[Reliability, trainability and stability of auditory discrimination performance in 2 computer-assisted assessment and training methods]. / Reliabilität, Trainierbarkeit und Stabilität auditiv diskriminativer Leistungen bei zwei computergestützten Mess- und Trainingsverfahren.

OBJECTIVES: The present study focuses on the possibilities and effects of training dyslexic children in tone and phoneme discrimination tasks. METHODS: A computer program was developed to train dyslexic children to discriminate between tone and speech stimuli. The correlation between auditory discrimination and reading and orthography performance was then tested in a preliminary study of n = 63 children. In a prospective study 44 children were assigned to one of three paralyzed groups: tone training, phoneme training or a control group. Upon completion of the initial diagnostics for all groups, the two training groups received four weeks of discrimination training, after which all three groups were immediately re-tested for the first time. Parallel thereto all children underwent specific training in reading and orthography at their school. Six months later all were re-tested a second time. RESULTS: Both test methods showed a high reliability (rn = .94; .95). Significant correlations between auditory discrimination and reading and orthography performance were confirmed. Auditory discrimination was significantly trainable. Specific training effects, as well as independent developmental effects were found. While the training effects of phoneme discrimination were stable over six months, those of tone discrimination were not. CONCLUSION: The central auditory discrimination between tone and phoneme stimuli can be trained successfully in dyslexic children and might also affect their reading and orthography performance.

[Possible definitions and subsequent incidence of circumscribed reading and spelling disorders--theoretical considerations and empirical findings in a representative sample of young adults]. / Definitionsmöglichkeiten und sich daraus ergebende Häufigkeit der umschriebenen Lese- bzw. Rechtschreibstörung--theoretische Uberlegungen und empirische Befunde an einer repräsentativen Stichprobe junger Erwachsener.

OBJECTIVES: With reference to an epidemiological sample of adolescents and young adults the impact of different models on the number of children classified as having specific reading and spelling problems is investigated. METHODS: Using the same set of data, the effects of alternative measurement models, definitions and methodological procedures on the prevalence of specific spelling problems are shown. The virtual consequences of various norm-oriented definitions of cases are discussed with reference to external empirical criteria. RESULTS: In the present study case definitions of specific spelling retardation based on substantial criteria result in prevalence rates between six and nine percent.

[Concentrating on weaknesses or compensating by strengths? Comparison of 2 strategies for remediation of children with comprehensive reading-spelling disorder]. / An Schwächen üben oder durch Stärken ausgleichen? Vergleich zweier Strategien in der Förderung von Kindern mit einer umschriebenen Lese-Rechtschreib-Schwäche.

Our study compares the efficiency and acceptance of two different methods of treating dyslexia in children. The first method addresses the most commonly encountered deficits in sequential processing. It relies primarly upon the "Kieler Lese-Rechtschreibaufbau". The second proceeds from the child's relative resources with regard to simultaneous processing as described by Kaufman. Training materials are those prescribed by Kaufman. Normally gifted primary school third-graders were trained in two groups (n = 13 and n = 12) and achieved a mean SIF score of SW = 101 on the K-ABC. As expected, the children scored significantly lower on the SED scale (SW = 95) than on the SGD scale (SW = 105). At the beginning of the respective training program their spelling ability fell 1.5 SD below the class mean. One year of regular weekly one-hour training according to the simultaneous processing method was significantly more successful than training in sequential processing, whereas girls improved significantly more than boys regardless of the method used. Acceptance of the methods did not vary. This result requires careful consideration and should be replicated in younger samples such as first- and second-graders in the early stages of learning to read and write, and/or in children whose dyslexia is more severe than that encountered in the current sample. It underscores that determination of an adequate method of remediation entails more than the mere identification of the underlying deficits.

[Test construction, analysis and trial of the Heidelberg Sound Discrimination Test for measuring auditory-kinesthetic perceptual discrimination acuity]. / Testkonstruktion, -analyse und Erprobung des Heidelberger Lautdifferenzierungstests zur auditiv-kinästhetischen Wahrnehmungstrennschärfe (HD-LT).

The provisional trial was carried out in a sample of 133 second- and 139 fourth-graders from the Heidelberg area. The HD-LT was subjected to an item selection, test criteria were ascertained and temporary percentile norms for the second and fourth grades were established. High item difficulty resulted for both grades, i.e. the test was relatively easy. Test criteria were generally satisfactory. Significant correlations were found in both grades between the HD-LT and the children's spelling ability. The HD-LT accounted for 30% of the spelling variance among second-graders as compared to 10% of that among fourth-graders. This reflects the specific significance of phonetic discrimination ability in the first years of elementary school. Children with spelling difficulties were compared to those with good spelling abilities in respect to their ability to discriminate sound. Spelling-impaired children in both grades exhibited a significantly lower overall HD-LT score. No significant sex differences were found with regard to the auditory and kinesthetic phonetic discrimination ability. Since the HD-LT turns out to be well-suited to indicate a phonetic discrimination disability during the initial phases of acquisition of written language, its further development and extension of its application to the pre-school level are recommended.

