Cognitive emotion regulation in children: Reappraisal of emotional faces modulates neural source activity in a frontoparietal network.

Emotion regulation has an important role in child development and psychopathology. Reappraisal as cognitive regulation technique can be used effectively by children. Moreover, an ERP component known to reflect emotional processing called late positive potential (LPP) can be modulated by children using reappraisal and this modulation is also related to children's emotional adjustment. The present study seeks to elucidate the neural generators of such LPP effects. To this end, children aged 8-14 years reappraised emotional faces, while neural activity in an LPP time window was estimated using magnetoencephalography-based source localization. Additionally, neural activity was correlated with two indexes of emotional adjustment and age. Reappraisal reduced activity in the left dorsolateral prefrontal cortex during down-regulation and enhanced activity in the right parietal cortex during up-regulation. Activity in the visual cortex decreased with increasing age, more adaptive emotion regulation and less anxiety. Results demonstrate that reappraisal changed activity within a frontoparietal network in children. Decreasing activity in the visual cortex with increasing age is suggested to reflect neural maturation. A similar decrease with adaptive emotion regulation and less anxiety implies that better emotional adjustment may be associated with an advance in neural maturation.

Psychiatric treatment outcomes of preschool children in a family day hospital.

This study describes the treatment outcomes of preschoolers with severe mental health problems who were treated at the child psychiatric family day hospital for preschool children in Münster, Germany. The eclectic multi-modal treatment combines behavioral and psychodynamic techniques for both parents and children in various settings within an intermittent attendance structure provided by a multi-disciplinary team. This study evaluated 185 children with the Caregiver-Teacher Report Form (C-TRF/1.5-5), which was completed by therapists, and the Child Behavior Checklist (CBCL/1.5-5), which was completed by mothers, at admission and discharge. The mothers' ratings of their children were statistically adjusted for the distortion caused by their own psychopathology. After treatment, the patients showed significant improvement on the C-TRF/CBCL Total Problem score with an average Cohen's d = -0.50 based on therapists' ratings, d = -0.97 for the non-adjusted maternal ratings, and d = -0.68 for the adjusted maternal ratings. We conclude that specialized family day hospitals may successfully treat preschool psychiatric patients.

[Multiprofessional intermittent psychiatric treatment of children in preschool age and their parents in a family day clinic]. / Multiprofessionelle Intervallbehandlung psychisch kranker Kinder im Vorschulalter und ihrer Eltern in einer Familientagesklinik.

Psychiatric treatment of children in preschool age (0-6 years) and their parents is an expanding field of research due to its high clinical significance. Specific family psychiatric treatment programs have been developed to meet the demands of this young age group, but are little known. A multiprofessional intermittent treatment approach sensitive to developmental and family context has been established in the Preschool Family Day Hospital for Infants, Toddlers and Preschoolers and their Families at Münster University Hospital, Germany. Group and individual therapeutic interventions for both children and parents, video-based parent-child-interaction therapy, psychiatric and psychotherapeutic treatments of parents and family therapeutic interventions integrating siblings are supporting and enhancing each other in an innovative and integrated family psychiatric program. First results of evaluation studies are reported that show that this treatment is effective.

Correction of distortions in distressed mothers' ratings of their preschool children's psychopathology.

The often-reported low informant agreement about child psychopathology between multiple informants has lead to various suggestions about how to address discrepant ratings. Among the factors that may lower agreement that have been discussed is informant credibility, reliability, or psychopathology, which is of interest in this paper. We tested three different models, namely, the accuracy, the distortion, and an integrated so-called combined model, that conceptualize parental ratings to assess child psychopathology. The data comprise ratings of child psychopathology from multiple informants (mother, therapist and kindergarten teacher) and ratings of maternal psychopathology. The children were patients in a preschool psychiatry unit (N=247). The results from structural equation modeling show that maternal ratings of child psychopathology were biased by maternal psychopathology (distortion model). Based on this statistical background, we suggest a method to adjust biased maternal ratings. We illustrate the maternal bias by comparing the ratings of mother to expert ratings (combined kindergarten teacher and therapist ratings) and show that the correction equation increases the agreement between maternal and expert ratings. We conclude that this approach may help to reduce misclassification of preschool children as 'clinical' on the basis of biased maternal ratings.

Inter-rater reliability and aspects of validity of the parent-infant relationship global assessment scale (PIR-GAS).

