[Course of development in the second and third decades of life in patients with Kanner's syndrome. Results with special consideration of socially adaptive behavior]. / Entwicklungsverlauf im 2. und 3. Lebensjahrzehnt bei 18 Patienten mit Kanner-Autismus. Ergebnisse einer qualitativen Retrospektivstudie unter besonderer Berücksichtigung des sozialadaptiven Verhaltens.

The course of development of 18 patients with Kanner autism (mean age 28 years) in their second and third decades was explored and recorded with respect to factors affecting social competence in adulthood. To validate the diagnosis, we used the Childhood Autism Rating Scale. A version of the Vineland Adaptive Behavior Scales was employed to assess social adaptation. On average, the individuals showed socially adaptive skills that are typical for healthy children at the age of 4 years and 3 months. Of the autistic persons, 72% showed a characteristic pattern: scoring highest in daily living skills and lowest in social skills, especially in interpersonal relationships, where they performed at an average age equivalent of only 2 years and 7 months.

[Kanner autism. Course of the disorder in the 2nd and 3rd decade in 18 patients with special reference to social adjustment. Results of a qualitative retrospective study]. / Kanner-Autismus. Entwicklungsverlauf im 2. und 3. Lebensjahrzehnt bei 18 Patienten unter besonderer Berücksichtigung des sozial-adaptiven Verhaltens. Ergebnis einer qualitativen Retrospektivstudie.

The development of Kanner autism in 18 patients (mean age 28 years) in their second and third decade was explored and recorded with respect to factors affecting social competence in adulthood. To validate the diagnoses, we used the Childhood Autism Rating Scale (CARS). A version of the Vineland Adaptive Behavior Scales (VABS) was employed to assess social adaptation. On average, the individuals showed socially adaptive skills typical for healthy children at the age of 4 years and 3 months. Seventy-two percent of the autistic persons showed a characteristic pattern: they scored highest in daily living skills and lowest in social skills, especially in interpersonal relationships, where they performed at an average age equivalent of only 2 years and 7 months! Correlation analysis was conducted between developmental factors due to the disorder on the one hand and socially adaptive skills on the other. It showed, among other results, that positive developmental tendencies during adolescence are related to better social adaptation in adulthood ( r=0.57).

[Substance addiction in children and adolescents]. / Drogenkonsum schon im Schulalter weit verbreitet. Was tun, wenn Kinder kiffen?

Youngsters in Germany are becoming addicted at an ever younger age--not only to alcohol and tobacco, but also to illegal drugs. The underlying causes are manifold: in the first place peer duress, curiosity and a search for solace render the child susceptible to the promise of the "panacea". It is of importance to distinguish between "dependency syndrome" and "harmful use". The diagnosis of substance dependence is based on typical clinical features and on detection of the substance in the blood or urine. If dependence is present, the first step is usually detoxification, with efforts undertaken to initiate a competent pediatric/adolescent psychiatric diagnostic work-up and treatment as early as possible. The leading preventive measure is to provide relevant instruction on the dangers of the legal drugs alcohol and tobacco.

[Significance of sibling relations in parental separation]. / Die Bedeutung von Geschwisterbeziehungen bei einer Trennung der Eltern.

Sibling relationships ar a new field in empirical science, and existing data are rather sparse. An overview will be given about the diversity of sibling relationships. General research results will be reported briefly, and special emphasis will be put on the situation of siblings in families undergoing divorce. Starting with the situation of current research an their diverse results two major studies will be described more closely (Conger and Conger 1996; Schmidt-Denter and Beelmann 1995). Furthermore problems of research in the area of sibling relationships will be discussed. Implications of these research results for expert opinions in custody cases will be presented (Karle et al. 2000). A following case study will again demonstrate the complexity of this topic.

[Adolescent arsonists--psychodynamics, family dynamics and attempt at framing a typology based on 40 expert opinions]. / Jugendliche Brandstifter--Psychodynamik, Familiendynamik und Versuch einer Typologie anhand von 40 Gutachtenanalysen.

Psychiatric, psychological and medical data of 40 adolescent firesetters are obtained from a retrospective analysis of expert opinions which have been drawn up by the Department of Child and Adolescent Psychiatry in Tübingen over a period of 16 years (1981-1997). This analysis mainly focusses on the patients' physical and psychosexual development, their social integration and competence and their family dynamics. It further concentrates on the psychic situation at the time of the offense, the reasons and motives given for firesetting (by the patient and by the expert) and specific psychological test results. According to the results three different characteristic groups can be found: 1st a group of offenders who have set fires to their parents' house, 2nd firesetters being member of the firebrigade, and 3rd an unspecific inhomogeneous group of firesetters.

