Gail A. Edelsohn

The significance of self-reported anxious symptoms in first-grade children

It is generally believed that prior to the middle to late elementary school years childrens reports of anxious symptoms represent nothing more than transient developmental phenomena. In light of the limited empirical study of this issue and its import to the allocation of mental health resources, the present study seeks to provide empirical evidence of the significance of anxious symptoms in children younger than 7. Specifically, utilizing an epidemiologically defined population of 1197 first-grade children, followed longitudinally from the fall to spring of first grade, we examine the stability, prevalence and caseness of childrens self-reports of anxious symptoms. Self-reported anxious symptoms proved relatively stable over 4-month test-retest interval. In addition, they appeared to have a significant impact on academic functioning in terms of reading achievement. These findings on stability, caseness, and prevalence suggest childrens self-reported anxious symptoms in the early elementary school years may have clinical significance. However, further study is necessary before firm conclusions can be drawn.

The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

OBJECTIVE We investigated the influence of race/ethnicity in diagnostic and disposition decision-making for children and adolescents presenting to an urban psychiatric emergency service (PES). METHOD Medical records were reviewed for 2991 child and adolescent African-American, Hispanic/Latino and white patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were used to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions. RESULTS Binomial logistic regression analyses reveal that African-American (OR=2.28, P<.001) and Hispanic/Latino (OR=2.35, P<.05) patients are more likely to receive psychotic disorders and behavioral disorders diagnoses (African American: OR=1.66, P<.001; Hispanic/Latino: OR=1.36, P<.05) than white children/adolescents presenting to PES. African-American youth compared to white youth are also less likely to receive depressive disorder (OR=0.78, P<.05), bipolar disorder (OR=.44, P<.001) and alcohol/substance abuse disorder (OR=.18, P<.01) diagnoses. African-American pediatric PES patients are also more likely to be hospitalized (OR=1.50, P<.05), controlling for other sociodemographic and clinical factors (e.g., Global Assessment of Functioning). CONCLUSIONS The results highlight that nonclinical factors such as race/ethnicity are associated with clinical diagnostic decisions as early as childhood suggesting the pervasiveness of such disparities.

The course of aggression in first-grade children with and without comorbid anxious symptoms.

We studied the course of aggressive behavior in an epidemiologically defined sample of first graders with and without comorbid anxious symptoms. Our primary purpose in doing so was to understand whether the stability of aggression in young children was attenuated or strengthened in the presence of comorbid anxiety. Previous studies of older children and adolescents had produced equivocal findings in this regard. Data on anxious symptoms were obtained through an interview of the children, whereas aggressive behavior was assessed through the use of a teacher interview and peer nominations. Assessments were performed in the fall and spring of first grade. In contrast to children classified as aggressive alone in the fall of first grade, boys and girls classified as aggressive and anxious in the fall of first grade were significantly more likely to be classified as aggressive in the spring in terms of teacher ratings and/or peer nominations of aggression. Thus our findings suggest that the link between early and later aggression may be strengthened in the presence of comorbid anxious symptoms, rather than attenuated. Future studies are needed to identify the mechanisms by which the course of aggression is influenced by the presence of comorbid anxiety.

Hallucinations in Nonpsychotic Children

Abstract: Sixty‐two cases of children with hallucinations but without psychosis were identified in a psychiatric emergency service. Auditory hallucinations were more frequent than visual ones. There were positive trends between the content of auditory hallucinations and diagnosis. Recognition of this clinical phenomenon of hallucinations in children in the absence of psychosis and awareness of underlying psychopathology and precipitating factors is necessary in evaluating hallucinations in nonpsychotic children. Children with such presentations run the risk of being misdiagnosed as having psychosis or schizophrenia and being subjected to the inherent risks of treatment with antipsychotics.

Ethics and Research With Vulnerable Children

address important questions regarding the prevalence of mental health problems and the receipt of mental health services of very young children who became involved with the child welfare system owing to an investigation of child maltreatment. The investigators use the extensive database from the National Survey of Child and Adolescent Well-Being (NSCAW II), a longitudinal study of children referred to child welfare agencies. Direct interviews were conducted with caregivers and child welfare workers of 1,117 children 12 to 36 months of age. Sociodemographic characteristics, social services involvement, and health and developmental data on children and caregivers were collected. The outcomes measurements were scores higher than the clinical cutpoints of the Brief Infant Toddler Social Emotional Assessment (BITSEA) scales (for children 12 to 18 months) and the Child Behavior Checklist (CBCL; for those 19 to 36 months of age). Horwitz et al. found that nearly 35% of the younger children scored high on the problem scale of the BITSEA and slightly more than 20% scored low on social competence. Among the toddlers, 10% scored in the clinically significant range of the CBCL. The investigators also found that black children were less likely to have high scores on the BITSEA problem scale and that children living with a depressed caregiver were more likely to have higher scores on the CBCL. Only a disappointingly low 2.2% of children identified with mental health problems received direct clinical services; when parental skill training was counted toward mental health services, the rate increased to a still low 19.2%. This article, which focuses on the prevalence of mental health problems and related services in young children at risk, highlights several ethical questions relevant to the field of child behavioral health: Are there special considerations around informed consent for vulnerable populations? How can needed research focused on vulnerable