Prenatal maternal stress is associated with lower cortisol and cortisone levels in the first morning urine of 45-month-old children

Prenatal stress (PS) has been related to altered hypothalamic-pituitary-adrenal (HPA) axis activity later in life. So far, studies in children assessing HPA axis functioning have focused on salivary cortisol, reflecting daytime activity. The present work is part of a prospective study and aims to extend knowledge about the association between PS and HPA axis regulation in children. To do so, we investigated cortisol, cortisone, and the ratio cortisone/(cortisone + cortisol) in the first morning urine of 45-month-old children in relation to several measures of maternal stress during pregnancy. Urinary cortisol and cortisone were measured by online turbulent flow chromatography coupled with high performance liquid chromatography-tandem mass spectrometry. PS was defined as: perceived stress for aim 1 (Perceived Stress Scale; n = 280); presence of self-reported (n = 371) and expert-rated psychopathology for aim 2 (Mini International Neuropsychiatric Interview; n = 281); continuous measures of anxiety and depression for exploratory aim 3 (State-Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale; n = 280). Aim 1: Perceived maternal PS showed negative associations with cortisol and cortisone levels. Aim 2: The presence of expert-rated maternal psychopathology was associated with reduced morning cortisone. Aim 3: Continuous measures of anxiety and depression showed negative associations with cortisol and cortisone levels. After correcting for multiple testing, perceived maternal PS (aim 1) and prenatal level of anxiety (aim 3) were significant predictors of children's urinary cortisol and cortisone in the morning (and, in the case of cortisone, also prenatal level of depression). The ratio cortisone/(cortisone + cortisol) as a global marker for the balance between the enzymes metabolizing cortisol to cortisone and vice versa (11β-hydroxysteroid dehydrogenases type 1 and 2; 11β-HSD1 and 2) was not associated with any measure of maternal PS (aims 1-3). The present study provides insight into possible programming effects of PS on nocturnal HPA axis activity and a proxy of 11β-HSD in a large sample. The results suggest that the nocturnal rate of cortisol production is lower in children exposed to PS, but do not support the hypothesis of divergent 11β-HSD activity.

Stress reactivity in preschool-aged children: Evaluation of a social stress paradigm and investigation of the impact of prenatal maternal stress

Prenatal maternal stress is an established risk factor for somatic and psychological health of the offspring. A dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in offspring has been suggested as an important mechanism. However, the impact of prenatal stress on stress reactivity in preschool-aged children is not yet well understood. This is partly due to the fact that for this age group there is no stress test as well established as for older children and adults. In the present work a previously published stress test (Kryski et al., 2011) was evaluated in a large sample of 45-month-old children (n = 339). Furthermore, the relation between measures of prenatal maternal stress and cortisol reactivity was investigated. Prenatal stress was defined as psychopathology (self-report available for n = 339; expert-rating available for a subsample of n = 246) and perceived stress (n = 244) during pregnancy. The stress paradigm elicited significant increases in salivary cortisol 30 and 40 min after the test, and 60.8% of the children were classified as responders. Lower cortisol levels after the stress test were observed in the group of children with prenatal stress defined as maternal psychopathology (both self-reported and expert-rated). Maternal perceived stress as a continuous measure was not significantly associated with cortisol levels. However, when comparing children in the highest quartile of maternal perceived stress to all other children, significantly lower cortisol values were observed in the prenatally stressed group. The present study confirms the paradigm by Kryski et al. as an effective stress test for preschool-aged children. Moreover, it provides further evidence that prenatal stress impacts HPA axis reactivity. Future studies should target the timing, nature, and intensity of prenatal stressors and their effect on the stress response in offspring at different developmental stages.

EEG Source Imaging Indices of Cognitive Control Show Associations with Dopamine System Genes

Cognitive or executive control is a critical mental ability, an important marker of mental illness, and among the most heritable of neurocognitive traits. Two candidate genes, catechol-O-methyltransferase (COMT) and DRD4, which both have a roles in the regulation of cortical dopamine, have been consistently associated with cognitive control. Here, we predicted that individuals with the COMT Met/Met allele would show improved response execution and inhibition as indexed by event-related potentials in a Go/NoGo task, while individuals with the DRD4 7-repeat allele would show impaired brain activity. We used independent component analysis (ICA) to separate brain source processes contributing to high-density EEG scalp signals recorded during the task. As expected, individuals with the DRD4 7-repeat polymorphism had reduced parietal P3 source and scalp responses to response (Go) compared to those without the 7-repeat. Contrary to our expectation, the COMT homozygous Met allele was associated with a smaller frontal P3 source and scalp response to response-inhibition (NoGo) stimuli, suggesting that while more dopamine in frontal cortical areas has advantages in some tasks, it may also compromise response inhibition function. An interaction effect emerged for P3 source responses to Go stimuli. These were reduced in those with both the 7-repeat DRD4 allele and either the COMT Val/Val or the Met/Met homozygous polymorphisms but not in those with the heterozygous Val/Met polymorphism. This epistatic interaction between DRD4 and COMT replicates findings that too little or too much dopamine impairs cognitive control. The anatomic and functional separated maximally independent cortical EEG sources proved more informative than scalp channel measures for genetic studies of brain function and thus better elucidate the complex mechanisms in psychiatric illness.

