Jane Hood

A review of the long-term effects of child sexual abuse

The existing literature on the long-term sequelae of child sexual abuse is reviewed. The evidence suggests that sexual abuse is an important problem with serious long-term sequelae; but the specific effects of sexual abuse, independent of force, threat of force, or such family variables as parental psychopathology, are still to be clarified. Adult women with a history of childhood sexual abuse show greater evidence of sexual disturbance or dysfunction, homosexual experiences in adolescence or adulthood, depression, and are more likely than nonabused women to be revictimized. Anxiety, fear, and suicidal ideas and behavior have also been associated with a history of childhood sexual abuse but force and threat of force may be a necessary concomitant. As yet, there is insufficient evidence to confirm a relation between a history of childhood sexual abuse and a postsexual abuse syndrome and multiple or borderline personality disorder. Male victims of child sexual abuse show disturbed adult sexual functioning. The relation between age of onset of abuse and outcome is still equivocal. Greater long-term harm is associated with abuse involving a father or stepfather and abuse involving penetration. Longer duration is associated with greater impact, and the use of force or threat of force is associated with greater harm.

Attachment in Mothers with Anxiety Disorders and Their Children

OBJECTIVE This study examined adult attachment in mothers diagnosed with anxiety disorders and child-mother attachment in their children. METHOD Eighteen mothers with Axis I anxiety disorders completed the Adult Attachment Interview and standardized questionnaires. These mothers and their preschool children (n = 20) then participated in the Strange Situation Procedure. RESULTS All mothers were classified as nonautonomous with respect to attachment, with 78% judged unresolved. When those judged unresolved were reassigned to their alternate categories, the proportion of nonautonomous mothers was 61%. Eighty percent of the children were classified as insecurely attached, with 65% judged disorganized. When those judged disorganized were reassigned to their alternate categories, the proportion of insecurely attached children was 55%. Sixty-five percent of the children matched their mothers attachment classification. Mothers of securely attached children reported fewer recent life events, fewer depressive symptoms, and a greater sense of parenting competence than mothers of insecurely attached children. CONCLUSIONS These results suggest that attachment measures can be applied to anxious populations. The high rate of insecurity among offspring of anxious mothers indicates a need for longitudinal studies of these children.

Behavioural inhibition, attachment and anxiety in children of mothers with anxiety disorders.

Objective This study examined the relationship between behavioural inhibition, insecure mother-child attachment and evidence of anxiety in the offspring of mothers with anxiety disorders. Method Twenty children aged 18 to 59 months who were born to 18 mothers with diagnosed anxiety disorders were examined for behavioural inhibition (Kagans measures) and mother-child attachment (Strange Situation Procedure). Child anxiety was assessed using DSM-III-R criteria and the Child Behavior Checklist (CBCL). Results Sixty-five percent of the children were behaviourally inhibited. They showed more somatic problems and fewer destructive behaviours than those who were not inhibited. Eighty percent of the children were insecurely attached. They had higher CBCL internalizing scores than secure children and three of them met diagnostic criteria for anxiety disorders. Conclusion Though preliminary, this work suggests a need to identify children of anxious mothers as being at risk for anxiety, especially in the presence of inhibited temperament or attachment difficulties.

Psychiatric risk in children with speech and language disorders

Based on an initial community sample of 1,655 5-year-old children, this report utilized the risk statistic to estimate a childs risk for developing a psychiatric disturbance depending on his or her status as speech/language-impaired. Results showed that risk estimates varied as a function of gender and source of information (teacher, parent, psychiatric reports). Overall, speech- and language-impaired children had a higher risk for developing a psychiatric disturbance compared with normal language controls, with speech/language-impaired girls being at greater risk than boys.

Empirical classification of speech/language impairment in children: II. Behavioral characteristics.

