Helen Minnis

The Strengths and Difficulties Questionnaire: a pilot study of a new computer version of the self-report scale.

Abstract. A computer-based version of the self-report Strengths and Difficulties Questionnaire (SDQ) was developed with colourful graphics illustrating each question. One hundred and two children referred to child and adolescent mental health services were recruited and randomly allocated to complete either the new computer-based version or the paper original. A further 112 children from local schools were recruited and completed the computer-based version of the scale. All children who took part in the study were aged between 8 and 15 years. The paper version of the SDQ is recommended for use in children aged 11 and over and, in this age group, the computer-based questionnaire was able to discriminate between the clinical and community sample (ROC = 0.761, 95 % CI 0.676–0.846). Comparison of the paper-based SDQ and computer-based SDQ within the clinic sample found trends towards better test-retest reliability, inter-rater reliability and significantly better user satisfaction in the computer version compared to the paper-based version. The computer-based SDQ has the added advantage of results being automatically added to a spreadsheet out of view from the user reducing the chance of operator error in coding and entering the data. These preliminary results suggest that the computer-based version of the SDQ may represent a further improvement on the paper SDQ. All versions of the SDQ, including the computer-based version, can be downloaded from the Strengths and Difficulties website address www.sdqinfo.com.

Children in foster care : Mental health, service use and costs

ObjectiveTo assess the prevalence of mental health problems in children in foster care, their families’ use of services and the associated costs.MethodsInformation on mental health problems, service use and costs was collected, by postal questionnaires and home interviews, on 182 children, their foster carers and teachers from 17 local authorities in Central Scotland.ResultsOver 90% of the children had previously been abused or neglected and 60 % had evidence of mental health problems including conduct problems, emotional problems, hyperactivity and problems with peer relations. When compared with 251 children from local schools, the children in foster care had significantly higher symptom scores for Reactive Attachment Disorder. Those children with highest scores for mental health problems were attracting a high level of service support from a wide range of agencies, except Child and Adolescent Mental Health Services (CAMHS). Costs were associated with learning disability, mental health problems, and a history of residential care.ConclusionsChildren in “mainstream” foster care are at greater risk of mental health problems, and are attracting greatest costs, but CAMHS are not successfully targeting these problems. CAMHS may need to develop new models of service delivery.

An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children.

OBJECTIVE To explore attachment narratives in children diagnosed with reactive attachment disorder (RAD). METHOD We compared attachment narratives, as measured by the Manchester Child Attachment Story Task, in a group of 33 children with a diagnosis of RAD and 37 comparison children. RESULTS The relative risk (RR) for children with RAD having an insecure attachment pattern was 2.4 (1.4-4.2) but 30% were rated as securely attached. Within the RAD group, children with a clear history of maltreatment were more likely to be Insecure-Disorganised than children without a clear history of maltreatment. CONCLUSIONS Reactive attachment disorder is not the same as attachment insecurity, and questions remain about how attachment research informs clinical research on attachment disorders.

Vitamin D and autism: Clinical review

BACKGROUND Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with multiple genetic and environmental risk factors. The interplay between genetic and environmental factors has become the subject of intensified research in the last several years. Vitamin D deficiency has recently been proposed as a possible environmental risk factor for ASD. OBJECTIVE The aim of the current paper is to systematically review the research regarding the possible connection between ASD and vitamin D, and to provide a narrative review of the literature regarding the role of vitamin D in various biological processes in order to generate hypotheses for future research. RESULTS Systematic data obtained by different research groups provide some, albeit very limited, support for the possible role of vitamin D deficiency in the pathogenesis of ASD. There are two main areas of involvement of vitamin D in the human body that could potentially have direct impact on the development of ASD: (1) the brain (its homeostasis, immune system and neurodevelopment) and (2) gene regulation. CONCLUSION Vitamin D deficiency--either during pregnancy or early childhood--may be an environmental trigger for ASD in individuals genetically predisposed for the broad phenotype of autism. On the basis of the results of the present review, we argue for the recognition of this possibly important role of vitamin D in ASD, and for urgent research in the field.

Altered stress responses in children exposed to early adversity: A systematic review of salivary cortisol studies

Pathological stress responses are implicated in numerous disorders. Hypothalamic–pituitary–adrenal axis function is influenced by gene–environment interaction, with early-life environmental adversity having long-lasting effects. We examine the evidence that, in humans, these effects are apparent from infancy. We systematically reviewed published findings on cortisol response to a stressor, in 0–5-year-olds already exposed to adversity. Adversity was defined as a negative environmental influence present post-conception. We searched Ovid MEDLINE (1950–May 2010), EMBASE (1980–May 2010) and PsychINFO (1806–May 2010). We included peer-reviewed, English language studies that analysed salivary cortisol before and after a standardised stressor. We identified 30 studies, of which 27 reported a significant effect of adversity on the cortisol response to stress. Six of these demonstrated an effect of prenatal substance exposure. Thirteen studies found that psychosocial adversity increased cortisol reactivity. Three studies reported that cortisol reactivity could be normalised by intervention programmes. The studies were heterogeneous, both in nature of adversity studied and in stressor used, precluding meta-analysis and assessment of publication bias. Our review presents evidence that adversity disrupts the stress response from an early age. Longitudinal studies are required to determine whether effects persist, alter with time, or are reversible with intervention.

