Journal of the American Academy of Child & Adolescent Psychiatry

In This Issue/Abstract Thinking: Evolving Picture of Susceptibility Factors in Autism Spectrum Disorders

Jeremy Veenstra-VanderWeele — 2012-05-01

This issue of the Journal draws our attention to risk factors and outcomes for neurodevelopmental disorders, including autism spectrum disorder (ASD) and early-onset schizophrenia spectrum disorders.

Our Baby: Commentary on Foster Care for Young Children: Why It Must Be Developmentally Informed

Anonymous — 2012-05-01

Child and adolescent psychiatry should advocate for foster care for young children that is child centered and developmentally informed. The evidence is clearly laid out in a recent edition of the Journal. We know the practical meaning of attachment theory and research. We can assert that the foster parent, as the primary attachment figure for a young child, must provide substantial and sustained contact—literal physical contact—for the child. Primary caregivers must be substantially emotionally invested in the child and psychologically committed to the child's well-being. The caregivers must be present to help the child through potentially traumatic events, such as the visitation of biological parents and transitions to alternative placements.

Coda to Our Baby

Charles H. Zeanah, Carole Shauffer, Mary Dozier — 2012-05-01

We appreciate the thoughtful, inspiring, and important response to our Translations article about foster care for young children. We wholeheartedly agree that we did not do justice to the issues for foster parents—not because they are unimportant—but only because, in a short, focused piece, we targeted only the needs of children. Our overarching point is that our society neither values nor supports the importance of foster care (including foster parents) for young children. Fortunately, this Perspective more fully delineates the burdens on foster parents that our recommendations entail.

The Long Road Ahead to Mental Health Parity

Gregory K. Fritz, Patrick J. Kennedy — 2012-05-01

Mental health advocates breathed an exhausted sigh of relief in 2008 when Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. It took years of intense political fighting, including some “close-but-not-yet-there” disappointments, to end what was essentially government-sanctioned discrimination by insurance companies against patients with psychiatric and substance-use disorders. With the passage of this law, insurance companies were required to apply the same reimbursement policies to the treatment of psychiatric disorders as to medical illnesses.

Autism Risk Factors: Moving From Epidemiology to Translational Epidemiology

James C. Harris — 2012-05-01

In this issue of the Journal, two articles focus on nonspecific risk factors for autism and autism spectrum disorder (ASD)—socioeconomic status (SES) and maternal age. The relation of parental characteristics, including high intelligence, to autism was raised in Leo Kanner's classic study, “Autistic Disturbances of Affective Contact.” Subsequently, it was proposed that children diagnosed with ASDs are overrepresented in families with a higher SES. The findings have been mixed; similar numbers of studies have reported a positive correlation with a higher SES and equivalent numbers have found none. Thus, the issue is not resolved. A 2010 cross-sectional study used data from the Autism and Developmental Disabilities Monitoring Network to identify 8-year-old children with ASD among defined populations. The investigators found a positive correlation with a higher SES, more so in previously ascertained cases, and no SES difference in those with diagnoses of ASD and intellectual disability. Questions persist about whether the association is genuine or, potentially, a consequence of ascertainment bias. If the difference is due is to ascertainment bias, children from lower SES families may not be receiving needed services. If not due to ascertainment bias alone as proposed in this study, further investigation is needed.

The Voices Go, But the Song Remains the Same: How Can We Rescue Cognition in Early-Onset Schizophrenia?

Peter Bachman, Maria Jalbrzikowski, Carrie E. Bearden — 2012-05-01

Current treatments for psychosis in children and adolescents are sorely in need of efficacy data. In the past decade we have seen a dramatic increase in the prescription of antipsychotic medication for individuals younger than 18 years and an increased awareness that subclinical and overt psychotic symptoms are more prevalent in pediatric populations than previously believed. Despite its widespread implementation, exactly how pharmaceutical intervention affects cognitive and psychosocial functioning in youth remains unknown.

