potential mediators between children's adjustment and traumatic events. To shed some light in this arena, we review literature on trauma, adversity, and resilience, and discuss how parenting practices may mediate trauma and adverse environmental contexts. Using a social interaction learning perspective (Forgatch & Knutson, 2002; Patterson, 2005), we propose a prevention research framework to examine the role that parenting practices may play in influencing children's adjustment in the wake of trauma exposure. The article concludes by providing a specific model and role for evidence-based parenting interventions for children exposed to mass trauma.

Differential family and peer environmental factors are related to severity and comorbidity in children with ADHD

Behavioral genetic studies imply that salient environmental influences operate within families, making siblings in a family different rather than similar. This study is the first one to examine differential sibling experiences (as measured with the Sibling Inventory of Differential Experience) and its effect on behavioral outcomes within ADHD families. Subjects were 45 Dutch ADHD probands and their unaffected siblings (n = 45) aged 10-18 years. ADHD probands and their unaffected siblings reported differences in sibling interaction, parental treatment, and peer characteristics. These nonshared environmental influences were related to both the severity of ADHD symptoms as well as to comorbid problem behaviors. These findings suggest that environmental influences that operate within ADHD families appear relevant to the severity of problem behaviors of ADHD children and their siblings.

Depressive symptomatology in child and adolescent twins with attention-deficit hyperactivity disorder and/or developmental coordination disorder

Previous research has demonstrated a link between attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD), and depression. The present study utilized a monozygotic (MZ) differences design to investigate differences in depressive symptomatology between MZ twins discordant for ADHD or DCD. This extends previous research as it controls for genetic effects and shared environmental influences and enables the investigation of nonshared environmental influences. In addition, children and adolescents with comorbid ADHD and DCD were compared on their level of depressive symptomatology to those with ADHD only, DCD only, and no ADHD or DCD. The parent-rated Strengths and Weaknesses of ADHD Symptoms and Normal Behavior, Developmental Coordination Disorder Questionnaire, and Sad Affect Scale were used to assess ADHD, DCD, and depressive symptomatology respectively. The results revealed higher levels of depressive symptomatology in MZ twins with ADHD or DCD compared to their nonaffected co-twins. In addition, children and adolescents with comorbid ADHD and DCD demonstrated higher levels of depressive symptomatology compared to those with ADHD only, DCD only, and no ADHD or DCD. The implications of these findings are discussed with emphasis on understanding and recognizing the relationship between ADHD, DCD, and depression in the assessment and intervention for children and adolescents with these disorders.

Are sibling relationships protective? A longitudinal study

BACKGROUND

Although the protective effects of familial and parental support have been studied extensively in the child psychopathology literature, few studies have explored the protective quality of positive sibling relationships.

METHODS

A two-wave longitudinal design was used to examine the protective effect of positive sibling relationships on child adjustment for children experiencing stressful life events. Mothers reported on stressful life events and child adjustment. Older siblings assessed the quality of relationship between themselves and target children.

RESULTS

Sibling affection moderated the relationship between stressful life events and internalizing symptomatology but not the relationship between stressful life events and externalizing symptomatology. Notably, the protective effect of sibling affection was evident regardless of mother-child relationship quality.

CONCLUSIONS

Positive sibling relationships are an important source of support for children experiencing stressful life events. Implications for intervention are discussed.

Genetic and environmental contributions to common psychopathologies of childhood and adolescence: a study of twins and their siblings

We report findings based on analyses of self-reports of six common adolescent psychopathologies (attention deficit/hyperactivity disorder, ADHD; conduct disorder, CD; oppositional defiant disorder, ODD; generalized anxiety disorder, GAD; separation anxiety disorder, SAD; and major depressive disorder, MDD) in a sample of 1,162 male and female adolescent (12-19 years) twin pairs and 426 siblings. Prevalence statistics for past year and lifetime reports confirm differences between genders for CD, GAD, SAD, and MDD, and a lack of differences between twins and their non-twin siblings. Biometrical modeling was conducted to ascertain the relative influences of genes, and shared and non-shared environments contributing to these disorders. A more robust estimate of these parameters was obtained by including non-twin siblings. Age-specific thresholds were integrated into the analyses to appropriately model the developmental patterns of behavior. We found evidence for both genetic and non-shared environmental influences for all disorders. Shared environmental influences also seem to be important for MDD and lifetime GAD.

