Persistence of literacy problems: spelling in adolescence and at mid-life.

BACKGROUND: Developmental reading problems show strong persistence across the school years; less is known about poor readers' later progress in literacy skills. METHOD: Poor (n = 42) and normally developing readers (n = 86) tested in adolescence (ages 14/15 years) in the Isle of Wight epidemiological studies were re-contacted at mid-life (ages 44/45 years). Participants completed a spelling test, and reported on educational qualifications, perceived adult spelling competence, and problems in day-to-day literacy tasks. RESULTS: Individual differences in spelling were highly persistent across this 30-year follow-up, with correlations between spelling at ages 14 and 44 years of r = .91 (p < .001) for poor readers and r = .89 (p < .001) for normally developing readers. Poor readers' spelling remained markedly impaired at mid-life, with some evidence that they had fallen further behind over the follow-up period. Taking account of adolescent spelling levels, continued exposure to reading and literacy demands in adolescence and early adulthood was independently predictive of adult spelling in both samples; family social background added further to prediction among normally developing readers only. CONCLUSIONS: By adolescence, individual differences in spelling and its related sub-skills are highly stable. Encouraging young people with reading disabilities to maintain their exposure to reading and writing may be advantageous in the longer term.

Posttraumatic stress disorder in the general population and in children.

Posttraumatic stress disorder (PTSD) is a complex psychopathologic condition that represents a significant challenge to the psychiatric profession. This distressing disorder has been found to affect both adults and children, although the pattern of symptoms in children can differ from that commonly seen in adults. This article presents an overview of the prevalence and incidence of PTSD and discusses factors that may be influential in the development of this disorder following exposure to traumatic events. In addition. the clinical presentation of PTSD in children is reviewed and treatment options for affected children are discussed.

War exposure and maternal reactions in the psychological adjustment of children from Bosnia-Hercegovina.

As part of a UNICEF-sponsored Psychosocial Programme in Bosnia, data were collected from a representative sample of 339 children aged 9-14 years, their mothers, and their teachers in order to investigate risk and moderating factors in children's psychological reactions to war. Self-report data from children revealed high levels of post-traumatic stress symptoms and grief reactions, but normal levels of depression and anxiety. Mothers' self-reports also indicated high levels of post-traumatic stress reactions, but normal levels of depression and anxiety. Child distress was related to both their level of exposure and to maternal reactions. Structural equation modeling was used to quantify the relationships between these risk factors and child distress, and to examine putative pathways to account for the association between child and maternal health. Children's adjustment was associated significantly with both exposure (phi = .37) and maternal mental health (phi = .37). Modeling also revealed a significant distorting effect of mother's own mental health on behavioural ratings of her child (psi = .59). Although evidence exists for an association between maternal mental health and mother rating errors, there is also a substantive association between maternal mental health and children's adjustment following war.

An experimental investigation of hypervigilance for threat in children and adolescents with post-traumatic stress disorder.

BACKGROUND: The present study examined biases in visual attention for emotional material in children and adolescents with post-traumatic stress disorder (PTSD) and healthy controls. METHODS: The participants carried out an attentional deployment task in which probe detection latency data were used to determine the distribution of visual attention for threat-related and depression-related material. RESULTS: The results showed that children and adolescents with PTSD, relative to controls, selectively allocated processing resources towards socially threatening stimuli and away from depression-related stimuli. This attentional avoidance of depression-related information in the PTSD participants declined with age. CONCLUSIONS: The results of the study are interpreted as a consolidation and extension of previous research on attentional bias and emotional disorder in younger participants.

Risk factors for long-term psychological effects of a disaster experienced in adolescence: predictors of post traumatic stress disorder.

