Controlled comparison of three interventions for mother and toddler problems: preliminary communication.

This paper summarizes the preliminary thinking, the hypotheses and design and some preliminary results of a large community-based intervention project which is currently underway in the North East of England.

ABC of child abuse. Role of the child psychiatry team.

In summary, a child psychiatrist can make an important contribution to the management of child abuse. At least one child psychiatrist in each district should take an interest in this work and should be given the time to do so. As for other professionals, child abuse is an aspect of the work of child psychiatrists that is particularly harrowing and time consuming.

Abnormal illness behaviour in young women in a primary care setting: is Briquet's syndrome a useful category?

In a study of abnormal behaviour in women aged 16-25 in one large group practice a screening instrument and an interview were used to identify Briquet's Syndrome. The prevalence, 2.04 per 1000, was lower than that found in previous studies. The fact that many other patients showed both the high consultation rates and the other correlates of Briquet's Syndrome brings the usefulness of a discrete syndrome into doubt.

Psychotherapy for Munchausen syndrome by proxy.

The management of a case of Munchausen syndrome by proxy is described. Possible indications for individual interpretive psychotherapy in child abuse are given.

Abdominal pain in six-year-olds: an epidemiological study in a new town.

This study investigated recurrent abdominal pain in all 494 second-year infant children in a new town using a postal questionnaire followed by sampling and detailed interview. A prevalence of between 24.5 and 26.9% was found and there were associations with psychiatric deviance both at home and at school. There were also associations with social support of the mother, difficulties in settling into school and status of house ownership. Details of parental management of their children's symptoms are described.

Dilemmas of adolescents with developmental retardation: a review.

Adolescence is highlighted in this review as the age of crisis and concern for those with developmental retardation. The complexities of this stage of life are considered from the perspectives of the individual's development and the commitment required by the family, school, professional services and society. These issues, illustrated with a case vignette, are critically examined using the evidence available in the literature.

Massage for very severe self-injurious behaviour in a girl with Cornelia de Lange syndrome.

The authors report the use of massage in a case of severe self-injurious behaviour in a girl with Cornelia de Lange syndrome, after failing to elicit a response to conventional management for 10 years. Improvement was dramatic and the possible mechanisms are discussed.

Research note: temperament and behaviour in six-year-olds with recurrent abdominal pain: a follow up.

Dimensions of temperament and behaviour were measured in a group of infant school children with recurrent abdominal pain and in a control group. Children with recurrent abdominal pain were temperamentally more difficult than those without, and in particular, girls were found to have a more irregular temperamental style and boys to be more likely to withdraw in new situations. Temperamental differences were more persistent than the abdominal pain itself. There was little difference behaviourally between the groups. It is hypothesized that abdominal pain represents an interaction between a vulnerable temperamental style and environmental stresses.

Psychoneurotic disturbance and drug-taking in Borstal boys.

Their own accounts of their use of drugs, together with a detailed description of psychiatric history and present mental state, were obtained from a sample of institutionalized delinquents, Subjects reporting extensive involvement in drug abuse were found to be disturbed on a number of psychiatric variables; however, those reporting some limited abuse were less disturbed than subjects reporting no experience of drug taking. The results and their implications are discussed.

Hostel-based respite care for adolescents with developmental retardation: the need for "normalized" respite resources.

Hostel respite care for adolescents with developmental retardation is the most readily available organized support for their families. This comparison of users and non-users shows that hostel-care usage relates to some measures of family functioning rather than to qualities of the adolescent. These family measures reflect less good organization and support rather than current stress. Consumer opinion indicates that hostel care is not meeting the carers' perceived needs for relief. A greater range of "normalized" and family-orientated respite care resources might be more effective for relieving stress and providing support to improve family-based community care.

A study of expressed emotion in the parental primary carers of adolescents with intellectual impairment.

Expressed emotion (EE) was measured in the parental primary carer (carer) of 92 adolescents with intellectual impairment to examine its associated characteristics. High EE was mainly a result of high levels of emotional overinvolvement. High EE was associated with psychological illhealth, poor-quality marriage and poor practical social support of the carer, and psychiatric disorder in the adolescent with intellectual impairment. This suggests that EE may be a useful indicator of coping difficulties in these families. The subgroup of high EE emotional overinvolvement was associated with a carer with more psychological illhealth, a worse-quality marriage, less practical social support, greater professional support and an insecure style of respite care usage for an adolescent of greater intellectual impairment. The subgroup of criticism have an adolescent of less severe intellectual impairment, more behavioural disturbance and yet the carer has less professional support. Appreciation of the quality of the relationship of the carer with their dependent family member may enable greater understanding of how to improve the quality of life for both the carer and the cared for.