Mental health and foster carer training

AIMS To evaluate the impact of training foster carers on childrens emotional and behavioural functioning. METHODS In a randomised controlled trial in 17 Scottish local council areas, with immediate and nine month follow up, 182 children and their foster families were randomly allocated to either standard services alone or standard services plus extra training for foster carers on communication and attachment. Main outcome measures were child psychopathology, attachment disorder, self esteem, and cost of foster care. RESULTS Over 60% of children had measurable psychopathology at baseline. The training was perceived as beneficial by participants. Scores for parent reported psychopathology and attachment disorders decreased by around 5%, self esteem increased by 2%, and costs by 22% in the intervention group. Results were non-significant. CONCLUSIONS Despite being well received by foster carers, the training was not sufficient to make a useful impact on the high level of psychopathology. This group may warrant more intensive interventions.

Dyslexia and psycho-social functioning: an exploratory study of the role of self-esteem and understanding

Individuals with dyslexia may have lower self-esteem and exhibit more emotional and behavioural difficulties than those without reading problems. However, the nature of any relationship between self-esteem and psychopathology remains unknown. This exploratory study assessed levels of self-esteem using the Self-Perception Profile for Children (Manual for the Self-Perception Profile for Children. University of Denver, CO: Denver; 1985) and psycho-social adjustment using the Strengths and Difficulties Questionnaire (J. Child Psychol. Psychiatry, 1997; 38: 581-586) and examined child and parent understanding, attitudes and the perceived impact of reading difficulties on daily life. Sixty-eight children assessed as dyslexic on the basis of discrepancy scores (mean age 11.2 years; 44 male), and their parents, participated. No global self-esteem deficit was found, but the mean score for both child and parent-rated scholastic competence was significantly lower than that of the general population. Rates of social, emotional and behavioural difficulties were significantly higher than in the general population and were correlated with self-esteem. For children who had high global self-worth, both children and their parents had more positive attitudes towards their reading difficulties and were less likely to perceive a negative impact on relationships. The association between academic self-esteem and emotional symptoms is consistent with the proposed link between dyslexia and internalizing difficulties. Good self-esteem and a good understanding of dyslexia may help children avoid some of these difficulties. Further research with larger more representative samples is necessary as understanding the factors that promote successful psycho-social adjustment is essential to the development of effective prevention and intervention strategies.

Reactive attachment disorder—a theoretical model beyond attachment

Despite its importance in public health, reactive attachment disorder (RAD) is an under-researched and little used clinical category. Abnormalities of social relatedness have long been documented in children who have been abused, neglected or institutionalised, but there have been more recent efforts to define these behaviours within the psychiatric nosology. There has been an implicit assumption that the central deficit in RAD is in the attachment system, but this has caused controversy and may have blocked research. We propose that RAD is better construed within the framework of intersubjectivity, which has a central role in the development of core brain and social functions and may also have had an important role in the evolution of a key human characteristic—complex social functioning. This broader framework may potentially explain apparently diverse symptoms such as indiscriminate friendliness and negative or unpredictable reunion responses. Finally, we suggest that a change of name may be useful in progressing the field, but accept that this may be difficult until there is better agreement in the clinical and scientific communities about the core features and aetiology of this disorder.

Disruptive behaviour disorders: a systematic review of environmental antenatal and early years risk factors

Disruptive behaviour disorders (DBDs), including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) are chronic disorders with significant overlap in aetiology and presentation. An integrative examination of environmental risk factors is lacking. Six literature searches of web-based bibliographic databases were completed to identify literature on DBDs in general and five disorders in particular: CD, ODD, ADHD, deficits of attention, motor control and perception, and reactive attachment disorder. Searches were filtered to focus on studies including diagnostic assessment, focussing on environmental risk and protective factors in the first 4 years of life. The database searches generated 9806 papers of which 47 were reviewed after filters had been applied. The evidence suggests links between a number of early life risk factors and DBDs, including prenatal cigarette smoking and alcohol use, prenatal viral illness, maternal stress and anxiety, low birthweight, peri-partum and early neonatal complications, parental stress and parenting styles in infancy, early deprivation, adoption and separation. Despite the understanding that there is sharing of risk factors between the DBDs, there has been a disproportionate focus on the role of certain risk factors at the expense of others and the field is weakened by difficulties in controlling for all potential confounding variables.

Facial Emotion Recognition in Child Psychiatry: A Systematic Review.

This review focuses on facial affect (emotion) recognition in children and adolescents with psychiatric disorders other than autism. A systematic search, using PRISMA guidelines, was conducted to identify original articles published prior to October 2011 pertaining to face recognition tasks in case-control studies. Used in the qualitative synthesis were: 2 studies on schizophrenia, 18 on mood disorders, 16 on anxiety disorders, 4 on eating disorders, 14 on ADHD and 9 on conduct disorder. Our review suggests that there are abnormalities in facial emotion recognition in a wide range of child psychiatric disorders and that these are likely to have a negative effect on both family and peer relationships. Scope for further research has been identified.