Prediction of early-onset asthma in genetically at-risk children.

The W.T. Grant Foundation Asthma Risk Study was designed to prospectively examine children who were considered at a genetically increased risk for the development of asthma. The respective contributions of 11 potential risk factors, both environmental and biological, were assessed in order to determine their relative roles in affecting the early onset of asthma. This is a report of an inception cohort of children born to asthmatic mothers and followed for a 3-year period. All 150 families were recruited from the general community and living within 2 h of the National Jewish Center for Immunology and Respiratory Medicine (Denver, CO). Mothers in the index risk sample had been previously diagnosed with asthma and were recruited during their pregnancy through physician referrals and media solicitation. The index sample of 150 families was 92% Caucasian and predominantly middle class. The mean age of mothers was 29.3 years, and of fathers, 31.1 years. The main outcome was the determination of the early onset of asthma and its association with quantified risk factors. By age 3 years, 14 of the 150 children had developed asthma. Frequent illness, IgE levels at age 6 months, parenting difficulties, and early eczema were significantly associated with the onset of asthma (P = 0.003, P = 0.006, P = 0.01, and P = 0.03, respectively). Only frequent illness, elevated serum IgE levels, and parenting difficulties entered a predictive model where they were independently related to the development of asthma.

Effective treatment for mental disorders in children and adolescents.

As pressure increases for the demonstration of effective treatment for children with mental disorders, it is essential that the field has an understanding of the evidence base. To address this aim, the authors searched the published literature for effective interventions for children and adolescents and organized this review as follows: (1) prevention; (2) traditional forms of treatment, namely outpatient therapy, partial hospitalization, inpatient treatment, and psychopharmacology; (3) intensive comprehensive community-based interventions including case management, home-based treatment, therapeutic foster care, and therapeutic group homes; (4) crisis and support services; and (5) treatment for two prevalent disorders, major depressive disorder and attention-deficit hyperactivity disorder. Strong evidence was found for the treatment of attention-deficit hyperactivity disorder, depression, anxiety, and disruptive behavior disorders. Guidance from the field relevant to moving the evidence-based interventions into real-world clinical practice and further strengthening the research base will also need to address change in policy and clinical training.

Institute of Medicine report on prevention of mental disorders. Summary and commentary.

A comprehensive report mandated by the U.S. Congress on the state of the science of prevention recommends a stricter definition of the term prevention; summarizes specific preventive intervention research programs across the life span; and specifies funding, personnel, and coordination priorities to build a national prevention research infrastructure. A major conceptual recommendation is a focus on reducing risk for mental disorders, which has been a fruitful strategy in the prevention of physical illness. The report argues that the prevention field should also draw from advances in mental disorder treatment research and from the major contributions to the knowledge base occurring in the behavioral and biological core sciences. Relevant advances in neuroscience, genetics, epidemiology, and developmental psychopathology are examined in detail. Five major disorders are chosen to illustrate possible approaches to prevention: conduct disorder, depressive disorders, alcohol abuse and dependence, schizophrenia, and Alzheimer's disease.

Early asthma onset: the interaction between family stressors and adaptive parenting.

It has been repeatedly noted by clinicians that psychological stressors appear to be associated with the expression of asthma in individuals who have a genetic vulnerability for developing the disease. While retrospective evidence has supported this clinical observation (Levitan 1985; Teiramaa 1986), the association between emotional stressors and illness onset can only be convincingly demonstrated using a longitudinal design (Mrazek 1988; Steinhausen et al. 1983). In 1985 the W. T. Grant Asthma Risk Study was designed to identify which physiological and psychological risk factors for asthma were most highly associated with eventual expression of the disease. Young infants who were genetically at risk for asthma were evaluated and their development was prospectively monitored. The primary objective of the longitudinal study was to identify risk factors for illness expression. If this were possible, these risk factors could then be targeted for intervention efforts designed to delay the initial onset of asthmatic symptoms. The ultimate objective of an effective intervention would be that for some children, the illness could be prevented completely.

Resilience in child maltreatment victims: a conceptual exploration.

While many child maltreatment victims suffer serious negative emotional sequelae, others do surprisingly well. Resilience in children is a relative concept which can change over time and is affected by environment and genetics. Resilience is fostered by protective factors which ameliorate or alter a child's response to the hazards of maltreatment that usually predispose to maladaptive outcome. Personal characteristics or skills that may foster resilience include (1) rapid responsivity to danger; (2) precocious maturity; (3) dissociation of affect; (4) information seeking; (5) formation and utilization of relationships for survival; (6) positive projective anticipation; (7) decisive risk taking; (8) the conviction of being loved; (9) idealization of an aggressor's competence; (10) cognitive restructuring of painful experiences; (11) altruism; and (12) optimism and hope. There are also generic life circumstances, such as having access to good health, educational, and social welfare services, that foster resilience in children regardless of the specific nature of the stressor. Additionally, there may be abuse-specific protective factors in the environment. Examples might include the quick and full acknowledgment of an offender regarding abuse, or timeliness and permanence of legal actions affecting a child's custody. The life stories of three well-known survivors of various forms of child maltreatment illustrate how protective factors contribute to resilience. A caution is noted regarding how personal characteristics developed for survival may become maladaptive if overused and/or not given up when the stressor no longer exists. Characterological problems are most likely to develop when a child's life circumstances fail to change and the environment never becomes secure.

Sexual abuse of children in the United Kingdom.

Questionnaires were circulated to 1,599 family doctors, police surgeons, paediatricians, and child psychiatrists to determine the frequency and nature of child sexual abuse in the United Kingdom. At least three per 1,000 children are currently being recognized as sexually abused sometime during their childhood. The majority of cases reported involved actual or attempted intercourse, and 74% of the perpetrators were known to the child. Family disturbance was noted in 56% of the cases. The most common outcome (43%) was criminal prosecution of the perpetrator. Area Review Committees had no clear policy for the management of sexual abuse. Before it is possible to protect children and to develop therapeutic services for the family, it will be necessary to acknowledge that sexual abuse is part of the child abuse spectrum.