The children of psychiatrically disturbed parents: differences as a function of the sex of the sick parent.

To examine the effects of the sex of psychiatrically disturbed parent on the offspring, we compared children of a schizophrenic parent, a psychiatrically disturbed but not schizophrenic parent, and a normal parent using behavioral, attentional, and neurological indices. Results of a discriminant analysis indicate that children of psychiatrically disturbed mothers have an increased sensitivity to tactile stimulation, possibly reflecting more labile autonomic nervous system functioning. In addition, children with a schizophrenic parent of either sex show evidence of neurological motor dysfunction.

Anxiety disorders in children and their families.

The first- and second-degree relatives of children with anxiety disorders were compared with relatives of children with attention deficit-hyperactivity disorder and children who had never been psychiatrically ill for lifetime rates of psychopathological conditions, particularly anxiety disorders. Results from blind, diagnostic interviews indicated an increased prevalence of anxiety disorders in the first-degree relatives of children with anxiety disorder compared with relatives of both children with attention deficit-hyperactivity disorder and never psychiatrically ill children. Relationships between specific anxiety disorders in children and their relatives revealed an increased rate of panic disorder among the first-degree relatives of children with over-anxious disorder, compared with the relatives of children with separation anxiety disorder and children with other types of anxiety disorders. There also was a trend for panic disorder to be more prevalent among relatives of children with panic disorder than among relatives of children with anxiety disorder without panic. Obsessive-compulsive disorder was the only other anxiety disorder that appeared to show a similar specific relationship between children and their relatives. In general, the findings from this study suggest that there is a familial component involved in the pathogenesis of childhood anxiety disorders. The specificity of this relationship varies among individual anxiety disorders.

An evaluation of the family history method for ascertaining psychiatric disorders.

This methodologic study assessed the accuracy of family history data in ascertaining psychiatric disorders in relatives. Comparison of diagnoses based on family history with diagnoses based on direct interview indicated that the specificity for the family history method is high, but that the sensitivity is generally low. Accuracy was better for affective disorders and alcoholism than for less severe disorders; spouses and offspring provided more accurate information than parents and siblings. The use of multiple information increased sensitivity somewhat, with little adverse effect on specificity. However, because errors were often correlated when more than one person provided information about a particular relative, the use of multiple informants generally did not improve accuracy substantially. Analysis of family-genetic studies should take account of the differential quality of data obtained by the family history method vs direct interview.

Lifetime prevalence of specific psychiatric disorders in three sites.

Lifetime rates are presented for 15 DSM-III psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses were alcohol abuse and dependence, phobia, major depressive episode, and drug abuse and dependence. Disorders that most clearly predominated in men were antisocial personality and alcohol abuse and dependence. Disorders that most clearly predominated in women were depressive episodes and phobias. The age group with highest rates for most disorders was found to be young adults (aged 25 to 44 years). Correlates with race, education, and urbanization are presented.

Six-month prevalence of psychiatric disorders in three communities 1980 to 1982.

Six-month prevalence rates for selected DSM-III psychiatric disorders are reported based on community surveys in New Haven, Conn, Baltimore, and St Louis. As part of the Epidemiologic Catchment Area program, data were gathered on more than 9,000 adults, employing the Diagnostic Interview Schedule to collect information to make a diagnosis. The most common disorders found were phobias, alcohol abuse and/or dependence, dysthymia, and major depression. The most common diagnoses for women were phobias and major depression, whereas for men, the most predominant disorder was alcohol abuse and/or dependence. Rates of psychiatric disorders dropped sharply after age 45 years.

A community study of anxiety in children and adolescents.

The authors used an epidemiologic approach to investigate rates, symptoms, and behavioral concomitants of anxiety across the child and adolescent age span. They drew 210 children aged 8, 12, and 17 in equal numbers from a community sample and evaluated them with structured diagnostic assessments. They found anxiety to be the most frequently reported type of psychopathology across all three age groups. Although the prevalence of any anxiety symptom remained constant, specific types of anxiety varied with age. Age differences in nonanxiety behavior were found between subjects with and without anxiety, particularly with regard to interpersonal dysfunction.

Anxiety disorders in mid-adolescence: a community sample.

The authors report the 6-month period prevalence of anxiety disorders in a community sample of 150 adolescents 14 to 16 years old. Diagnoses were based on structured psychiatric interviews, DSM-III criteria, and a psychiatrist's review of the data. Additional measures of affect, self-concept, and coping were also obtained for all subjects. Seventeen percent of the adolescents met criteria for one or more anxiety diagnoses and 8.7% were identified as "cases" of anxiety disorder. A significant relationship was found between anxiety and depression. The authors discuss the distribution and expression of anxiety disorders among adolescents in the community.

Depression and depressive symptoms in preschool children from the general population.