[Effects and significance of specific spelling problems in young adults--empirical studies in an epidemiologic patient sample]. / Auswirkungen und Bedeutung spezifischer Rechtschreibprobleme bei jungen Erwachsenen--empirische Befunde in einer epidemiologischen Stichprobe.

OBJECTIVE: With reference to an epidemiological sample of adolescents and young adults the impact of different models on the number of children classified as having specific spelling problems is investigated. METHOD: Using the same set of data, the effect of alternative definitions and methodological procedures on the prevalence of specific spelling retardation is shown. The virtual consequences of various norm-orientated definitions of cases is discussed with reference to external empirical criteria. RESULTS: Particularly, obsolete norms lead to a large overestimation of cases. In the present study case definitions of specific spelling retardation based on substantial criteria result in prevalence rates between 6 and 9 percent. Academic achievement is considerably affected by persisting specific spelling problems and the attendance of secondary schools is rare, in spite of sufficient nonverbal intelligence. CONCLUSIONS: Because of the high impact of spelling ability for educational success, dyslexic children need help by early intervention. Furthermore scholastic promotion is necessary to enable a school carer appropriate to the intellectual possibilities of the child.

Testing the hypothesis of the relationships between laterality and ability according to Annett's right-shift theory: findings in an epidemiological sample of young adults.

In a large epidemiological sample of young adults, predictions of the right-shift (RS) theory of Annett that cognitive abilities will vary with right-left hand skill were tested. Presenting a theory of a genetic balanced polymorphism with heterozygote advantage for laterality and ability, Annett & Manning (1989, 1990a) and Annett (1993c) claimed that probands at the right end of the R-L hand skill continuum would show lower general intelligence in IQ testing and that specific verbal abilities and educational success would be lower at both extremes of the R-L distribution, taking the form of an inverted U. Most of these predictions could not be confirmed by our study. In particular, our data contrast with the important and specific prediction of the RS theory that strong dextrals will be the most disfavoured group. In our sample, probands at the left end of the R-L continuum had significantly lower scores in spelling and educational success and showed a tendency to have lower non-verbal IQ scores, while strong dextrals tended to have average or even marginally higher ability scores. The effects, however, are small and decrease when controlling for other variables. Implications of these empirical findings for the right-shift theory are discussed.

[Handedness and cognitive abilities: findings in a representative sample of adolescents and young adults]. / Händigkeit und kognitive Fähigkeiten: Befunde an einer repräsentativen Stichprobe Jugendlicher und junger Erwachsener.

Handedness and cognitive abilities in a representative sample of adolescents and young adults. The relationship between laterality and cognitive ability was examined in a representative sample of adolescents and young adults between 16 and 30 years of age. The study was designed as a possible replication of Annett's data supporting her right-shift theory (rst), but included other measures of laterality as well. We found, as Annett did, that strong right-handedness was associated with a weak left hand rather than a strong right hand. However, we could not confirm two other predictions of the rst with our data: The nonverbal IQ was significantly lower in both extreme groups of handedness than in the two middle groups. Because of the sample size this rather small effect, explaining only 1.9% of the variance, is significant, but it disappears with other kinds of grouping for handedness. We could not find the linear decline in nonverbal IQ from the left to the right extreme of handedness as predicted by the rst. In spelling, too, there was a rather small, but significant effect of handedness, explaining 2.4% of the variance. Spelling in the first (left most) quartile of handedness was worse than in quartiles two and four. The predicted poorer spelling in the extreme groups than in the middle groups (inverted U) was not found in our sample. In multivariate analysis with variables explaining larger proportions of the variance in spelling (education, nonverbal IQ and sex) the small effect of handedness on spelling completely disappeared. A weak relationship between left-handedness and dyslexia was evident only with the strictest definition of dyslexia, regardless of how handedness was defined. The implications of these data for the rst are discussed.

AIDS anxieties of adolescents: determinants of "state" and "trait" anxiety dimensions in a linear structural model.

