Proceedings of the fifth Northern Region Paediatric Colloquium.

The disciplines of medicine, law and ethics frequently impinge upon each other in clinical practice but are seldom given the opportunity to come together in dialogue. It was with this aim that senior professionals from law and medicine met at the fifth Northern Region Paediatric Colloquium. An added dimension to the ethical viewpoint was brought to the meeting by the attendance of local religious leaders for the first time. We report the proceedings of the Colloquium, which adopted the usual format of clinical case presentation followed by discussion.

Medicolegal issues in paediatric practice: proceedings of the 4th Northern Regional Paediatric Colloquium.

Ethical dilemmas frequently arise in paediatric practice. Given the nature of the speciality, these issues are pertinent to both the medical and legal professions. It is of potential benefit for the professions to meet and discuss such cases outwith the immediate clinical setting. A series of such meetings have been held in the Northern region. We report the proceedings of the fourth meeting. Four cases were presented and the issues arising were debated. The key points from each discussion are described.

Language-impaired preschoolers: a follow-up into adolescence.

This paper reports a longitudinal follow-up of 71 adolescents with a preschool history of speech-language impairment, originally studied by Bishop and Edmundson (1987). These children had been subdivided at 4 years into those with nonverbal IQ 2 SD below the mean (General Delay group), and those with normal nonverbal intelligence (SLI group). At age 5;6 the SLI group was subdivided into those whose language problems had resolved, and those with persistent SLI. The General Delay group was also followed up. At age 15-16 years, these children were compared with age-matched normal-language controls on a battery of tests of spoken language and literacy skills. Children whose language problems had resolved did not differ from controls on tests of vocabulary and language comprehension skills. However, they performed significantly less well on tests of phonological processing and literacy skill. Children who still had significant language difficulties at 5;6 had significant impairments in all aspects of spoken and written language functioning, as did children classified as having a general delay. These children fell further and further behind their peer group in vocabulary growth over time.

Responding to concerns about childhood emotional abuse.

Doctors are increasingly involved in child protection proceedings which consider whether emotional abuse has occurred. This may be a complex and difficult area, hindered by the paucity of consensus opinion and research in this area. This review suggests how doctors can assist in the decision-making process and outlines the management of children and adults who suffer sequelae of emotional abuse.

Childhood emotional abuse.

BACKGROUND: The assessment and management of childhood emotional abuse is of increasing importance in psychiatric practice. At present there are no consensus views about the definition of emotional abuse and information from research is limited. METHOD: Information about emotional abuse from the medical, psychological, social science and legal literature is summarised. Definitions and proposed mechanisms of damage are discussed. Current research data and an overview of childhood and adult sequelae are presented. Proposals for clinical and medico-legal practice are made. RESULTS: Theoretical models of emotional abuse and its consequences are derived from theories of childhood psychological development. Empirical research is beginning to show that emotional abuse may have a profound effect on aspects of psychological development in children. CONCLUSIONS: The developmental theories and methods of assessment well established in psychiatry are useful approaches to the clinical assessment and further understanding of emotional abuse.

Use of drugs in child and adolescent psychiatry.

BACKGROUND: The prescription of psychotropic drugs for children is a sensitive and highly contentious subject which may explain the apparent lack of uniformity and consistency in clinical practice. METHOD: This review is based on Medline and manual search of the literature. RESULTS: More than 1000 relevant references were found, and information has been culled from all these. Fifty particularly relevant articles have been selected for the reference list. CONCLUSION: Recent years have seen considerable research in this field, and a clearer picture of the benefits and limitations of drug use in children is emerging.

The challenge of working with patients diagnosed as having a borderline personality disorder.

Patients with a borderline personality disorder evoke unique problems and treatment dilemmas among members of an inpatient treatment team. This article explores the essential interplay of various treatment modalities during the course of intensive inpatient hospitalization and also describes guidelines, approaches, and therapeutic interventions aimed at reducing destructive influences and maximizing treatment outcome.