Colonic transit times and behaviour profiles in children with defecation disorders

AIMS

To evaluate children referred for defecation disorders using the child behavioural checklist (CBCL).

METHODS

A total of 215 patients were divided into three groups: 135 (5-14 years of age) with paediatric constipation (PC), 56 (5-17 years) with functional non-retentive faecal soiling (FNRFS), and 24 (5-16 years) with recurrent abdominal pain (RAP). Behavioural scores were correlated with colonic transit time (CTT) and anorectal function parameters (manometry and EMG).

RESULTS

No significant differences in the mean CBCL scores were found among the three patient groups. However, children with PC and FNRFS had significantly more behavioural problems than the Dutch normative sample, while children with RAP had scores within the normal range. No significant differences were found between CTT in the patient groups, with respect to the CBCL. Similarly, no significant difference existed between children able or unable to relax their pelvic floor muscles during defecation attempts and their behaviour profiles.

CONCLUSION

There seems to be no relation between colonic/anorectal function and specific behavioural profiles. On the other hand, children with defecation disorders show more behavioural problems than do controls.

Usefulness of the retrospective Life-Chart method manual in outpatients with a mood disorder: a feasibility study

The aim of this project was to evaluate whether the Life-Chart Manual (LCM) can help patients to complete their own Life-Chart (LC). All patients were recruited via the outpatient department for affective disorders of the Academic Hospital Maastricht. They were diagnosed as having a unipolar or bipolar disorder according to DSM-IV criteria. Following a short briefing interview, these patients were asked to complete their own LC for the last 6 years, using the manual. Seventy-four patients were selected, of whom 44 were willing to participate in the study. About half of these patients (n=20) completed the LC adequately (60-80% of the items completed) with only minimal professional help. Although patients found it difficult to complete the LC, most considered it worthwhile. The LCM is an adequate tool to help patients with a major affective disorder to complete their own LC with minimal professional assistance.

Development after prenatal exposure to cocaine, heroin and methadone

In Amsterdam a longitudinal, prospective and multidisciplinary study on the development of infants of drug-dependent mothers (IDDM) was started in 1983: 35 IDDM and 35 reference infants were originally enrolled. The drug-dependent women had used combinations of methadone, heroin, cocaine and other drugs during pregnancy. Of the IDDM, 80% had to be treated pharmaceutically for neonatal abstinence symptoms (NAS). Physical, neurological, cognitive and the socio-emotional development of the children were studied regularly from birth until 5.5 years of age. Differences between the reference group and the IDDM were found most clearly in cognitive development. The IDDM also had more behavioural problems at some of the ages studied. No group differences were seen in motor development. So far the results of the study show that IDDM and their caregivers need extra support in order to improve early communication and the children's cognitive development.

Noradrenergic and adrenergic functioning in autism

A neurochemical assessment of noradrenergic and adrenergic functioning was carried out with autistic patients and normal control individuals. Norepinephrine and related compounds were measured in autistic (n = 17 unmedicated, 23 medicated; age range 9-29 years old) and normal controls (n = 27; age range 9-36 years old). Plasma levels and urinary excretion of 3-methoxy-4-hydroxy-phenylglycol (MHPG) were measured, as were urinary excretion rates of norepinephrine (NE), epinephrine (EPI), and vanillylmandelic acid (VMA). No significant group mean differences were seen between the autistic and control groups. In both the autistic and control groups urinary excretion rates of norepinephrine and epinephrine were substantially higher in the afternoon-evening (5-11 PM) compared to the overnight (11 PM-7 AM) collection period. Based on our neurochemical assessment, marked abnormalities in basal noradrenergic functioning do not appear to be present in autism.

Psychosocial effects of two years of human growth hormone treatment in Turner syndrome. The Dutch Working Group: Psychologists and Growth Hormone

Thirty-eight girls with Turner syndrome were treated for 2 years with human growth hormone. Both parents and patients carried out assessments of the effects of treatment on various aspects of psychosocial functioning. The children used the Piers-Harris Self-Concept Scale and the Social Anxiety Scale for children, while parents were interviewed and filled in the Child Behavior Checklist. Both parents and children used the Therapy Evaluation Scale and the Silhouette Apperception Technique. Teachers completed the Teacher Rating Form. Results showed no significant changes with treatment in self-concept or social anxiety, or in behavioural problems, though immature behaviour was less common after the treatment period. Therapy was evaluated positively, and improvements were apparent in both social and emotional functioning; about a quarter of the patients became more independent, happier and more involved in social interactions. Unrealistic perceptions of present height and expectations of future height were expressed by a large proportion of both children and parents.