BACKGROUND: The Parent-Infant Relationship Global Assessment Scale (PIR-GAS) signifies a conceptually relevant development in the multi-axial, developmentally sensitive classification system DC:0-3R for preschool children. However, information about the reliability and validity of the PIR-GAS is rare. A review of the available empirical studies suggests that in research, PIR-GAS ratings can be based on a ten-minute videotaped interaction sequence. The qualification of raters may be very heterogeneous across studies. METHODS: To test whether the use of the PIR-GAS still allows for a reliable assessment of the parent-infant relationship, our study compared a PIR-GAS ratings based on a full-information procedure across multiple settings with ratings based on a ten-minute video by two doctoral candidates of medicine. For each mother-child dyad at a family day hospital (N = 48), we obtained two video ratings and one full-information rating at admission to therapy and at discharge. This pre-post design allowed for a replication of our findings across the two measurement points. We focused on the inter-rater reliability between the video coders, as well as between the video and full-information procedure, including mean differences and correlations between the raters. Additionally, we examined aspects of the validity of video and full-information ratings based on their correlation with measures of child and maternal psychopathology. RESULTS: Our results showed that a ten-minute video and full-information PIR-GAS ratings were not interchangeable. Most results at admission could be replicated by the data obtained at discharge. We concluded that a higher degree of standardization of the assessment procedure should increase the reliability of the PIR-GAS, and a more thorough theoretical foundation of the manual should increase its validity.

The neural basis of cognitive change: reappraisal of emotional faces modulates neural source activity in a frontoparietal attention network.

Emotions can be regulated effectively via cognitive change, as evidenced by cognitive behavioural therapy. The neural correlates of cognitive change were investigated using reappraisal, a strategy that involves the reinterpretation of emotional stimuli. Hemodynamic studies revealed cortical structures involved in reappraisal and highlighted the role of the prefrontal cortex in regulating subcortical affective processing. Studies using event-related potentials elucidated the timing of reappraisal by showing effective modulation of the Late Positive Potential (LPP) after 300ms but also even earlier effects. The present study investigated the spatiotemporal dynamics of the cortical network underlying cognitive change via inverse source modelling based on whole-head magnetoencephalography (MEG). During MEG recording, 28 healthy participants saw angry and neutral faces and followed instructions designed to down- or up-regulate emotions via reappraisal. Differences between angry and neutral face processing were specifically enhanced during up-regulation, first in the parietal cortex during M170 and across the whole cortex during LPP-M, with particular involvement of the parietal and dorsal prefrontal cortex regions. Thus, our data suggest that the reappraisal of emotional faces involves specific modulations in a frontoparietal attention network.

Implementing psychiatric day treatment for infants, toddlers, preschoolers and their families: a study from a clinical and organizational perspective.

BACKGROUND: An increasing number of empirical studies indicate that infants, toddlers and preschoolers may suffer from non-transient mental illnesses featuring developmental psychopathology. A few innovative child psychiatric approaches have been developed to treat infants, toddlers and preschoolers and their families, but have not yet been conceptually presented and discussed in the framework of different healthcare systems. The organizational and clinical experience gained while developing specific approaches may be important across disciplines and guide future developments in psychiatric treatment of infants, toddlers, preschoolers and their families. RESULTS: This article introduces the Preschool Family Day Hospital for Infants, Toddlers and Preschoolers and their Families at Münster University Hospital, Germany. This hospital is unique in the German healthcare system with regard to its social-service institution division of labor. Specifically, it uses an intermittent treatment approach and an integrated interactional family psychiatric approach to treat children and their parents as separate patients. This multidisciplinary, developmentally and family-oriented approach includes components of group treatments with children and separate treatments with parents. Specific techniques include video-assisted treatments of the parent-child interaction, psychiatric and psychotherapeutic treatments for parents, and conjoint family therapies that include both parents and siblings. CONCLUSIONS: The Family Day Hospital for infants, toddlers and preschoolers and their families offers innovative family-oriented treatments for those who suffer from a wide range of severe child psychiatric disorders that cannot be sufficiently treated in outpatient settings. Treatment is based on the need for family-oriented approaches to the early psychiatric treatment of infants, toddlers and preschoolers. Family day hospitals are an innovative approach to preschool child psychiatry that requires further evaluation.

