Modifying the 'Positive Parenting Program' for parents with intellectual disabilities.

BACKGROUND: Many parents with intellectual disabilities (ID) want and/or need professional guidance and support to learn skills and strategies to prevent and manage child behaviour problems. However, the available support is rarely suitable, and suitable support is rarely available. The aim of this study was to determine whether a popular mainstream parenting training programme, known as 'Group Triple P' (Positive Parenting Program), could be successfully modified for this parent group. METHOD: A pilot study was undertaken to determine whether a modified version of Group Triple P would engage and retain parents with ID. A non-experimental, pre-test post-test study, involving a total of 30 parents with ID, was then undertaken to obtain preliminary efficacy data. RESULTS: Parent engagement and participation levels were high. No parent 'dropped out' of the programme. After completing the modified Group Triple P programme, parents reported a decrease in psychological distress, maladaptive parenting and child conduct problems. Parents reported high levels of satisfaction with the information and support they received. CONCLUSION: Research-informed adaptation of mainstream behavioural family interventions, such as Group Triple P, could make 'suitable support' more readily available, and more engaging for parents with ID.

How common are motor problems in children with a developmental disorder: rule or exception?

BACKGROUND: Few co-morbidity studies have been conducted since the Leeds Consensus Statement on developmental co-ordination disorder (DCD) in 2006. In this Statement, international cut-offs and inclusion criteria were agreed and consequently, the status of DCD changed. Furthermore, most existing co-morbidity studies are small clinical studies, rather than epidemiological studies, resulting in a broad range of co-morbidity rates. DCD has a higher incidence for boys in comparison with girls; questions arise if this preponderance remains the same in combination with other developmental disorders. Therefore, in this study we aimed to determine co-morbidity and gender differences of motor problems in children with a pervasive developmental disorder, a hyperkinetic disorder and/or a speech, language or learning disability. METHODS: Profiles of 3608 children (mean age: 9 years 1 month) referred to rehabilitation centres for behavioural, developmental and sensorineural disorders were studied. RESULTS: Motor problems were reported in one-fifth of the total sample. Co-morbidity of motor problems in specific disorders varied from almost one-fourth to more than one-third. The male/female ratio was significantly higher in children with motor problems and two or more other disorders, compared with children with motor problems and less than two other disorders. CONCLUSIONS: This study indicates that co-morbidity of motor problems with other clinical disorders is not exceptional and developmental deviance is seldom specific to one domain. However, current co-morbidity studies tend to overestimate the number of children with motor problems. In addition, there may be different patterns of symptoms between the genders. These findings stress the importance of assessing motor skills in children with various developmental disorders.

[Narcolepsy in children with a psychiatric disorder]. / Narcolepsie bij kinderen met een psychiatrische stoornis.

Children with a psychiatric disorder often have sleep problems. To interpret these problems correctly one needs to conduct a multimodal investigation at three levels: internal, psychiatric and neurological. On the basis of a case study we discuss the differential diagnostic considerations for narcolepsy and a diagnostic protocol for children.

Psychopathology among preterm infants using the Diagnostic Classification Zero to Three.

AIM: To compare the prevalence of psychopathology in infants born preterm with matched full-term infants at the corrected age of 1 year. METHODS: Between June 2003 and April 2005, a case-control longitudinal cohort study was conducted at the neonatal unit of the University Hospital of Antwerp, Belgium. We prospectively enrolled 123 live-born infants between 25 and 35 weeks of gestation and/or infants with a birth-weight of <1500 g. Thirty full-term infants were recruited among day care centres in the region. Diagnoses were based on the Diagnostic Classification Zero to Three (DC: 0-3), using the MacArthur Communicative Developmental Inventory Dutch version, Infant-Toddler Sensory Profile, Bayley Scales of Infant Development II, Parent Infant Relationship Global Assessment Scale and Functional Emotional Assessment Scale. RESULTS: At the (corrected) age of 12 months, 89 infants were eligible for follow-up and complete data were available for 69 (77%) infants. Fifty-four percentage of the preterm infants fulfilled one or more DC 0-3 diagnoses. Premature infants had significantly more diagnoses than full-term infants on axis I, axis III and axis V of the DC: 0-3. CONCLUSION: In this study, the prevalence of psychopathology was significantly higher among preterm infants in comparison with full-term infants. This study did not confirm previous findings of higher rates of relationship disorders among preterm infants.

