Sexually abused girls: patterns of psychopathology and exploration of risk factors.

This paper studies the patterns of psychopathology in sexually abused girls. It also explores some environmental risk factors for psychopathology including abuse characteristics and environmental experiences. The data are derived from the baseline assessment of 81 sexually abused girls referred to the London Child Sexual Abuse Psychotherapy Outcome Study (collaborative Tavistock and Maudsley project). Data about abuse were collected from the parent or foster parent using a standardised, semi-structured interview format. The girls' psychopathology was assessed using the Kiddie-SADS schedule. Widespread and serious psychopathology in sexually abused girls attending a psychotherapy clinic previously reported in a small-scale study was confirmed; so, too, was the extent of comorbidity and impairment of psychosocial functioning. Further, a significant association was found between children looked after away from home and high rates of Separation Anxiety Disorder. No such significant associations were found for Major Depressive Disorder nor impairment of functioning. Multivariate prediction analysis revealed that significant predictors of Major Depressive Disorder consisted of seriousness of abuse, the abuser not being a parent figure, and the abuse not being recent; the only significant predictor of Separation Anxiety Disorder was that the abuser was not a parent figure; finally, impairment of general functioning was strongly predicted by the greater seriousness of abuse and also by the abuser/s not being a parent figure. Theoretical explanations advanced for the reported associations have a sense of face validity: that girls abused by strangers will be at risk of developing Separation Anxiety Disorders; that serious sexual abuse is followed by the development of a Major Depressive Disorder and a high level of impairment of social functioning.

Social adjustment in three cultures: data from families affected by chronic blood disorders. A sibling study.

This study explores the rate of psychosocial dysfunction in affected and unaffected children from families with haemophilia or beta-thalassaemia, as part of a cross-sectional, multicentre study into the resilience of 115 families with blood disorders. Sociodemographic and developmental data were collected from the parents using a standardized and semi-structured interview format, and medical data were obtained from the clinician. The children's social functioning over the year prior to the assessment was assessed with The Social Adjustment Scale adapted for school-aged children. Children with beta-thalassaemia showed significantly higher rates of social dysfunction than their unaffected siblings or children with haemophilia and their siblings. Older children showed significantly higher social dysfunction at school. The high rate of social dysfunction in children with beta-thalassaemia compared with unaffected siblings is likely to have a basis in the negative experiences associated with their medical problems. In contrast, the therapeutic advances in haemophilia allows boys to lead an almost normal life. Overall, the rates of social dysfunction in families with both these disorders proved commoner than reported in population surveys, but with the unavailability of local population controls, caution needs to be exercised in the interpretation of this finding.

Psychopathology in children from families with blood disorders: a cross-national study.

BACKGROUND: This study examines the prevalence of psychiatric disorders in affected and in unaffected siblings from families with haemophilia or beta-thalassaemia. METHOD: Based on data derived from a cross-sectional and multi-centre study into the resilience of 115 families with blood disorders. Sociodemographic and developmental data were collected from the parent using a standardised and semi-structured interview, and medical data were elicited from the attending clinician. The children's psychopathology was assessed with the Schedule for Affective Disorders and Schizophrenia (K-SADS). RESULTS: Children with beta-thalassaemia were twice as likely to receive a diagnosis of psychiatric disorder and more likely to show a higher degree of impairment of general functioning than haemophilic boys or unaffected children from families with blood disorders. Clinical severity of haemophilia or beta-thalassaemia was not associated with significant differences in prevalence of child psychiatric disorders or impairment. Mothers' evaluation of their relationship with their child as 'less than easy' predicted psychopathology. CONCLUSIONS: The high prevalence of psychopathology in children with beta-thalassaemia reported in this study suggests that specific blood disorders have differential impact on affected children. This difference may be related to medical therapy advances in haemophilia so that haemophilic boys can lead an almost normal life.

Psychotherapy for sexually abused girls: psychopathological outcome findings and patterns of change.

BACKGROUND: Controversy exists about the efficacy of psychotherapy for the mental health problems of sexually abused children. AIMS: To compare the relative efficacy of focused individual or group therapy in symptomatic sexually abused girls, and to monitor psychiatric symptoms for persistence or change. METHOD: A multi-centre psychotherapy outcome study recruited 71 sexually abused girls aged 6-14 years who were randomly assigned to focused individual psychotherapy (up to 30 sessions) or psychoeducational group therapy (up to 18 sessions). Changes over the course of the study were monitored. RESULTS: Both treatment groups showed a substantial reduction in psychopathological symptoms and an improvement in functioning, but with no evident difference between individual and group therapy. However, individual therapy led to a greater improvement in manifestations of post-traumatic stress disorder (PTSD). CONCLUSIONS: The beneficial effects on PTSD support the use of individual therapy. However, the small sample size and lack of a control group limit conclusions about changes attributable to treatment.