A gene-by-sex interaction for nicotine reward: evidence from humanized mice and epidemiology

It has been proposed that vulnerability to nicotine addiction is moderated by variation at the μ-opioid receptor locus (OPRM1), but results from human studies vary and prospective studies based on genotype are lacking. We have developed a humanized mouse model of the most common functional OPRM1 polymorphism rs1799971_A>G (A118G). Here we use this model system together with a cohort of German youth to examine the role of the OPRM1 A118G variation on nicotine reward. Nicotine reinforcement was examined in the humanized mouse model using i.v. self-administration. Male (n=17) and female (n=26) mice homozygous either for the major human A allele (AA) or the minor G allele (GG) underwent eight daily 2 h sessions of nicotine self-administration. Furthermore, male (n=104) and female (n=118) subjects homozygous for the A allele or carrying the G allele from the Mannheim Study of Children at Risk were evaluated for pleasurable and unpleasant experiences during their initial smoking experience. A significant sex-by-genotype effect was observed for nicotine self-administration. Male 118GG mice demonstrated higher nicotine intake than male 118AA mice, suggesting increased nicotine reinforcement. In contrast, there was no genotype effect in female mice. Human male G allele carriers reported increased pleasurable effects from their first smoking experience, as compared to male homozygous A, female G and female homozygous A allele carriers. The 118G allele appears to confer greater sensitivity to nicotine reinforcement in males, but not females.

Monoamine oxidase A polymorphism moderates stability of attention problems and susceptibility to life stress during adolescence

Attention problems affect a substantial number of children and adolescents and are predictive of academic underachievement and lower global adaptive functioning. Considerable variability has been observed with regard to the individual development of attention problems over time. In particular, the period of adolescence is characterized by substantial maturation of executive functioning including attentional processing, with the influence of genetic and environmental factors on individual trajectories not yet well understood. In the present investigation, we evaluated whether the monoamine oxidase A functional promoter polymorphism, MAOA-LPR, plays a role in determining continuity of parent-rated attention problems during adolescence. At the same time, a potential effect of severe life events (SLEs) was taken into account. A multi-group path analysis was used in a sample of 234 adolescents (149 males, 85 females) who took part in an epidemiological cohort study at the ages of 11 and 15 years. Attention problems during early adolescence were found to be a strong predictor of attention problems in middle adolescence. However, in carriers of the MAOA-LPR low-activity variant (MAOA-L), stability was found to be significantly higher than in carriers of the high-activity variant (MAOA-H). Additionally, only in MAOA-L carriers did SLEs during adolescence significantly impact on attention problems at the age of 15 years, implying a possible gene × environment interaction. To conclude, we found evidence that attention problems during adolescence in carriers of the MAOA-L allele are particularly stable and malleable to life stressors. The present results underline the usefulness of applying a more dynamic GxE perspective.

MORC1 exhibits cross-species differential methylation in association with early life stress as well as genome-wide association with MDD

Early life stress (ELS) is associated with increased vulnerability for diseases in later life, including psychiatric disorders. Animal models and human studies suggest that this effect is mediated by epigenetic mechanisms. In humans, epigenetic studies to investigate the influence of ELS on psychiatric phenotypes are limited by the inaccessibility of living brain tissue. Due to the tissue-specific nature of epigenetic signatures, it is impossible to determine whether ELS induced epigenetic changes in accessible peripheral cells, for example, blood lymphocytes, reflect epigenetic changes in the brain. To overcome these limitations, we applied a cross-species approach involving: (i) the analysis of CD34+ cells from human cord blood; (ii) the examination of blood-derived CD3+ T cells of newborn and adolescent nonhuman primates (Macaca mulatta); and (iii) the investigation of the prefrontal cortex of adult rats. Several regions in MORC1 (MORC family CW-type zinc finger 1; previously known as: microrchidia (mouse) homolog) were differentially methylated in response to ELS in CD34+ cells and CD3+ T cells derived from the blood of human and monkey neonates, as well as in CD3+ T cells derived from the blood of adolescent monkeys and in the prefrontal cortex of adult rats. MORC1 is thus the first identified epigenetic marker of ELS to be present in blood cell progenitors at birth and in the brain in adulthood. Interestingly, a gene-set-based analysis of data from a genome-wide association study of major depressive disorder (MDD) revealed an association of MORC1 with MDD.

Increasing association between a neuropeptide Y promoter polymorphism and body mass index during the course of development

OBJECTIVE

To investigate the association of the neuropeptide Y (NPY) promoter polymorphism rs16147 with body mass index (BMI) during the course of development from infancy to adulthood.

DESIGN

Longitudinal, prospective study of a German community sample.

SUBJECTS

n = 306 young adults (139 males, 167 females).

MEASUREMENTS

Participants' body weight and height were assessed at the ages of 3 months and 2, 4.5, 8, 11, 15 and 19 years. NPY rs16147 was genotyped.

RESULTS

Controlling for a number of possible confounders, homozygote carriers of the rs16147 C allele exhibited significantly lower BMI scores when compared with individuals carrying the T allele. In addition, a significant genotype by age interaction emerged, indicating that the genotype effect increased during the course of development.

CONCLUSIONS

This is the first longitudinal study to report an association between rs16147 and BMI during childhood and adolescence. The finding that this effect increased during the course of development may either be due to age-dependent alterations in gene expression or to maturation processes within the weight regulation circuits of the central nervous system.

Cigarette craving increases after a psychosocial stress test and is related to cortisol stress response but not to dependence scores in daily smokers

Stress is known to induce cigarette craving in smokers, but the underlying mechanisms are widely unknown. We investigated how dependence severity, smoking habits and stress-induced cortisol secretion are associated with increased cigarette craving after a standardised laboratory stressor. Hundred and six healthy participants (50 men, age 18-19 years) underwent a standardised public speaking stress task. In all, 35 smoked daily (DS), 13 smoked occasionally (OS), and 58 never smoked (NS). Smoking was unrestricted until 2 h before stress onset. Plasma cortisol was measured before and up to 95 min after the stressor. All current smokers rated intensity of cigarette craving immediately before and immediately after the stressor using the Brief Questionnaire of Smoking Urges (BQSU). Cortisol levels significantly increased in response to stress in all groups. The magnitude of this stress response was significantly lower in DS compared with OS and NS but did not differ between OS and NS. Baseline BQSU scores were significantly higher in DS than OS. BQSU scores increased significantly during the stress period and were positively correlated to the cortisol response in the DS but were unrelated to their nicotine dependence scores. In OS, no change in cigarette craving could be observed. In daily smokers, cigarette craving is increased after compared with before stress exposure and is related to the magnitude of cortisol stress response rather than to severity of nicotine dependence. This result supports, but does not prove, the concept that hypothalamus-pituitary-adrenal stimulation is one of the mechanisms how stress can elicit cigarette craving.