This study presents the effects of general psychologic characteristics on acquired immunodeficiency syndrome (AIDS) anxieties and sexual behaviour of adolescents. To this end, data were collected in a complex interview and subsequently subjected to a linear structural model analysis. The questioned adolescents were divided into one representative group (n = 256) and a second group who had participated in a voluntary human immunodeficiency virus (HIV) antibody test (n = 45). AIDS anxieties have to be divided into two independent dimensions: first, a relatively stable feeling of AIDS anxiety (trait anxiety) and second, a manifest personal anxiety toward AIDS experienced in a concrete situation (state anxiety). A principal component analysis of the primary data brought forth four variables described as depression/general anxiety, extent of phobic anxieties, compulsion, and tendency to self-consciousness. The present study reveals that the AIDS trait anxiety is more pronounced among those subjects who are not well informed about AIDS, who tend to phobic anxieties, and who observe themselves in a particularly intensive manner. The AIDS state anxiety however, is stronger among subjects who are well informed about AIDS, have sexual experience, and observe themselves intensively. Among the participants who took part in the HIV test, there were more individuals with a higher manifest AIDS anxiety and stronger tendency to depression. The percentage of adolescents who were indeed exposed to a possible risk of getting infected was relatively low. Generally speaking, those young people who are depressed, anxious, and sexually active agreed more easily to take the test than young people with a pronounced phobia toward the risk of infection and less sexual experience. As a conclusion, we can state that those adolescents with less sexual experience tend to externalize their general sexual anxieties in the form of concrete AIDS anxieties.

[An unusual coincidence: elective mutism and sleep-related bioelectric seizure status syndrome]. / Ein ungewöhnliches Zusammentreffen: Elektiver Mutismus und Syndrom des schlafgebundenen bioelektrischen Krampfstatus (ESES).

A case study of a 9-year-old girl is presented which suffers from elective mutism and a rare, special form of cerebral seizures (ESES). After a brief review of the literature concerning these two rare diseases diagnosis, psychotherapy and anticonvulsive treatment as well as a follow-up are described. It is argued that in this case there are two independent, very rare diseases, and problems are discussed which arise from the necessity to integrate two heterogeneous therapeutic concepts.

[Long-term course of dyslexia beyond the school years: catamnesis from pediatric psychiatric ambulatory care]. / Der langfristige Verlauf der Legasthenie über die Schulzeit hinaus: Katamnesen aus einer Kinderpsychiatrischen Ambulanz.

In our follow-up study 12 years after index admission we were able to examine 59 out of 115 male patients who had been diagnosed in our department as dyslexic (mean age: 10.1 years). Spelling skills at follow-up were more than one standard deviation below the norm for the subjects' age (T-value on the RT of only 24). About half of our patients had participated in a specific spelling remediation program lasting more than 6 months, but at follow-up no effect of therapy could be demonstrated. The patients with the higher IQs regressed in spelling less than those with the lower IQs. We assume that the effects of remediation programs do not survive therapy and school for long because later on good spelling is no longer either required or encouraged. Our patients were severely impaired in their school career: Although their average IQ was 112 only 6 out of 59 had completed a college-preparatory program (Abitur), all of them from middle-class families with well-educated parents. Our patients chose occupations corresponding to the type of high school diploma they had, often those requiring practical skills rather than reading or spelling skills. Patients who had completed no more than the nine obligatory years at school were less content with their work than expected. Emotional disorders during the past 6 months were no more frequent than expected. In a self-report about delinquency there was no difference compared to a random sample.

[Experiences with the revisions of the classification systems for psychiatric disorders (ICD-10 and Axis 5 MAS)]. / Erfahrungen mit den Neufassungen der Klassifikationssysteme für psychische Störungen (ICD-10 und 5.Achse MAS).

In our study clinical experiences in 1990 and 1991 with the new installed ICD-10 and the new version of the fifth axis of the MAS for registering abnormal psychosocial conditions are presented. The strictly descriptive proceeding of these two new systems meets problems of acceptance in a department, whose tradition emphasizes strongly the importance of individually etiological relevant factors in the "Biographische Anamnese" for the psychiatric diagnosis.

[Determinants and educational approaches to AIDS anxiety in adolescents]. / Einflussfaktoren und Erklärungsansätze zur AIDS-Angst bei Jugendlichen.

On the basis of a questionnaire filled out by 480 adolescents determinants of fear of AIDS were evaluated with a model of linear structural equations. The main factors that appeared were knowledge about AIDS (those who know more report less fear), personal involvement (those who are confronted more with the problem of AIDS report more fear) and sexual experience (those who are sexually more experienced report less fear). The last finding is interpreted to the effect that mainly sexually inexperienced adolescents, who are usually also the younger ones, shift their sexual fears to the AIDS-complex.

[Follow-up of adolescent homicide perpetrators committed in accordance with section 63 of the federal penal code: 4 case reports]. / Katamnesen von nach 63 StGB untergebrachten jugendlichen Tötungsdelinquenten: vier Kasuistiken.

