Sean Perrin

Symptoms following mild head injury: expectation as aetiology.

An affective, somatic, and memory check-list of symptoms was administered to subjects who had no personal experience or knowledge of head injury. Subjects indicated their current experiences of symptoms, then imagined having sustained a mild head injury in a motor vehicle accident, and endorsed symptoms they expected to experience six months after the injury. The checklist of symptoms was also administered to a group of patients with head injuries for comparison. Imaginary concussion reliably showed expectations in controls of a coherent cluster of symptoms virtually identical to the postconcussion syndrome reported by patients with head trauma. Patients consistently underestimated the premorbid prevalence of these symptoms compared with the base rate in controls. Symptom expectations appear to share as much variance with postconcussion syndrome as head injury itself. An aetiological role is suggested.

A Prospective Study of Childhood Anxiety Disorders

OBJECTIVE To evaluate course and outcome of DSM-III-R anxiety disorders prospectively in clinically referred children. METHOD Children were blindly and repeatedly assessed with a structured diagnostic interview over a 3- to 4-year period to determine recovery from anxiety disorder and development of new psychiatric disorders. Both psychopathological (attention-deficit hyperactivity disorder, n = 50) and never psychiatrically ill (NPI, n = 83) controls served as comparison groups for children with anxiety disorders (n = 84). RESULTS The majority of children (82%) were free from their intake anxiety disorders by the end of the follow-up. Relapse of these anxiety disorders after remission was rare (8%). During follow-up, anxious children were more likely to develop new psychiatric disorders (30%), primarily new anxiety disorders (16%), than were NPI children (11% and 2%, respectively), but not psychopathological controls (42% and 10%, respectively). CONCLUSIONS Overall, results suggest a favorable outcome with respect to diagnostic status for clinically referred children with anxiety disorders. However, these children may be at risk for new psychiatric disorders over time.

DSM-III-R Anxiety Disorders in Children: Sociodemographic and Clinical Characteristics

This study investigated the characteristics of each of the specific DSM-III-R (American Psychiatric Association, 1987) anxiety disorders in a clinic sample of 188 anxiety disordered children. Characteristics examined included sociodemographic variables (age-at-intake, gender, and race of the child, and family marital and socioeconomic status) and clinical variables (disorder age-at-onset and severity, and history of additional disorders). Findings are discussed in light of the contemporary literature on childhood anxiety disorders.

Practitioner review: The assessment and treatment of Post-traumatic Stress Disorder in children and adolescents

Post-traumatic Stress Disorder (PTSD) is a syndrome defined by the intrusive re-experiencing of a trauma, avoidance of traumatic reminders, and persistent physiological arousal. PTSD is associated with high levels of comorbidity and may increase the risk for additional disorders over time. While controversies remain regarding the applicability of the PTSD criteria to very young children, it has proved to be a useful framework for guiding assessment and treatment research with older children and adolescents. This article presents an overview of the literature on the clinical characteristics, assessment, and treatment of PTSD in children and adolescents.

Stress, coping, and well-being among third-year medical students

BACKGROUND. Medical school is recognized as a stressful environment that often exerts a negative effect on the academic performance, physical health, and psychological well-being of the student. METHOD. Stress, coping, depression, and somatic distress were examined among 69 third-year students completing a psychiatry clerkship in 1992–93 at the University of Mississippi School of Medicine. Stress was assessed using the Medical Education Hassles Scale-R. Coping was assessed using the Coping Strategies Inventory. Depression was assessed using the Center for Epidemiologic Studies-Depression Scale, and somatic distress was assessed using the Wahler Physical Symptoms Inventory. Statistical methods included correlational analysis and hierarchical regression. RESULTS. Clinical levels of depression were found in 16 (23%) of the students, and 39 (57%) endorsed high levels of somatic distress. Stress accounted for a large percentage of the distress variance (i.e., 29% to 50%). Coping efforts contributed significant variance to the prediction of distress above and beyond that accounted for by stress alone, especially in relation to depression. Coping efforts classified by Engagement strategies were associated with fever depressive symptoms, while coping efforts classified by Disengagement strategies were associated with higher levels of depressive symptoms. CONCLUSIONS. Because students who employed coping efforts characterized by Engagement strategies suffered from fewer depressive symptoms, the results suggest that training in these types of strategies may be a useful intervention to lessen the negative consequences of stress among medical students.

