John F. Simonds

Sleep behaviors and disorders in children and adolescents evaluated at psychiatric clinics.

The parents of 150 children and adolescents, evaluated at a university psychiatry outpatient clinic and a mental health center, were surveyed to determine the frequency of various sleep-related behaviors. This clinic sample was compared with a nonclinic sample of 309 subjects from the general population. A significantly higher incidence of restless sleep, limb movements, nightmares, night terrors, reluctance going to sleep, sleeping with others, fear of dying, fears of dark, and daytime overactivity differentiated the clinic population from the nonclinic population. there were no significant differences in the frequencies of sleep behaviors in the clinic sample due to chronic ear-nose-throat (ENT) problems, sex, or social class. However, bedwetting, sleeping with others, bedtime rituals, need for security objects, fears of the dark, and daytime overactivity were significantly more frequent in the younger age population. Nightmares and restless sleep were more likely to occur in patients having anxiety-affective disorder or conduct disorder DSM III diagnoses, as compared to clinic patients without psychiatric diagnoses. Patients with mental retardation were more likely to experience fears of the dark. A significantly greater number of patients with attention deficit disorder manifested problems with snoring, head banging, restless sleep, and nighttime awakening. There appeared to be an association between chronic ENT problems and daytime overactivity.

Depression among incarcerated delinquents

The authors examined the prevalence of depression among incarcerated delinquents and nonincarcerated, nondelinquent adolescents and reported a prevalence of 18% and 4%, respectively. The possible effect of incarceration on the development of depression was also studied. DSM-III diagnostic criteria for major depressive disorders were used. Of the 100 delinquents admitted consecutively to a detention center, 11 showed evidence of depression both during and before incarceration, while seven developed a depressive disorder in the center. With regard to specific symptoms, 100% of the depressed incarcerated adolescents were found to suffer from sleep difficulties, and 94% experienced disturbances of appetite. Psychomotor retardation or agitation were the symptoms least commonly observed.

Psychiatric Status of Diabetic Youth in Good and Poor Control

Two groups — identified as “good control” and “poor control” — of 40 diabetic youth, between 6 years and 18 years, matched for age, sex and duration of diabetes, were interviewed by a child psychiatrist who was not aware of the status of their diabetic control. After each interview psychiatric diagnoses, interpersonal conflicts and noninterpersonal conflicts were determined. At the same time, mothers completed a childrens behavorial-emotional symptom checklist. Six psychiatric diagnoses were made (7 ½ per cent occurrence): four in the poor control group and two in the good control group, not a significant difference. Fifty per cent of the psychiatric diagnoses were found in the prepubertal girls who had the earliest onset of diabetes. A significantly greater number of patients in poor control had interpersonal conflicts compared with patients in the good control group. Mothers of patients in poor control had checked significantly more behaviors as slight and considerable-severe problems compared to mothers of patients in good control. Five per cent of the patients in good control and fifteen per cent of the patients in poor control stated that they experienced a “different” self-image because of their diabetes. The frequency of psychiatric diagnoses (7 1/2 per cent) for the entire group was not higher than literature reports of serious psychiatric disorders in normal population studies.

Specific Drug Use and Violence in Delinquent Boys

Delinquent boys who had been committed to a training school were interviewed by a psychiatrist to determine drug abuse status. Crimes that were officially recorded were classified as person offenses or property offenses, and the number of offenses was determined from the juvenile record. Drug scores were given subjects for each of 13 drug categories according to the following scale: 0, no use of drug; 1 to 4 v, varying use frequencies increasing in stepwise fashion but not reaching abuse proportions; 5, use greater than 8 days per month and abuse as defined in DSM III. Subjects number of crimes against persons were correlated with subjects drug scores for each of 13 drug categories. Five drugs had significantly positive correlations: phencyclidine, barbiturates, cocaine, Valium, and amphetamines. Scores for alcohol, LSD, mescaline, volatile substances, codeine, marijuana, heroin, and morphine did not correlate significantly with the number of person offenses in the person offender group. Mean drug scores for 13 drug categories of all subjects who were violent person offenders were compared with drug scores of subjects who were property only offenders. The t tests for independent means revealed that drug scores were significantly higher in the person offending group for five drugs: marijuana, alcohol, cocaine, heroin, and LSD. A high drug score for marijuana was the most predictive of all drug scores for membership in the person offending group.