This paper examines risk factors for the development of Post Traumatic Stress Disorder (PTSD), and its severity and chronicity, in a group of 217 young adults who survived a shipping disaster in adolescence. The survivors were followed up 5 to 8 years after the disaster. Risk factors examined fell into three main categories: pre-disaster child and family vulnerability factors, including childhood psychopathology; objective and subjective disaster-related experiences; and post-disaster factors, including results from screening questionnaires administered 5 months post-disaster, coping mechanisms adopted subsequently, life events, and availability of social supports. Developing PTSD following the disaster was significantly associated with being female, with pre-disaster factors of learning and psychological difficulties in the child and violence in the home, with severity of exposure to the disaster, survivors' subjective appraisal of the experience, adjustment in the early post-disaster period, and life events and social supports subsequently. When all these factors were considered together, measures of the degree of exposure to the disaster and of subjective appraisal of life threat, and ratings of anxiety obtained 5 months post-disaster, best predicted whether survivors developed PTSD. For those survivors who developed PTSD, its duration and severity were best predicted not by objective and subjective disaster-related factors, but by pre-disaster vulnerability factors of social, physical, and psychological difficulties in childhood together with ratings of depression obtained 5 months post-disaster, and whether survivors received post-disaster support at school. The implications of these findings are considered for targeting assessment and intervention efforts at survivors most at risk of developing difficulties in adjustment following similar traumatic experiences.

Judgements about emotional events in children and adolescents with post-traumatic stress disorder and controls.

Research with clinically anxious adults has revealed that they estimate future negative events as far more likely to occur, relative to healthy controls. In addition, anxious adults estimate that such events are more likely to happen to themselves than to others. Previous research with anxious children and adolescents, in contrast, has revealed no increased probability estimates for negative events, relative to controls, and the events were rated as more likely to happen to others than to the self. The present study followed up these discrepant findings by investigating probability judgements concerning future negative events generated by children and adolescents who had actually experienced an extreme negative event and who met criteria for a diagnosis of Post-traumatic Stress Disorder (PTSD). Control groups comprised a group of healthy participants, and a group of healthy participants whose parents had experienced a trauma and who met criteria for PTSD. The results revealed no overall differences between the clinical group and the controls. However, children and adolescents with PTSD estimated all negative events as significantly more likely to happen to others than to themselves, with this other-referent bias being strongest for events matched to their trauma. In contrast, the two control groups exhibited an other-referent bias for physically threatening events but not for socially threatening ones. Developmental analyses indicated that the strength of the relationship between anxiety and elevated judgements about future negative events declined with age in the control participants but that there was no significant relationship in the groups who had been exposed to trauma. The findings are discussed in the context of the literature on information processing biases and PTSD.

Memory bias for emotional information in children and adolescents with posttraumatic stress disorder: a preliminary study.

Studies with adult participants with emotional disorders have revealed an explicit memory bias in favor of recalling negative emotional information, particularly if the information is related to the participants' emotional concerns. This process was investigated in a preliminary study with children and adolescents with posttraumatic stress disorder and control participants. Participants were presented with sets of negative, neutral, and positive words and asked to recall them after a short retention interval. Posttraumatic stress disorder participants showed poorer overall memory performance compared with control participants. They also showed a bias in favor of recalling negative information, but there was no evidence of any specificity beyond this for threat-related material. Regression analyses revealed no relationship between mood, memory bias, and age. Results are discussed in terms of the adult literature and with respect to issues of the developmental continuity of posttraumatic stress disorder.

The Herald of Free Enterprise disaster. Lessons from the first 6 years.

A substantial body of data has been collected on survivors of the Herald of Free Enterprise disaster over the first 6 years. These data show the psychological effects to be considerable, and although they appear to decrease over time, 6 years later there remains a substantial minority that remains highly distressed. Our research has also pointed to those factors that appear to be important in determining the severity and chronicity of symptoms. Levels of crisis support early on seem to be protective. Not everyone has access to supportive others, and these people would seem to be at increased risk of disturbance. But even if crisis support is potentially available from family and friends, not everyone is in a position to draw on these resources. Those individuals who possess negative attitudes toward emotional expression might be less likely to seek out support. Evidence would suggest that modifying such attitudes might be an important component of intervention. A further target for intervention would seem to be the causal attributions made by survivors. It was found that those who perceived the causes of events during the disaster as internal and controllable were at greatest risk of psychological disturbance. The data gathered in the wake of this disaster suggest that intervening early with respect to these three components (crisis support, attitude to emotional expression, and attributional style) is highly likely to mitigate against long-term distress.

From pogroms to "ethnic cleansing": meeting the needs of war affected children.