[Good things come in small packages? Psychosocial aspects of small stature]

Short stature is considered as a social disadvantage. This review deals with the findings of studies on cognitive and socio-emotional functioning in children with growth hormone deficiency, constitutional short stature, Turner syndrome, skeletal dysplasias and chronic illnesses. The consequences of short stature in adulthood are also described. The short term effect of growth hormone treatment on psychosocial functioning appears positive, but long term results have to be awaited before conclusions can be drawn.

Problems reported for clinically referred American and Dutch children

Child Behavior Checklists completed by parents of 50 children of each sex at each age from 4 to 16 seen in 28 American and 21 Dutch mental health services (N = 2,600) were examined. Analyses controlling for sex, age, and socioeconomic status showed somewhat higher total problem scores for American than Dutch children, with a mean of 57.27 versus 53.18 on a scale ranging from 0 to 240. This nationality difference accounted for less than 1% of the variance in total scores. American children obtained higher scores on more externalizing items than Dutch children. Small but significant differences in total, externalizing, and internalizing problems found between the two samples may reflect nationality differences in referral patterns. Competence scores were significantly higher for American than Dutch referred children, but did not differ as much as in comparable normative samples. Competence scores may reflect cultural differences more than problem scores do.

Whole blood serotonin and tryptophan in autism: temporal stability and the effects of medication

Whole blood serotonin (5-HT) was significantly increased in a drug-free autistic group (n = 17) compared to age- and sex-matched normal control (n = 20). Blood tryptophan (TRP) values and platelet counts were similar in unmedicated autistics and normal subjects; but whole blood concentrations of TRP were significantly lower, and 5-HT values tended to be lower in the medicated group compared to unmedicated autistics. Highly significant intraclass correlation coefficients and low mean percentage differences were found for repeated measures over a year's period of whole blood 5-HT and the platelet count in the unmedicated but not in the medicated group. Blood TRP values were highly variable over time in both the medicated and drug-free autistic groups.

Neurochemical study of dopamine functioning in autistic and normal subjects

Plasma prolactin (PRL) and homovanillic acid (HVA) levels, and urinary HVA and dopamine (DA) excretion, were measured in groups of unmedicated autistics, medicated autistics, and normal controls. No significant differences were found between unmedicated autistics and normal controls in plasma PRL and HVA levels. Excretion rates of urinary HVA and DA were also similar in the unmedicated autistic and normal subjects. Plasma PRL and HVA, as well as urinary HVA excretion, were significantly increased in the autistics on neuroleptic medication compared to the unmedicated autistics. A significant correlation (r = 0.46, p = less than 0.05) was observed between dose of neuroleptics and plasma PRL values; the correlation (r = 0.42) between neuroleptic dose and plasma HVA levels approached significance (p = 0.06). In contrast, no differences were observed in urinary DA excretion between medicated and unmedicated autistics. In general, the findings indicate that peripheral indices of dopamine functioning are normal in autistic subjects.

Agreement between parents' and teachers' ratings of behavioral/emotional problems of children aged 4-12

Parents' and teachers' reports of behavioral/emotional problems in 1161 children aged 4-12 from the general population and assessed via the Achenbach Child Behavior Checklist were compared. Low to moderate agreement was found, with parents reporting more problems than teachers. Agreement was higher for externalizing problems than for internalizing problems and higher for children receiving special education than for those receiving regular education. Agreement was slightly higher for older than younger children. Sex of the child did not influence parent-teacher agreement. Teachers scored children higher on problems related to peer relations and on problems interfering with academic functioning, whereas parents scored their children higher on problems associated more strongly with externalizing than with internalizing syndromes.