Does early adolescent sex cause depressive symptoms?

A recent study by the Heritage Foundation (Rector, Johnson, & Noyes, 2003) found evidence of a positive relationship between early sexual intercourse and depressive symptoms. This finding has been used to bolster support for funding abstinence only sex education. However, promoting abstinence will only yield mental health benefits if there is a causal link between sexual intercourse and depression. Using the National Longitudinal Study of Adolescent Health (Add Health), I carefully examine the relationship between early teen sex and several measures of depression. Controlling for a wide set of individual level and family level observable characteristics, cross section estimates consistently show a significant positive relationship between early sexual activity for females and three measures of adverse mental health: self reported depression, a belief that one's life is not worth living, and serious thoughts of suicide. However, difference-in-difference estimates reflect no evidence of a significant relationship between early teen sex and depressive symptoms. These findings suggest that the positive association observed by Rector et al. (2003) can be explained by unmeasured heterogeneity. Thus, promoting abstinence among adolescents is unlikely to alleviate depressive symptoms

Mutual influences on maternal depression and child adjustment problems

Often undetected and poorly managed, maternal depression and child adjustment problems are common health problems and impose significant burden to society. Studies show evidence of mutual influences on maternal and child functioning, whereby depression in mothers increases risk of emotional and behavioral problems in children and vice versa. Biological mechanisms (genetics, in utero environment) mediate influences from mother to child, while psychosocial (attachment, child discipline, modeling, family functioning) and social capital (social resources, social support) mechanisms mediate transactional influences on maternal depression and child adjustment problems. Mutual family influences in the etiology and maintenance of psychological problems advance our understanding of pathways of risk and resilience and their implications for clinical interventions. This article explores the dynamic interplay of maternal and child distress and provides evidence for a biopsychosocial model of mediating factors with the aim of stimulating further research and contributing to more inclusive therapies for families.

Genetic and environmental contributions to stability and change in children's internalizing and externalizing problems

OBJECTIVE

To estimate genetic, shared environmental, and nonshared environmental contributions to stability and change in internalizing and externalizing problems.

METHOD

Maternal Child Behavior Checklist ratings were obtained for 3,873 twin pairs at age 3 and 1,924 twin pairs at age 7. For 1,575 twin pairs, ratings were available at both ages.

RESULTS

For Internalizing/Externalizing ratings, genetic, shared, and nonshared environmental factors explained about 59/51%, 10/30%, and 31/19% of the variance at age 3, and 40/52%, 31/32%, and 29/16% of the variance at age 7. The phenotypic correlation of r = 0.38/0.54 between problems assessed at 3 and 7 years of age was explained for 66/55% by genetic factors, for 23/37% by shared environmental factors, and for 11/8% by nonshared environmental factors. The genetic, shared environmental, and nonshared environmental correlations between ages 3 and 7 were 0.51/0.57, 0.47/0.66, and 0.13/0.24, respectively.

CONCLUSIONS

Genetic and shared environmental factors were most important for the stability of Internalizing and Externalizing Problems between ages 3 and 7. Nonshared environmental factors were mainly age-specific. For Internalizing Problems, shared environment may become more important from early to middle childhood.

Depression in adolescence

Major depressive disorder is a common problem for adolescents. It has a wide array of symptoms affecting somatic, cognitive, affective, and social processes. Academic failure, poor peer relationships, behavioral problems, conflict with parents and other authority figures, and substance abuse are some of the consequences of major depressive disorder in this age group. Effective treatments include nontricyclic antidepressants and coping skills training. The nurse is key to depression detection and suicide prevention, especially in primary care settings. Through psychoeducation, nurses can promote recovery from depression by encouraging a healthy lifestyle, enhancing social skills, and assisting the adolescent to identify and use sources of social support. These measures can prevent premature death and promote long-term well-being of the adolescent.

