J.H. Beitchman

Prevalence of Psychiatric Disorders in Children with Speech and Language Disorders

A representative sample of 5-year-old kindergarten children was assessed for speech and language disorders. Those identified as having a speech/language disorder ( N = 142) as well as a matched control group, were then assessed for behavioral or emotional problems by parents, teachers, and by a psychiatrist. Results indicated that the speech/language-impaired group was more likely than the control group to (1) show behavioral disturbance according to teachers and a primary parent (usually the mother); (2) be diagnosed as having some DSM-III Axis I disorder, particularly Attention Deficit Disorder; and (3) suffer from psychosocial stressors. Not only was the speech/language-impaired group at a relatively higher risk for psychiatric disorder; this level of risk was relatively high, ranging from 22.1% (parents) to 48.7% (psychiatric evaluation). Surprisingly, speech/language-impaired girls were consistently at greater risk than were speech/language-impaired boys; the percentage of girls rated in the clinical range varied from 37.0% (teachers) to 44.9% (parents), while the figures for the boys were 23.0% and 25.0%. These results argue strongly for increased support to the health and educational systems dealing with these children, better screening for behavioral and emotional problems among the girls, and further research investigating the factors associated with these disorders.

Familial Transmission of Speech and Language Impairment: A Preliminary Investigation

The familial transmission of speech and language disorders was investigated using a community sample of five year old children with speech and/or language impairment and a control group with normal language skills. The results indicated a significantly higher prevalence rate of language-related problems in families of speech and language impaired children than in normal language controls. Girls with speech/language impairments had more affected relatives than boys, suggesting that girls with this type of family history are at a greater risk of developing speech or language related problems. The pattern of transmission of speech and language disorders was also compared with published reports of the family histories of stuttering and reading disabilities, and with reports of cognitive and linguistic deficits among families of autistic individuals. The findings are discussed in relation to the theory of an underlying neurolinguistic diathesis common to these various disabilities.

IQ and child psychiatric disorder.

The WISC-RIQ scores of 85 children between 7 and 12 years of age taken from the inpatient, outpatient and day care facilities of a Regional Treatment Centre were compared with the expected IQ scores of the standard normal population. In addition, analysis of variance techniques were used to test for an association between IQ variables and seven operationally defined symptom subtypes taken from the childs chart. Significant differences between the clinical sample and the standard normal population were found for the distribution and means for full scale IQ and verbal IQ but not performance IQ. In addition, significant associations were found between FSIQ and the level of aggressive symptoms, and between VIQ and the level of hyperkinetic and aggressive symptom subtypes. The importance of IQ variables and in particular VIQ in understanding the nature of childhood psychiatric disorder is emphasized. The implications of these findings for educational policy are discussed.

Types of disorders and demographic variables in a Canadian child psychiatry population.

The value and extent of epidemiologic investigations of adult psychopathology is contrasted with the paucity of similar data in child psychiatry. Some findings from American and British sources on the epidemiology of childhood psychopathology are noted but it is not known whether these findings would also be true in the Canadian setting, and what little Canadian data are available are not readily comparable with much of these foreign data. Using both the D.S.M.II diagnostic schema and the childs symptoms as the definition of type of disorder, the relationship between type of disorder and demographic variables among 96 children attending a Canadian Regional Treatment Centre was investigated. The results indicate that, in general, the relationship between type of disorder and age is consistent with reports from American and other foreign studies. No significant associations between social class and type of disorder could be discerned. The analysis of sex and type of disorder produced somewhat contradictory results. Using symptom data, the possibility of changing patterns of symptom expression (toward increased proportion of externalizing symptoms) among girls is raised. If the reference point is diagnosis rather than symptom type, the results are more consistent with expected notions of neurotic disturbances being more common among girls, and conduct problems being more common among boys, but the possibility of sex stereotyping on the part of the diagnosing physician cannot be ruled out. Finally, it is suggested that population studies are needed to investigate further the relationships between childhood psychopathology and demographic variables.

Social class, symptom type and the utilization of children's psychiatric services: some comparative Canadian data.

This paper examines three aspects of the distribution and use of childrens psychiatric services in Canada under National Health Insurance. These are: 1) Class disparities in the utilization rates of these services; 2) The extent to which those children most in need of treatment are receiving it; and 3) The extent of unmet need for psychiatric services for children 17 years of age and under in the Ottawa-Carleton region. The subjects of this investigation were 96 children between the ages of 6.5 and 12 years who have attended the Childrens Services at the Royal Ottawa Hospital. The results indicate that class disparities in the distribution of services were the reverse of those typically found under private fee-for-service arrangements. The high social class had the lowest proportionate use and the welfare classes the highest. In addition, there was a significant association between social class and age for the boys only; the higher the social class, the younger the boy at the time of referral. Almost two-thirds of this sample were found to have antisocial and aggressive disorders. Consistent with estimates of the high rates of these disorders in the general population, this suggests that a proportionate number of those children most in need of treatment are receiving it. For children 17 years of age and under, the one-year treated prevalence of disorder in the Ottawa-Carleton region was estimated to be .95%. Though higher than reports from other sources, it is clear that free medical care alone is not sufficient to bridge the gap between estimates of the true prevalence and treated prevalence of childhood psychiatric disorder. These findings are discussed in terms of the importance of non-economic factors as determinants of the distribution and use of childrens psychiatric services. As well, the importance of referral practice, especially for the lower social classes is commented upon. Finally, suggestions are made for further research.