Early predictors of antisocial developmental pathways among boys and girls

OBJECTIVE

We investigated in a high-risk sample the differential impact of biological and psychosocial risk factors on antisocial behaviour pathways.

METHOD

One hundred and thirty-eight boys and 155 girls born at differing degrees of obstetric and psychosocial risk were examined from birth until adolescence. Childhood temperament was assessed by a highly-structured parent-interview and standardized behavioural observations, adolescent temperament was measured by self-report. Neurodevelopmental variables were assessed by age-specific developmental tests. Emotional and behaviour problems were measured at the ages of 8 and 15 by the Achenbach scales.

RESULTS

In both genders, psychosocial adversity and early self-control temperament were strongly associated with early-onset persistent (EOP) antisocial behaviour. Psychosocial adversity and more severe externalizing problems differentiated the EOP from childhood-limited (CL) pathway. In girls, adolescent-onset (AO) antisocial behaviour was strongly associated with novelty seeking at 15 years.

CONCLUSION

Our findings emphasize the need for early support and intervention in psychosocially disadvantaged families.

[Addiction across the lifespan]

Alcohol and nicotine are with us during most of our lifetime. About 4,000 children with fetal alcohol syndrome and another 20,000 children with fetal alcohol effects are born per year in Germany. Alcohol contributes to accidents and suicides especially in young people. It is particularly toxic for the developing brain.Germany is among the countries with a high consumption of alcohol and nicotine. Consequently substance-related diseases are highly prevalent. In the group of people aged 65 and older we expect a doubling of alcohol problems within the next 10 years. This will also lead to a sharp increase in alcohol-related dementias. Overall, treatment is effective especially if one considers the chronic relapsing nature of the disorder. Unfortunately, less than 10% of patients really receive specialist care. This segment needs to be expanded especially by psychiatrists and psychotherapists. Different prevention strategies are being applied but there is a reluctance to use a ban or curtail advertising and to raise taxes for a reduction in overall consumption.

The impact of language skills on mental health in teenagers with hearing impairments

OBJECTIVE

The aim of this study was to examine the relationship of language competence level and mental distress in teenagers with hearing impairments.

METHOD

43 pupils were given a battery of linguistic tests and the Strengths and Difficulties Questionnaire (SDQ), which was also completed by 40 parents. Comparisons were made between the group of 33 children in mainstream education and 10 who were in a segregated school for the deaf.

RESULTS

The children had impaired language skills relative to published norms, especially marked in segregated schools. Parents rated children as having more distress than published norms. Those with superior level of spoken language had fewer peer relationship problems in mainstream education, but significantly more in segregated schools. The reverse was almost significant for those proficient in signed language.

CONCLUSION

Peer relationship problems are associated with the language competence levels in the way that children at school communicate with one another.

Association between ADHD and smoking in adolescence: shared genetic, environmental and psychopathological factors

The present study aimed to examine the extent to which the co-occurrence of ADHD and smoking in adolescents could be attributed to common genetic, environmental and psychopathological factors. Data are from an ongoing prospective study of the outcome of early risk factors. At age 15 years, 305 adolescents completed self-report questionnaires measuring tobacco consumption and deviant peer affiliations. Lifetime psychiatric diagnoses were obtained using standardized interviews. DNA was genotyped for the dopamine D4 receptor (DRD4) gene exon III polymorphism. Adolescents with a lifetime diagnosis of ADHD displayed significantly higher smoking activity than non-ADHD controls. A major component of this association could be accounted for by deviant peer affiliations and the comorbidity with oppositional-defiant and conduct disorder, while a minor part was attributable to DRD4 in males but not in females. These findings suggest that the association of ADHD with smoking relies on risk factors shared by the two behaviors.

Is the serotonin transporter polymorphism (5-HTTLPR) associated with harm avoidance and internalising problems in childhood and adolescence?

The S allele of the 5-HTTLPR has been associated with anxiety-related behavioural traits and harm avoidance. The 5-HTTLPR polymorphism is suggested to modulate the serotonergic response to stress, meaning that individuals carrying the SS genotype who have significant stress histories may tend to develop depressive symptoms. In the Mannheim Study of Risk Children, which followed a cohort of n = 384 from birth to adolescence, the association of 5-HTTLPR with harm avoidance and internalising problems was examined, including gender and early life stress as possible moderators. Child and adolescent characteristics were assessed using the Junior Temperament and Character Inventory, the Child Behaviour Checklist and the Youth Self Report. Early life stress was determined by a risk index measuring the presence of 11 adversity factors. Results did not reveal an association with 5-HTTLPR genotype. There were no moderating effects of early life stress or gender. An explanation for the negative findings is that the S allele may be a necessary but not sufficient component cause in a composite risk factor.

Interaction between the dopamine D4 receptor and the serotonin transporter promoter polymorphisms in alcohol and tobacco use among 15-year-olds

Early onset of alcohol and tobacco use during adolescence increases the risk for establishing a substance use disorder in adulthood. Both alcohol and nicotine stimulate the dopamine (DA) and the serotonin (5-HT) systems. The DA system has been implicated in the mediation of the rewarding effects of self-administered drugs of abuse. A possible role of an interaction between these neurotransmitter systems in substance use behavior has been suggested but is as yet unknown. The present study was designed to examine the influence of the DA D4 receptor (DRD4) and the serotonin transporter (5-HTT) genotype and their interaction on adolescent alcohol and tobacco experimentation. Participants were from a longitudinal study of a birth cohort consisting initially of 384 children from a high-risk community sample. At the age of 15 years, adolescents completed a self-report questionnaire measuring tobacco and alcohol consumption. DNA was taken from 305 participants (146 boys, 159 girls) and genotyped for the DRD4 exon III and the 5-HTTLPR polymorphisms. The DRD4 7-repeat allele was associated with greater smoking and drinking involvement in boys. In girls, a significant DRD4 x 5-HTT interaction was detected. Girls without the DRD4 7-repeat allele and who were homozygous for the long allele of 5-HTTLPR displayed the highest smoking and drinking activity. The genetic and potential molecular background underlying adolescent vulnerability to substance abuse is discussed.

