Parent-dependent stressors and the onset of anxiety disorders in children: links with parental psychopathology.

Exposure to stressors is associated with an increased risk for child anxiety. Investigating the family origins of stressors may provide promising avenues for identifying and intervening with children at risk for the onset of anxiety disorders and their families. The aim of this study was to compare the frequency of parent-dependent negative life events and chronic adversities experienced by children with an anxiety disorder (n = 34) in the 12 months prior to the onset of the child's most recent episode, compared to healthy controls (n = 34). Life events and chronic adversities were assessed using maternal report during an investigator-based interview, which provided independent panel ratings of the extent that reported experiences were related to parent behaviour. There were no group differences in the number of parent-dependent negative life events for anxious children compared to controls. However, significantly more parent-dependent chronic adversities were present for anxious children compared to controls. Findings suggest that parents contribute to an increased frequency of chronic adversities but not negative life events prior to their child's most recent onset of anxiety. Furthermore, increased child exposure to parent-dependent chronic adversities was related to parental history of mental disorder.

Use of services and associated costs for young adults with childhood hyperactivity/conduct problems: 20-year follow-up.

BACKGROUND: Although childhood hyperactivity and conduct problems are associated with difficulties in adulthood, little is known about later service use or public expenditure costs in the UK. AIMS: To describe the use of services and calculate recent (past 6 months) and early adulthood (since the age of 18 years) public expenditure costs incurred by young adults who had hyperactivity and/or conduct problems during childhood. METHOD: A 20-year follow-up of a community sample of 6- to 7-year-old boys (n = 83) with hyperactivity only, conduct problems only, mixed hyperactivity and conduct problems, and no behaviour problems (control). Information was obtained about service use; recent (past 6 months), and early adulthood (since age 18 years) public expenditure costs were calculated. RESULTS: High levels of childhood conduct problems were associated with a two- to threefold increase in early adulthood costs, mainly driven by criminal justice contacts. Although the mixed problems group had the highest recent costs in terms of receipt of benefits and health and social care, they had the lowest criminal justice costs. CONCLUSIONS: High levels of early childhood conduct problems are particularly associated with increased health, social care and criminal justice costs in adulthood.

Parent-child and spousal relationships in families with a young child with end-stage renal disease.

BACKGROUND: End-stage renal disease (ESRD) leads to the need for dialysis and renal transplantation (Tx). Peritoneal dialysis (PD) of young children is normally performed at home by the parents and affects the whole family. We studied the coping of families with a young child with ESRD by interviewing the parents of 19 children. METHODS: The spousal and parent-child relationships were assessed by using the Psychosocial Assessment of Childhood Experiences (PACE) and the Brief Measure of Expressed Emotion, respectively. A control group of 22 families with a healthy child was used for the parent-child relationship evaluation. RESULTS: The spousal relationship at the start of PD was good or fairly good in most of the families and remained good in half of the families following renal Tx. Lack of support from close relatives and renal Tx were associated with a poorer relationship quality. Almost all parents expressed much or fairly much emotional warmth towards the child throughout the study, but there was a trend towards increased criticism over time. No differences in the degree of expressed warmth or criticism were noted between the index parents and controls. CONCLUSIONS: Overall, the study families appeared to cope well despite the serious illness of their child and the demands of the treatments.

[Somatization and somatoform disorders in children and adolescents]. / Somatisointi ja somatoformiset häiriöt lapsilla ja nuorilla.

The diagnosis of a somatoform disorder involves a continuum that ranges from common aches and pains to disabling functional symptoms. The currently available diagnostic classification systems can't easily be applied to children and adolescents. Whenever somatization is suspected, the clinician needs sufficient time to examine the child and to find out about his/her whole life situation. It is essential for the clinician to convey understanding that the patient's pain is real and involves neural nociceptive and affective components, both processed by the central nervous system, and influenced by the individual's past experiences, genetic background and environment.

Severe life events and chronic adversities as antecedents to anxiety in children: a matched control study.