Prognosis and continuity of child mental health problems from preschool to primary school: results of a four-year longitudinal study.

In a four-year longitudinal study, changes in and continuity of behavioral and emotional problems were examined in 814 subjects from kindergarten to primary school. Mental health problems were assessed by means of the Child Behavior Checklist (CBCL). The distribution of the CBCL broadband groups revealed a high level of continuity of internalizing symptoms over the four-year period and a shift from externalizing symptoms at baseline towards a combination of internalizing and externalizing symptoms at follow-up. The presence of mental health problems at follow-up was correlated with gender (higher amongst boys), pre-existing mental health problems at baseline, and separation or divorce of the parents, but not with single-family status or the age and educational level of the mother. The increasing number of children with a combination of internalizing and externalizing symptoms demonstrates the increasing complexity of child mental health problems in the developmental span from preschool age to school age.

Regulatory disorders in early childhood: Correlates in child behavior, parent-child relationship, and parental mental health.

According to the guidelines published by the German Society of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (2007), regulatory disorders of early childhood are characterized by a symptom triad, including (a) behavioral symptoms such as excessive crying, sleeping, or feeding problems; (b) a disturbed parent-child relationship; and (c) parental psychopathology. On the basis of a clinic-referred sample of 162 children, we examined whether children with and without regulatory symptoms differed in the quality of parent-child relationship and parental mental health, and how often the criteria of the symptom triad were fulfilled in the group of children with regulatory symptoms. In addition, emotional and behavior problems were compared in children with and without regulatory symptoms. Children with regulatory symptoms and children with other psychiatric symptoms did not differ with respect to child-parent relationship quality. However, parents of children with regulatory symptoms scored higher on the Symptom Checklist 90 Items-Revised (G.H. Franke, 2002) than did the other parents. On the Child Behavior Checklist (T.M. Achenbach & L.A. Rescorla, 2000), children with regulatory symptoms tended to show more somatic problems, but they showed significantly less withdrawn behavior than did the other children. Of the 67 children with regulatory symptoms, only 11 (16.4%) fulfilled all three criteria of a regulatory disorder.

Early emotion discrimination in 8- to 10-year-old children: magnetoencephalographic correlates.

Emotional cues motivate attention and modulate event-related potentials as well as magnetic fields in adults. Central components enhanced by emotional content are Early Posterior Negativity (EPN, 150-300 ms) and Late Positive Potential (LPP, >300 ms). Previous electroencephalography studies in children revealed a differentiation of the late component in response to emotional scenes, but failed to detect an EPN effect. Twenty-two children aged 8-10 years saw 200 arousing pleasant and non-arousing neutral pictures in a rapid serial visual presentation (RSVP) design, while event-related magnetic fields were recorded with whole-head magnetoencephalography (MEG). Analysis of MEG data based on individual picture ratings yielded LPP-m but also EPN-m effects with topography and latency resembling that of adults. Thus, the mechanism of motivated attention at early processing stages (>150 ms) appears mature in children of this age group.

The influence of maternal psychopathology on ratings of child psychiatric symptoms: an SEM analysis on cross-informant agreement.

The distorting influence of maternal depression on the ratings of child behaviour is known as the depression-distortion hypothesis. This study investigated the depression-distortion hypothesis in a clinical sample of child psychiatric preschool children and extended the depression-distortion hypothesis to maternal psychopathology-distortion hypothesis in general. Subjects were 124 children, who were referred for treatment in a Child Psychiatric Family Day Hospital for preschool children, and their parents. Children were rated on the CBCL/1.5-5 and the C-TRF/1.5-5 by their mothers, kindergarten teachers and therapists. Maternal psychopathology was assessed by self-rating with the SCL-90-R and the BDI. The appropriateness of the depression-distortion hypothesis, as well as two alternatives, the accuracy and the combinatory model, were subsequently analysed by structural equation modelling (SEM), including the ratings of all three informants. Model fit and parameter estimation supported the distortion model, suggesting that ratings of child behaviour by mothers may be biased by maternal psychopathology. Findings are discussed with regard to the existing cross-informant literature, with particular consideration of the distortion hypothesis and third person ratings of child psychopathology in preschool age.

Impact of life events on child mental health before school entry at age six.