Diagnostic interviewing with children: the use and reliability of the diagnostic coding form.

There have been few attempts to standardize assessment methods in Child Psychiatry. This paper describes a semi-structured approach to diagnostic interviewing of the child. Thirty-four children six to 13 years of age, and their parents, were interviewed two weeks apart by two different psychiatrists. A diagnostic coding form consisting of 29 clinical symptom items, eight summary items, and nine positive health ratings was used. Three diagnostic items were also included: “severity of clinical condition,” “probability of disorder,” and “adjustment status.” Twelve of the Time 2 interviews with the child and parent were videotaped and rated by three different psychiatrists. Results indicated that summary items had higher reliability than individual symptom items and the three diagnostic items had the highest reliability, suggesting reliability is better for broad classes of behaviour. Interrater reliability was higher for the face-to-face rating than videotaped ratings. This suggests first that face-to-face interviews are reasonably stable over a two week period and second, since videotaped ratings had lowest reliability on items that depended on inferences about the childs feedlings, an important source of variance in assessment may be the clinicians ability to empathize with the child and draw inferences about internal feeling-states. It was concluded that this interview schedule can be a part of routine clinical practice. It ensures a reasonably standard, yet flexible and reliable approach to diagnostic interviewing.

Child psychiatry and early intervention. III: The developmental disorders

This paper is the third in a series of four using the concepts introduced in the paper Child Psychiatry and Early Intervention: I. The Aggregate Burden of Suffering. This paper reviews the developmental disorders of childhood to set priorities for early intervention programs. This review discusses the prevalence, course, risk, early indicators, associated impairments, and responses to intervention. The specific developmental disorders, especially learning disabilities, have a significant impact on community resources. Since the developmental disorders are easily recognized among preschool children, early intervention is feasible. However, successful interventions have yet to be demonstrated. Priority should be given to the development of effective interventions. There is a great need for research studies on the effects and effectiveness of early intervention with these individuals.

Predicting hospitalization in child psychiatry: The influence of diagnosis and demographic variables

The case records of 849 children seen at the University of Michigan Childrens Psychiatric Hospital have been examined to determine which factors are associated with hospitalization. Of all variables considered, diagnosis proved to be the single best predictor of hospitalization. This relationship was moderated by age, sex, social class, and the presence or absence of environmental stress. Of note was the decreased likelihood of hospitalization among 11–12 year old children with psychotic disorders, and the decreased likelihood for children with psychophysiologic disorders to be hospitalized at the 13 and older age group. Environmental stress was most strongly associated with children hospitalized with developmental and psychophysiologic disorders. Sex was not associated with the hospitalization status of children with personality disorders, while girls were more likely than boys to be hospitalized with psychophysiologic and developmental disorders, and boys more likely to be hospitalized with neurotic an...

A Survey of Referral Problems to a Psychiatric Preschool Program: Patient Characteristics and Therapeutic Considerations

This study provides a detailed account of the nature of referral problems found in a consecutive series of 90 cases admitted to a psychiatric preschool treatment program. The characteristics of the sample, including age, sex, and ordinal position of the children are described. The type of presenting problems and such features of the child as speech and language function and intelligence are included as well. The characteristics of the parents are also included, such as their social class and their marital and psychiatric status. These results are understood in the context of a developmental-interactional frame of reference, such that four categories of problems can be identified: 1) those children with organic/constitutional difficulties; 2) those children with mild developmental difficulties that put them in conflict with their parents’ or teachers’ expectations; 3) those children whose problems are reactive to family conflict and marriage breakdown; and 4) those marginally coping parents who decompensate when their preschooler reactivates unresolved internal conflicts of their own, which are then projected onto the child who becomes the identified patient. The nature and details of the treatment program are described with particular reference to the four categories of problems identified. The unique advantage of a program such as this, and the difficulties providing service and continuity of care for these children and families are highlighted. The importance of an integrated and comprehensive approach which coordinates the educational, social and psychiatric services is emphasized if preventive psychiatry is to retain its meaning and fulfill its mandate.

Child psychiatry and early intervention: I. The aggregate burden of suffering.

This paper discusses the need to estimate the costs of an illness to properly allocate intervention resources for the various psychiatric disorders of childhood. Disorders that require the most community resources should be given the highest priority for early intervention programs. Factors to consider for estimating disorders which are most costly are discussed here: the incidence of the disorder, its severity, whether it is episodic or stable, and its impact on the individual, family and the community. These factors contribute to the aggregate burden of suffering caused by a disorder.