One of the strengths of this journal is its breadth. There are several other journals that concentrate on clinical studies, or on basic developmental psychology, but JCPP brings epidemiologic research to clinicians, clinical trials to developmental psychologists, and basic developmental research to epidemiologists. What unites this varied content is a concern for children.
This volume is unusual in containing very little about the ‘core’ disorders that occupy the time of most clinicians: nothing directly on disruptive behavior disorders, anxiety disorders, or depression. But don't close the covers and turn on the television! There are several papers that will interest you. For example, Ruschena and colleagues have taken advantage of their large birth cohort of Australian children born in 1983 to take a hard look at the effect on internalizing (emotional) and externalizing (behavioral) problems at age 17–18 of parental divorce, remarriage, and other forms of family transition across childhood. The sample was big enough for findings of no between-group differences to be believable, rather than attributable to lack of power. And, indeed, the important finding was that there were very few differences overall between children from intact families and those who went through various kinds of family transition, even bereavement. Since their findings differ so markedly from those of other studies, notably some from the United States, it is important to ask why. There are many methodological reasons, as always, but there is also, as the authors discuss, the possibility that Australia's more supportive social policies protect families from the full stress of divorce and parental death, and encourage resilience in children and adolescents.
Another paper, by Stewart and colleagues, shows how interesting findings of no between-group differences can be. In this case the comparison is between children from Hong Kong and the United States, and the topic is suicidal ideation and its predictors. Despite higher levels of depression and hopelessness and lower levels of self-esteem in the adolescents from Hong Kong, levels of suicidal ideation were similar, as were the predictors of suicidality in the multivariable models. Apart from its interest as a study of the impact of ethnicity on suicidal ideation, the study demonstrates, as does the Center for Disease Control's national surveys in the United States, how common it is for adolescents to think about killing themselves. Should we, as parents, clinicians, and researchers, take this calmly as a temporary manifestation of adolescent weldschmertz, one that will disappear along with the navel ring? If not, what should we be doing about it?
The general reader will also be interested in the paper by Harlaar and colleagues on the genetics of word recognition, using a twin study design to partition the variance among its genetic, shared environmental, and non-shared environmental components. Genes made by far the largest contribution, with shared and non-shared environment dividing the rest. Of particular interest is the evidence that the distribution was very similar both for the full range of scores and for the extreme scores; i.e., for the level of word recognition deficits that could be seen as disabling. If word recognition deficits are largely heritable, it is critically important that schools should recognize this and develop remedial programs for children who begin school at a serious disadvantage.
Eating disorders, narrowly defined, are relatively rare in the general population, but as Lamerz and colleagues show, by age 5 to 6 binge eating (2.0% prevalence) and night eating (1.1% prevalence) were already quite common in a large community sample from Aachen, Germany. The concept of ‘night eating’ was unfamiliar to me, but Google came up with 50,000 citations, and it is recognized as a syndrome in ICD-10. Both types of eating problem were strongly associated with mothers’ eating problems, and also, in this community with many immigrant families, with having parents who came from Eastern Europe and who were not native German-speakers. If the mothers’ eating problems were a response to the stress of translocation, this is a troubling example of stress in one generation affecting the health of the next generation.
Another study of eating disorder, by Ametller and colleagues, has as its focus severe anorexia nervosa, one of the most dangerous and intractable of the psychiatric disorders of adolescence, though fortunately rare in this extreme form. Since eating is a behavior that is largely controlled by the individual, attitudes are centrally important to predicting behavioral change. Anorexia research has developed useful attitudinal measures, one of which is used in this study. The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) clearly predicted whether the outpatient sample would require inpatient hospitalization over the next 6 to 9 months. Similar attitudinal measures are widely used in drug abuse research. I wonder if they would help us to understand other kinds of behavioral psychopathology; conduct disorder, for example?
Another rare and intractable condition, autism, is the focus of two papers. In McGovern and Sigman's follow-up study of 48 children into adolescence or young adulthood the conclusions were not completely gloomy. Almost all the children still met criteria as adolescents, but both parents and observers reported fewer symptoms and more adaptive and empathic behavior. The authors point out the importance of early language and cognitive training, if the children were to make behavioral progress. They also point out that this sample was born in the 1970s, and express the hope that later generations of children with autism will benefit by improvements in education and treatment.
The second paper, by Fisher and colleagues, examines the association between language and theory of mind in two groups: children with autistic spectrum disorders (ASD) and children with mild learning disabilities. The strong association between the two in ASD children leads the authors to suggest that there is a causal relationship here; that is, that some grammatical understanding is necessary to the development of a theory of mind. The conclusions that can be drawn are highly dependent on the extent to which the experimental task – a test of false beliefs – does indeed measure theory of mind.
The validity of cognitive performance tasks is also at issue in Denney and colleagues’ study of aspects of the continuous performance task, that stalwart laboratory test of ‘maintenance of attention for infrequent but critical events over time’ that is widely used to help to diagnose ADHD. The authors found performance differences as a function of both the target itself and the density with which targets were presented. Increased target density increased the error rate for one paradigm, but reduced it for the other. Findings like this will help to sharpen our understanding of working memory, and of the deficits that ADHD encompasses.
Finally, two papers with strong clinical implications. Limond and Leeke's review of the efficacy of cognitive rehabilitation programs for children with acquired brain injury is an illustration of how desperately these programs are needed, and how desperately hard it is to do scientifically valid research into their effectiveness. Each brain-injured child is different, and clinicians identify a different set of treatment needs at different stages of recovery and for different developmental stages. How is it possible to assemble the large groups needed to do the standard randomized controlled trials? How can researchers ethically withhold treatment when they believe that timing is of the essence? Perhaps we should be looking for different research designs for work of this kind; possibly some variant of the single case design.
Parents are the focus of the treatment trial of parent management training (PMT) described by Peters, Calam, and our deeply missed colleague Dick Harrington. In this paper the focus is on what predicts attendance, the sine qua non for treatment effectiveness. The findings are surprising and intriguing. Parents with high levels of expressed emotion (EE) and highly critical of their children's behavior were no more likely than low-EE, non-blaming parents to drop out. What did predict dropout was having been told that the child had a psychiatric diagnosis! The researchers suggest that a diagnosis ‘limits further causal search and willingness to try new treatment options’. If so, this is worrying, especially in the United States where a formal DSM diagnosis is often necessary to receive treatment at all. The other cause of dropout was low income. The struggle of poor mothers to get to treatment sessions is underestimated in most research, and it is good to have it recognized here.
Once again, we have an issue of JCPP bulging like a Christmas stocking with treats of many kinds. Enjoy!