Genes, environment and schizophrenia

BACKGROUND

Data from family, twin and adoption studies show overwhelming evidence of a substantial genetic component in schizophrenia and although molecular genetic studies have been more difficult to replicate, recent improvements in technology have resulted in the implication of genes at several chromosomal loci. Nevertheless, it remains clear that environmental factors both add to and interact with genetic factors to produce the disorder.

AIMS

To incorporate genetic and environmental risk factors into a neurodevelopmental model in order to conceptualise the liability to schizophrenia.

METHOD

A representative selection of the literature related to this issue is reviewed, together with a reformulation of Meehl's term 'schizotaxia' to describe the liability to the disorder.

RESULTS

The literature supports a multi-factorial view of the liability to schizophrenia, which includes both genetic and environmental components.

CONCLUSIONS

Schizotaxia provides a useful way to conceptualise both the liability for schizophrenia, and also the development of treatment strategies aimed at the eventual prevention of the illness.

Schizophrenia: vulnerability versus disease

One of the most important trends in the treatment of schizophrenia involves its early diagnosis and intervention. The ultimate goal of research is the prevention of the disorder, A major impediment to the development of prevention strategies, however, is that we do not yet know what the liability for schizophrenia is before the onset of psychosis. Consequently, early treatment attempts are focused on the “prodrome,” which involves the early symptoms of psychosis. In a companion paper, we recently suggested that prevention work should focus not only on the prodrome, but also on “schizotaxia,” which is a clinically meaningful condition that may reflect the vulnerability to schizophrenia in the absence of psychosis. Because schizotaxia can be assessed prior to the prodrome, studies of schizotaxia might lead to more effective prevention programs. We continue the characterization of schizotaxia in this paper by focusing on the etiological roots of schizotaxia, plus its likely neurodevelopmental course, clinical expression, and treatment. Finally, the importance of including neurobiological variables in the conceptualization and eventual diagnosis of schizotaxia is reviewed.

Role of the family in the onset and outcome of childhood disorders: selected research findings

OBJECTIVE

Three areas of basic family research were selected for review as being of special importance to the clinically oriented child and adolescent psychiatrist: behavioral genetics, expressed emotion, and the interaction of family dynamics and childhood illness.

METHOD

Medline and PSYCINFO searches using appropriate keywords were obtained for each of the 3 major areas. All English-language articles published after 1989 that included empirical research pertaining to children or adolescents were reviewed.

RESULTS

Behavioral genetics research indicates that the shared environment, including issues of parental monitoring and discipline, is important in the development and outcome of externalizing disorders. Differential parental treatments of one sibling are critical in internalizing disorders. Criticism (as measured by expressed emotion) is associated with poor outcome of many childhood medical and psychiatric disorders. Chronic illness in a child changes the family dynamics toward being more structured and less emotionally warm and communicative. The family's role in adherence to treatment is critical, and families with high levels of criticism have more difficulty.

CONCLUSIONS

Families can cause problems, but many times the problems families have are in response to a child's problems. There is a continued need to empirically assess which family processes are important for specific childhood disorders.

Specific life events and chronic experiences differentially associated with depression and anxiety in young twins

Behavioral genetic analyses indicate that environmental influences associated with depression and anxiety are specific to each symptom type; however, this has not been tested specifically in children. Sixty-one (61) child twin pairs in which at least one twin had a very high anxiety or depression score, and 29 nonanxious, nondepressed pairs were interviewed about life events and chronic stressors in the previous 12 months. Loss events, schoolwork stressors, family relationship problems, and friendship problems were all significantly associated with depression but not anxiety. Threat events were significantly associated with anxiety but not depression. Loss events and schoolwork stressors appeared to act as shared environment influences in that they made twin pairs resemble one another. Threat events, friendship problems, and family relationship problems were individual specific and accounted for differences within the pairs. These results clarify the associations between life events and depressive and anxious symptoms in children and adolescents and reveal specific associations previously unidentified in this age range.