Parental Socioeconomic Status and Risk of Offspring Autism Spectrum Disorders in a Swedish Population-Based Study

2012-03-23

Objective: Epidemiological studies in the United States consistently find autism spectrum disorders (ASD) to be overrepresented in high socioeconomic status (SES) families. These findings starkly contrast with SES gradients of many health conditions, and may result from SES inequalities in access to services. We hypothesized that prenatal measures of low, not high, parental SES would be associated with an increased risk of offspring ASD, once biases in case ascertainment are minimized. Method: We tested this hypothesis in a population-based study in Sweden, a country that has free universal healthcare, routine screening for developmental problems, and thorough protocols for diagnoses of ASD. In a case-control study nested in a total population cohort of children aged 0 to 17 years living in Stockholm County between 2001 and 2007 (N = 589,114), we matched ASD cases (n = 4,709) by age and sex to 10 randomly selected controls. We retrieved parental SES measures collected at time of birth by record linkage. Results: Children of families with lower income, and of parents with manual occupations (OR = 1.4, 95% CI = 1.3–1.6) were at higher risk of ASD. No important relationships with parental education were observed. These associations were present after accounting for parental ages, migration status, parity, psychiatric service use, maternal smoking during pregnancy, and birth characteristics; and regardless of comorbid intellectual disability. Conclusions: Lower, not higher, socioeconomic status was associated with an increased risk of ASD. Studies finding the opposite may be underestimating the burden of ASD in lower SES groups.

Advancing Maternal Age Is Associated With Increasing Risk for Autism: A Review and Meta-Analysis

2012-04-06

Objective: We conducted a meta-analysis of epidemiological studies investigating the association between maternal age and autism. Method: Using recommended guidelines for performing meta-analyses, we systematically selected, and extracted results from, epidemiological scientific studies reported before January 2012. We calculated pooled risk estimates comparing categories of advancing maternal age with and without adjusting for possible confounding factors. We investigated the influence of gender ratio among cases, ratio of infantile autism to autism spectrum disorder (ASD), and median year of diagnosis as effect moderators in mixed-effect meta-regression. Results: We found 16 epidemiological papers fulfilling the a priori search criteria. The meta-analysis included 25,687 ASD cases and 8,655,576 control subjects. Comparing mothers ≥35 years with mothers 25 to 29 years old, the crude relative risk (RR) for autism in the offspring was 1.52 (95% confidence interval [CI] = 1.12–1.92). Comparing mothers ≥35 with mothers 25 to 29, the adjusted relative risk (RR) for autism in the offspring was 1.52 (95% CI = 1.12–1.92). For mothers <20 compared with mothers 25 to 29 years old, there was a statistically significant decrease in risk (RR = 0.76; 95% confidence interval = 0.60–0.97). Almost all studies showed a dose-response effect of maternal age on risk of autism. The meta-regression suggested a stronger maternal age effect in the studies with more male offspring and for children diagnosed in later years. Conclusions: The results of this meta-analysis support an association between advancing maternal age and risk of autism. The RR increased monotonically with increasing maternal age. The association persisted after the effects of paternal age and other potential confounders had been considered, supporting an independent relation between higher maternal age and autism.

Longitudinal Follow-Up of Children With Autism Receiving Targeted Interventions on Joint Attention and Play

2012-04-09

Objective: This study examines the cognitive and language outcomes of children with an autism spectrum disorder (ASD) over a 5-year period after receiving targeted early interventions that focused on joint attention and play skills. Method: Forty children from the original study (n = 58) had complete data at the 5-year follow-up. Results: In all, 80% of children had achieved functional use of spoken language with baseline play level predicting spoken language at the 5-year follow-up. Of children who were using spoken language at age 8 years, several baseline behaviors predicted their later ability, including earlier age of entry into the study, initiating joint attention skill, play level, and assignment to either the joint attention or symbolic play intervention group. Only baseline play diversity predicted cognitive scores at age 8 years. Conclusions: This study is one of the only long-term follow-up studies of children who participated in preschool early interventions aimed at targeting core developmental difficulties. The study findings suggest that focusing on joint attention and play skills in comprehensive treatment models is important for long-term spoken language outcomes.