The Children’s Revised Impact of Event Scale (CRIES): Validity as a Screening Instrument for PTSD

The Childrens Revised Impact of Event Scale (CRIES) is a brief child-friendly measure designed to screen children at risk for Posttraumatic Stress Disorder (PTSD). It has good face and construct validity, a stable factor structure, correlates well with other indices of distress, and has been used to screen very large samples of at-risk-children following a wide range of traumatic events. However, few studies have examined the scales validity against a structured diagnostic interview based on the DSM-IV criteria for PTSD. In the present study, the CRIES and the PTSD section of the Anxiety Disorders Interview Schedule-Child and Parent Version (ADIS-CP) were administered to a sample of children and adolescents (n=63) recruited from hospital accident and emergency rooms and the validity of the CRIES as a screening tool evaluated. Cutoff scores were chosen from this sample with a low base-rate of PTSD (11.1%) to maximize sensitivity and minimize the likelihood that children with a diagnosis of PTSD would fail to be identified. Cutoff scores were then cross-validated in a sample of 52 clinically referred children who had a high base-rate of PTSD (67.3%). A cutoff score of 30 on the CRIES-13 and a cutoff score of 17 on the CRIES-8 maximized sensitivity and specificity, minimized the rate of false negatives, and correctly classified 75-83% of the children in the two samples. The CRIES-8 (which lacks any arousal items) worked as efficiently as the CRIES-13 (which includes arousal items) in correctly classifying children with and without PTSD. Results are discussed in light of the current literature and of the need for further development of effective screens for children at-risk of developing PTSD.

Principal components analysis of the impact of event scale with children in war

A new 13-item version of the Impact of Event Scale (Horowitz, Wilner, & Alvarez, 1979) was adminstered to 2976 9–14 year old children from Bosnia as part of a large epidemiological screening survey. The IES-13 consists of four intrusion items, four avoidance items, and five new arousal items. Factor analyses showed the scale to have an identical underlying factor structure as when it was used with British children who experienced a single-incident trauma. In addition, there was also a third factor of hyperarousal, closely related to intrusion. These results are discussed in the context of the cross-cultural validity of post traumatic stress reactions in children.

War exposure among children from Bosnia-Hercegovina: Psychological adjustment in a community sample

As part of a United Nations Childrens Fund (UNICEF) psychosocial programme during the war in Bosnia-Hercegovina, data were collected from a community sample of 2,976 children aged between 9 and 14 years. Children completed standardized self-report measures of posttraumatic stress symptoms, depression, anxiety, and grief, as well as a report of the amount of their own exposure to war-related violence. Results showed that children reported high levels of posttraumatic stress symptoms and grief reactions. However, their self-reported levels of depression and anxiety were not raised. Levels of distress were related to childrens amount and type of exposure. Girls reported more distress than boys, but there were few meaningful age effects within the age band studied. Results are discussed in the context of service development for children in war.

Social Desirability and Self-Reported Anxiety in Children: An Analysis of the RCMAS Lie Scale

There are important applied and theoretical reasons for research into the association between social desirability and self-reported anxiety in young people. The aim of this study was to examine the relationship between anxiety and social desirability in a large normative sample of 7- to 14-year-olds (N = 1,786). Participants completed the Revised Childrens Manifest Anxiety Scale and their teachers rated children as anxious-not anxious according to specified descriptions. Results indicated that anxiety and lie scores do not correlate for either gender or age grouping. However, anxiety scores interacted with lie scores differently for males and females in terms of the agreement between childrens and teachers ratings of anxiety. Indications are that social desirability levels may in part explain the consistent discrepancies found between child and adult reports of anxiety in young people.

Anxiety disorders in African-American and white children

There are little available data on African-American children with anxiety disorders. Treatment-seeking African-American (n=30) and white children (n=139), with a current DSM-III-R anxiety disorder, were compared on sociodemographic background variables, clinical characteristics, and lifetime rates of specific DSM-III-R anxiety disorders. Overall, results suggested that the anxiety-disordered African-American and white children who sought treatment from an outpatient mental health facility were more similar than different. The two groups did, however, differ somewhat on several variables (trend only), including rates of school refusal, severity of primary anxiety disorder, lifetime prevalence of posttraumatic stress disorder, and total scores on the Fear Survey Schedule for Children-Revised. More specifically, white children were more likely to present with school refusal and higher severity ratings, while African American children were more likely to have a history of posttraumatic stress disorder and score higher on the FSSC-R. The impact of these findings and the need for additional research are discussed.