Peripheral markers of serotonergic and noradrenergic function in post-pubertal, caucasian males with autistic disorder.

Some studies have suggested that disorders in the peripheral and central metabolism of serotonin (5-HT) and noradrenaline may play a role in the pathophysiology of autistic disorder. This study examines serotonergic and noradrenergic markers in a study group of 13 male, post-pubertal, caucasian autistic patients (age 12-18 y; I.Q. > 55) and 13 matched volunteers. [3H]-paroxetine binding Kd values were significantly higher in patients with autism than in healthy volunteers. Plasma concentrations of tryptophan, the precursor of 5-HT, were significantly lower in autistic patients than in healthy volunteers. There were no significant differences between autistic and normal children in the serum concentrations of 5-HT, or the 24-hr urinary excretion of 5-hydroxy-indoleacetic acid (5-HIAA), adrenaline, noradrenaline, and dopamine. There were no significant differences in [3H]-rauwolscine binding Bmax or Kd values, or in the serum concentrations of tyrosine, the precursor of noradrenaline, between both study groups. There were highly significant positive correlations between age and 24-hr urinary excretion of 5-HIAA and serum tryptophan. The results suggest that: 1) serotonergic disturbances, such as defects in the 5-HT transporter system and lowered plasma tryptophan, may play a role in the pathophysiology of autism; 2) autism is not associated with alterations in the noradrenergic system; and 3) the metabolism of serotonin in humans undergoes significant changes between the ages of 12 and 18 years.

Child sexual behavior inventory: A Dutch-speaking normative sample.

OBJECTIVES: To describe normative sexual behavior in Dutch-speaking children; to assess the frequencies of different types of sexual behaviors reported in children by their parents; to analyze the relation of these sexual behaviors to demographic, personal, familial, and general behavioral variables; and to compare the Dutch-speaking sample with American samples. METHOD: Nine hundred seventeen children (2-12 years of age), screened to exclude sexual abuse, were rated by their caregiver via parent report consisting of the translated Dutch version of the Child Sexual Behavior Inventory, the Child Behavior Checklist, a life event checklist, and a questionnaire assessing family nudity and parental attitudes regarding sexuality. RESULTS: Frequencies of a wide variety of sexual behaviors for 2- to 5-, 6- to 9-, and 10- to 12-year-old children are presented. Sexual behavior was found to be related to the child's age, maternal education, family nudity, and parental attitudes toward sexuality. The positive relation to general behavioral problems was confirmed. Findings were primarily similar to previously published American studies. CONCLUSION: Our study confirms that sexual behavior in children is varied and related to developmental, personal, and familial factors. The relative frequency of the wide variety of sexual behaviors in a Dutch-speaking normative sample is comparable to American samples.

Psychopathology among children and adolescents in child welfare: a comparison across different types of placement in Flanders, Belgium.

BACKGROUND: Children and adolescents in child welfare are characterised by a high rate of psychopathology. However, prevalence estimates vary greatly, and comparisons between studies are limited owing to different target populations, measurement tools and how results are presented. In addition, little is known about the situation of children under child welfare care still living with their parents. METHODS: The Achenbach System of Empirically Based Assessment and the Strengths and Difficulties Questionnaire used to measure psychopathology, were administered to parent, agency carer and adolescent (if older than 11). Data of 292 children aged 3-17 years (mean age, 12.13 years) with at least one respondent of four types of placement, namely foster care, residential care, day care and home-based care, were included (response rate, 78%). Socioeconomic characteristics and psychopathology were examined across these four types of placement. RESULTS: Overall, the proportion of children scoring within the clinical range according to at least one informant was 56% according to the Strengths and Difficulties Questionnaire and 54% according to the Achenbach System of Empirically Based Assessment. Rates were highest among children living at home and significantly lower among children in out-of-home placement, even after correcting for age, income and duration of the ongoing placement. Adolescents scored themselves lower on psychopathology in comparison with their parents and the agency carer. CONCLUSIONS: The prevalence of psychopathology in this child welfare population was very high; however, the findings were consistent with results obtained in previous studies. The prevalence estimates differed depending on the type of placement: the highest rates were found among children in home-based care, and children in foster care suffered less psychopathology. The findings stress the vulnerable mental status of children in child welfare and the need for additional support for child welfare professionals and children, as well as their parents, especially for those living with their parents.