Cycle of child sexual abuse: links between being a victim and becoming a perpetrator.

BACKGROUND: There is widespread belief in a 'cycle' of child sexual abuse, but little empirical evidence for this belief. AIMS: To identify perpetrators of such abuse who had been victims of paedophilia and/or incest, in order to: ascertain whether subjects who had been victims become perpetrators of such abuse; compare characteristics of those who had and had not been victims; and review psychodynamic ideas thought to underlie the behaviour of perpetrators. METHOD: Retrospective clinical case note review of 843 subjects attending a specialist forensic psychotherapy centre. RESULTS: Among 747 males the risk of being a perpetrator was positively correlated with reported sexual abuse victim experiences. The overall rate of having been a victim was 35% for perpetrators and 11% for non-perpetrators. Of the 96 females, 43% had been victims but only one was a perpetrator. A high percentage of male subjects abused in childhood by a female relative became perpetrators. Having been a victim was a strong predictor of becoming a perpetrator, as was an index of parental loss in childhood. CONCLUSIONS: The data support the notion of a victim-to-victimiser cycle in a minority of male perpetrators but not among the female victims studied. Sexual abuse by a female in childhood may be a risk factor for a cycle of abuse in males.

Inner city disadvantage and family functioning.

The co-existence of types of social, environmental and family disadvantage and domains of family dysfunction is explored through individual interviews and use of the Family Assessment Device in a cross-sectional study of 143 inner city families. The dependence upon social welfare by the family and the overall degree of disadvantage experienced both correlate significantly with all forms of family dysfunction. Marital disruption, poor physical care of the home or of the child(ren) and poor quality of mothering correlate significantly with difficulties both in role allocation and in affective involvement. Those families suffering more types of environmental disadvantage are more likely also to be dysfunctional in each domain of family life. Some possible mechanisms for these associations are highlighted and their implications for planning of effective interventions discussed.

The peer relations of disruptive children with reference to hyperactivity and conduct disorder.

Literature reviews indicate that children with disruptive behaviour disorders have peer relationship problems, but little information is available concerning the differential effects of hyperactivity and conduct disorder on peer relationships. Using a database from North of England research, this paper uses standard frequency analysis complemented by multivariate analyses to explore the independent effects of pervasive hyperactivity and conduct disorder on the sociometry of peer relations among 7- to 8- and 11- to 12-year-olds. The findings suggest that (a) social isolation in 7-8-year-olds shows no significant association with hyperactivity. However there is a significant association with conduct disorder in 11-12-year-olds. (b) Rejection is not significantly associated with hyperactivity alone nor with conduct disorder alone in 7-8-year-olds. However, it is associated with a combination of hyperactivity and conduct disorder. In 11-12-year-olds rejection is associated with conduct disorder alone and with conduct disorder and hyperactivity in combination. It is also associated with low cognitive ability alone and in combination with conduct disorder. Overall, these findings provide some limited evidence of adverse sociometric responses to both hyperactivity and below average cognitive ability. However, in the at-risk samples analysed here, conduct disorder emerges as the most powerful independent predictor of isolation and rejection, and this is especially so among older children.

Behavioural psychopathology of child sexual abuse in schoolgirls referred to a tertiary centre: a North London study.

The sexually abused girls in this study were a sub-sample of a group of girls referred to a Regional Centre for Psychotherapy for the whole of London, North Thames. An inclusion criterion was that they were psychologically symptomatic and so it is likely that they were more problematic cases causing concern in their locality. The control clinical group consisted of referrals to local Child and Family consultation services, were an opt-in matched sample and not a total clinic referral sample. In addition, the reasons for referral covered both child disorder and family problems. It is, therefore, important to bear in mind the differences between these two groups. Certain clear cut findings have emerged from this study. No disorders specific to child sexual abuse in girls were identified but the extent and severity of the disturbance in the sexually abused sample was most striking. In these girls an event (CSA), together with referral because of emotional symptoms, was associated with enhanced severity of disorder and comorbidity particularly with reference to a cluster of disorders comprising post-traumatic stress disorder, depressive disorder, anxiety disorders (general and separation), social phobias and reactive attachment disorder. In the community clinic sample the identified disorders were mainly those of separation anxiety disorders and adjustment. Wide comorbidity was common in the sexual abuse sample and also severity of impairment was notable when compared to the clinic sample. However, because of the selected nature of the abuse group the findings are not generalisable beyond the population from which they emerged. The view is advanced that there are strong grounds for exploring the utility of psychodynamic psychotherapy in similar samples of sexually abused girls. These findings are discussed in the light of the current literature.

Early life family disadvantages and major depression in adulthood.