Maternal depression and parenting behavior: a meta-analytic review

The results of 46 observational studies were analyzed to assess the strength of the association between depression and parenting behavior and to identify variables that moderated the effects. The association between depression and parenting was manifest most strongly for negative maternal behavior and was evident to a somewhat lesser degree in disengagement from the child. The association between depression and positive maternal behavior was relatively weak, albeit significant. Effects for negative maternal behavior were moderated by timing of the depression: Current depression was associated with the largest effects. However, residual effects of prior depression were apparent for all behaviors. Socioeconomic status, child age, and methodological variables moderated the effects for positive behavior: Effects were strongest for studies of disadvantaged women and mothers of infants. Studies using diagnostic interviews and self-report measures yielded similar effects, suggesting that deficits are not specific to depressive disorder. Research is needed to identify factors that affect the magnitude of parenting deficits among women who are experiencing depression and other psychological difficulties.

Schizophrenia: genes and environment

The historical and genetic foundations of our current understanding of schizophrenia are reviewed, as are the present and future directions for research. Genetic epidemiological investigations, including family, twin, and adoption studies have confirmed the contributions of genetic and environmental determinants of schizophrenia. For example, identical twins show average concordance rates of only 50%; rates of 100% would be expected on the basis of genetic equivalence alone. Genetic factors may cause errors in brain development and synaptic connections. A broad range of environmental components may further damage the brain. Biological components may include pregnancy and delivery complications, such as intrauterine fetal hypoxia, infections, and malnutrition. Primarily nonbiological components may include psychosocial stressors, such as residence in an urban area and dysfunctional family communication. It is likely that the environmental factors interact with the genetic liability in a negative manner to produce disorders in the schizophrenic spectrum. Genetic and environmental components of the disorder are examined, as well as their interactions in producing either neurodevelopmental syndromes or schizophrenia itself. The implication of these findings for prevention and treatment are considered.

A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders

Empirical findings regarding childhood traumatic stress are placed within a developmental life-trajectory model that incorporates a tripartite etiology of posttrauma distress. This approach recognizes an intricate matrix of child-intrinsic factors, developmental maturation and experience, life events, and evolving family and social ecologies. Of central developmental importance in the field of traumatic stress is the ontogenesis of appraisal, emotional response, emotional and physiological regulation, and consideration of protective action with regard to danger. The complexity of traumatic situations and their aftermath suggests the relevance of multiple stress diatheses in understanding individual variability in proximal and distal effects. Neurobiological systems that subserve danger mature over childhood and adolescence. Neurophysiological and neurohormonal studies among traumatized children and adolescents suggest potential neurodevelopmental stage-related vulnerabilities within these systems. Advances in child development and traumatic stress provide tools for investigating proximal and distal interplay of psychopathology, disturbances in the acquisition and maintenance of developmental competencies, and life-trajectory outcomes. A developmental psychopathology model suggests different avenues by which dangerous circumstances, childhood traumatic experiences, and posttraumatic stress disorder (PTSD) can intersect with other anxiety disorders over the life span.

Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. AACAP

Child and adolescent major depressive disorder and dysthymic disorder are common, chronic, familial, and recurrent conditions that usually persist into adulthood. These disorders appear to be manifesting at an earlier age in successive cohorts and are usually accompanied by comorbid psychiatric disorders, increased risk for suicide, substance abuse, and behavior problems. In addition, depressed youth frequently have poor psychosocial, academic, and family functioning, which highlights the importance of early identification and prompt treatment. Both psychotherapy and pharmacotherapy have been found to be beneficial for the acute treatment of youth with depressive disorders. Opinions vary regarding which of these treatments should be offered first and whether they should be offered in combination. In general, the choice of initial therapy depends on clinical and psychosocial factors and therapist's expertise. Based on the current literature and clinical experience, psychotherapy may be the first treatment for most depressed youth. However, antidepressants must be considered for those patients with psychosis, bipolar depression, severe depressions, and those who do not respond to an adequate trial of psychotherapy. All patients need continuation therapy and some patients may require maintenance treatment. Further research is needed on the etiology of depression; the efficacy of different types of psychotherapy; the differential effects of psychotherapy, pharmacotherapy, and integrated therapies; the continuation and maintenance treatment phases; treatment for dysthymia, treatment-resistant depression, and other subtypes of major depressive disorder; and preventive strategies for high-risk children and adolescents.