Neurocognitive Outcomes in the Treatment of Early-Onset Schizophrenia Spectrum Disorders Study

2012-03-15

Objective: To assess neurocognitive outcomes following antipsychotic intervention in youth enrolled in the National Institute of Mental Health (NIMH)–funded Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS). Method: Neurocognitive functioning of youth (ages 8 to 19 years) with schizophrenia or schizoaffective disorder was evaluated in a four-site, randomized, double-blind clinical trial comparing molindone, olanzapine, and risperidone. The primary outcomes were overall group change from baseline in neurocognitive composite and six domain scores after 8 weeks and continued treatment up to 52 weeks. Age and sex were included as covariates in all analyses. Results: Of 116 TEOSS participants, 77 (66%) had post-baseline neurocognitive data. No significant differences emerged in the neurocognitive outcomes of the three medication groups. Therefore, the three treatment groups were combined into one group to assess overall neurocognitive outcomes. Significant modest improvements were observed in the composite score and in three of six domain scores in the acute phase, and in four of six domain scores in the combined acute and maintenance phases. Partial correlation analyses revealed very few relationships among Positive and Negative Syndrome Scale (PANSS) baseline or change scores and neurocognition change scores. Conclusions: Antipsychotic intervention in youth with early-onset schizophrenia spectrum disorders (EOSS) led to modest improvement in measures of neurocognitive function. The changes in cognition were largely unrelated to baseline symptoms or symptom change. Small treatment effect sizes, easily accounted for by practice effects, highlight the critical need for the development of more efficacious interventions for the enduring neurocognitive deficits seen in EOSS. Clinical trial registry information—Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS); http://www.clinicaltrials.gov; NCT00053703.

Psychiatric Diagnostic Interviews for Children and Adolescents: A Comparative Study

2012-05-01

Objective: To compare examples of three styles of psychiatric interviews for youth: the Diagnostic Interview Schedule for Children (DISC) (“respondent-based”), the Child and Adolescent Psychiatric Assessment (CAPA) (“interviewer-based”), and the Development and Well-Being Assessment (DAWBA) (“expert judgment”). Method: Roughly equal numbers of males and females of white and African American ethnicity, aged 9 to 12 and 13 to 16 years, were recruited from primary care pediatric clinics. Participants (N = 646) were randomly assigned to receive two of the three interviews, in counterbalanced order. Five modules were used: any depressive disorder, anxiety disorders, oppositional defiant disorder, conduct disorder, and attention-deficit/hyperactivity disorder. At two sessions about 1 week apart, parent and child completed one of two interviews plus five screening questionnaires. Results: When interviewed with the DAWBA, 17.7% of youth had one or more diagnoses, compared with 47.1% (DISC) and 32.4% (CAPA). The excess of DISC diagnoses was accounted for by specific phobias. Agreement between interview pairs was 0.13 to 0.48 for DAWBA-DISC comparisons, 0.21 to 0.61 for DISC-CAPA comparisons, and 0.23 to 0.48 for CAPA-DAWBA comparisons. DAWBA-only cases were associated with higher parent-report questionnaire scores than DISC/DAWBA cases, but equivalent child-report scores. Conclusions: The DAWBA is shorter and cases were probably more severe, making it a good choice for clinical trials, but the user cannot examine the data in detail. The DISC and CAPA are similar in length and training needs. Either would be a better choice where false-negative results must be avoided, as in case-control genetic studies, or when researchers need to study individual symptoms in detail.