This multiphasic study used four independent sources of information to investigate depression and depressive symptoms in a sample of preschool-age children from a general population. The study provides evidence that major depressive disorder exists in preschoolers and that stressful life events are associated with depressive symptoms; it underscores the importance of the teacher's report for identifying the presence of depression in this age group. Details of the findings, including a new scale for rating depression in young children, are discussed.

Paranoid schizophrenia in adolescence.

BACKGROUND: Paranoid schizophrenia is considered to be a rare condition in adolescence. Since this is contrary to the authors' clinical experience, they hypothesized that a controlled study would show that a significant number of adolescents would be diagnosed with paranoid schizophrenia and that scores from the childhood version of the Schedule for Affective Disorders and Schizophrenia (K-SADS) would differentiate between the paranoid schizophrenic adolescents and adolescents with other types of schizophrenia or with affective disorder. METHOD: The authors conducted a prospective study of 120 adolescents admitted consecutively to an adolescent psychiatric inpatient department. Patients were diagnosed on the basis of DSM-III after an 8-week period during which they were evaluated with a structured psychiatric history and psychiatric examination, the K-SADS, repeated nonstructured interviews, and extensive ward observations. RESULTS: Thirty-eight percent of the schizophrenic adolescents and 14% of the total hospitalized population met the DSM-III criteria for paranoid schizophrenia. The symptom profile of the paranoid schizophrenic adolescents clearly distinguished them from adolescents with other psychiatric disorders. CONCLUSIONS: Given the incidence of paranoid schizophrenia in an adolescent population, adolescent psychiatrists are likely to encounter this disorder. DSM-III-R should be used in future studies to further clarify the issue of the prevalence of paranoid schizophrenia in adolescents.

Early onset psychiatric disorder in high risk children and increased familial morbidity.

The relationship between child psychopathology and familial morbidity in second degree relatives was examined for children considered at risk on the basis of parental affective illness. Second degree relatives in high-risk families with no child psychopathology were no different from low-risk families in their rates of depression and anxiety. Second degree relatives in high-risk families positive for child psychopathology had significantly higher rates of depression and anxiety than relatives of low-risk children and relatives of high-risk children with no disorder. The implications of these findings are discussed with respect to risk status, prepubertal onset of psychopathology, and familial morbidity for specific psychiatric disorders.

Continuity of psychopathology in a community sample of adolescents.

OBJECTIVE: To examine the continuity between the primary (first) diagnosis and secondary (second) diagnosis of those adolescents who have more than one episode of psychiatric disorder. Data were examined to determine whether the second episode "breeds true" (i.e., remains within the same diagnostic category as the first) or involves a different disorder. METHOD: The sample consisted of 236 youngsters selected from the larger (n = 1,507) population of adolescents (aged 14 through 18 years) from the Oregon Adolescent Depression Project who had been assessed on two occasions, approximately 1 year apart. RESULTS: Results support the continuity hypothesis for the categories of disorder studied (major depression, anxiety, disruptive, substance use), with the exception of dysthymia. Primary dysthymia did not result in the diagnosis of secondary dysthymia, because most adolescents who had dysthymia had not recovered within the time frame of the study and were chronic cases, often with secondary anxiety. Also presented are data on age of onset of disorder (lowest for anxiety and highest for substance use) and information on remission intervals between episodes (well time) (lowest for substance use and highest for anxiety). CONCLUSIONS: The findings are interpreted as providing support for the "breed true" hypothesis, although clearly not all second episodes are identical with the first. While the psychosocial factors examined did not predict the nature of the second disorder, this clearly needs further study.

Sexually abused children at high risk for post-traumatic stress disorder.

Ninety-two sexually abused children were studied using structured interviews and standardized instruments to determine the frequency of post-traumatic stress disorder (PTSD) and associated symptoms. Of these sexually abused children, 43.9% met DSM-III-R PTSD criteria; 53.8% of children abused by fathers, 42.4% abused by trusted adults, and 10% of those abused by strangers met criteria as opposed to none of the children abused by an older child. No relationship was observed between the time lapsed since last abusive episode and the presence of PTSD. Many children not meeting full criteria exhibited partial PTSD symptoms. Only one standardized instrument (Child Behavior Checklist) detected group differences with PTSD children exhibiting more symptoms. This study replicates an earlier pilot study and underscores the need for further PTSD research.

Psychometric properties of the K-SADS-P in an Israeli adolescent inpatient population.

Seventy adolescent admissions to a psychiatric unit were evaluated with a Hebrew translation of the Schedule for Affective-Disorders and Schizophrenia for School-Aged Children (K-SADS-P). Interrater and test-retest reliability and mother-child agreement were evaluated for diagnoses, symptom clusters, and 20 affective symptoms. K-SADS diagnoses were also compared with 3-month unit evaluation diagnoses as a measure of consensual validity. The reliability of assessing psychosocial functioning was additionally examined. Reliability and validity of diagnoses were high and reliability of symptoms and syndromes was good to excellent. Mother-child agreement faired less well on all measures. The use of semistructured interviews and DSM-III criteria in an Israeli adolescent psychiatric setting are discussed.

