Maternal anxiety predicts favourable treatment outcomes in anxiety-disordered adolescents.

OBJECTIVE: To determine the differential impact of maternal and paternal internalizing psychopathology on cognitive-behavioural treatment (CBT) outcome of anxiety-disordered children and adolescents. METHOD: Participants consisted of 127 children and 51 adolescents with a primary anxiety diagnosis. Children were randomly assigned to a standardized group CBT or individual CBT; adolescents received individual CBT. Parents received four training sessions. Participants were evaluated at pre- and post-treatment with a clinical interview and with self- and parent-reported questionnaires. Lifetime anxiety and mood disorders in parents were obtained with a clinical interview. RESULTS: For children, no associations were found between maternal and paternal anxiety or mood disorders and treatment outcome. For adolescents, however, maternal lifetime anxiety disorders were positively associated with pre-post-treatment improvement in clinician severity ratings and with treatment success. CONCLUSION: Lifetime maternal anxiety disorders were significantly associated with favourable treatment outcomes in adolescents. Paternal disorders were not associated with treatment response.

Associations between HPA axis functioning and level of anxiety in children and adolescents with an anxiety disorder.

The hypothalamus-pituitary-adrenal (HPA) axis becomes active in response to stress. Hence, increased levels of anxiety in children and adolescents may be associated with changes in HPA-axis functioning. The aim of this study was to test if level of anxiety or specific anxiety disorders were associated with basal HPA axis activity in children and adolescents with an anxiety disorder. In 99 8- to 16-year-olds with an anxiety disorder, basal cortisol levels were assessed. It was tested if (1) cortisol levels correlated with the level of self-reported anxiety and (2) if cortisol levels were different for individuals with different anxiety disorders. In girls, low levels of anxiety were associated with a stronger rise in early morning cortisol concentrations. In both boys and girls, harm avoidance predicted low cortisol concentrations after awakening. Separation anxiety and physical anxiety symptoms predicted cortisol concentrations at noon. Differences between individuals with different anxiety disorders were not found. More research is needed regarding mechanisms that explain the associations that were found, and to investigate if treatment may influence HPA axis functioning in children and adolescents with an anxiety disorder.

Separation anxiety and overanxious disorders: relations to age and level of psychosocial maturity.

OBJECTIVE: To study the developmental underpinnings of age trends in the prevalence of separation anxiety disorder (SAD) and overanxious disorder (OAD) in children and adolescents. METHOD: The sample consisted of 118 children and adolescents (aged 8-18 years) with SAD or OAD, who were referred to an outpatient psychiatric clinic. Anxiety disorders were assessed with Silverman and Nelles' Anxiety Disorders Interview Schedule for Children; level of psychosocial development was conceptualized and assessed by means of Jane Loevinger's model and measure of ego development. Logistic regression analyses were applied to study the extent to which age and level of ego development were related to the presence of SAD or OAD. RESULTS: Level of ego development was the strongest predictor of group membership (SAD versus OAD). Although age was a strong predictor as well, the age effect became insignificant after ego level had been entered into the regression equation. As predicted, SAD was related primarily to the Impulsive ego level, whereas OAD was related mostly to the Conformist ego level. The comorbid condition (SAD and OAD) fell squarely in between the 2 "pure" groups, both in terms of age and ego level. The results were controlled for possibly confounding variables, such as gender, IQ, and socioeconomic status. CONCLUSIONS: The presence of SAD and OAD appears to be related to specific levels of psychosocial maturity, irrespective of age.

The persistence of borderline personality disorder in adolescence.

The stability of borderline personality disorder in adolescents is quite uncertain. To determine the persistence of the borderline personality disorder (BPD) and of separate borderline symptoms in adolescents, a follow-up study was conducted of hospitalized adolescents with (n = 14) and without (n = 22) BPD, according to the diagnostic interview for borderline patients (DIB). Of the 14 borderline adolescents, only two cases were again classified as BPD after 3 years, but some of the separate borderline symptoms were still present. In the nonborderline group, no new borderline cases were found after 3 years.