Examining Overgeneral Autobiographical Memory as a Risk Factor for Adolescent Depression

Adhip Rawal, Frances Rice — 2012-04-16

Objective: Identifying risk factors for adolescent depression is an important research aim. Overgeneral autobiographical memory (OGM) is a feature of adolescent depression and a candidate cognitive risk factor for future depression. However, no study has ascertained whether OGM predicts the onset of adolescent depressive disorder. OGM was investigated as a predictor of depressive disorder and symptoms in a longitudinal study of high-risk adolescents. In addition, cross-sectional associations between OGM and current depression and OGM differences between depressed adolescents with different clinical outcomes were examined over time. Method: A 1-year longitudinal study of adolescents at familial risk for depression (n = 277, 10-18 years old) was conducted. Autobiographical memory was assessed at baseline. Clinical interviews assessed diagnostic status at baseline and follow-up. Results: Currently depressed adolescents showed an OGM bias compared with adolescents with no disorder and those with anxiety or externalizing disorders. OGM to negative cues predicted the onset of depressive disorder and depressive symptoms at follow-up in adolescents free from depressive disorder at baseline. This effect was independent of the contribution of age, IQ, and baseline depressive symptoms. OGM did not predict onset of anxiety or externalizing disorders. Adolescents with depressive disorder at both assessments were not more overgeneral than adolescents who recovered from depressive disorder over the follow-up period. Conclusions: OGM to negative cues predicted the onset of depressive disorder (but not other disorders) and depressive symptoms over time in adolescents at familial risk for depression. Results are consistent with OGM as a risk factor for depression.

The Phenomenology and Course of Depression in Parentally Bereaved and Non-Bereaved Youth

2012-04-09

Objective: To compare the phenomenology and course of bereavement-related depression to depression that occurred later in the course of bereavement and to depression in non-bereaved youth. Method: This sample is drawn from a cohort of parentally bereaved youth and non-bereaved controls followed for approximately 5 years. Three groups of depressed youth were compared with respect to symptoms, severity, duration, risk for recurrence, and correlates and risk factors: (1) a group with bereavement-related depression (BRD, n = 42), with the onset of a depressive episode within the first 2 months after parental loss; a group with later bereavement depression (LBD, n = 30), with onset at least 12 months after parental loss; and a non-bereaved control group with depression (CD, n = 30). Results: BRD episodes were similar to LBD and CD with respect to number of symptoms, severity, functional impairment, duration, risk for recurrence, and most risk factors and correlates. BRD, compared with both CD and LBD, were younger, exposed to fewer life events, and less likely to have experienced feelings of worthlessness. Also, caregivers of BRD showed higher rates of depression and post-traumatic stress disorder at the time of the depression compared with each of the other two groups. Conclusion: BRD is similar to both LBD and CD in phenomenology, course, and risk factors, supporting a diagnostic and therapeutic approach to BRD similar to that for non–bereavement-related depressions. In the bereaved child who presents with depression shortly after parental death, the clinician should also be alert to caregiver depression and post-traumatic stress disorder.

Assistant Editor's Note

Laura M. Prager — 2012-05-01

This month we encounter three books about very different topics. In one, an Arab-American author explores the aftershocks of 9-11 on young Arab-American adults. In the second, two authors try to “shock” their readers with new and provocative ideas about child-rearing. In the third, a young woman with a bright future suffers a debilitating stroke yet lives to talk about the long road to recovery. These are very different books, yes, but ones that share a common goal. Each one takes us out of our comfort zone and encourages us to look at the world from an alternative and sometimes uncomfortable vantage point.

Frieda Aboul-Fotouh — 2012-05-01

How Does it Feel to Be a Problem? is a book that comes straight out and addresses a story now firmly woven into the American landscape: what has happened to young Arab Americans whose identity was significantly affected by the events and aftermath of 9-11? Author Moustafa Bayoumi, an Associate Professor of English at Brooklyn College in New York City, writes, “This book was conceived out of my frustrations, but it is not about me. It is about … twenty-something Arab Americans who since 2001 have had to navigate a rocky terrain somewhere between expectation and frustration” (p. 6).