Genetic association of the human corticotropin releasing hormone receptor 1 (CRHR1) with binge drinking and alcohol intake patterns in two independent samples

To investigate the role of the corticotropin releasing hormone receptor 1 (CRHR1) in patterns of human alcohol drinking and its potential contribution to alcohol dependence, we analysed two independent samples: a sample of adolescents, which consisted of individuals from the 'Mannheim Study of Risk Children' (MARC), who had little previous exposure to alcohol, and a sample of alcohol-dependent adults, who met DSM-IV criteria of alcohol dependence. Following determination of allelic frequencies of 14 polymorphisms of the CRHR1 gene, two haplotype tagging (ht)SNPs discriminating between haplotypes with a frequency of > or =0.7% were identified. Both samples were genotyped and systematically examined for association with the htSNPs of CRHR1. In the adolescent sample, significant group differences between genotypes were observed in binge drinking, lifetime prevalence of alcohol intake and lifetime prevalence of drunkenness. The sample of adult alcohol-dependent patients showed association of CRHR1 with high amount of drinking. This is the first time that an association of CRHR1 with specific patterns of alcohol consumption has been reported. Our findings support results from animal models, suggesting an importance of CRHR1 in integrating gene-environment effects in alcohol use disorders.

Association of DRD4 exon III polymorphism with auditory P300 amplitude in 8-year-old children

OBJECTIVES

The present study was designed to investigate the association between the DRD4 genotype and auditory P300 amplitudes in a high-risk community sample.

METHODS

ERPs were elicited in 197 eight-year-olds (98 boys, 99 girls) using a passive and an active oddball task. Auditory stimuli of 60 dB HL were presented binaurally at 1000 (standard stimulus) and 2000 Hz (target stimulus), at a relative frequency ratio of 80:20. Two trial blocks of 250 stimuli each were collected. P300 amplitudes were analyzed from Fz, Cz and Pz. DNA was genotyped for the DRD4 exon III polymorphism.

RESULTS

A pattern of significant interactions of the DRD4 genotype with gender and experimental conditions was obtained. In both the active and the passive task, boys with at least one copy of the DRD4 7-repeat allele displayed significantly lower P300 amplitudes during the second trial block than boys carrying other alleles.

CONCLUSIONS

This finding provides further evidence supporting a role of P300 amplitude reduction as an endophenotype for disinhibited psychopathology.

Gender-related pathways for behavior problems in the offspring of alcoholic fathers

The objective of the present study was to examine gender differences in the influence of paternal alcoholism on children's social-emotional development and to determine whether paternal alcoholism is associated with a greater number of externalizing symptoms in the male offspring. From the Mannheim Study of Risk Children, an ongoing longitudinal study of a high-risk population, the developmental data of 219 children [193 (95 boys and 98 girls) of non-alcoholic fathers, non-COAs, and 26 (14 boys, 12 girls) of alcoholic fathers, COAs] were analyzed from birth to the age of 11 years. Paternal alcoholism was defined according to the ICD-10 categories of alcohol dependence and harmful use. Socio-demographic data, cognitive development, number and severity of behavior problems, and gender-related differences in the rates of externalizing and internalizing symptoms were assessed using standardized instruments (IQ tests, Child Behavior Checklist questionnaire and diagnostic interviews). The general linear model analysis revealed a significant overall effect of paternal alcoholism on the number of child psychiatric problems (F = 21.872, d.f. = 1.217, P < 0.001). Beginning at age 2, significantly higher numbers of externalizing symptoms were observed among COAs. In female COAs, a pattern similar to that of the male COAs emerged, with the predominance of delinquent and aggressive behavior. Unlike male COAs, females showed an increase of internalizing symptoms up to age 11 years. Of these, somatic complaints revealed the strongest discriminating effect in 11-year-old females. Children of alcoholic fathers are at high risk for psychopathology. Gender-related differences seem to exist and may contribute to different phenotypes during development from early childhood to adolescence.

Children with oppositional-defiant disorder display deviant attentional processing independent of ADHD symptoms

OBJECTIVE

To examine neurophysiological correlates of attentional processing in children with oppositional-defiant disorder (ODD) independent of ADHD symptoms.

METHOD

Thirteen children with oppositional-defiant disorder without comorbid ADHD symptoms and 13 healthy control children (all 11 years) performed a cued Continuous Performance Test (CPT-AX). Event-related potentials (ERP) to cue and target stimuli were examined for group differences.

RESULTS

Children with ODD showed significantly reduced parietal P3a and P3b amplitudes to cues and to targets, compared with healthy controls. ERP amplitudes correlated with oppositional and aggressive behavior scores.

CONCLUSIONS

Event-related potentials revealed reduced orienting to cues and reduced executive target processing in children with ODD. These findings indicate that ODD children show neurophysiological deviances independent of ADHD comorbidity.

Are regulatory problems in infancy precursors of later hyperkinetic symptoms?

AIM

To examine whether regulatory problems in infancy predict later hyperkinetic symptoms in childhood and pre-adolescence.

METHODS

In a prospective longitudinal study of 319 children at risk of later developmental problems and psychopathology, hyperkinetic behaviour problems were assessed at the ages of 2, 4.5, 8 and 11 y by means of a standardized parent interview. Infant regulatory problems at the age of 3 mo were determined from multiple sources of information. An observational procedure was used to assess the quality of mother-infant interaction.

