Laurence Jerome

Overrepresentation of adopted children attending a children's mental health centre.

A retrospective analysis was made of case records of children attending a Childrens Mental Health Centre during the years 1959 to 1973. Annual comparisons were made between the numbers of adopted, children seen in the province of Ontario and within the clinic setting. The results indicated that over a fifteen year period the adopted children in the clinic were seen with twice the expected annual incidence predicted from the community rates. “So far as it is known, the proportion of successful and unsuccessful adoptions does not seem unsatisfactory. This result is in accordance with clinical experience which does not suggest that an undue proportion of adopted children are referred to child guidance clinics.” Bowlby (1951)

A comparison of the demography, clinical profile and treatment of adopted and non adopted children at a children's mental health centre

A retrospective analysis of adopted and non adopted children attending a childrens mental health centre between 1959 and 1973 indicated a higher than expected number of males and a significantly higher number of professional fathers than expected in the adopted group. A sub-group of adopted children identified as having learning problems by reports of the parents and teachers had a different pattern of test scores on the Wechsler Intelligence Scale for Children from a non adopted group, who were also selected for learning difficulties. On the parents and clinicians ratings, the adopted group had more parent-identified hyperactivity symptoms and clinicians’ diagnoses of hyperactivity. Treatment data indicated that they used more stimulant medication; this was particularly significant for the early adoptees. The early adoptees were considered to be more hyperactive by their parents than the late adoptees. The late adoptees were more impaired on psychometric testing than those placed early, before six months of age. These findings are discussed in relation to possible explanations for the higher than expected prevalence of adoptees seen in clinical populations.

Bupropion and drug-induced parkinsonism.

trans mit ter sys tem may un der lie as pects of the pa thol ogy ob served in au tis tic pa tients (1). Risperidone, an atyp i cal antipsychotic that is both a se ro to nin and do pa mine an tag o nist, has been shown to treat adults with au tism ef fec tively (2). Studies have shown that risperidone also im proves symp toms in sev eral psy chi atric dis or ders of older chil dren and ad oles cents (3–5). In this let ter, we de scribe its use for treat ing chil dren with au tism. Our sam ple con sisted of 9 sub jects with a DSM-IV di ag no sis of au tis tic dis or der (7 males and 2 fe males; me dian age 7.1 yrs, range 3.4 to 13.4 yrs). Screening pro ce dures in cluded med i cal his tory, phys i cal and neu ro log i cal ex am i na tions, com plete blood count, elec tro lytes, glu cose, se rum urea ni tro gen, creatinine, liver func tion, uri nal y sis, ECG, EEG, and au di tory evoked po ten tials. Pa tients were drug-free for at least 4 weeks before the be gin ning of the trial. No other psy cho ac tive med i ca tion was given dur ing the study.

Perception of Body Image

The article by Noh and Avison (1) raises a number of practice issues regarding the provision of psychiatric services to an immigrant population. In a retrospective study that we are currently undertaking on patients ofAsian background (i.e., immigrants from Southeast Asia) we found that 50% of our sample had a poor command, or no knowledge, of English. Language barriers and cultural differences make it more difficult for immigrant populations to receive appropriate psychiatric assessment and treatment. We concur with Noh that instruments such as the SCL-90 are useful and need to be translated into other languages to provide for patients of different ethnic groups. In our study, the length ofhospitalization in the Asian sample was on average twice as long as that of a matched sample of patients of Canadian origin. In addition, we found that in those who had a poor command of English, the focus of management was pharmacological rather than rehabilitative (for example, social skills training, occupational services, family therapy). We agree with Noh thatprospective studies and those that include native samples from the country of origin would contribute to a better understanding of mental illness in immigrant populations.

Novice drivers with attention-deficit hyperactivity disorder

The recent CMAJ lead editorial on the high rate of injuries and deaths among youthful drivers is long overdue.[1][1] It focuses our attention on potentially modifiable human factors in this important public health epidemic.[2][2] The latest edition of the CMA drivers guide includes changes

The benefit of stimulants in reducing driving risk in adult drivers with ADHD

Redelmeier and Tien[1][1] have provided an excellent update on the medical interventions to reduce driving risk. A recent article by Chang and colleagues[2][2] from Sweden may be of interest to CMAJ readers. The authors reported on an epidemiologic study between 2006 and 2009 of over 17 000 drivers

Forensic risk assessment and dangerous driving

Comment on: The clinical use of risk assessment. Glancy GD, Chaimowitz G. Can J Psychiatry. 2005; 50(1):12-7. Language: en

Increased rate of early smoking in children and adolescents with attention-deficit/hyperactivity disorder

I applaud the article by Thombs and colleagues[1][1] on behavioural interventions for the prevention and treatment of cigarette smoking among school-aged children. The article recommends that prevention and treatment strategies exclude patients who have cognitive deficits, mental or physical health

Re: Long-acting stimulants for novice drivers with ADHD.

One important omission in this article is information regarding psychiatrists’ knowledge of behavioural and learning disabilities. In the last edition of the handbook on fitness to drive (2000), attention-deficit hyperactivity disorder (ADHD) was mentioned for the first time as a reportable condition. In the December 2006 edition, more specific advice is given to physicians regarding novice drivers with ADHD. Physicians are now advised to consider recent metaanalysis data examining the effects of various medications used to treat ADHD and to consider prescribing long-acting stimulants.

Re: Motivation and Mechanism in Motor Vehicle Collisions

This article comments on a paper by Dumais et al. (Psychiatric Risk Factors for Motor Vehicle Fatalities in Young Men, Canadian Journal of Psychiatry, November 2005). It is posited that the original authors did not discuss the possible underlying mechanisms leading to fatal collisions, and that they did not make mention of a key Axis I diagnosis strongly associated with motor vehicle crashes: Attention Deficit-Hyperactivity Disorder (ADHD). Demographic details of the accidents could provide information about the underlying mechanisms involved in motor vehicle crashes. It is unclear from the description of the methodology whether information concerning the nature or circumstances of these deaths was available. Importance of a careful evaluation of possible comorbidities in categorical diagnoses with the potential for problem driving lies in the emerging literature about the protective value of medications for managing impulsive and aggressive behavior patterns.