Marcus Favero — 2012-05-01

I always feel that self-help books, business best sellers, and lay books on child development are interesting and problematic. They also have something in common. They are engaging books that charm the reader but often lack depth; they carry the promise of good habits and hidden strengths and how to switch from good to great. Read this one to discover what you should do or not do to nurture your child.

Dana Kober — 2012-05-01

I must be willing to give up what I am in order to become what I will be. —Albert Einstein Jill Bolte Taylor is a neuroanatomist who, at the age of 37, suffered a left hemisphere hemorrhagic stroke. Her book is part chronicle of her experience of the actual stroke in action, part brief neuroanatomy/physiology lesson, part inspirational patient viewpoint, and quasi-self-help vociferation. The main text is only 187 pages and it is easy enough to access the section that is more applicable to the reader. The remainder consists of appendices on how to take care of a person who has had a stroke. Her ability to recognize or reassemble what capabilities were fleeting owing to which brain area was failing provides unique insight into a stroke in process. The neuroanatomy and physiology section is brief and easily understandable. Particularly interesting is the process of her recovery and demonstrated patience and determination. Bolte Taylor had to relearn how to read, walk, and how to see in three dimensions and color. She did not recover color vision until she was prompted. Her cones functioned just fine, but her mind was constrained. The concept of color had flown out of her mind and had to be purposely brought back. Imagine what our brains are capable of if we have such a paradigm shift. One moment the world is colorless, the next moment the circuit snaps into place and everything is illuminated. This is not a guidebook on poststroke cognitive retraining. She provides less than desired physiologic explanation about the process of her recovery but does explain why she lost skills owing to the stroke. This is not Oliver Sacks. This is her own memoir on what happened the day of her stroke and the following months and a thank you to her mother for patiently helping her reconnect her brain.

Practice Parameter for Psychodynamic Psychotherapy With Children

Jennifer Medicus — 2012-05-01

This Practice Parameter describes the principles of psychodynamic psychotherapy with children and is based on clinical consensus and available research evidence. It presents guidelines for the practice of child psychodynamic psychotherapy, including indications and contraindications, the setting, verbal and interactive (play) techniques, work with the parents, and criteria for termination.

Instructions for Authors

2012-05-01

Editorial Board

2012-05-01

Council Page

2012-05-01

Journal of the American Academy of Child & Adolescent Psychiatry

In This Issue/Abstract Thinking: Evolving Picture of Susceptibility Factors in Autism Spectrum Disorders

Our Baby: Commentary on Foster Care for Young Children: Why It Must Be Developmentally Informed

Coda to Our Baby

The Long Road Ahead to Mental Health Parity

Autism Risk Factors: Moving From Epidemiology to Translational Epidemiology

The Voices Go, But the Song Remains the Same: How Can We Rescue Cognition in Early-Onset Schizophrenia?

Parental Socioeconomic Status and Risk of Offspring Autism Spectrum Disorders in a Swedish Population-Based Study

Advancing Maternal Age Is Associated With Increasing Risk for Autism: A Review and Meta-Analysis

Longitudinal Follow-Up of Children With Autism Receiving Targeted Interventions on Joint Attention and Play

Neurocognitive Outcomes in the Treatment of Early-Onset Schizophrenia Spectrum Disorders Study

Psychiatric Diagnostic Interviews for Children and Adolescents: A Comparative Study

Examining Overgeneral Autobiographical Memory as a Risk Factor for Adolescent Depression

The Phenomenology and Course of Depression in Parentally Bereaved and Non-Bereaved Youth

Assistant Editor's Note

Practice Parameter for Psychodynamic Psychotherapy With Children

Instructions for Authors

Editorial Board

Council Page

Table of Contents