Autism and the immune system.

As our knowledge of the interactions of the immune, nervous and endocrine systems progresses, complex links with the origin and course of psychopathology in childhood are revealed. In this article the neuroimmunological literature on autism is reviewed. Relevant aspects of immune functioning and the neuroendocrine-immune network are described. We present the immunological findings in autistic patients within two related conceptual frameworks: a viral and an autoimmune hypothesis. Interpretation of data is hampered by conceptual and methodological differences between studies. Both the clinical significance of the immune changes and the causal connection between immune changes and psychopathological phenomena in autism remain to be elucidated. Recommendations for further research are given.

Measuring children's self-concept with a Dutch version of the "self-perception profile for children": factorial validity and invariance across a nonclinic and a clinic group.

Harter's (1985) Self-perception Profile for Children (SPPC) is used to investigate whether the pattern and size of relations among the subscales in a clinic group are equivalent to those in a nonclinic group of children, and whether the items are perceived in the same way and with the same degree of accuracy across both groups. The first aspect indicates equivalence of structure, the latter equivalent measurement. Both are aspects of between-group invariance. It is essential to show evidence of these aspects before content-based comparisons are made between these groups. Using restrictive factor analysis, support was found for equivalence of structure. Equivalence of measurement was partially found. The items were perceived in the same way, but not with the same degree of accuracy. The conclusion is that the SPPC has sufficient between-group invariance to be used in studies with children in a clinic group.

The smile in anencephalic infants.

During the period 1947-1959 twelve new-born mero-anencephalics were observed, who survived for more than 1 day after birth. Two even lived for 20 and 237 days, respectively. In 4 of the 12 children studied touching or slight pressure, and also faradic stimulation of various spots of the cerebro-vascular area were invariably followed by a facial expression which was very similar to smiling. Movies of it were shown to groups of impartial observers. In 78% the facial expression was judged to be a smile, a laugh or a grin. The neuroanatomical finding of a largely intact pontine tegmentum as being the most rostrally situated identifiable structure of the brainstem, has led to the hypothesis that the neural mechanisms underlying the smile are localized in the pontine tegmentum.

Borderline and schizotypal disorders in children and adolescents.

Until recently, research on borderline disorder in children has sought the common denominator of the symptoms. In recent years there have been attempts to circumscribe the definition with the help of DSM-III criteria and the DIB. This approach appears fruitful. The scanty data on schizotypal children suggest that the validity of this diagnosis in childhood should be investigated. In adolescence it is possible to discern those with borderline and schizotypal disorders whose symptoms meet both DIB and DSM-III-R criteria respectively. No data exist, however, concerning the predictive validity of such disorders in adolescents. Classification on an empirical basis is advocated in order to refine the diagnosis of these and related disorders in children and adolescents.

The systematic collection of patient data in a centre for child and adolescent psychiatry.

Computerisation of case records has been slow to take place in child psychiatry, partly because of the amount of detailed and sometimes complex information required. A program for storing case records has been developed and it has proved of great value in epidemiological work, for example, regarding patient age structures and family compositions.

[A case of Munchausen syndrome by proxy]. / Een geval van het syndroom van Münchhausen bij proxy.

In this paper the case is described of a one-year-old girl who was diagnosed as to have the Münchhausen syndrome by proxy. There had been a single-sided, chronic parotitis, followed by a single-sided orbita-cellulitis. In the pathological-anatomical matter derived from the parotid a substance was found that does not belong to the human body (most likely to be alum), and which contained aluminium, silica, and iron. Based on pediatric, psychological, and child psychiatric diagnoses, the conclusion was that in all probability the matter was injected by the patient's grandmother, who acted as foster-mother. The grand-mother herself appeared to be a patient with the Münchhausen syndrome. After the girl was separated from her grand-parents, she soon recovered. Following after a total stay of 18 months in three different hospitals, the girl could be placed in a therapeutic foster home.