RESULTS

At the age of 3 mo, 17% of the infants (n = 55; 27 boys, 28 girls) suffered from multiple regulatory problems. Compared to a control group (n = 264), these children presented more hyperkinetic symptoms throughout childhood. Negativity in the mother-infant interaction and early family adversity each contributed to later hyperkinetic symptoms. When controlling for family adversity, the association between infant multiple regulatory problems and later hyperkinetic problems was rendered insignificant.

CONCLUSIONS

These findings suggest that multiple regulatory problems may not be a key variable for later hyperkinetic problems. The impact of early family adversity factors clearly outweighed that of infant psychopathology on later behaviour disorder.

The dopamine D4 receptor gene exon III polymorphism is associated with novelty seeking in 15-year-old males from a high-risk community sample

In recent years, studies focussing on a possible association between the dopamine D4 receptor (DRD4) gene exon III polymorphism and the personality trait of novelty seeking (NS) have yielded inconsistent results. The present study sought to examine the association of the DRD4-7r allele with NS in a sample of 303 15-year-old adolescents (144 males, 159 females) using data from a high-risk community sample. The Junior Temperament and Character Inventory--JTCI/12-18 was administered to assess dimensions of adolescent temperament. Males in the DRD4-7r allele group scored significantly higher on the NS (p=.002) and the harm avoidance (p=.045) scales than males without this allele. In females no association with temperament was observed. This association could not be explained by the presence of either an attention-deficit/hyperactivity disorder (ADHD) or a DRD4 by ADHD interaction.

Depressive St�rungen und aggressiv-dissoziale St�rungen im Kindes- und Jugendalter

Mental disorders belong to the most frequent disorders in the community and lead to noticeable functional impairments. The lifetime prevalence of clinical depression (ICD-10 diagnoses F33, F34) up to age 25 is 12.7%, showing a female-male ratio of 2:1. From adolescence onwards, persistence rates of depressive disorders are comparably as high as those found in externalizing disorders. Subclinical depression (ICD-10 subthreshold disorders) at ages 8 and 13 increases the risk for later clinically relevant mental disorders. Conduct disorders (ICD-10 diagnoses F91, F92) are the most frequent mental disorders in children and adolescents with lifetime prevalence rates of 22.4% up to age 25. Conduct disorders show unfavorable courses beginning at preschool age. Precursors of later disorders can be detected as early as toddlerhood. Adverse family factors in childhood and early externalizing problems of the child were most predictive for later conduct disorders. Therefore, the need for early prevention of conduct disorders is highlighted. The focus should be on families with low socioeconomic status (objective: strengthening family and child resources). For depressive disorders, we recommend testing and evaluating the indicated prevention programs in adolescence (objective: strengthening the resources of the adolescent).

Attentional enhancement to NoGo stimuli in anxious children

OBJECTIVE

To measure neurophysiological correlates of inhibition in children with anxiety disorders.

METHOD

Anxiety-disordered children and healthy control children (11 years of age) performed a cued Continuous Performance Test (CPT-AX). Event-related potentials following NoGo and distractor stimuli as well as performance data were examined for group differences.

RESULTS

Anxious children displayed a significantly larger NoGo-related N1 global field power than did control children while no group differences were found for the N2 and P3 potentials. Groups did not differ in CPT performance.

CONCLUSIONS

Anxious children showed early attentional enhancement (N1) to stimuli indicating need for inhibition but not increased resource allocation to actual response inhibition.

Association of dopamine D4 receptor (DRD4) gene with attention-deficit/hyperactivity disorder (ADHD) in a high-risk community sample: a longitudinal study from birth to 11 years of age

BACKGROUND

In recent years, a growing number of studies has focused on the dopamine D4 receptor gene (DRD4) as mediating the susceptibility to attention-deficit/hyperactivity disorder (ADHD). While their results are contradictory, the reason for this inconsistency remains as yet unclear.

METHOD

The present study sought to examine the association between ADHD and the DRD4 exon III polymorphism during child development using longitudinal data from a high-risk community sample (n = 265, 129 females, 126 males) who have been followed from birth to 11 years of age.

RESULTS

Higher rates of ADHD were observed in boys with the 7 repeat allele of exon III than in boys with other alleles at the ages of 4 1/2 (Fisher's exact test, p = .061), 8 (p = .026), and 11 years (p = .005). Boys with this allele also exhibited higher rates of persistent disorder (p = .024). In girls, a trend towards an association (p = .055) with the 7 repeat allele emerged only at preschool age.

CONCLUSIONS

These findings provide additional evidence for the role of the dopamine D4 receptor in ADHD during the course of child development.

Early motherhood and disruptive behaviour in the school-age child

AIM

To determine the significance of young maternal age, family adversity and maternal behaviour during mother-toddler interaction in the prediction of child disruptive behaviour at age eight.

METHODS

From an ongoing longitudinal study of infants at risk for later psychopathology (n = 362), 72 young mothers aged between 15 and 24 y (median 22 y) at first birth were compared with 197 primiparous older mothers ranging in age from 25 to 41 y (median 29 y). Family adversity at childbirth was assessed using a modified version of Rutter's Family Adversity Index (FAI) and measures of child disruptive behaviour at age eight were obtained using Achenbach's Teacher Report Form (TRF). An observational procedure was used to assess maternal behaviour during mother-child interaction at the age of 2 y.

RESULTS

Young mothers encountered more adverse family characteristics and were more inadequate, restrictive and more negative during interaction with their toddlers. Their school-aged children showed higher scores on all disruptive behaviour scales of the TRF. Hierarchical regression analyses revealed that family adversity and maternal behaviour during toddler interaction could account for most of the association between early motherhood and child disruptive behaviour.

