Introducing the White Noise task in childhood: associations between speech illusions and psychosis vulnerability.

BACKGROUND: Auditory verbal hallucinations (AVH) are common during development and may arise due to dysregulation in top-down processing of sensory input. This study was designed to examine the frequency and correlates of speech illusions measured using the White Noise (WN) task in children from the general population. Associations between speech illusions and putative risk factors for psychotic disorder and negative affect were examined. METHOD: A total of 1486 children aged 11-12 years of the Copenhagen Child Cohort 2000 were examined with the WN task. Psychotic experiences and negative affect were determined using the Kiddie-SADS-PL. Register data described family history of mental disorders. Exaggerated Theory of Mind functioning (hyper-ToM) was measured by the ToM Storybook Frederik. RESULTS: A total of 145 (10%) children experienced speech illusions (hearing speech in the absence of speech stimuli), of which 102 (70%) experienced illusions perceived by the child as positive or negative (affectively salient). Experiencing hallucinations during the last month was associated with affectively salient speech illusions in the WN task [general cognitive ability: adjusted odds ratio (aOR) 2.01, 95% confidence interval (CI) 1.03-3.93]. Negative affect, both last month and lifetime, was also associated with affectively salient speech illusions (aOR 2.01, 95% CI 1.05-3.83 and aOR 1.79, 95% CI 1.11-2.89, respectively). Speech illusions were not associated with delusions, hyper-ToM or family history of mental disorders. CONCLUSIONS: Speech illusions were elicited in typically developing children in a WN-test paradigm, and point to an affective pathway to AVH mediated by dysregulation in top-down processing of sensory input.

Psychotic experiences and hyper-theory-of-mind in preadolescence--a birth cohort study.

BACKGROUND: Knowledge on the risk mechanisms of psychotic experiences (PE) is still limited. The aim of this population-based study was to explore developmental markers of PE with a particular focus on the specificity of hyper-theory-of-mind (HyperToM) as correlate of PE as opposed to correlate of any mental disorder. METHOD: We assessed 1630 children from the Copenhagen Child Cohort 2000 regarding PE and HyperToM at the follow-up at 11-12 years. Mental disorders were diagnosed by clinical ratings based on standardized parent-, teacher- and self-reported psychopathology. Logistic regression analyses were performed to test the correlates of PE and HyperToM, and the specificity of correlates of PE v. correlates of any Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) mental disorder. RESULTS: Univariate analyses showed the following correlates of PE: familial psychiatric liability; parental mental illness during early child development; change in family composition; low family income; regulatory problems in infancy; onset of puberty; bullying; concurrent mental disorder; and HyperToM. When estimating the adjusted effects, only low family income, concurrent mental disorder, bullying and HyperToM remained significantly associated with PE. Further analyses of the specificity of these correlates with regard to outcome revealed that HyperToM was the only variable specifically associated with PE without concurrent mental disorder. Finally, HyperToM did not share any of the investigated precursors with PE. CONCLUSIONS: HyperToM may have a specific role in the risk trajectories of PE, being specifically associated with PE in preadolescent children, independently of other family and child risk factors associated with PE and overall psychopathology at this age.

Predictors (0-10 months) of psychopathology at age 11/2 years - a general population study in The Copenhagen Child Cohort CCC 2000.

BACKGROUND: Epidemiological studies of mental health problems in the first years of life are few. This study aims to investigate infancy predictors of psychopathology in the second year of life. METHODS: A random general population sample of 210 children from the Copenhagen Child Birth Cohort CCC 2000 was investigated by data from National Danish registers and data collected prospectively from birth in a general child health surveillance programme. Mental health outcome at 1(1/2) years was assessed by clinical and standardised measures including the Child Behavior Check List 1(1/2)-5 (CBCL 1(1/2)-5), Infant Toddler Symptom Check List (ITSCL), Checklist for Autism in Toddlers (CHAT), Bayley Scales of Infant Development (BSID II), Mannheim Eltern Interview (MEI), Parent Child Early Relational Assessment (PC ERA) and Parent Infant Relationship Global Assessment Scale (PIR-GAS), and disordered children were diagnosed according to the International Classification of Diseases (ICD-10) and Diagnostic Classification Zero to Three (DC: 0-3). RESULTS: Deviant language development in the first 10 months of life predicted the child having any disorder at 1(1/2) years, OR 3.3 (1.4-8.0). Neuro-developmental disorders were predicted by deviant neuro-cognitive functioning, OR 6.8 (2.2-21.4), deviant language development, OR 5.9 (1.9-18.7) and impaired social interaction and communication, OR 3.8 (1.3-11.4). Unwanted pregnancy and parents' negative expectations of the child recorded in the first months of the child's life were significant predictors of relationship disturbances at 1(1/2) years. CONCLUSIONS: Predictors of neuro-developmental disorders and parent-child relationship disturbances can be identified in the first 10 months of life in children from the general population.

Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population.

BACKGROUND: Failure to thrive (FTT) in early childhood is associated with subsequent developmental delay and is recognised to reflect relative undernutrition. Although the concept of FTT is widely used, no consensus exists regarding a specific definition, and it is unclear to what extent different anthropometric definitions concur. OBJECTIVE: To compare the prevalence and concurrence of different anthropometric criteria for FTT and test the sensitivity and positive predictive values of these in detecting children with "significant undernutrition", defined as the combination of slow conditional weight gain and low body mass index (BMI). METHODS: Seven criteria of FTT, including low weight for age, low BMI, low conditional weight gain and Waterlow's criterion for wasting, were applied to a birth cohort of 6090 Danish infants. The criteria were compared in two age groups: 2-6 and 6-11 months of life. RESULTS: 27% of infants met one or more criteria in at least one of the two age groups. The concurrence among the criteria was generally poor, with most children identified by only one criterion. Positive predictive values of different criteria ranged from 1% to 58%. Most single criteria identified either less than half the cases of significant undernutrition (found in 3%) or included far too many, thus having a low positive predictive value. Children with low weight for height tended to be relatively tall. CONCLUSIONS: No single measurement on its own seems to be adequate for identifying nutritional growth delay. Further longitudinal population studies are needed to investigate the discriminating power of different criteria in detecting significant undernutrition and subsequent outcomes.

The reliability of the ICD-10 and the DC 0-3 in an epidemiological sample of children 1½ years of age.

The aims of this study were to investigate the reliability of ICD-10 and DC 0-3 in the diagnostic classification of mental health problems in 1½ -year-old children from the general population. The reliability study was conducted as a part of an epidemiological survey of psychopathology in 1½ -year-old children from the general population. In this survey, the children were assessed and diagnosed according to the ICD-10 and the DC 0-3 after a 2-hr session including standardized and clinical methods and videorecordings. The case records and video material of 18 children were rediagnosed by the three child psychiatrists, who had diagnosed children in the epidemiological survey. In general, the reliability in diagnostic classification of mental health problems in 1½-year-old children was improved with the DC 0-3 compared to the ICD-10. In the classification of psychopathology at Axis I, the interrater reliability and test-retest reliability kappas were 0.66 and 0.57, respectively, with the ICD-10, and 0.72 and 0.74, respectively, with the DC 0-3. The reliability of the classification of relationship disturbances at Axis II with the DC 0-3 was high, corresponding to κ = 1. A high agreement among raters in the differentiation between psychopathology and normal variations was found. Given experienced clinicians and standardized assessment methods, it is possible to reliably identify and diagnose psychopathology in 1½-year-old children from the general population.

Assessment and classification of psychopathology in epidemiological research of children 0-3 years of age: a review of the literature.

The research of psychopathology in children 0-3 years of age is dominated by clinical case studies and theoretical reflections, and epidemiological studies are few. This paper reviews methods to assess and classify psychopathology in children 0-3 years old in an epidemiological context. Diagnostic assessments of children 0-3 years of age are based on information from different sources and investigation of several domains of mental functioning, and the rapid developmental changes and the relationship context are taken into account. The reviewed literature shows a range of methods to assess and classify psychopathology in children 0-3 years of age: screening instruments with established psychometric properties, such as the Child Behaviour Checklist (CBCL) and the Checklist for Autism in Toddlers (CHAT), and methods of in-depth assessment known from both clinical practice and research: developmental tests, such as the Bayley Scales, and relationship assessments, such as the Early Relational Assessment (ERA). The classification of psychopathology in young children can be approved by the Diagnostic Classification 0-3. The reliability and validity of DC 0-3 have not yet been established, but preliminary results seem promising. The demands made on diagnostic assessment procedures in epidemiological research of children 0-3 years of age can be met by a combination of well-established research instruments, such as the CBCL, with in-depth clinical assessment procedures, such as the Bayley Scales and the ERA, and diagnostic classification by DC 0-3.

[Infant psychiatry]. / Spaed- og småbørnspsykiatri.