BACKGROUND: There is evidence that exposure to social and family disadvantages in childhood are a risk factor for adult depression. AIMS: To explore the effects of multiple adversity in early childhood on adult depression, and the relative effects of the different adversities. METHOD: This study utilises data from the Newcastle Thousand Family Study. Information on childhood disadvantages was collected when the participants were 5 years old, and information on mental health was gathered when they were 33 years old. Mental health data were scrutinised blind to the evidence of early disadvantage, and best-estimate diagnoses of major depressive disorder were made according to DSM-III-R criteria. RESULTS: Multiple family disadvantages in childhood substantially increase the risk of suffering a major depressive disorder in adulthood. Such disadvantages include family or marital relationship instability, a combination of poor mothering and poor physical care, and a combination of dependence on social welfare and overcrowding. For females major depression was linked in particular to the quality of parenting in early life. CONCLUSIONS: Social and family (especially multiple family) disadvantages during childhood predispose individuals to an increased risk of major depression in adulthood.

Is there a comorbid relationship between hyperactivity and emotional psychopathology?

Some of the early literature implied that emotional disorders were almost incompatible with hyperactivity in childhood. The paper addresses this issue using a large epidemiological data base--of two cohorts of 7- & 8-year-old and 11- & 12-year-old children from the North of England. There are two themes, first, the paper reports on the prevalence of emotional symptoms and disorder among hyperactive children. Second, it explores co-occurrence of hyperactivity and emotional psychopathology according to whether the hyperactivity is situational or pervasive and according to the age of the child. Hyperactivity proved to have an association with emotional symptoms and disorder at both ages but the links with disorder were most prominent among the older children. Among our high risk or maladjusted samples the strongest links were with home-based situational hyperactivity. However, among the general population cohort, emotional disorder proved to be a function of pervasiveness of hyperactivity and older age.

Hyperactivity: prevalence and relationship with conduct disorder.

This paper reports the prevalence of situational and pervasive hyperactivity using different definitions of 'caseness', and explores the relationship between situational and pervasive hyperactivity and conduct disorder, using a large data base from the North of England. The prevalence of hyperactivity, and its relationship with conduct disorder, varied according to whether hyperactivity was pervasive or situational, according to the age of the child and to the definition of hyperactivity 'caseness'. Among younger children only, school based situational and pervasive hyperactivity had comparable comorbidity with other available evidence of psychiatric disorder and hyperactivity was virtually a prerequisite for conduct disorder. Among older children, pervasive hyperactivity had greater comorbidity with other psychiatric disorder than situational hyperactivity and, furthermore, displayed the strongest links with conduct disorder.

Development and evaluation of a diagnostic algorithm for depression in childhood.

This paper describes the development and validation of a brief questionnaire intended for the rapid assessment of depression in childhood. It is primarily a clinical interview but there is an associated algorithm for the diagnosis of a syndrome of depression. It can equally be used for the clinical diagnosis of a depressive disorder. The current battery includes features representative both of "depressive cognitions" and "endogenous depression". However, it is less effective in the identification of a syndrome of endogenous depression than depressive cognitions.

Diagnosing childhood depression who should be interviewed--parent or child? The Newcastle Child Depression Project.

The extent of the similarities and discrepancies in the reporting of depressive symptomatology by children and their mothers was examined. Child-parent agreement was not always impressive, particularly for more subjective symptoms. It is suggested that direct psychiatric assessment of children provides a more accurate picture of their mental state regardless of presenting disorder, but particularly where depression is suspected.

Reliability and validity of two self-rating scales in the assessment of childhood depression.

A comparison was made of the reliability and validity of two self-rating scales, the Children's Depression Inventory (CDI) and Depression Self-Rating Scale (DSRS), in the diagnosis of depression in 93 children (aged 8-16 years) attending a university child psychiatry department. The two scales were of comparable merit but had only moderate discrimination between depressed and non-depressed children, with each scale having a misclassification rate of 25%. Better agreement was obtained in more verbally intelligent children, irrespective of age. Girls scored higher on the instruments than boys. No significant relationship was found between teacher assessment of classroom behaviour and the two self-rating depression instruments.

The context of childhood depression. The Newcastle Childhood Depression Project.

This paper examines the family background, premorbid personality traits and adverse life events preceding childhood depression. The non-depressed group proved more likely to have experienced pre-school bereavement and familial disturbance, and to come from the more deprived background; there was also an excess of premorbid anxiety and hysterical personality traits in this group. School phobia and premorbid obsessional traits were associated with the depressed group. Although there was an association between depression and the total number of adverse life events, this was more substantial when the perceived impact of the events was taken into account. Of the individual classes of life event, only illness and a change in social relationships were associated specifically with depression.

The dexamethasone suppression test in children: lack of an association with diagnosis.

The dexamethasone suppression test was carried out on 44 children to assess agreement with diagnosis of depression. No significant association was found between suppression of plasma cortisol and depression diagnosed clinically or by cluster analysis.