Adolescent depression. Epidemiology, nosology, life stress and social network. Minireview based on a doctoral thesis

The study engaged a total population of 16-17-year-old urban high-school students and 2300 (93%) were screened for depression and previous suicide attempts. Adolescents with high depression scores in self-evaluation (12.3%) or reporting previous suicide attempts (2.4%) were diagnostically interviewed together with one control for each, matched for gender and educational program. After the interview self-ratings were completed regarding social network, family climate, and life events. Major depression was prevalent during the last year in 5.8% and during life time in 11.4%, 4 girls for every boy. A depression with remaining symptoms for a year or more was the most common type. Dysthymia without major depressive episodes was diagnosed in 1.1%, two girls for every boy. Short hypomanic episodes had been experienced by 13.2% of those with major depressive disorder. Anxiety disorder was comorbid to depression in one half and conduct disorder in one forth of the depressed adolescents. Alcohol was abused by 6.5% and used regularly by another 12%. Other drugs were used by 6.5% of depressed adolescents and not at all by controls. The depressed used tobacco twice as frequently as non-depressed. Social network and family climate were compared within the originally matched pairs. Adolescents with long-lasting depressions had a smaller and unsatisfying social network. They also had experienced many stressful life events related to family adversities, while those with shorter depressive episodes had stress related to the peer group. Depressed adolescents with comorbid conduct disorder reported insufficient support from the close network and a more negative family climate.

Attention-deficit hyperactivity disorder with bipolar disorder: a familial subtype?

OBJECTIVE

To clarify the nosological status of children with attention-deficit hyperactivity disorder (ADHD) who also satisfy diagnostic criteria for bipolar disorder (BPD).

METHOD

Blind raters and structured psychiatric interviews were used to examine 140 children with ADHD, a sample of 120 non-ADHD comparisons, and their 822 first-degree relatives. Data analyses tested specific hypotheses about the familial relationship between ADHD and BPD.

RESULTS

After stratifying the ADHD sample into those with and without BPD, the authors found that (1) relatives of both ADHD subgroups were at significantly greater risk for ADHD than relatives of non-ADHD controls; (2) the two subgroups did not differ significantly from one another in their relatives' risk for ADHD; (3) a fivefold elevated risk for BPD was observed among relatives when the proband child had BPD but not when the proband had ADHD alone; (4) an elevated risk for major depression with severe impairment was found for relatives of ADHD + BPD probands; (5) both ADHD and BPD occurred in the same relatives more often than expected by chance alone; and (6) there was a trend for random mating between ADHD parents and those with mania.

CONCLUSIONS

The data suggest that comorbid ADHD with BPD is familially distinct from other forms of ADHD and may be related to what others have termed childhood-onset BPD.

Cognitive and behavioral deficits associated with parental alcohol use

OBJECTIVE

To review and synthesize the scientific literature on cognitive and behavioral deficits associated with parental alcohol use and to highlight areas for future attention.

METHOD

Studies of children of alcoholic parents (generally fathers) and of children prenatally exposed to alcohol were reviewed, focusing on cognitive and behavioral findings. Relevant animal studies were also reviewed.

RESULTS

Large numbers of children may be affected by parental alcohol use. Prenatal alcohol exposure is frequently associated with specific cognitive and behavioral deficits. Children of alcoholic fathers also can present with difficulties in learning, language, and temperament. Similarities in the deficits of these two groups were noted.