Emotions and compliance in diabetic children

Abstract Emotional disorders in diabetic children and adolescents can result in mismanagement of the diabetes regimen. The children and their families may fail to comply with their regimen by omitting insulin injections, falsifying urine test reports, eating indiscriminately, or not keeping appointments. The reasons for noncompliance are numerous. The author reviews the literature on medical noncompliance in diabetic patients, compares results of studies of the effects of emotions on metabolism, and gives suggestions for improving compliance.

Relationship of Maternal Parenting Behaviors to Preschool Children's Temperament

Mothers of 182 preschool nursery school children rated their own parenting responses on a “Parents Report” questionnaire. At the same time the mothers responded to the “Behavior Style Questionnaire” (BSQ) from which scores were determined for nine categories of temperament. On the basis of category scores the children were grouped into one of five temperament clusters i.e. easy, difficult, slow to warm up, high intermediate, low intermediate. The childrens membership in BSQ clusters was independent of sex, age, birth order, and mothers employment status but there was a significantly higher ratio of “easy” children from higher socioeconomic classes I and II. Mothers of children grouped in either the “difficult” or “slow to warmup” clusters were more likely to use “guilt inducing” and “temper-detachment” parenting styles than mothers of children grouped in the “easy” cluster.

Hallucinations in Nonpsychotic Children and Adolescents.

The case histories of ten nonpsychotic patients (nine female and one male) who had experienced hallucinations are summarized. Significant anxiety and depression were found in the majority of the patients, five of whom expressed suicidal ideas. Stress factors were primarily family and school. Eight children had combined auditory and visual hallucinations, which involved dead relatives in five cases. The aims or purposes of the hallucinations were multiple, but escape mechanisms were most common. A profile of the nonpsychotic patient most likely to experience hallucinations would be a socially immature teenage girl who is experiencing depression and anxiety due to stress within the family.

Behavioral and psychiatric assessment of preterm and full-term low birth weight children at 9-11 years of age.

Preterm (N = 33) and full-term (N = 18) low birth weight subjects were compared at age 9 to 11 years to 52 full-term normal birth weight subjects of similar age and socioeconomic levels. All groups were evaluated by a psychiatrist who was not aware of prenatal or perinatal histories at the time of the interview. Mothers completed various standardized questionnaires designed to elicit information about the childrens behaviors. There were no significant differences among the groups in the numbers of subjects with diagnoses of psychiatric disorders or in scores on ratings of hyperactivity, general behavioral maladjustment, and specific behavioral factors. These results indicate that low birth weight per se does not portend serious psychiatric sequelae during middle childhood.

Folie a Deux in a Child.

Folie à deux is the transference of delusional ideas and behaviors from one person to another with whom there has been a close association. Its occurrence in children has been rarely described in the literature, which was reviewed for case reports, diagnostic criteria, and etiological theories. A detailed case history of a 10- year- old girl who had delusions of special powers and delusions of persecution as well as hypochondriacal and hysterical symptoms is presented as an example of folie à deux between child and parent. This girl had developed a symbiotic incestuous relationship with her stepfather, a paranoid schizophrenic patient. Six criteria for making the diagnosis of folie à deux in a child were applied to the case studied. General and specific aspects of treating this disorder were discussed.

Relationship between minor physical anomalies, perinatal complications, and psychiatric diagnoses in children

Thirty-three preterm infants of low birth weight, 18 full-term infants of low birth weight, and 52 full-term infants of normal birth weight were evaluated at ages 9 to 11 years for psychiatric diagnoses and for minor physical anomalies. Mothers completed various child behavior questionnaires. Analysis of variance of the mean anomaly scores revealed that significant differences in the scores were due to the presence or absence of perinatal complications other than low birth weight and preterm delivery. Significant differences were also related to the presence or absence of at least one psychiatric diagnosis. The variables of perinatal complications and psychiatric diagnoses seemed to be acting independently of each other. The minor physical anomaly scores also correlated significantly with Conners Parent-Teacher Questionnaire scores for hyperactivity in both the full-term normal birth weight group and the preterm low birth weight group.