CONCLUSION

The impact of young motherhood on child mental health is not confined to teenage mothers and is mainly attributed to psychosocial and interactional factors.

[Role of androgens in externalizing behavior problems in adolescents]

OBJECTIVE

While an association between androgens and different types of aggression has been well documented in male offenders, the influence of androgens on externalizing behavior in adolescents at risk for antisocial behavior has not been investigated so far.

METHODS

Plasma levels of the main androgen metabolites testosterone (T) and 5a-dihydrotestosterone (DHT) were measured in N = 119 14-year-olds (51 boys, 68 girls) from a prospective longitudinal study of children at risk. The Achenbach Child Behavior Checklist (CBCL) and the Youth Self Report Form (YSR) were used to assess externalizing behavior at age 14.

RESULTS

The CBCL revealed significant positive correlations between DHT levels and the subscales "externalizing problems" and the problem scales "aggressive behavior" and "delinquent behavior" in male adolescents. Only the YSR subscale "delinquent behavior" exhibited a marginally significant association with DHT. Neither scale showed any significant correlations between androgen levels and externalizing behavior in female adolescents.

CONCLUSIONS

Earlier findings of androgen effects on aggressive and antisocial behavior in male offenders were confirmed for male adolescents from a general population sample. The results stress the importance of the androgen metabolite DHT.

Frontal EEG correlates of externalizing spectrum behaviors

An atypical EEG pattern of frontal brain activation, which has been related to compromised emotional regulation in children and adults, is hypothesized to be also present in children with externalizing behavior problems. Seventy-eight children at 11 years of age were examined to answer the following questions: 1) do children with externalizing behaviors exhibit an atypical pattern of frontal brain activation which can be linked to the severity of their problem behaviors? and 2) are there gender differences in these frontal activation patterns? Spontaneous EEG activity was subjected to power spectral analysis. In externalizing girls, the well-known pattern of a significantly greater right than left frontal brain activation emerged that has been found previously in emotionally disordered children, whereas healthy girls showed a significantly greater left than right frontal activation. In contrast, healthy boys demonstrated a significantly greater right than left frontal activation, whereas externalizing boys did not display a frontal brain asymmetry. Thus, the pattern of frontal brain activation was gender specific. The atypical activation pattern in externalizing children is hypothesized to be a biological correlate of difficulties in regulating emotion.

[Psychological symptoms in children of alcoholic fathers]

OBJECTIVES

In spite of a growing interest in recent years in epidemiological research on behavior problems of children of alcoholics (COAs), few prospective longitudinal child psychiatric studies have been conducted up to now.

METHODS

In the Mannheim Study of Risk Children, an ongoing prospective study of high risks, the data of 219 children (26 COAs and 193 non-COAs) were analyzed from birth to the age of 11 years. Sociodemographic data, organic and psychosocial risk factors, the number and severity of behavior problems, and the rate of expansive and introversive disorders have been investigated.

RESULTS

The family status of the COAs was characterized by the father's lower level of education as well as by socioeconomic difficulties and more numerous adverse life events. Other psychosocial problems such as marital conflict and a lack of coping mechanisms were also more frequent in COA families. A significantly higher rate of expansive symptoms and disorders was found in children of alcoholic fathers from the age of two years on.

CONCLUSIONS

Children of alcoholic fathers represent a group at risk for the early onset of psychiatric problems and are deserving of more attention in prevention and early intervention programs.

Motorische, kognitive und sozial-emotionale Entwicklung von 11-Jährigen mit frühkindlichen Risikobelastungen: späte Folgen

Zusammenfassung: Fragestellung: Untersuchung der Auswirkungen frühkindlicher Risiken auf das Entwicklungsniveau im Alter von 11 Jahren. Methode: In einer prospektiven Längsschnittstudie von der Geburt bis zur späten Kindheit an einer Stichprobe von 362 Kindern mit unterschiedlichen frühkindlichen Risikobelastungen wurde der Verlauf von Entwicklungs- und Verhaltensstörungen untersucht. Organische (prä- und perinatale Komplikationen) und psychosoziale Risiken (familiäre Belastungen) wurden in einem zwei-faktoriellen Design systematisch variiert. Im Alter von 11 Jahren wurden Kennwerte der motorischen, kognitiven und sozial-emotionalen Entwicklung von 341 Kindern (168 Jungen, 173 Mädchen, entsprechend 94,2% der Ausgangsstichprobe) erfasst. Die vorausgegangenen Erhebungen waren im Alter von 3 Monaten, 2, 4½ und 8 Jahren durchgeführt worden. Ergebnisse: Die Auswirkungen früher Entwicklungsrisiken bestanden bis in die späte Kindheit fort. Mit Risiken hoch belastete Kinder waren bis zu dreimal häufiger in ihrer Entwicklung beeinträchtigt als unbelastete Kinder. Sowohl organische als auch psychosoziale Risiken trugen zu einer ungünstigen Prognose bei. Während prä- und perinatale Komplikationen vor allem motorische und kognitive Funktionen beeinträchtigten, konzentrierten sich die Auswirkungen belasteter familiärer Lebensverhältnisse auf die sozial-emotionale Entwicklung. Spätschäden von Schwangerschafts- und Geburtskomplikationen manifestierten sich insbesondere im Bereich kognitiver Funktionen und schulischer Leistungen. Auch im Schulalter ließ sich der kumulative Einfluss beider Risikobereiche am besten durch eine Addition der Einzeleffekte erklären. Schlussfolgerungen: Frühkindliche Entwicklungsrisiken haben spezifische und langfristige Auswirkungen, die sich später in ungünstigen schulischen Entwicklungen niederschlagen.

[Motor, cognitive and socio-emotional development of 11-year-olds with early childhood risk factors: late sequelae]

OBJECTIVES

The investigation of the impact of early childhood risk factors on developmental outcome at the age of 11 years.