The longterm follow-up of four juvenile murderers is described, who had been examined at the Department of Child and Adolescent Psychiatry of the University of Heidelberg and were sent to psychiatric hospitals according to 63 StGB by the courts. These follow-ups are discussed in relation to the literature and some problems of this special group of mentally ill delinquents are pointed out.

On the image of child psychiatry amongst the people and the parents concerned.

In questionning altogether 313 parents who had made use of the help of child psychiatry, as well as parents who had taken their child to a children's hospital, or persons who lived in the vicinity of a child psychiatric clinic, clear prejudices against children who had undergone child psychiatric treatment, their families and facilities were found. The child and adolescent psychiatrist's job description and his sphere of responsibility were indefinite and not well-defined in comparison with other professional groups (e.g. psychologists). His advice was often only sought for after other facilities, above all paediatricians and educational advice centres, had been consulted without the desired success. Parents who had made use of a child psychiatrist's help were less inclined to prejudices and were better informed than the other two groups mentioned above. Even today however, patients who have undergone psychiatric treatment and their families still have to reckon on reservations in their social surroundings especially from other children.

[Homicides by adolescents and young adults from the viewpoint of the adolescent psychiatry expert]. / Tötungsdelikte Jugendlicher und Heranwachsender aus der Sicht des jugendpsychiatrischen Gutachters.

From 1966 to 1986, the Department of Child and Adolescent Psychiatry of the Psychiatric Hospital of the University of Heidelberg gave expert opinions at the request of criminal courts in 37 cases involving homicide and 8 attempted homicide. Eighteen of the offenders were between 14 and 17 years old ("Jugendliche" under German law), 17 between 18 and 20 ("Heranwachsende") and 2 over 20. The largest group (N = 18) consisted of maladjusted male adolescents who had grown up in disadvantageous surroundings, had limited education and, not infrequently following the example of other members of their families, tended to show aggressive behaviour, intolerance to frustration, emotional instability and uncontrolled drinking. The questions the expert was asked by the court were mainly concerned with: liability for crime (section 3 JGG), applicability of juvenile law to offenders aged 18 to 20 years (section 105 JGG) penal responsibility (section 20 and 21 StBG or section 51, Section 1 and 2 StGB a.F.), and measures under section 63 StGB. The court took the expert's position in 28 of the 33 decisions which we were able to obtain for examination; 2 other proceedings were quashed. The juridical classification of the homicides was attempted or completed first-degree murder in 17 and attempted or completed second-degree murder in 6 cases.

Mortality of patients dependent on benzodiazepines.

For patients dependent on benzodiazepines alone, or in combination with alcohol and/or other legal and illegal drugs, observed mortality rates were compared with the average population, and, in cases of isolated benzodiazepine dependence, also with a control group of non-dependent patients chosen to match each dependent not only in sex and date of birth, but also in pre-existing psychiatric illness besides dependence. For patients with an isolated benzodiazepine dependence, the mortality rate was increased, when compared with the average population, by a ratio of observed to expected numbers of deaths of about 3. However, this mortality rate did not differ from that of the control group (non-dependent patients with comparable psychiatric illnesses). For patients combining benzodiazepines with alcohol among other addictive drugs, and for patients combining benzodiazepines with illegal drugs among other addictive substances, the ratio of observed to excepted numbers of deaths was 6.2 resp. 21, thus corresponding well with other studies on mortality rates associated with alcoholism and dependence on illegal drugs. We conclude that our study does not give evidence of higher risk of early death correlated with dependence on benzodiazepines alone. However, it confirms the well-known fact of increased mortality rates in patients with psychiatric illnesses, especially with dependence on alcohol or illegal drugs.

[Catamnestic study of the problem of the course and diagnostic changes in 22 adolescents with affective psychosis]. / Katamnestische Untersuchung zur Frage des Verlaufs und Diagnosewechsels bei 22 an Affektiver Psychose erkrankten Jugendlichen.

Among the adolescents seen as inpatients at the University of Göttingen psychiatric hospital in 1972 and 1973, the diagnosis of affective psychosis was made about as often as that of a schizophrenic psychosis, both being rare compared with the total number of children and adolescents treated. At 10- to 11-year follow-up it was found that 4 of the 22 patients with affective psychoses had committed suicide. Only 3 patients had not required subsequent inpatient care. In 2 cases the diagnosis had to be changed to a schizophrenic psychosis, and in 1 to exogenous psychosis. The outcome was more favorable with regard to the subjects' social and occupational development. Most had been able to complete their schooling and to enter their chosen occupation. Only 2 were unemployed.