Children are both the direct and indirect targets during wars. They are directly affected by violence aimed at them and their families; they are indirectly affected by the distress caused to their families; they may be internally displaced or find themselves crossing borders as asylum seekers. Their experiences during and immediately after war militate against their developing in a safe, secure, and predictable environment. Their human rights are compromised and their mental health put at risk. Whether in the country at and after war, or in the country that offers refuge, children's mental health needs have to be properly assessed and met. In many cases, children may only require a sense of safety and support via their family and school. In other cases, they require more complicated psychosocial interventions that address the various stress reactions they manifest. This paper addresses these issues against the context of a major community-based programme in Mostar in Bosnia during the recent civil war there. It argues that we have reasonably good screening measures to identify children at high risk of developing mental health problems. It presents an hierarchical model of support and intervention whereby psychosocial help is delivered primarily through schools with only a small proportion of more complex needs being met by specially trained mental health professionals. There is a strong need to evaluate various methods of delivering help and to develop new ways of reaching needy children in a nonstigmatising way.

War trauma and psychopathology in Bosnian refugee children.

This paper describes the pattern of psychopathology in a sample of 95 children of 8-13 years, who had experienced war in Bosnia. The children were assessed with a battery of standardised measures during a psychosocial support programme in Northern Greece. They either came from refugee families (44%) or had suffered significant family loss (a parent had been killed in 28% and the father was injured or absent in 27% of cases). Children recalled a substantial number of war traumatic experiences. According to previously established cut-off scores on self-report measures, 45 children (47%) scored within the clinical range on the Depression Self-Rating Scale for Children, 28 (23%) on the Revised Children's Manifest Anxiety Scale, and 65 (28%) on the Impact of Event Scale (IES) measuring PTSD reactions. There was a significant association between the number of war traumatic experiences and the intrusion and avoidance scores on the IES. The findings are discussed in relation to setting up intervention programmes for children victims of war and their families.

The long-term psychological effects of a disaster experienced in adolescence: I: The incidence and course of PTSD.

Previous studies have shown that children and adolescents exposed to traumatic experience in a disaster can suffer from high levels of post-traumatic stress. The present paper is the first a series reporting on the long-term follow-up of a group of young adults who as teenagers had survived a shipping disaster-the sinking of the "Jupiter" in Greek waters-between 5 and 8 years previously. The general methodology of the follow-up study as a whole is described, and the incidence and long-term course of Post-Traumatic Stress Disorder (PTSD). It is the first study of its kind on a relatively large, representative sample of survivors, using a standardised diagnostic interview, and comparing survivors with a community control group. Survivors of the Jupiter disaster (N = 217), and 87 young people as controls, were interviewed using the Clinician Administered PTSD Scale (CAPS). Of the 217 survivors, 111 (51.7%) had developed PTSD at some time during the follow-up period, compared with an incidence in the control group of 3.4 % (N = 87). In the large majority of cases of PTSD in the survivors for whom time of onset was recorded, 90 % (N = 110), onset was not delayed, being within 6 months of the disaster. About a third of those survivors who developed PTSD (30%, N = 111) recovered within a year of onset, through another third (34 %, N = 111) were still suffering from the disorder at the time of follow-up, between 5 and 8 years after the disaster. Issues relating to the generalisability of these findings are discussed.

The long-term psychological effects of a disaster experienced in adolescence: II: General psychopathology.

Children and adolescents exposed to trauma can suffer major adverse psychological effects including not only post-traumatic stress but also other psychological disorders. This study investigates the long-term course of general psychopathology following trauma in adolescence using a standardised diagnostic interview and comparisons with a matched control group. Young people (N= 216) who as teenagers had survived a shipping disaster-the sinking of the "Jupiter" in Greek waters-between 5 and 8 years previously and 87 young people as matched controls were interviewed. The survivors showed raised rates of diagnosis in a range of anxiety and affective disorders during the follow-up period. The highest rates were among the survivors who had developed Post-Traumatic Stress Disorder (PTSD), and those survivors who had not were generally similar to the controls. Onset of anxiety and affective disorders varied between being indefinitely close to the disaster to years later. Differences in rates of disorder between the survivor and control groups had lessened by the time of follow-up but were still apparent, due to continuing distress among the survivors still suffering from PTSD, and to a lesser extent among those who had recovered from PTSD. Generalisability of the findings are discussed.