[Child sexual abuse. How to deal with suspected abuse?]. / Sexueller Kindesmissbrauch. Was tun beim Verdacht?

Sexual abuse in children is defined as the exploitation of children by adults for the sexual gratification of the latter. A particular problem is sexual violence within the family. The chronicity of the abuse, by means of which the child is precipitated into role conflicts is typical. Whether inside or outside the family, sexual abuse almost always has negative effects on the child's development. When such abuse is suspected, a gentle physical examination and an empathetic age-adapted psychiatric diagnostic work-up are indicated. The overriding objective of an intervention is to protect the child. The indication of psychotherapy is determined by the severity of the symptomatology. Among other things, prevention strategies are aimed at increasing the autonomy of the child.

Allegations of sexual abuse in child custody disputes.

OBJECTIVE: Allegations of sexual abuse are increasingly made in the context of divorce proceedings. The aim of the study was to describe ideal typical patterns of family dynamics when sexual abuse is alleged in divorce proceedings. METHOD: Development of an assessment plan according to the methods of the qualitative descriptive social sciences and retrospective assessment of 24 legal cases of custody and visitation right proceedings in which allegations of sexual abuse (N = 30 children) were made. RESULTS: In our sample, we found a significant incidence of sexual deviations of a parent. With respect to the allegations of sexual abuse in divorce cases, we were able to identify four types of family dynamics. Our qualitative assessment of the data showed that distinguishing between actual abuse and false allegations cannot adequately help to clarify the family dynamics. Rather, it tends to conceal the fact that even a false allegation usually originates from a sexualized atmosphere in the family. The main family structures which were observed without exception in our sample generally already existed before the separation phase and had corresponding effects on the child which must be considered in the evaluation.

Psychiatric-psychotherapeutic crisis intervention for inpatient adolescents.

We assessed retrospectively in two periods of evaluation all inpatient crisis interventions (n1 = 75, n2 = 65) conducted in a psychiatric hospital for children and adolescents aged 13 to 19 years. In a first preliminary study we described patterns of family dynamics and developed an evaluation plan, which was used in the second study reported here. Familial conflict situations proved to be the essential factors. The adolescents' psychiatric diagnoses differed considerably from those of adult patients. Therapeutic management using a psychoanalytically oriented focal therapy and a more social-psychiatrically oriented crisis management is discussed. Data on adolescents' and families' collaboration as well as on the success of therapy are reported. It was possible to offer developmental prospects if the adolescents were able to consider their inner conflicts and if concurrently an agreement could be reached with the family. Collaboration with community health-care professionals, in particular with the appropriate social workers, was an important step in the majority of cases. Usually discharge to the home followed within a few days, in some cases to a supervised residence group. Twenty-three percent of patients required longer inpatient therapy.

[Expert advice concerning the limitation or suspension of the right of visitation]. / Sachverständigen-Empfehlungen zur Einschränkung oder zum Ausschluss des Umgangsrechts.

Between 1991 and 1994 the Department of Child and Adolescent Psychiatry and Psychotherapy of the University of Tübingen has drawn up 439 expert opinions in family court cases (child custody or visiting privileges). In 83 cases (18.9%) the judicial question exclusively referred to visitation, in 89 cases (20.3%) it referred to child custody and visitation. In 39 (22.7%) out of these 172 expert opinions the recommendation was to suspend the visits for a certain period; in 31 (18%) cases the expert adviced to restrict the visits. The main criteria, which led to the recommendations are discussed.

[Recommendations for terminating child custody--reasons and grounds in 30 expert decisions]. / Empfehlungen zum Ausschluss des Umgangsrechts-Gründe und Begründungen aus 30 Gutachten.

In a retrospective analysis 30 expert opinions on the right of visitation, which recommend the exclusion of this right for the non-custodial parent, are evaluated. These cases represent 23% of the expert opinions concerning the right of visitation that have been given by the department of Child and Adolescent Psychiatry of the University of Tübingen between 1991 and 1994. Focusing on the decisive argument for the expert to exclude the right of visitation, it became apparent that in 40% of the cases the will of the child was the determining factor, followed by sustained tension between the parents in 33% of the cases. Emotional neglect, (continuous) abuse and maltreatment (12%) as well as offences against the clause of good behaviour (Wohlverhaltensklausel) were of significant smaller influence on the decision. And although 61% of the children have been classified as psychological disturbed, only in 5% of the cases this diagnosis was of importance.

[Murder of the mother by the daughter--family dynamics and mythology]. / Muttermord durch die Tochter--Familiendynamik und Mythologie.