[Psychotherapy training in specialist child and adolescent psychiatry].

This paper presents the guidelines for psychotherapy training as part of specialist child and adolescent psychiatry training, as approved by the Section of Child and Adolescent Psychiatry and Psychotherapy (CAPP) of the European Union of Medical Specialties (UEMS). The goal of psychotherapy training as part of specialist CAPP training is to raise the trainees` awareness as regards the requirements in force in each EU country, for one or all the main psychotherapeutic modes. That is: psychoanalytic/psychodynamic individual psychotherapy, cognitive behavioral psychotherapy, or family psychotherapy. Psychotherapy training consists of three elements described in detail for each psychotherapeutic mode: (a) familiarity with theoretical models, (b) personal skills and knowledge of techniques, and (c) awareness of own life experience. The guidelines also include the following: (a) Τhe volume of training for each mode, while stressing the need for individual and group supervision of the trainees by a qualified child and adolescent therapist, (b) Τhe competence level and what is included in each psychotherapeutic mode, (c) Τhe evaluation of the training process. It should be noted that the situation in the field of psychotherapy training, as well as the educational resources and potential, vary from one European country to another.

Pathophysiology of autism: current opinions.

Research on the neurochemical aspects of the pathophysiology of autism is still increasing and publications are abundant. In this paper we reviewed significant data from the last decade and recent research results from our center. We focused on molecules influencing the central nervous system (CNS) and consecutively responsible for typical autistic behavior. We highlighted the mutual relationship between the serotonergic, immunological and endocrinological system and the interaction of these three pivotal systems with predisposing (genetic)and external (pre-, peri- and postnatal) conditions and xenobiotics. We stressed the influence of age, pubertal stage, sex, race and IQ on biological data. There is growing evidence that the complexity and variability of those interactions might be responsible for the heterogeneity of behavioral phenotypes and biological findings in Autism. Genetic, neuroanatomical and neurophysiological data were mentioned according their relevance to neurochemical opinions.

Antisocial behaviour and mental health. Findings from three communities.

AIM: To investigate the relationship between antisocial behaviour and psychopathology (depression, somatization, anxiety), expectations for the future, and sensation seeking in adolescents. METHOD: A cross-national self-report study assessing 955 students in Antwerp (Belgium), 1026 in Arkhangelsk (Russia) and 1391 in New Haven (US) was conducted. Adolescents were assigned antisocial group status according to the nature of their reported deviant behaviour. A non-antisocial group, a moderate antisocial group (non-aggressive behaviour) and a severe antisocial group (mainly aggressive behaviour) were identified. RESULTS: In both genders and in all three countries, depression, somatization, negative expectations for the future and sensation seeking gradually increased from the non-antisocial group to the moderate antisocial group, and finally to the severe antisocial group. Levels of anxiety were insignificant across most groups. CONCLUSION: Although cross-national differences exist, the variables of interest showed markedly similar trends between antisocial groups across countries. The current study adds to the debate over the relationship between anxiety and antisocial behaviour.

A descriptive survey of Flemish delinquent adolescents.

Previous research has shown that delinquent adolescents are characterized by a number of psychiatric problems. Most of these assessments, however, have been conducted on incarcerated adolescents. By means of semi-structured assessment (Child Assessment Schedule) and self-report measures, we assessed psychiatric status in a group of 72 delinquent adolescents, adjudicated before the Juvenile Court of Antwerp, Belgium. A significant difference was found between ethnic groups on self-report scores. Seventy per cent of subjects received at least one psychiatric diagnosis. The most prevalent diagnoses were conduct disorder (CD), substance abuse disorder and attention deficit hyperactivity disorder (ADHD). Less prevalent were post traumatic stress disorder (PTSD) and major depression (MD). As we found that an unselected sample of delinquent adolescents show a great number of psychiatric disorders, we suggest that psychiatric screening of delinquent adolescents should be done systematically. The predictive value of psychiatric assessment and subsequent treatment in delinquent adolescents should be investigated by future, prospective research.