The assessment and treatment of Post-traumatic Stress Disorder in children and adolescents.

Post-traumatic Stress Disorder (PTSD) is a syndrome defined by the intrusive re-experiencing of a trauma, avoidance of traumatic reminders, and persistent physiological arousal. PTSD is associated with high levels of comorbidity and may increase the risk for additional disorders over time. While controversies remain regarding the applicability of the PTSD criteria to very young children, it has proved to be a useful framework for guiding assessment and treatment research with older children and adolescents. This article presents an overview of the literature on the clinical characteristics, assessment, and treatment of PTSD in children and adolescents.

Lack of attentional bias for emotional information in clinically depressed children and adolescents on the dot probe task.

The present study utilised a cognitive paradigm to investigate attentional biases in clinically depressed children and adolescents. Two groups of children and adolescents--clinically depressed (N = 19) and normal controls (N = 26)--were asked to complete a computerised version of the attentional dot probe paradigm similar to that used by MacLeod, Mathews, and Tata (1986). Results provided no support for an attentional bias, either toward depression-related words or threat words, in the depressed group. This finding is discussed in the context of cognitive theories of anxiety and depression.

Biases in visual attention in children and adolescents with clinical anxiety and mixed anxiety-depression.

Recent research has indicated that anxious adult and child patients and high trait-anxious adults selectively shift attention toward threatening stimuli. The present study extends this research and investigates the content-specificity of the effects in clinically anxious and mixed anxious-depressed children and adolescents. Twenty four generally anxious patients, aged 9 to 18, 19 mixed anxious-depressed patients, and 24 normal controls were comparable with respect to age, sex, verbal IQ, and vocabulary level. The participants carried out an attentional deployment task in which probe detection latency data were used to determine the distribution of visual attention for threat-related and depression-related material. The results showed that clinically anxious children, relative to controls, selectively allocated processing resources toward threat stimuli. However, mixed anxious-depressed children, relative to controls, did not show any attentional bias towards either threat- or depression-related stimuli. Preliminary data on age and gender differences are also presented. The results of this study are discussed in the light of previous research.

Performance of children and adolescents with PTSD on the Stroop colour-naming task.

BACKGROUND: Investigators have used various experimental paradigms such as the Stroop colour naming test to study how adults with different emotional disorders process emotional information. However, to date, little research has been carried out on younger subjects. METHOD: In the current experiment, children and adolescents with post-traumatic stress disorder (PTSD) and control subjects aged 9-17 years, participated in a modified Stroop colour naming task. RESULTS: The results indicated that the children and adolescents with PTSD showed increased Stroop interference for trauma-related material relative to neutral words and to the performance of the controls. CONCLUSIONS: These findings indicate that attentional bias to trauma-congruent information is a function of PTSD in young age groups. The results are discussed with respect to the literature on information processing in PTSD.

Everyday memory deficits in children and adolescents with PTSD: performance on the Rivermead Behavioural Memory Test.

Adult post-traumatic stress disorder (PTSD) patients often report a wide range of cognitive problems in memory, concentration, attention, planning, and judgement. Evaluation of these cognitive aspects of PTSD in adults has helped to define the nature of the disorder. However, there is a paucity of such work in younger subjects. This study has employed the Rivermead Behavioural Memory Test (RBMT) to examine cognitive factors in children and adolescents with PTSD. Eighteen child and adolescent patients with PTSD and 22 control subjects completed the test. PTSD subjects showed poorer overall memory performance compared with controls. Specifically, they were worse on the prospective and orientation items of the RBMT. The results are discussed in the light of research on everyday memory in adults with PTSD.

Performance of children of adults with PTSD on the stroop color-naming task: a preliminary study.

Investigators have used various experimental paradigms to study how individuals with different emotional disorders process emotional information. However, little research has been done on relatives of individuals with emotional disorders, despite developments in the area of emotional contagion. In the current experiment, children of adults with posttraumatic stress disorder (PTSD) (n = 18) and control participants (n = 21), ages 9-17 years, participated in a modified Stroop color-naming task. The results indicated that the children of adults with PTSD showed increased Stroop interference for threat-related relative to neutral words and to the performance of the controls. These findings are discussed with respect to the literature on information processing in PTSD and emotional contagion in families.