Multple criterion screen for identifying secondary school children with psychiatric disorder: characteristics and efficiency of screen.

A multiple criterion screen was developed as part of a study which was designed to assess different types of intervention for school children with psychiatric disorder. The foremost requirement was that false positives be kept to a minimum, with selected children being unequivocally disturbed. Children were identified for treatment by the following measures: (a) teacher rating on the Rutter B2 Scale, giving a total score and subscores for neurotic and antisocial behaviour; (b) peer ratings on a sociometric measure, yielding isolation and rejection scores; and (c) self ratings on the Junior Eysenck Personality Inventory, specifically the neuroticism dimension. A weighting system was developed so that children could be selected on the basis of extreme scores on either teacher or self-rating measures alone, or by a combination of less extreme scores on more than one measure. The results are presented and discussed.

The nature of mother and toddler problems. (ii) Patterns of disturbance and disadvantage.

Prevalence estimates for psychiatric disturbance in mothers and their 2 1/2 year old children and the variations in prevalence associated with marriage quality, social class and the child's developmental level are presented. It was found that both the mother's psychiatric disturbance, and more specifically, depression were associated most strongly with child disturbance, poor marriage quality and low child developmental level. For toddler disturbance, the strong associations were with type and severity of disturbance in mother, social class, marriage quality and low developmental quotient.

Screening schoolchildren for high risk of emotional and educational disorder.

Junior schoolchildren were screened for high risk of emotional and educational disorder. The information was gathered from the school, using standard and objective tests. The multiple criterion screen employed, comprised: (a) classroom behaviour scale (Rutter B Scale), rated by teachers; (b) sociometric tests; choice of companions by classmates. From these, lack of positive choices was taken as a measure of isolation and a high rate of negative choices, as a measure of rejection; (c) Reading quotient of 75 or below on the Young Reading Test; (d) Absence from school for reasons considered by teachers to be trivial. The number of cases identified by the screening was found to be 322 children per thousand. They may be seen as representing a high risk rate. Using extreme scores as indicative of high risk, approximately 17 per cent of children were identified on the basis of the behaviour test; 12 per cent by the reading test; 9 per cent by the isolation test; 8 per cent by the rejection test and 3 per cent by the absenteeism test. Seventy per cent of the identified children were rated clinically as disturbed. Absenteeism identified the smallest percentage of cases and made the smallest independent contribution of identification. Isolation was not impressively related to neurotic or antisocial behaviour. The three important criteria, therefore, were behaviour, rejection and reading. Corrected disturbance rates for our population of 7-8-year-old children, including those not identified by the screen, were 6-8 per cent markedly maladjusted and 33-7 per cent somewhat maladjusted.

Temperamental patterns in aggressive boys.

Four groups of aggressive body ( and one group of controls) were studied, on the basis of: clinical referrals to a hospital clinic; teacher reports of assaultive behaviour in school; teacher reports of severe aggressive behaviour in school; and peer reports of aggressive behaviour. Questionnaire techniques were used to study behaviour and temperament. The last three groups proved to have rather similar patterns of behaviour and temperament and, therefore, they have been combined to give rise to an 'any school criterion' group. We compared three main groups: (i) clinical referrals; (ii) 'any criterion' (school-identified); and (iii) controls. On behaviour, the clinical group had the most adverse scores, especially on antisocial behaviour. The school-identified group also had a higher score than the controls on this dimension, and differed in degree from the clinical referral group. On temperament, the clinical referral group had a significantly more adverse score on all dimensions than both the controls and the 'any criterion' group. The 'any criterion' group scores were intermediate between the other two sets of scores. The differences on temperament between the control and the 'any criterion' groups appeared to be one of degree but not of type. Moreover, no specific type of temperament was associated with the different kinds of aggression we have studied. Principal components analysis supports the notion of no qualitative temperamental differences between the 'any criterion' and the control groups.

The nature of mother and toddler problems--I. Development of a multiple criterion screen.

A multicriterion screen made up of the General Health Questionnaire, the Behaviour Checklist and a health visitor questionnaire was given in a community project. This paper describes the usefulness of the screen and compares it with others which might be used in similar situations.