Eight month follow-up of delinquent adolescents: predictors of short-term outcome.

Clinicians working with young delinquents are concerned with finding methods to predict recidivism in these subjects. It has not been investigated yet to what extent psychiatric assessment can be of any help in this field. In this study, we investigated whether psychiatric assessment can help to predict recidivism in already delinquent adolescents. By means of semi-structured psychiatric assessment (Child Assessment Schedule), developmental interview of the parents and self-report instruments, we assessed the psychiatric status of 72 delinquent adolescents, adjudicated before the Juvenile Court of Antwerp (Belgium). A follow-up of criminal status after eight months was conducted. Self-report questionnaires by the subjects did not differentiate recidivists from non-recidivists, while parent questionnaires did. Through a semi-structured interview, we found that a diagnosis of conduct disorder significantly predicts recidivism, while subjects with ADHD and substance abuse show a tendency towards more recidivism. We were unable, however, due to the small number of subjects showing a psychiatric disorder (e. g. ADHD and PTSD) unrelated to conduct disorder, to assess the relative contribution of these disorders to the recidivism rate. This study found that psychiatric assessment of delinquent adolescents could be of help in predicting recidivism. The necessity of gathering information from parents and teachers is demonstrated. Future research should include a more extensive group of a delinquent adolescent and should focus on the effect of therapeutic interventions.

Increased serum albumin, gamma globulin, immunoglobulin IgG, and IgG2 and IgG4 in autism.

BACKGROUND: Research on the biological pathophysiology of autism has found some evidence that immune alterations may play a role in the pathophysiology of that illness. As a consequence we expected to find that autism is accompanied by abnormalities in the pattern obtained in serum protein electrophoresis and in the serum immunoglobulin (Ig) and IgG subclass profile. METHOD: We examined whether subjects with autism showed changes in total serum protein (TSP) and the serum concentrations of albumin, alpha1 globulin, alpha2 globulin, beta globulin and gamma globulins, IgA, IgM and IgG and the IgG subclasses IgG 1, IgG2, IgG3 and IgG4, compared with normal controls. RESULTS: We found significantly increased concentrations of TSP in autistic subjects, which were attributable to increased serum concentrations of albumin and gamma globulin. Serum IgG, IgG2 and IgG4 were also significantly raised. In autism there were significant and positive correlations between social problems and TSP and serum gamma globulin and between withdrawal symptoms and TSP and serum albumin and IgG. CONCLUSIONS: The results suggest that autism is characterized by increased TSP, a unique pattern obtained in serum protein electrophoresis, i.e. increased serum albumin and IgG, and by a specific IgG subclass profile, i.e. increased serum IgG2 and IgG4. The increased serum concentrations of IgGs in autism may point towards an underlying autoimmune disorder and/or an enhanced susceptibility to infections resulting in chronic viral infections, whereas the IgG subclass skewing may reflect different cytokine-dependent influences on autoimmune B cells and their products.

A major SNP haplotype of the arginine vasopressin 1B receptor protects against recurrent major depression.

Increasing amounts of data suggest that affective disorders might be related to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, one of the stress-response systems. Arginine vasopressin (AVP) influences several symptoms, relevant to affective disorders, notable memory processes, pain sensitivity, synchronization of biological rhythms and the timing and quality of REM sleep. We examined whether genetic variations in the AVP receptor 1b gene (AVPR1b) could be associated with increased susceptibility to affective disorders using a gene-based association analysis of single-nucleotide polymorphisms (SNPs). Five SNPs were identified in AVPR1b and genotyped in two well-diagnosed samples of patients with recurrent major depression and matched controls. In the Swedish sample, we observed significant allele (P=0.02) and genotype (P=0.01) association with SNP AVPR1b-s3, and in the Belgian sample, a borderline significant association with SNP AVPR1b-s5 (P=0.04). In both patient-control samples, the haplotype defined by alleles A-T-C-A-G for the AVPR1b-s SNPs s1-s2-s3-s4-s5 was significantly over-represented in controls compared to patients. Our data support a protective effect of this major haplotype for recurrent major depression.