CONCLUSIONS

The problems associated with parental alcohol use merit much more clinical and research attention. Current clinical approaches often fail to recognize the diagnostic and therapeutic significance of this history, and subgroups of alcohol-affected children may confound research studies of other problems. Subtle deficits in learning, language, and self-regulation may be the most developmentally devastating and the least likely to be identified and addressed effectively. This is an important area in which to combine behavior genetic and environmental approaches to understanding development.

Child and adolescent bipolar disorder: a review of the past 10 years

OBJECTIVE

To provide a review of the epidemiology, phenomenology, natural course, comorbidity, neurobiology, and treatment of child and adolescent bipolar disorder (BP) for the past 10 years. This review is provided to prepare applicants for recertification by the American Board of Psychiatry and Neurology.

METHOD

Literature from Medline and other searches for the past 10 years, earlier relevant articles, and the authors' experience and ongoing National Institute of Mental Health-funded project "Phenomenology and Course of Pediatric Bipolarity" were used.

RESULTS

Age-specific, developmental (child, adolescent, and adult) DSM-IV criteria manifestations; comorbidity and differential diagnoses; and episode and course features are provided. Included are age-specific examples of childhood grandiosity, hypersexuality, and delusions. Differential diagnoses (e.g., specific language disorders, sexual abuse, conduct disorder [CD], schizophrenia, substance abuse), suicidality, and BP-II are discussed.

CONCLUSION

Available data strongly suggest that prepubertal-onset BP is a nonepisodic, chronic, rapid-cycling, mixed manic state that may be comorbid with attention-deficit hyperactivity disorder (ADHD) and CD or have features of ADHD and/or CD as initial manifestations. Systematic research on pediatric BP is in its infancy and will require ongoing and future studies to provide developmentally relevant diagnostic methods and treatment.

Severe conduct disorder--some key issues

OBJECTIVE

To examine the state of knowledge about clinically severe conduct disorder and identify key issues.

METHOD

This paper surveys the literature on conduct disorder and delineates and discusses the critical issues.

RESULTS

Conduct disorder is the subject of a vast and growing amount of research on taxonomy, correlates, etiology, outcome, management, and prevention. There are 2 distinctive types: childhood and adolescent onset. Comorbidity with other disorders is common. It remains a costly disorder, however, with a generally poor prognosis for the childhood-onset type. The validity of the separation of conduct and antisocial personality disorder is questionable.

CONCLUSIONS

In view of its huge cost, chronicity, and generally poor outcome, childhood-onset or severe conduct disorder should be considered one of if not the major public health problems of our time, and resources for its study and management should reflect this. The disorder is poorly defined and inadequately studied in females.

Attention-deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study

OBJECTIVE

To investigate heritability and continuum versus categorical approaches to attention-deficit hyperactivity disorder (ADHD), using a large-scale twin sample.

METHOD

A cohort of 1,938 families with twins and siblings aged 4 to 12 years, recruited from the Australian National Health and Medical Research Council Twin Registry, was assessed for ADHD using a DSM-III-R-based maternal rating scale. Probandwise concordance rates and correlations in monozygotic and dizygotic twins and siblings were calculated, and heritability was examined using the De Fries and Fulker regression technique.

RESULTS

There was a narrow (additive) heritability of 0.75 to 0.91 which was robust across familial relationships (twin, sibling, and twin-sibling) and across definitions of ADHD as part of a continuum or as a disorder with various symptom cutoffs. There was no evidence for nonadditive genetic variation or for shared family environmental effects.

CONCLUSIONS

These findings suggest that ADHD is best viewed as the extreme of a behavior that varies genetically throughout the entire population rather than as a disorder with discrete determinants. This has implications for the classification of ADHD and for the identification of genes for this behavior, as well as implications for diagnosis and treatment.

Developmental factors influencing aggression. Animal models and clinical correlates

Clearly, models of developmentally induced aggression in animals can give us important insights into the factors inducing aggression in children. Several such models have been produced, and the neurochemical substrates eliciting the aggressive behavior have been identified. In many cases, the serotonergic system is involved. In the future, these animal models may also prove useful in identifying appropriate treatments.