Infant psychiatry is a discipline concerned with diagnostic assessment, treatment, and prevention of mental health problems in infancy and early childhood. A new diagnostic framework: Zero to three (DC 0-3) has been designed to complement the ICD 10/DSM IV, including new diagnostic categories, and a multiaxial construct addressing developmental and relational aspects. Prevalence and outcome for mental retardation and pervasive developmental disorders are well known. Our knowledge of variations in attachment patterns, disorders of neurophysiological regulation, eating disorders, failure to thrive, emotional, affective, and behavioural problems, disorders of relating and communication, and eventually parent-child relationship disorders is still incomplete. It is recommended to use video and combine clinical evaluation with structured tests in assessment. Intervention may include guidance, psychoeducation, psychotherapy, as well as social and educational support. Parent-child relationship treatment seems effective. Evaluating intervention and treatment raises immense methodological problems. Future research should address how risk and resilience interacts in the psychopathological process and enhance our knowledge of effective intervention strategies.

[Infant and child psychiatry in Denmark]. / Spaed- og småbørnspsykiatri i Danmark.

INTRODUCTION: A descriptive epidemiological study of children aged 0-36 months. METHODS: Diagnoses reported from the child psychiatric departments to The National Psychiatric Register were collected from a three-year period 1996, 1997, and 1998. The child psychiatric departments in Denmark filled in a questionnaire concerning referral, assessment, treatment, and consultant/liason functions. All the child psychiatric departments took part in the study. RESULTS: 529 children aged 0-3 years were reported to the National Psychiatric Register. In the period studied, there was a 30% increase in the number of children reported. Adjustment reactions were the commonest diagnosis in the youngest children, aged 0-12 months. Pervasive developmental disorders, particularly infantile autism, were commonest used in the age group 2-3 years. Twenty-four per cent of the children reported, especially the youngest children, had no specific psychiatric diagnosis. The increase in the number of children aged 0-1 year with adjustment reactions and non-specific diagnoses is discussed. Children aged 0-3 years are mainly treated as outpatients or by a consultant/liason child psychiatric service. The children referred to the child psychiatric departments in 1997 varied from fewer than 10 to about 100 children. Infant psychiatric units were established in two places in Denmark, in 1992 and 1997. DISCUSSION: The increasing number of children aged 0-3 years reported to the National Psychiatric Register in the period 1996-1998 reflects an increase in the children aged 2-3 years diagnosed with pervasive developmental disorders, and in the case of the youngest children, aged 0-1 year, a more extensive child psychiatric intervention in relation to populations at risk, such as infants with mentally ill mothers.

[Child psychiatric intervention in connection with district psychiatry. A 2-year experimental project with child psychiatric consultation]. / Børnepsykiatrisk intervention i forbindelse med distriktspsykiatri. Et toårigt forsøgsprojekt med børnepsykiatrisk konsulentfunktion.

The aim of the study was to describe the requirement for child psychiatric intervention in children of psychiatric patients treated within community psychiatry and to test the possibilities for intervention in practice. The study was carried out in a community psychiatric centre in Copenhagen, to which a child psychiatrist was associated as a consultant for two years. Assessment of known risk factors for child psychiatric illness was carried out in the families of all patients admitted to the centre who had children aged 0-14 years. Intervention was systematically carried out and described. The project was evaluated in a survey among the staff of the centre. Sixty-five patients, of which the majority were women, and 86 children were evaluated. The most frequent diagnoses were psychosis and personality disorder. More than half of the children were less than three years old. Fourteen children had no contact with their ill parent and 13 were placed in care. Ten families were referred to child psychiatric treatment. Primary intervention was carried out in six cases. A questionnaire among the members of the psychiatric staff showed that the project was well accepted and considered to be of great profit to the patients and their children. We conclude that a high frequency of risk factors for child psychiatric illness were identified in families of patients in community psychiatry. The community psychiatric setting made preventive intervention possible at a time where no such measures otherwise would have been taken. It is therefore recommended that child psychiatrists are integrated in community psychiatry as consultants.

The reliability of child psychiatric diagnosis. A comparison among Danish child psychiatrists of traditional diagnoses and a multiaxial diagnostic system.

The study was conducted to compare an experimental multiaxial diagnostic system (MAS) with traditional multicategorical diagnoses in child psychiatric work. Sixteen written case histories were circulated to 21 child psychiatrists, who made diagnoses independently of one another, using two different diagnostic systems. Diagnostic reliability was measured as percentage of interrater agreement. The highest diagnostic reliability was obtained in psychotic disorders, the lowest in personality disorders. The MAS implied improved diagnostic reliability of mental retardation, somatic disorders and developmental disorders. Adjustment reaction (reactio maladaptiva) was the diagnosis most commonly used, but with varying reliability in both systems. The reliability of the socio-economic and psychosocial axes were generally high.