Leon Cytryn

The development of a child assessment interview for research and clinical use

The Child Assessment Schedule (CAS) was developed to address the need for a standardized child interview that could be used for research and clinical purposes. The CAS has several distinguishing characteristics: (1) Questions and responses are standardized, (2) the format was designed to enhance rapport with the child, and (3) information necessary for DSM III childhood diagnoses is explicitly solicited. The CAS was administered to 32 child outpatients, 18 inpatients, and 37 normal controls. Derived scores were obtained for total psychopathology, 11 content areas, and 9 symptom complexes. Interrater reliability for the total CAS score was quite high. The CAS was able to discriminate among the three groups in total score indicating degree of psychopathology, on 9 of the 11 content areas, and on 8 of the 9 symptom complexes. Significant correlations were found between the CAS and maternal report of child behavior and between the CAS and child selfreport of internal affects. It was concluded that the CAS has adequate reliability and validity, although further research is indicated.

The Child Assessment Schedule (CAS) diagnostic interview: a report on reliability and validity.

This paper describes data relevant to the reliability and validity of the Child Assessment Schedule (CAS). The CAS, a diagnostic instrument for children, was designed for clinical assessment as well as collection of research data. Information relevant to making a differential diagnosis is solicited within a format of standardized questions and response items. Two independent reliability studies have been conducted with a total of 63 children. Interrater reliability for the total CAS score was found to be high in both studies (0.91 and 0.90). High interrater reliability was also demonstrated for subscales of the CAS. Data relevant to the concurrent validity of the CAS are also presented.

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.

Offspring of Patients with Affective Disorders: II

Nineteen children, aged 5 to 15, of 13 manic-depressive parents and 21 children aged 5 to 15 of 13 normal parents were evaluated for affective disorder using blind ratings and interviewers and employing both the Weinberg Criteria and the DSM-III. Significantly more index families had depressed children than normal families as measured by Weinberg and DSM-III Criteria. The presence of depression in the children did not correlate with age or sex and no manic or psychotic children were seen.

Urinary Metabolites in Chronically Depressed Children

Abstract Three groups of children were examined—chronically depressed inpatients, orthopedic inpatients screened for psychopathology, and a control group of physically and emotionally healthy outpatients. The urinary metabolites studied were norepinephrine (NE), vanillylmandelic acid (VMA), and 3-methoxy-4-hydroxyphenylethylene glycol (MHPG). Only MHPG showed a significant difference between the groups: the outpatient control group had the highest mean vaalues—1,092 μg/m 2 ± 109; the depressed patients, 735 μg/m 2 ± 64; and the orthopedic patients, 504 μg/m 2 ± 32. The discussion centers on the possible relationship between the activity and the MHPG values in these children. VMA and NE values would seem to rule out activity as the cause of the differences seen. Finally, a theory concerning a reactive suppression of the arousal system is proposed to explain the low MHPG values in the orthopedic patients.

Studies of Behavior in Children with Down’s Syndrome

My interest in mental retardation goes back to the years of my pediatric training. My chief at the time was Harry Gordon, one of the country’s outstanding pediatric teachers, who later became the director of the Rose Kennedy Research Institute at the Einstein Medical School. Gordon inculcated in all of us a basic respect for the mentally retarded and their families both as patients and as subjects of scientific investigation. Continuing on my professional journey I came into the orbit of Leo Kanner and Leon Eisenberg at Johns Hopkins. There my interest in mental retardation deepened and I first began to be concerned with the personality development of the mentally retarded, their emotional vulnerability, and the link between mental retardation and mental illness, particularly the childhood psychoses. Kanner introduced me to his pioneering thoughts on early infantile autism and pseudofeeblemindedness, as well as to his historical perspective of mental retardation. Eisenberg added to this his profound interest in the social forces that shape human behavior and the basic defects in our social and value system responsible in large measure for the existing psychopathology in our society. From there, I went to Children’s Hospital in Washington, D.C., to complete my training under Reginald S. Lourie. Lourie’s interest in the mentally retarded and dedication to their rehabilitation was a source of inspiration to me. He contended that the mentally retarded are capable of attaining optimal personality development under favorable circumstances.

CURRENT RESEARCH IN CHILDHOOD DEPRESSION: Introduction

Several years ago I advocated continuing interest and exploration in the field of affective disorders in children despite the confusion and wide diversity of views in this area (Cytryn, 1977). I am certainly gratified by the gradual acceptance by the mental health professionals of childhood affective illness as a valid clinical entity. This is in contrast to the skepticism or even nihilism which was often prevalent in the not too distant past. However, there are still many unanswered questions which only further research may clarify. This special section presents a sampling of recent research efforts in this area. There seems to be an emerging consensus about the existence of major affective disorders in children which can be classified according to adult criteria (Cytryn et al., 1979; Kovacs and Beck, 1977; Puig-Antich et al., 1978). Carlson and Cantwell, in their paper, join this general trend. It is still uncertain, however, how frequently such major affective disorders occur in childhood. Most likely there are more children who present with symptoms of depression of lesser severity; the possibility that this group is related to major affective illness cannot be discounted. Specifically, depressive symptoms may represent forerunners of such illness in ad-