A comparison of syndromes derived from the child behavior checklist for American and Dutch girls aged 6-11 and 12-16

Child Behavior Checklists completed by parents of 1848 clinically referred American and Dutch girls aged 6-11 and 12-16 were subjected to principal components analyses with varimax rotations. For the 6-11 yr age group, seven of the nine empirically derived syndromes showed cross-national correlations ranging from 0.80 to 0.98. For 12-16-yr-old girls, all eight of the American syndromes were firmly replicated for Dutch girls with correlations ranging from 0.84 to 0.97. Furthermore, cross-national similarities in the distribution of scores for normative samples supported the use of the same syndrome scales by clinicians and researchers in the two countries.

Urinary 5-hydroxyindoleacetic acid and whole blood serotonin and tryptophan in autistic and normal subjects

Urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion in two consecutive collection periods (5:00 PM-11:00 PM and 11:00 PM-8:00 AM) and whole blood serotonin (5-HT) and tryptophan (TRP) were measured in groups of unmedicated autistics (n = 16), medicated autistics (n = 20), and normal controls (n = 27). Whole blood 5-HT values were significantly higher in unmedicated autistics compared to normal controls. No significant differences were found in 5-HIAA excretion (microgram/mg creatinine, mean +/- SD) between unmedicated autistics (4.07 +/- 1.52) and normal controls (3.50 +/- 1.07), or between medicated (5.35 +/- 2.93) and drug-free autistic individuals. No correlations were found between 5-HT values and urinary 5-HIAA excretion. Urinary 5-HIAA (microgram/mg creatinine, mean +/- SD) was significantly greater in hyperserotonemic autistic subjects (4.88 +/- 0.87) compared to normal controls (3.50 +/- 1.07, total collection period; p = 0.002). The relevance of these findings to the possibility that increased gut production of 5-HT might cause the elevated whole blood 5-HT levels seen in autism is discussed.

Mental health in Dutch children: (III). Behavioral-emotional problems reported by teachers of children aged 4-12

Standardized teacher reports on children's behavioral-emotional problems can provide information on areas of children's functioning not readily accessible to other informants such as parents or clinicians. Once we accept the generally low agreement between different informants as inevitable, we may make use of the different types of information available from different sources. To do so we need base-line data from different informants that take account of key demographic variables such as gender, age and socio-economic status. In a previous report we provided such data for parent reported behavioral-emotional problems in children aged 4 through 16. In the present study we reported on the prevalence of a wide range of specific behavioral-emotional problems reported by teachers in a representative sample of 1,162 Dutch children aged 4 through 12; identified differences related to demographic variables and compared our data with those from other population based surveys. We used the Achenbach Teacher's Report Form (TRF) to collect our data because a comparison between different standardized teacher assessment instruments showed the TRF to be the most promising due to its solid psychometric background and its ready applicability. Our data supported the TRF's reliability and validity. For each of the 118 behavioral-emotional problems, the prevalence rates were presented graphically for both genders in two-year age groups. ANCOVAs were performed to assess the main effects and interaction of age and gender with SES as covariate for each problem item and total problem score. Of the demographic variables gender showed most numerous effects on problem items and showed the largest effect on total problem score. The main findings were: Boys obtained higher scores than girls. Many items on which boys scored higher are related to socially disapproved behavior. Boys obtained higher scores on concentration, attention and hyperactivity problems. Boys (especially the younger ones) scored higher on problems related to academic functioning. Teacher reports revealed larger gender differences than parent reports. Both parents and teachers scored boys higher on items predominantly associated with the externalizing syndrome. More boys than girls were attending education in special schools. Age showed no significant effect on total problem score, although older children were scored higher on a number of items associated with academic, somatic and social functioning and with emotions related to inner feelings.(ABSTRACT TRUNCATED AT 400 WORDS)

The prevalence of nocturnal enuresis: do DSM III criteria need to be changed? A brief research report

In this study the prevalence of nocturnal enuresis defined according to the DSM III criteria was determined in a random sample of 2070 children aged from 4 to 16 years. Nocturnal enuresis declines in prevalence with age and is more frequent in boys than in girls. Moreover, the decline in prevalence with age was found to take place earlier in girls than in boys. It is therefore argued that the DSM III age limit for enuresis should be raised to 8 years for boys.