Case study: cyproheptadine and aggression in a five-year-old boy.

Cyproheptadine is an antihistamine and serotonin antagonist given to children for allergies, migraine headaches, and growth problems. A 5-year-old boy began to have episodes of violent behavior after the initiation of cyproheptadine therapy. After cyproheptadine was discontinued, the aggression ceased over the course of a few weeks. Although there are other causal explanations possible in this case, cyproheptadine seems the most likely cause of the violent behavior, especially in view of the literature on the relation between serotonin and aggression.

An intervention to improve the reliability of manuscript reviews for the Journal of the American Academy of Child and Adolescent Psychiatry.

OBJECTIVE: The effects of methods used to improve the interrater reliability of reviewers' ratings of manuscripts submitted to the Journal of the American Academy of Child and Adolescent Psychiatry were studied. METHOD: Reviewers' ratings of consecutive manuscripts submitted over approximately 1 year were first analyzed; 296 pairs of ratings were studied. Intraclass correlations and confidence intervals for the correlations were computed for the two main ratings by which reviewers quantified the quality of the article: a 1-10 overall quality rating and a recommendation for acceptance or rejection with four possibilities along that continuum. Modifications were then introduced, including a multi-item rating scale and two training manuals to accompany it. Over the next year, 272 more articles were rated, and reliabilities were computed for the new scale and for the scales previously used. RESULTS: The intraclass correlation of the most reliable rating before the intervention was 0.27; the reliability of the new rating procedure was 0.43. The difference between these two was significant. The reliability for the new rating scale was in the fair to good range, and it became even better when the ratings of the two reviewers were averaged and the reliability stepped up by the Spearman-Brown formula. The new rating scale had excellent internal consistency and correlated highly with other quality ratings. CONCLUSIONS: The data confirm that the reliability of ratings of scientific articles may be improved by increasing the number of rating scale points, eliciting ratings of separate, concrete items rather than a global judgment, using training manuals, and averaging the scores of multiple reviewers.

Follow-up one year after parent-child interaction training: effects on behavior of preschool children.

A preventive mental health intervention previously reported found positive effects in a parent-child interaction training program on attention deficit and internalizing symptoms of low-income preschool children as rated by parents. Families were randomly assigned to a "minimal treatment" control group or a more extensive treatment experimental group. The present study reports follow-up results measured approximately 1 year after the end of the intervention. Parent ratings and child achievement test scores showed no difference between the two groups. Teachers blind to the condition of the intervention, however, rated experimental children as significantly superior to control children with respect to attention deficit and hyperactivity symptoms (preintervention ratings by teachers on the same variable were statistically controlled). Composite teacher ratings of child behavior also significantly favored the experimental group. Children's improvements in classroom behavior were significantly correlated with improvements parents had shown during the intervention in their behavior toward the children.

A symptom self-report measure for preschool children.

The Preschool Symptom Self-Report (PRESS) is a pictorial instrument designed to facilitate the self-report of depressive symptoms by preschool children. It was tested with a sample of 84 Head Start children and their parents and teachers. A parent-teacher version of the instrument correlated with other measures designed for adult rating of children's depression about as well as those measures correlate with one another. It showed high reliability upon retesting by a different examiner within 24 hours. The instrument also showed high internal consistency, which implies that the children responded to items based upon their meaning rather than upon irrelevant characteristics. The retest reliability of the instrument did not depend upon the child's mental age. The children's self-reports showed no relation to adults' ratings of the children's symptoms; this result is consistent with some findings with older children.

Reduction of attention deficit and internalizing symptoms in preschoolers through parent-child interaction training.

A preventive mental health intervention was tested with low income parent-child dyads. Parents who were having a problem with the behavior of their preschool child were recruited; 89 parents, of 96 children, completed pre- and postintervention assessments. Families were randomly assigned to a "minimal treatment" control group or a more extensive treatment experimental group. Parent training was supervised by the authors and delivered by paraprofessionals using standard treatment manuals. The more extensive intervention produced significantly more improvement in parents' ratings of children's symptoms of attention deficit and internalizing symptoms than did the control intervention. A blind measure of videotaped interaction between parent and child also demonstrated significantly more improvement from the experimental intervention. Both groups improved with respect to parents' ratings of children's oppositional symptoms. Change in parent ratings of children's behavior was correlated with change in blind observers' ratings in parents' behavior.

Control groups for psychosocial intervention outcome studies.

In psychosocial outcome research, as contrasted to pharmacologic research, control groups receiving inert treatment, designed to raise expectations but otherwise provide no service, are almost never indicated; this is true because of methodologic as well as ethical reasons. Four types of comparisons suffice as alternatives: treatment versus no treatment, treatment versus minimal treatment, treatment A versus treatment B, and dismantling. When choices are made among these types of comparisons with power analysis and eight other factors taken into account, the questions of outcome research should be answerable with maximum economic efficiency, with maximum benefit to subjects, and without deception.