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Most often children are referred to child psychiatric services because of learning difficulties and conduct problems. The background of each problem area can be highly variable. Learning difficulties may be related to cognition but also to emotion, while conduct problems may derive from disturbances in cognition, emotion and parenting; i.e., the context of the child's individual and environmental situation plays an important role for his or her psychosocial functioning and needs to be carefully looked after by the adults. In particular, the understanding of the mechanisms of emotion regulation in terms of cognitive-emotional processes seems to be important for both, the conceptualisation of normal child development as well as coping with disorders of anxiety/depression and their principal role in learning sciences at school and habits in real life.

Herba et al. and Ladouceur et al. present neuropsychological data in 4- to 16-year-old children which raise this point and give some helpful insights concerning emotional facial expressions. The ability to assess one's social environment quickly, interpreting emotional cues and acting the right way, is crucial not only for successful social communication but also for successful learning in a didactic context. Helping children to acquire and handle these abilities in detail is necessary, since in real life facial expressions and gestures are rarely displayed at their maximum intensity. Further, cognitive-emotional control processes have to be learned in order to regulate disstressing emotional stimuli which may otherwise affect attentional capabilities and finally lead to school problems. Such cognitive control processes subserve to inhibit negative affect or emotional behaviours that may not be appropriate in a given context (e.g., actively remember positive events in the face of stressful situations). Development of cognitive-emotional processing is closely linked to the interactive maturation of certain brain regions (i.e., amygdala/prefrontal cortex). Thus, it is understandable that performance of frontal-lobe-sensitive executive functions (e.g., inhibition, measured with a Go/NoGo task), which engage cognitive control processes, is influenced in children and adolescents diagnosed with an affective disorder. Moreover, as Ladouceur et al. show, angry faces influenced the performance of anxious children, whereas sad faces influenced the performance of the depressed group; i.e., cognitive-emotional control is disorder-specific. Beyond the meaning for refining clinical interventions, these findings may have implications with regard to learning at school: anxious and depressed children may not perform to their optimal potential if learning takes place in a context where they perceive emotional cues as threatening or sad, while healthy children can cope with such a situation in a cognitive-emotional balanced way. Although most well-trained teachers might be sensitive to these conditions of their pupils and adapt their didactic behaviour successfully, in many cases of children presenting with learning difficulties this is not the case. Therefore, informing the school system about these facts should help both the children and the teachers.

Besides the teachers, there are the parents who should provide an optimal setting for learning, especially for habits and social adaptation to reduce children's conduct problems. Coldwell et al., Gardner et al. and Blader present empirical evidence that parenting itself and parenting intervention, based on cognitive-behavioural principles, is effective for managing children's problem behaviour. Findings of Coldwell et al. suggest that household chaos (i.e., environments lacking in routine and organisation) is linked with more negative parenting as well as being a risk factor, above and over parenting, for children's behaviour; displaying lower levels of social competence and higher levels of problem behaviours. As such, clinical interventions with families may need to consider parental education regarding aspects of household organisation and giving support that enables parents to provide and structure an organised environment that may than have a beneficial effect on children's behaviour.

There is clear evidence from randomised controlled trials and systematic reviews that conduct problems can be prevented and treated with cognitive-behavioural parenting interventions. These interventions help parents to learn more effective skills and provide better settings. However, despite high levels of public concern about anti-social behaviour of children and adolescents, only a handful of such interventions were located in ‘real-life’ child mental health services/settings – and only a small proportion of most at-risk children and families access services for conduct disorder. Further, relatively few everyday services have a firm evidence base. Therefore a key policy question is how services can reach larger numbers of families, through provision that is effective, yet accessible at low cost. Gardner et al. made a successful first step in this direction. They tested (using a randomised controlled trial method) in 2- to 9-year-old children from primarily low-income families the effectiveness of a parenting intervention with a strong evidence-base for reducing children's conduct problems, the Webster–Stratton ‘Incredible Years’ programme, delivered in multiple neighbourhood sites by well-trained and supervised staff of a voluntary sector organisation. Not only was consumer satisfaction high but also change in positive parenting skill appeared to partially and significantly mediate change in observed child problem behaviour, whereas change in parent mood or sense of competence did not contribute to child outcome. Hence, improving parenting skills should be the main target for parenting interventions and may include supporting parents in order to adapt their personal parenting stress, as Blader suggested in his article.

It is well known that not only learning difficulties but also emotional and conduct problems are often associated with ADHD and parenting interventions are a key part of its multimodal treatment, especially in younger children (Rothenberger et al., 2004). Hence, two of the six highly informative articles including aspects of ADHD report data that may be considered when an optimal learning and treatment setting for children is planned.

In a longitudinal study Laucht et al. suggest that exploratory behaviour in infancy and novelty-seeking in adolescence may be two developmentally specific phenotypes related to ADHD. Also, aversion towards delay-related stimuli, i.e., the motivation to escape or avoid delay in preference for small immediate over large delayed rewards, needs to be mentioned. The latter preferences seemed to be normalised in ADHD under an extra stimulation condition, and children with ADHD were more willing to choose the large delayed reward, as Antrop et al. reported. This leads to considering the functional meaning of ADHD symptoms in relation to an environmental setting and shows how children with ADHD find strategies to cope with these variations. Thus, a learning as well as a behavioural treatment setting for children with ADHD should provide sufficient, variable and salient stimuli with short intervals and merely immediate rewards.

Finally, the strength of this volume of JCPP is underlined by the practitioner review of Cohan et al., showing that behavioural and cognitive-behavioural interventions help children with selective mutism, and by the meta-analysis of Rochelle and Talcott on balance deficits in dyslexia that are apparently more strongly related to associated ADHD and developmental coordination disorder than to reading ability. This casts doubt on the premise that balance training can transfer to improvements in literacy of children with dyslexia and raises new questions about the evidence base of the multitude of treatment approaches on the market pretending to improve dyslexia and dyscalculia.

Hopefully, the reader will be inspired by this editorial to make a choice for a closer look at the scientific and practical richness of JCPP, which I appreciated very much during my three years as joint-editor of the Journal.

Reference

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  2. Reference
  • Rothenberger, A., Döpfner, M., Sergeant, J., & Steinhausen, H.-C. (Eds.) (2004). ADHD beyond core symptoms: Not only a European perspective. European Child and Adolescent Psychiatry, 13(Suppl. 1).