METHODS

The onset and course of developmental and behavioral disturbances were examined in a prospective longitudinal study of a sample of 362 children born with different risks. Organic (obstetric complications) and psychosocial risks (family adversity) were varied in a two-factorial design. Measures of motor, cognitive and social-emotional outcome were obtained from 341 children aged 11 years (168 boys, 173 girls, corresponding to 94.2% of the initial sample). Previous assessments had been conducted at the ages of 3 months, and again at the ages of 2, 4 1/2 and 8 years.

RESULTS

The negative impact of early risk factors persisted into late childhood. Rates of developmental and behavioral disturbances in high-risk children were up to three times higher than in non-risk children. Both organic and psychosocial risks contributed to adverse outcomes. While organic complications were related to disturbances in motor and cognitive development, the detrimental effects of psychosocial adversity pertained to social-emotional functioning. Late sequelae of pre- and perinatal complications were found especially in cognitive outcome and school performance. The cumulative effect of early risks was best explained by summing up the single risk effects.

CONCLUSIONS

Early risk factors have specific and long-term sequelae resulting in adverse school outcomes at later ages.

Antisoziales Verhalten im Jugendalter: Entstehungsbedingungen und Verlaufsformen

Zusammenfassung: Ausmaß und Verbreitung von Gewalt und Delinquenz unter Kindern und Jugendlichen haben in den letzten 15 Jahren kontinuierlich zugenommen. Bei dem Bestreben, dieser Entwicklung entgegenzuwirken, können neuere Erkenntnisse der entwicklungspsychopathologischen und neurobiologischen Forschung wichtige Hilfestellung leisten. In einem Modell von Moffitt werden zwei Entwicklungswege antisozialer Verhaltensprobleme beschrieben, die sich hinsichtlich des Störungsbeginns und -verlaufs unterscheiden: ein Pfad, der durch eine frühzeitig einsetzende und über den Lebenslauf stabile Symptomatik charakterisiert ist (“life-course persistent”), sowie ein Pfad mit einem episodenhaften, auf das Jugendalter begrenzten Auftreten antisozialer Auffälligkeiten (“adolescence-limited”). Während im letzteren Fall die spezifischen Entwicklungsaufgaben und Lebensbedingungen Jugendlicher eine maßgebliche Rolle bei Entstehung und Verlauf spielen, entsteht persistentes antisoziales Verhalten als Resultat eines transaktionalen Prozesses zwischen Kind und Umwelt. Neben psychosozialen Faktoren kommt dabei biologischen Prädispositionen (genetische Belastung) und psychologischen Dispositionen (Temperaments- und Persönlichkeitsmerkmale) eine zentrale Bedeutung zu. Wichtige Aufschlüsse über die zugrunde liegenden Mechanismen versprechen die jüngsten Fortschritte der neurobiologischen und persönlichkeitspsychologischen Forschung. Die Integration beider Ansätze kann dazu beitragen, Maßnahmen der Prävention und Frühintervention zielgruppenorientierter auszurichten und damit wirkungsvoller zu gestalten.

[Antisocial behavior in adolescence: risk factors and developmental types]

Both the intensity and prevalence of violence and delinquency among children and adolescents have continued to rise during the past fifteen years. Efforts to counteract this development may benefit from recent evidence from developmental psychopathology and neurobiology. A model proposed by Moffitt describes two developmental pathways into antisocial problem behavior: one path characterized by an early onset and a stable course of symptoms ("life-course persistent") and the other by an episodic ("adolescence-limited") occurrence of anti-social behavior. While in the latter the specific developmental tasks and life circumstances of adolescence play a major role in the pathogenesis, persistent antisocial behavior is perceived to be a result of a transactional process between child and environment. Apart from psychosocial factors, biological predispositions (genetic susceptibility) and psychological dispositions (temperament and personality characteristics) are of primary interest. The recent progress in neurobiological and personality research promises significant insights into the underlying pathogenetic mechanisms. Integrating these approaches may help in targeting prevention and early intervention programs to high-risk groups and may thus contribute to improving their effectiveness.

Mutter-Kind-Interaktion und externalisierende Störungen bei Kindern im Grundschulalter

Zusammenfassung: Fragestellung: Das Verhalten von achtjährigen Kindern mit externalisierenden Störungen (hyperkinetische Störung und Störung des Sozialverhaltens) in der Interaktion mit ihren Müttern wurde untersucht. Methodik/Ergebnisse: Im univariaten Vergleich waren Mütter in der Interaktion mit ihren hyperkinetischen Kindern restriktiver, abwertender und weniger angemessen als Mütter unauffälliger Kinder, während sich die Kinder unaufmerksamer und impulsiver sowie weniger assertiv und hilflos verhielten. Kinder mit einer Störung des Sozialverhaltens waren in der Interaktion mit ihren Müttern abwertender, aggressiver und provokativer als unauffällige Kinder, während die Mütter mehr Ungeduld zeigten. Schlussfolgerung: Eine Interaktion zwischen aggressivem Kindverhalten und Restriktivität der Mutter trug zu vermehrten dissozialen Symptomen bei. Eine höhere Zahl hyperkinetischer Symptome wurde durch die Interaktion zwischen impulsivem Kindverhalten und mütterlicher Aversivität begünstigt.

[Mother-child interaction and externalizing disorders in elementary schoolchildren]

OBJECTIVES

The behavior of eight-year-old children with externalizing disorders (ADHD and CD) in interaction with their mothers was examined.

METHODS/RESULTS

Mothers of ADHD children were more restrictive and negative towards their children and showed less adequate control than did mothers of normal children. ADHD children paid less attention, were less assertive and helpless, and were more impulsive than controls. CD children were more negative towards their mothers, and were more aggressive and provocative than normal children, while their mothers were more impatient.

CONCLUSIONS

An interaction between aggressive child behavior and maternal restrictiveness contributed to increased conduct problems. Hyperactivity was enhanced by the interaction between the impulsive behavior of the child and the aversive maternal response.