The study examined the association between life events and early child mental health prior to school entry. The impact of single life events and the cumulative effect of multiple life events on child mental health were examined. In a northern German city, the complete 1-year intake of preschool children at the primary school entry assessment was included. In 1,887 children, life events and psychiatric symptoms were recorded by means of standardized parent questionnaires. Included were all life events between child's birth and school entry. For more than 80 percent of all children, at least one life event was reported. The number of life events was independent of any demographic variable; the mean was 2.2. The number of life events had a highly significant effect on the prevalence of child mental health problems. Six family-change-factors, especially coherent in content, could be identified by factor analysis. The study provides important data on the epidemiology and clinical impact of life events and psychopathology in early childhood. For child mental health, the cumulative effect of multiple life events was found to be much more important than the effect of specific single life events.

Five systems of psychiatric classification for preschool children: do differences in validity, usefulness and reliability make for competitive or complimentary constellations?

DSM-IV and ICD-10 have limitations in the diagnostic classification of psychiatric disorders at preschool age (0-5 years). The publication of the Diagnostic Classification 0-3 (DC:0-3) in 1994, its basically revised second edition (DC:0-3R) in 2005 and the Research Diagnostic Criteria-Preschool Age (RDC-PA) in 2004 have provided several modifications of these manuals. Taking into account the growing empirical evidence highlighting the need for a diagnostic classification system for psychiatric disorders in preschool children, the main categorical classification systems in preschool psychiatry will be presented and discussed. The paper will focus on issues of validity, usefulness and reliability in DSM-IV, ICD-10, RDC-PA, DC:0-3, and DC:0-3R. The reasons for including or excluding postulated psychiatric disorder categories for preschool children with variable degrees of empirical evidence into the different diagnostic systems will be discussed.

Child psychiatric symptoms in primary school : the second wave 4 years after preschool assessment.

OBJECTIVE: Prevalence of behavioural and emotional problems in primary school children was examined 4 years after a baseline survey at preschool age. The scope of symptoms was investigated. Due to anonymity of data only group differences between the two measurements were reported. METHOD: A representative sample of 1,481 children in fourth year primary school was assessed with the Child Behaviour Checklist (CBCL). In addition to the CBCL broadband groups of internalizing (INT) and externalizing symptoms (EXT) a third group of combined internalizing and externalizing symptoms (COM) was defined. RESULTS: The 6 month prevalence of child mental health problems at second wave was 18%-a significant increase on the previous baseline rate of 12.4%. Of those 18% of children with child mental health problems 27.3% had exclusively internalizing, 6.0% externalizing symptoms and 52.4% had combined symptoms of INT and EXT. CONCLUSION: The increasing prevalence was associated with an increase of symptoms of the broadband groups INT and COM but not EXT. The results also highlight an age and gender specific vulnerability of boys, both at preschool and primary school.

Prevalence of behavioural and emotional problems among six-years-old preschool children: baseline results of a prospective longitudinal study.

OBJECTIVE: To study the prevalence of behavioural and emotional problems and the scope of symptoms in preschool children. The results serve as baseline in a 4-year follow-up study. METHOD: The sample consisted of 1887 preschool children who started primary level education within 6 months upon data collection. The sample represented the complete 1-year intake of all first year primary school children in a northern German town of 254,000 residents. The data were collected with standardized parent questionnaires. RESULTS: The 6-month prevalence of behavioural and emotional symptoms was 12.4%. The overall score for internalizing symptoms (INT) was significantly higher than the score for externalizing symptoms (EXT). The disturbed children had the highest mean scores on the syndrome scale "Anxious or Depressed". CONCLUSIONS: The level of psychopathology in preschool children was already as high as levels seen elsewhere in school children. The predominant role of INT was unexpected, particularly for boys. The attention of child mental health services need to focus on preschool children as on school children and on INT as much as on EXT, especially in boys.

Abuso sexual da criança: uma abordagem multidisciplinar, manejo, terapia e intervençäo legal / The multiprofessional handbook of child sexual abuse: integrated management, therapy and legal intervention

Manual prático, multidisciplinar destinado aos profissionais envolvidos no tratamento e cuidado das crianças que sofreram abuso sexual e de suas famílias. Trata dos princípios de procedimento e os conceitos básicos utilizados para lidar com o assunto. Mostra também os problemas práticos e os obstáculos que surgem na prática cotidiana, que podem pôr em risco o sucesso da terapia e do manejo multidisciplinar (FSH)