Cost-Effectiveness of Individual versus Group Psychotherapy for Sexually Abused Girls.

BACKGROUND: Children who have been sexually abused may suffer from emotional and behavioural difficulties. Recent research found that individual and group psychotherapy have similar outcomes. In this study we compare the costs and cost-effectiveness of the two therapies and support for carers. METHODS: Subjects were recruited to two clinics in London and randomly allocated to the two treatments. The different components of each intervention were identified and costed. RESULTS: Total mean costs of individual therapy were found to be £1246 greater than for group therapy. Costs as they would apply in routine practice were relatively unchanged. Group therapy was thus more cost-effective than individual therapy. DISCUSSION: Carefully considering the impact of different therapies could allow more treatment to be offered from available staff resources and budgets. However, this is a single small study and further work is required to strengthen the evidence-base before change in practice is readily undertaken.

Secular trends in the mental health of primary school children.

Over the recent past, reports have argued that there has been a decline in the mental health of children and young people in Western societies. This is said to have occurred gradually over the second half of the last century and possibly longer. This view is based on evidence of a progressively declining peak age for adult type depressive disorders, and an apparent increase in adolescent disturbance such as substance abuse, attempted and completed suicide, perhaps eating disorders, and behaviour disorders. These phenomena have been attributed to the major changes in social values and behaviour, with their impact on child rearing and family life that gathered pace over the course of the last century.

Diagnosis and classification in child and adolescent psychiatry: the case of unipolar affective disorder.

Child and adolescent psychiatric classification is a broad domain in which the consideration of a developmental and longitudinal approach is essential. Some of the key issues involved are reviewed in this paper by focusing attention on childhood affective disorders, which are important both clinically and epidemiologically. It has been argued and demonstrated by Kovacs that in contrast to adults, children may not be capable of experiencing or reporting the symptoms thought to be representative of major depressive disorder. Nor may they be able to give an account of their duration. Hence, the pattern of manifested depressive symptoms is likely to vary according to age and stage of development of the child and young adolescent, and this is probably related to concept and language development. Further, distress and negative affect may be expressed by externalising symptomatology, especially in the pre-school years. The complexity of multiple depressive disorders, their coexistence and comorbidity with anxiety disorders needs to be studied further, employing whenever possible a developmental perspective and a longitudinal design.

Hyperactivity and conduct disorder: exploring origins.

OBJECTIVES: This paper explores the relationship of hyperactivity (HA), conduct disorder (CD) and combined hyperactivity and conduct disorder (HACD) with certain environmental and biological stresses and vulnerabilities. METHOD: It is based upon a large epidemiological database from the North of England. RESULTS: The findings suggest that CD is uncommon and strongly related to environmental stresses. This is true to a lesser extent of HACD. While both CD and HACD were related to family adversity and adverse styles of parental discipline, subtly different patterns of associations are also evident. In particular, CD is linked with poverty, parental violence and contact with child care social agencies. These findings are consistent with the hypothesis that HA contributes to a pattern of confrontation and punishment associated, in some cases, with the emergence of a more complex combination disturbance. However, CD occurs against a background of family conflict and poor child-care. CONCLUSIONS: Most apparent cases of conduct disorder are in fact hybrid conditions including symptoms of HA and CD. True CD should be diagnosed not only by positive symptomatology but also by the absence of hyperactivity symptoms.

Critical Notice.

"Goodness of Fit": Clinical Applications from Infancy through Adult Life. By Stella Chess & Alexander Thomas. Brunner/Mazel, Philadelphia, PA, 1999. pp. 229. pound24.95 (hb). Chess and Thomas's pioneering longitudinal studies of temperamental individuality started over 40 years ago (Thomas et al., 1963). Their publications soon became and remain classics. Their concept of "goodness of fit" emerges out of this monumental work but has had a long gestation period. In their new book, the authors distinguish between behaviour disorders that are reactive to the child's life circumstances, including life events, and which are self-correcting or responsive to the relevant changes in their environment, and more serious disorders.

The assessment of personality in young adulthood: Data on a normative sample.

The Personality Assessment Schedule has been modified for use with young adults living in the community. It has been administered to a population sample of 129 subjects aged 24-26 years. It proved possible to achieve a reliable assessment of personality trait. Further, utilising both clinical and statistical approaches personality types were defined. The dimension reflecting types of personality also proved reliable. Guidelines are provided as to what constitutes deviant scores on the elicited personality dimensions.