Psychopathology in a community sample of children and adolescents: a developmental perspective.

Psychiatric disorders, symptom clusters and adjustment problems in a community based sample comprised three age cohorts: 8, 12, and 17 years. The data indicated that anxiety symptoms decreased with age. Conduct problems increased with age for males, affective problems increased with age for females, and substance use and social anxiety increased with age for both sexes. Concerns about inadequacy also increases with age, but only for females. These gender-based developmental differences in psychopathology and other findings are discussed.

A secular increase in child and adolescent onset affective disorder.

Both longitudinal and cross-sectional studies utilizing population and family study samples have found evidence for a secular increase in major affective disorders in adults. Applying techniques used in cross-sectional studies in adults to family study data of children and adolescents, the authors demonstrate evidence of a parallel secular increase for child and adolescent onset affective disorders. Normal and depressed prepubertal probands were identified. All full siblings were directly interviewed for lifetime episodes of affective disorder. Analysis of the siblings (probands not further analyzed in this article) by the Cox proportional hazards model demonstrates that the risk for affective disorder is higher in siblings born more recently.

Children's understanding of death in relation to child suicidality and homicidality.

This review examines children's understanding of death and how such understanding may be related to the increasing incidence of child suicidality and homicidality. Several factors have been reported to influence children's acquisition of the concepts of death. Those most often reported involved include children's age, cognitive development, and exposure to death; religion and culture appear to play a more minimal role. Most of what we know about how and when children begin to understand death is derived from research with healthy children. Although less robust, the data available from chronically physically ill children and suicidal children indicate some distortions in and less mature concepts of death. These distortions may indeed make death appear more attractive and less permanent to some suicidal children. Despite these provocative findings, no similar investigations have been conducted with homicidal children. Implications of these data for future research and potential intervention are discussed.

The failure of 'adult' interventions with adolescent depression: what does it mean for theory, research and practice?

The literature on the biological and phenomenologic presentation of major depressive disorder (MDD) in adolescents is reviewed and compared with that of depressed adults. Biological and psychosocial treatment approaches with adults and adolescents are then contrasted and the applicability of adult interventions to adolescents is examined. Some biological, cognitive, and experiential differences between adult and adolescent MDD may have treatment implications which have not yet been adequately addressed in the field. No effective treatments for adolescent MDD have, as yet, been developed or empirically tested. Based upon the results of this review, suggestions are made for the direction of future research.

Children and depression--the children of depressed parents; the childhood of depressed patients; depression in children.

In order to understand the development of depression in children, three types of data are reviewed: (1) studies of the children of depressed parents; (2) studies of the childhood histories of depressed adults; (3) direct studies of depression in children. These data support an increased frequency of depression and other psychopathology in the children of depressed adults. An examination of the homes of children with a depressed parent reveals a disruptive, hostile, and rejecting environment. This atmosphere is also found in the homes of depressed children and in the homes of children who become depressed as adults. Methodological issues are discussed which will help sort out the relative influences of genes and environment in future studies.

Comparison of the family history method to direct interview. Factors affecting the diagnosis of depression.

This study compares information on the diagnosis of depression obtained by family history reports with the formation obtained by direct interview. Reports were obtained from family members on the psychiatric status of 696 individuals for whom direct SADS-L interviews were also available. The effects on family history reports of subjects characteristics, treatment status, age of onset of depression, and endogenous symptoms were examined. Sensitivity and specificity for family history reports on the specific symptoms of depression are also reported. The specificity of family history reports for the diagnosis of depression was consistently high but sensitivity varied as a function of subject and illness characteristics. Sensitivity was somewhat higher for females than males and appreciably higher for probands than for their first-degree relatives and spouses. Sensitivity was increased whenever treatment, hospitalization or endogenous symptoms were present in the subject, indicating that family history reports are most accurate for detecting the severest cases of depression. Finally, the symptoms of depression that are least accurately reported by relatives are identified and suggestions for modifying the family history criteria for depression are proposed.

Psychopathology in children of parents with recurrent depression.

We examined the prevalence of psychopathology in children of parents with recurrent major depression (n = 61) and children of normal control parents (n = 46). Rates of psychopathology in the children of depressed parents were consistently higher when compared either with the control children or with rates of disorder reported for nonclinically referred children from other studies. Forty-one percent of high-risk children met criteria for at least one psychiatric disorder compared with 15% of low-risk children. Significant differences between groups were found for affective disorders and attention deficit disorder, and a nonsignificant trend was noted for anxiety disorder, all of which were more prevalent in the children of depressed parents.