The comprehensive casuistry, which is based on the forensic examination by the author illustrates a family-drama, in which a 19-year-old girl killed her alcohol and tablet dependent mother in multiple ways and later, with the help of the three years younger sister plastered the body in a sarcophagus inside the apartment. The paper will delineate the life-circumstances, the family- and the psychodynamic of the criminal act. Beside a review of the literature concerning matricide by the daughter, the dynamic aspect of the matricide will be discussed on the basis of the greek tragedies Elektra (Sophokles) and Medea (Euripides). The victim is compared with the part of Medea, the fate of the daughter with the fate of Elektra.

[Bibliotherapeutic dream work after acute psychotic decompensation]. / Bibliotherapeutische Traumarbeit nach akuter psychotischer Dekompensation.

The paper reports about a follow-up treatment of a 15,5 year old female youth, who had suffered a polymorph psychotic disturbance with schizophrenic symptomatology. The symptoms began after a sexual encounter with a friend. During her illness the patient considered herself as "Jesus". By means of intensive dream work and bibliotherapy the psychotic events could be identified and understood subjectively. Three months after the onset of the illness the psychotic anxieties could be addressed by reading the Grimm fairy tale "The robber's bride" and could thus be better understood and classified. The patient's anxieties referred to physical and emotional disintegration (to be incorporated, to be Christ himself, and to give away his body). The patient could recall these anxieties as having actually occurred to her at the beginning of her illness.

[Patient admission to a child and adolescent psychiatric polyclinic. Referral, patient information, preparation, concepts, expectations and fears of children, adolescents and their parents]. / Die Eingangssituation in einer kinder- und jugendpsychiatrischen Poliklinik. Zugangswege, Informiertheit, Vorbereitung, Vorstellungen, Erwartungen und Befürchtungen bei Kindern, Jugendlichen und ihren Eltern.

This study investigates 77 families i.e. their children, aged 7-17, and their parents, who attended the out-patient clinic of the child psychiatric department for the first time. It was intended to examine and outline the subjective situation on entering the clinic. A structured verbal interview was conducted with the children before the start of the actual examination procedure, while a written questionnaire was submitted to the parents. Among the questioned items were modes of referral, references, sources of information, knowledge and preparedness, ideas, expectations and apprehensions about the institution and its treatments. The answer that were obtained reflected a lack of self-determination on the part of the children and the strength of influence exerted by the parents along with other relevant authorities. The children were often taken to the clinic without any active consent on their part. When asked about hopes of improvement they did not often confirm. Similarly fears about the impending examination were at first denied by most children but subsequently conceded, when concrete suggestions were made. Strikingly the better informed and prepared, children were able to admit to their fears more often. The results of the parental questionnaire illustrate an extensive lack of information about the institution that the families were actually attending. It may be concluded that the parents had also been little assertive when preparing their children for the examination. When asked about their expectations the parents primarily quoted "help" and "advice". Scepticism about the examination came only at the bottom of the list.(ABSTRACT TRUNCATED AT 250 WORDS)

Child-welfare recommendations in contested divorce and separation cases. Critical family situations and problematical behavior patterns on the part of parents and children.

Out of a collection of 121 child and adolescent psychiatric or psychological recommendations in family court cases, some 60 opinions were subjected to retrospective study. All the cases studied involved a single child to be recommended. In a retrospective analysis, the aim was to identify dangerous psychological constellations in the separating families, in particular typical behavioral and coping patterns of the parents in the process of separation and the typical reactive patterns of the children caught in the process. The study is designed as a descriptive analysis with the aim of sensitizing the helping-systems involved to better perception of such problem constellations. Thus it offers recommendations for parents, lawyers, judges and social-workers in the separation process.

Psychological maltreatment in the context of separation and divorce.

Children of separating or divorcing parents seldom escape suffering psychological stress, particularly when the parents are in open conflict. How much should such children be allowed to suffer? The author discusses the problem of defining the terms "emotional child abuse" and "psychological maltreatment" as they are used in the literature. Reviewing the common behavioral patterns that children in this situation resort to and the roles that they tend to take upon themselves, he attempts to distinguish between those instances of stress that can be regarded as acceptable and those that must be considered harmful. With respect to children in this situation, the following behavior patterns are discussed: (a) the inclination of the child to sacrifice itself for the sake of the parents, in particular for the "weaker" one; (b) the tendency of the children to reach agreements among themselves about how they should be divided up; (c) the phenomenon of parentization in which the child assumes the role of the substitute partner for one or the other parent; and (d) the child's discovery of both its power and its helplessness with respect to the situation and the feelings of guilt awakened by this discovery.