The present study compared the number of severe life events and chronic adversities as reported retrospectively by mothers of children with an anxiety disorder (n = 39) prior to the onset of their most recent episode, with controls (n = 39) matched for age and sex. The parent version of the Psychosocial Assessment of Childhood Experiences (PACE) was used to assess chronic adversities (long-term experiences with negative impact on child) and severe life events (discrete life events with high long-term threat). A significantly greater number of severe life events and chronic adversities were assessed prior to onset for anxious children compared to controls. The finding for severe life events held regardless of whether impact ratings were assigned by mothers or a panel of independent raters, suggesting the findings reflect actual as opposed to perceived differences. Results suggest that both discrete and chronic stressors may constitute risk for future episodes of anxiety in children.

Brief measure of expressed emotion: internal consistency and stability over time.

The study examined three methodological aspects of expressed emotion (EE) as assessed in the course of PACE (Psychosocial Assessment of Childhood Experiences) interviews with a parent. In a sample of 87 children, aged 6 13 years, enrolled in a prospective study examining the role of stress on the course of asthma, EE was assessed at three time points, 9 months apart. A high degree of agreement was found among the three concurrent measures of negative and positive EE (kappas from 0.74 to 0.97, and from 0.45 to 0.88, respectively; p < or = 0.0001 in all instances). The temporal stability of all measures was lower, although statistically significant in all but 2 instances (kappas from 0.19 to 0.59, and from 0.11 to 0.39, respectively). The temporal stability across measures, as well as across interviewers and over time, was broadly similar (kappas from 0.21 to 0.56 for negative EE, and from 0.09 to 0.38 for positive EE, with all but three of the 36 statistically significant). The findings provide support for the underlying assumptions of the PACE-EE and show the utility of measures based on just very brief periods of non-directive interviewing, making them practical in a wide range of studies with EE just one of a larger set of measures.

Psychosocial stressors: Concepts, causes and effects.

Key advances in life events research included recognition of the need to differentiate events that were independent of disorder; to take the social context of events into account; to assess life events in terms of the long term threat rather than degree of life change; to determine the temporal linkage between life events and onset of psychiatric disorder; to appreciate the importance of long term difficulties as well as acute events; and to examine the role of vulnerability and protective mechanisms in determining individual differences in response to life events. Stress effects in childhood are considered in terms of possible mediating mechanisms; of turning points in life trajectory; of individual differences in response; of difficulties in the concept and measurement of onset of psychiatric disorder; of possible additivity of negative life events; and of the origins of individual differences in exposure to negative life experiences.

Testing the reliability of a new measure of life events and experiences in childhood: The Psychosocial Assessment of Childhood Experiences (PACE).

There are few well validated instruments for measuring the impact of life events and experiences in childhood and adolescence. This study examines the reliability of a new instrument, the Psychosocial Assessment of Childhood Experiences of PACE. Fifteen children and parents were interviewed on two cassions ten days apart for the main test-retest reliability study. About half of the events recorded were reported on both occasions (0.45% and 0.55% concordance). When the impact of specific events was examined much higher levels of agreement were found. Inter-rater reliability tests also yielded higher rate (Kappa 0.74 and above). Possible reasons for these important differences are discussed and the inherent methodological difficulties considered.

The impact of persisting hyperactivity on social relationships: a community-based, controlled 20-year follow-up study.

OBJECTIVE: The purpose of this study was to examine whether persisting hyperactivity into adulthood was associated with impaired family, friendship, and partner relationships or poor coping skills in everyday life. METHOD: A 20-year community-based follow-up of 6- to 7-year-old boys showing pervasive hyperactivity (n = 40) and unaffected controls (n = 25) was conducted. At age 27 years, participants were assessed with detailed interview techniques as well as self-report ratings. RESULTS: ADHD in adulthood was associated with problems in intimate relationships and negotiation skills. Antisocial behavior did not influence the association, but remitting childhood hyperactivity was not associated with social relationship difficulties in adulthood. CONCLUSION: In an untreated, community-based sample of hyperactive children, the risk for unsatisfactory social relationships is largely confined to those patients who still show ADHD in adulthood. The majority of patients who experience childhood hyperactivity have positive social relationships in adulthood.