Behavioral symptomatology in 188 children, 5 years of age, classified according to four different speech/language profiles, is described. Information was collected from the teacher, parent, child self-report, and psychiatric interview. The results indicated that risk for psychiatric disorder, particularly ADHD, is greatest among children with general linguistic impairment. Specific deficits such as poor auditory comprehension or articulation problems were not consistently associated with behavioral disturbance. It is postulated that neurodevelopmental immaturity may be the common underlying antecedent of both linguistic impairment and psychiatric disorder.

Individual and familial predictors of impairment in childhood anxiety disorders.

OBJECTIVE To determine which correlates of childhood anxiety disorders are predictive of impaired functioning as judged by clinicians. METHOD Seventy-four families of children with anxiety disorders attending a hospital outpatient clinic completed questionnaires measuring child symptoms of anxiety and depression, maternal psychopathology, maternal ratings of child psychopathology, and developmental and environmental difficulties. Clinicians completed the Global Assessment of Functioning (GAF) for each child, and correlations between it and the other measures were ascertained. RESULTS Maternal ratings of child conduct problems, child symptoms of depression, maternal phobic anxiety, developmental difficulties, and psychosocial adversity were significantly correlated with GAF. Results of a multiple regression analysis revealed that these variables accounted for 25% of the variance in GAF scores. The first four variables were significant predictors of impairment in children with phobic disorders. Psychosocial adversity was the only significant predictor of impairment in children with generalized anxiety disorder. CONCLUSIONS In addition to child depression and developmental or psychosocial adversity, impairment in childhood anxiety disorders appears to be related to parental anxiety and behavior management difficulties, particularly in phobic disorders. Addressing the latter factors may enhance treatment efficacy.

Assessment of brain function in adolescent anorexia nervosa before and after weight gain

This study assessed brain function in 20 adolescent females with anorexia nervosa (AN) and 20 controls using event-related potentials (ERPs) and a battery of neuropsychological tests. In the AN group, N4 latencies for a nonverbal memory task were significantly longer than for a verbal task, and P3 latencies for the verbal task were significantly longer among anorexics as compared to controls. On the nonverbal task, the AN group failed to show a right > left hemispheric asymmetry for P3 amplitudes which was observed for controls. These group differences for P3 latency and amplitude were particularly pronounced in the central-parietal region of the head. Body Mass Index (BMI) in the anorexic group significantly predicted N4 amplitudes for the verbal task in the left hemisphere and P3 amplitudes for the nonverbal task in the right hemisphere. The two groups did not differ on any of the tests used to assess neuropsychological functioning. Eight nutritionally recovered patients and their matched controls were retested using the same procedures. Anorexics showed larger P3 amplitudes for the verbal as compared to the nonverbal task at follow-up. These findings provide evidence for localized brain dysfunction in anorexia nervosa that only partially normalizes with weight gain.

Empirical Classification of Speech/Language Impairment in Children I. Identification of Speech/Language Categories

Cluster analysis was employed to classify speech/language impairment in a sample of 347 children 5 years of age. Based on scores on a variety of speech and language tests, four groups of children with similar linguistic profiles were identified. These groups were labeled high overall, low overall, poor auditory comprehension, and poor articulation. Differences among these groups according to cognitive, developmental, demographic, and audiometry variables were examined. The low overall group was most disadvantaged on all measures, the high overall group was most advantaged, and the poor articulation and poor auditory comprehension groups were intermediate. The implications of these findings for the development of a theory of the relationship between speech/language and psychiatric disorders are discussed.

Diagnostic Continuity From Preschool to Middle Childhood

Most previous studies of preschool outcome have examined a limited range of psychiatric disorders and have used short-term follow-up intervals. The present investigation reports on the 5-year diagnostic and symptom outcome of 98 children who attended a therapeutic preschool program. Time I diagnoses, based on DSM-III criteria, fell into five broad categories: no Axis I diagnosis, conduct-type disorders, attention deficit disorder (ADD), emotional disorders, and developmental delay. Results indicated that children with developmental delay or ADD were most likely to receive the same diagnosis at follow-up, whereas conduct-type and neurotic children showed less diagnostic stability.

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.