John F. McDermott

Psychiatric symptoms of Hawaiian adolescents

The purpose of this study was to examine the interrelationship of depressive symptoms with symptoms of anxiety, aggression, and substance abuse in Native Hawaiian adolescents. A total of 1,819 Native Hawaiian students were recruited from three high schools as part of the initial phase of an ongoing, 4-year, longitudinal, cross-sequential study. Psychiatric symptoms were measured with the Center for Epidemiological Studies-Depression Scale (CES-D), Spielbergers State Anxiety Inventory (SAI), Braver Aggression Dimension Scale (BADS), and Substance Abuse Subtle Screening Inventory-Abbreviated (SASSI-A). Scales were standardized for this minority population. Depressive symptoms were strongly associated with symptoms of anxiety and aggression but only weakly associated with self-reported substance abuse. Girls had substantially higher scores than boys on all scales. Ninth graders reported more aggressive symptoms than did 12th graders. The educational level of the adolescents main caregiver was not associated with symptoms reported in any of the scales. Native Hawaiian adolescents report similar symptoms and symptom clusters as do adolescents on the mainland U.S. However, Native Hawaiian adolescent girls report a greater number of symptoms in all categories when compared to boys. This distinguishes them from most mainland adolescent populations.

Child Custody Decision Making: The Search for Improvement

Abstract There is currently a great demand for child psychiatrist to be involved in child custody decision making. Lack of adequate training and limited criteria which deal with measurable psychological tailors have made this a difficult problem for out field to meet. This paper describes a new assessment method, called the Patent-Child Interaction Test, for use by the child psychiatrist involved in child custody decisions. Experiences in its use by a family court are described. The historical development of custody criteria and an analysis of the working philosophy of a typical family court in custody cases is described, including criteria customarily considered and problems encountered in the decision-making process.

Influence of Family Adversity on School-Related Behavioural Problems among Multi-Ethnic High School Students

This study examines the influence of family adversity indicators on school-related behavioural problems among Hawaiian and non-Hawaiian adolescents. Questionnaire data from 2787 students were linked to school information, including grade point average (GPA), absences, suspensions and conduct infractions. Logistic regression analyses were performed. The cumulative effect revealed higher increases in the odds ratios for school-related behavioural problems among non-Hawaiians. Surprisingly, there was no cumulative effect of family adversity among Hawaiian adolescents. Given their high rates of adversity and behavioural problems, any family adversity may significantly impact this group. The family environment must be considered in the prevention and intervention of school-related behavioural problems.

Hyperkinetic syndrome: The role of depression

The hyperkinetic syndrome is one of many manifestations of minimal brain dysfunction and emotional distrubance. Both physical and psychologic factors can be seen in its etiology. Depression has often been found to be related to hyperkinesis. The children described in this study give ample support to the frequency of this relationship. Some preliminary hypotheses are also drawn about the dynamics of the relationship between depression and the hyperkinetic syndrome.

Family Diagnosis and Classification

In recent years, psychiatrists have increasingly realized the significant role the family plays in creating or maintaining childhood psychopathology. This emphasis on the family has broadened the therapist’s diagnostic and treatment perspective, but little comprehensive methodology has been developed to classify family pathologies systematically. Various students of human behavior have attempted to conceptualize the nature of family pathology. Sociologists tend to view the family as a social system and focus on the functions the family performs in society; psychologists, frequently studying their subjects in experimental settings, explore specific aspects of family function. Family therapists have strongly emphasized the value of treating the family as a whole, but have provided little systematic methodology with which the clinician can effect diagnosis and treatment. It is obvious, therefore, that there is an urgent need for a clinically applicable diagnostic methodology to facilitate systematic assessment of family functioning and to differentiate and classify family pathologies, so that relevant familyoriented treatment can be planned. In this paper, we present the nosological classifications of family pathologies that have been defined by our research team. Our initial research, which culminated in the development of the family functioning assessment, will be discussed in detail in a separate paper. In a continuing effort to examine family psychopathology, we have defined six major family types.

The Longitudinal Study: A Bridge to the Future

S b c f y b g n s o O ur Journal like most scientific journals, has a dual function: to develop a knowledge base for the field and to provide the latest information for clinical practice. For years, there was little connection between the two. Research was dominated by cross-sectional, retrospective studies of highly selected clinical cases, with all the distortions inherent in that method. Then, in the 1980s, came our own “Framingham studies,” prospective longitudinal studies of community-based samples. They promised not just to predict prevalence, but also to show us how symptoms develop, which symptom trajectories persist as disorder, and which ones change. The basic question was, what leads to what? Not only would the studies offer us a needed bridge between research and practice, they would examine the developmental process, too. They promised to change our cherished developmental theory into a developmental science. These studies came not just from the United States, but also from around the world. One of the most unique, one that separated it from the others, was the Dunedin Multidisciplinary Health and Development Study from the University of Otago Medical School in New Zealand. The investigators were a group of behavioral scientists (including a child psychiatrist), most of whom were practicing clinicians and epidemiologists. The research team followed a complete birth cohort of more than 1,000 babies born in 1972 at St Mary’s Hospital, Dunedin, a small university town on New Zealand’s South Island (home to a world-famous albatross colony) that looks as if it were plucked right out of Scotland. The researchers felt 1,000 was a cohort large enough to study psychiatric disorder for statistical purposes, yet small enough to obtain highquality data longitudinally. Indeed, these 1,000 children were followed comprehensively every 2

Selection of children for residential treatment: a study of evaluation procedures and decision making.

Abstract A questionnaire study of factors pertinent to patient selection in 39 childrens residential institutions revealed a network of relations between extensiveness of evaluations and certain specific evaluation procedures on the one hand, and the length of time children remain in residence and the percentage of rejected applications for admission on the other. Our findings led us to consider the role of an emphasis on the family in evaluations and to questions of evaluation thoroughness and redundancy. Certain aspects of the decision-making process and its relation to other characteristics of the institutions were considered.

The University of Hawaii/University of Indonesia Collaboration to Build and Sustain a Child Psychiatric Workforce

The authors describe the University of Hawaii/University of Indonesia collaboration, which introduced the specialty of child psychiatry to Indonesia in the early 1970s via a specially designed program, based in Hawaii, for five jointly selected Indonesian psychiatrists. All five graduates remained in Indonesia to practice and establish their own training program, which has since trained all of the “newer generation,” such that there are currently 40 child and adolescent psychiatrists in Indonesia. Since 2009, collaboration between the two institutions has been renewed and modernized through videoteleconferencing, jointly conducted with teaching sessions. The authors present this program as an example of a collaboration that developed the local workforce and that has utilized modern technology in international, bidirectionally beneficial education.

Objectives of Psychiatric Education in a Primary Care Curriculum.

This paper gives the rationale, background, and outline of psychiatric curriculum development in the education of the primary care physician at one medical school. It is important to clarify the educational objectives, to develop specific teaching techniques to meet the objectives, and to have adequate assessment measures to evaluate the objectives and techniques. Additionally, it is necessary for an ongoing committee to continue to monitor and adjust the program as the assessment requires. The value of the program has been educational clarity, the development of a high esprit de corp among the faculty, student acceptance, and integration of psychiatry into the total medical school curriculum.