Differential development of infants at risk for psychopathology: the moderating role of early maternal responsivity

The development of behaviour problems in infants born with biological risk (low birthweight) and psychosocial risk (psychosocially disadvantaged family) was studied in a sample of 347 children (171 males, 176 females) at the ages of 2, 4:6, and 8 years. In the search for factors that moderate the effects of early risks, the role of early responsive caregiving was examined. Results indicate that infants at psychosocial risk exhibited both more externalizing and internalizing problems across ages than infants not at psychosocial risk, while no overall differences were apparent between normal- and low-birthweight groups. With one exception, no interactions between biological and psychosocial risk factors emerged, suggesting that their simultaneous effect is largely additive. Maternal responsivity was found to moderate the effects of low birthweight on hyperkinetic and internalizing problems as well as to influence the consequences of family disadvantage on total problems. These findings stress the importance of early parenting in the behavioural development of at-risk children.

Child development after maternal tocolysis with beta-sympathomimetic drugs

The psycho-social development of both preterm and term children whose mothers reported tocolytic treatment was assessed at the ages of 2, 4.5, and 8 years. Term children exposed to tocolysis showed a higher rate of psychiatric disorders as well as poorer cognitive and motor performance than controls. In the preterm children no adverse impact of tocolysis could be found. The results are discussed concerning possible ways in which tocolytic treatment may influence child development. Restrictions because of the preliminary character of this study and the need of further prospective studies to clarify the developmental impact of tocolysis are also considered.

Behavioral sequelae of perinatal insults and early family adversity at 8 years of age

OBJECTIVE

This prospective longitudinal study investigated the simultaneous impact of early biological and psychosocial risk factors on behavioral outcome at school age.

METHOD

A cohort of 362 children born between 1986 and 1988 with different biological (perinatal insults) and psychosocial risk factors (family adversity) was followed from birth to school age. When their children were aged 8 years, parents of 89.0% of the initial sample completed the Child Behavior Checklist (CBCL).

RESULTS

More externalizing as well as internalizing problems were found in children born into adverse family backgrounds, whereas no differences at broad-band syndrome level were apparent between groups with varying obstetric complications. Children with family risk factors had higher scores on 5 of the 8 CBCL scales (including attention, delinquent, and aggressive problems), whereas children with perinatal risk factors had more social and attention problems than children in the nonrisk groups. With one exception, no interactions between risk factors emerged, indicating that perinatal and family risk factors contributed independently to outcome. The differences between risk groups applied irrespective of gender.

CONCLUSIONS

The adverse impact of family adversity clearly outweighed the influence of obstetric complications in determining behavioral adjustment at school age.

Epidemiology and prognosis of specific disorders of language and scholastic skills

Data from a prospective longitudinal study on the development of children born at biological and psychosocial risk were utilised to examine language and learning abilities of 320 children at ages 4.5 and 8 years. Following the research criteria of the ICD-10, specific developmental disorders of speech and language and specific developmental disorders of scholastic skills were diagnosed. Data were also provided for a clinical and general low achievement group according to less stringent criteria. Frequencies in the risk population were low for specific disorders (ICD-10) (0.6%-3.7% depending on age and type of disorder). Higher frequencies were found when a clinical definition (0.6%-13.6%) or overall low achievement score (0.6%-18.6%) was chosen. The impact of well-documented organic and psychosocial risks was analysed. Organic risk affected language abilities at 4.5 years of age but neither language nor learning abilities at 8 years of age. Psychosocial aspects of a child's environment proved to be associated with both specific language and learning abilities. Stability of language disorders, association between language and reading/spelling disorders as well as gender effects were investigated.

Oppositional children differ from healthy children in frontal brain activation

An atypical EEG pattern of frontal brain activation, which has been found in children and adults with emotional disorders, also is hypothesized to be present in disruptive behavior disorders. One hundred nineteen children (4 1/2 and 8 years of age) were examined with regard to the following questions: (1) Do children who are diagnosed with oppositional defiant disorder (ODD) exhibit an atypical pattern of frontal brain activation? (2) Can this pattern be demonstrated in preschool children (4 1/2 years of age) as well as in school children (8 years)? (3) Are there gender differences in these patterns similar to those that have been demonstrated in adults? Spontaneous EEG activity was subjected to power spectral analysis. In oppositional preschool and elementary school girls, the well-known pattern of lower left frontal than right frontal activation emerged that has been found previously in emotionally disordered children. Healthy girls showed no frontal brain asymmetry at 4 1/2 years of age, and left frontal activation at 8 years. In contrast, healthy boys demonstrated a greater right than left frontal activation, whereas ODD boys did not display any frontal brain asymmetry. Thus, the pattern of frontal brain activation seems to be gender-specific. The atypical activation pattern in oppositional children is hypothesized to be a biological substrate of negative affective style.

Atypical frontal brain activation in ADHD: preschool and elementary school boys and girls

OBJECTIVE

To investigate patterns of frontal brain activation in unmedicated preschool and school boys and girls with attention-deficit/hyperactivity disorder (ADHD).

METHOD

Baseline electroencephalographic activity of 117 children (66 aged 4 years, 51 aged 8 years) was subjected to power spectral analysis, and laterality scores were determined.

RESULTS

Boys with ADHD exhibited a less right-lateralized frontal activation pattern than normal control boys. Girls with ADHD displayed a more right-lateralized frontal activation pattern than normal control girls. This finding applied to children at both 4 1/2 and 8 years of age. There was no difference between children with ADHD and children with ADHD plus oppositional defiant disorder.

CONCLUSIONS

This pattern of frontal brain activation is in line with magnetic resonance imaging studies of ADHD. It could be demonstrated in children as young as 4 1/2 years, as well as in school-age children. The opposite direction of asymmetry in boys and girls stresses the importance of gender-specific analyses in ADHD.

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.

[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.

[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.

[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.