EARLY CHILDHOOD SCREENING PREDICTS LATER BEHAVIORAL PROBLEMS
emotional or behavioral problems are often not detected until affected
begin school. Moreover,
moderately severe cases, children with emotional and behavioral
not receive appropriate screening and intervention until they have been
school for several years. Researchers
A total of 1,004 socio-economically and ethnically diverse children were evaluated in this study. The children’s parents completed a standardized Brief Infant-Toddler Social and Emotional Assessment survey when their children were between 12 and 36 months of age (the average age of the children participating in this research study was 24 months). These children were again evaluated once they entered elementary school, at an average age of 6 years. Both parents and the children’s teachers participated in this latter evaluation of social and behavioral problems in this large group of children.
Among those infants and toddlers with evidence of social, developmental and emotional problems detected upon their initial evaluation, 49% were reported, when these children subsequently began elementary school, to have significant behavioral and social difficulties in class, based upon their teachers’ evaluations. The initial Brief Infant-Toddler Social and Emotional Assessment and Evaluation survey also predicted which babies and toddlers would later develop significant criteria for psychiatric disorders. Among those infants and toddlers who had evidence of developmental or behavioral difficulties on their initial survey, more than two-thirds (68%) were found to meet the criteria listed for specific psychiatric disorders after reaching elementary school.
As a disclaimer, I will mention that the disciplines of Psychiatry and Psychology are rather unique among the clinical sciences in that it is very difficult (if not impossible) to obtain completely objective research data in clinical research studies such as this one. Human behavior is extremely complex, variable, and unpredictable. Thus, unlike research studies that randomize different groups of patients to receive different medical therapies, or studies that involve laboratory experiments, clinical psychiatric and psychological research studies cannot completely control all of the experimental factors that might skew either the resulting data, or, for that matter, its interpretation. Therefore, I generally do not include such studies in my column. In this case, however, I chose to include this particular study, because I believe that it may be helpful for some parents (and teachers) to know about its findings.
While I absolutely do not advocate performing routine psychiatric testing on children who do not have any evidence of significant behavioral or psychiatric problems, the results of this study suggest that it may be possible to pick up evidence of significant behavioral or/and psychological problems in the majority of “at risk” children long before they begin their school years. While not every child with “abnormal” scores on the Infant-Toddler evaluation survey ultimately experienced psychiatric illnesses by the time they reached elementary school, in this study, more than two-thirds of such children were, in fact, subsequently diagnosed with a psychiatric disorder after starting elementary school.
Perhaps, if identified during late infancy or while still a toddler, children who are at high risk of developing significant emotional or psychiatric illnesses might be able to undergo more intensive early screening and, if appropriate, begin therapy before they start attending school. If effective therapy is available prior to beginning elementary school for any significant emotional or psychiatric illnesses that are identified early, then these children might have a much more positive and successful experience at school in their later years.
PSYCHIATRIC DISORDERS AMONG PARENTS OF AUTISTIC CHILDREN
The incidence of
autism in the
There is a great deal of debate about the potential causes of autistic disorders. Recent studies have shown that at least some cases of autism do appear to be linked to specific gene mutations, suggesting that some cases of autism are very likely a result of inheritance. There has also been a tremendous controversy regarding autism and its link, if any, with childhood vaccinations (and the mumps, measles and rubella, or MMR, vaccine, in particular). However, multiple rigorous clinical research studies have, so far, failed to find any link between the development of autism and vaccinations. In most cases, autism is diagnosed during the same age range as when children are beginning to receive their immunizations, and many public health experts have suggested that this factor is the most likely explanation for the apparent onset of the symptoms of autism following vaccinations.
study, also just published in the journal Pediatrics,
takes a look at the incidence of psychiatric illnesses in the parents
children who have been diagnosed with an autistic disorder. As is the case in most of
Scandinavia, and in
study was the result of collaboration between researchers from
In this study, the incidence of mental health disorders among the parents of autistic children was found to be significantly greater than what was observed among the parents of the much larger “control” group of parents of non-autistic children. Specifically, schizophrenia was found to be more common in both mothers and fathers of autistic children, while depression and personality disorders were found to be more common among mothers of autistic kids, only.
While the results of this study, as with previous studies, suggests that at least some cases of autism might be inherited (and might be associated with other psychiatric disorders that are also thought to be heritable), one must be very careful in drawing conclusions from this data. Certainly, caring for a child with autism, or other serious mental or physical illnesses, is a tremendously taxing and stressful undertaking. I can easily imagine that parents who are faced with, potentially, the lifelong care of a severely disabled child could rather easily succumb to the stresses of such demands by developing emotional or psychiatric illnesses themselves.
this study, which was based solely on confidential public health
SOCIAL & PSYCHIATRIC PROFILES OF YOUNG ADULTS BORN PREMATURELY
As neonatal intensive care units have become increasingly sophisticated in caring for extremely premature babies, more and more of these tiny infants are surviving into adulthood. There have been numerous clinical research studies published about this group of patients, with some studies finding a significant increase in the incidence of lifelong physical and mental health difficulties among those who were very premature at birth. As is often the case with public health research, there have also been quite a few studies published that have suggested that most people who were born prematurely do just fine if they survive into adulthood.
A new Dutch study in the Journal of Pediatrics, which was part of a larger ongoing study of children and adults born prematurely, evaluated 656 healthy adolescents who were born very prematurely, and compared them with their same-age peers with respect to general lifestyle, risk-taking behaviors, the presence of psychiatric disorders, and social interactions.
Interestingly, both the teenage boys and teenage girls who had been born prematurely were less likely to smoke than their peers who had been born after a full-term pregnancy. The teenage boys born prematurely were also less likely to drink alcohol than their full-term counterparts, while the adolescent girls who were born prematurely consumed alcohol as often as the girls who were born at full-term. Lifetime illicit drug use was also significantly less common among the teens (boys and girls) who were born prematurely, when compared to their full-term birth peers. With the notable exception of using public transportation without paying the fare… the adolescents born prematurely were far less likely to be involved in criminal activity than the kids who born at full-term. Although the boys born prematurely appeared to experience greater difficulty in establishing relationships than their full-term peers, on the whole, the incidence of psychiatric disorders did not differ significantly between the two groups of adolescent boys and girls.
Healthy adolescents who were born “very pre-term,” or at a “very low birth-weight,” like those who were included in this study, represent a very select subgroup of young adults who have managed to grow and thrive, and to achieve excellent overall health, despite severe prematurity at birth. In this particular subgroup of young adults born very prematurely, risk-taking behavior appeared to be less common than was observed in the general population. At the same time, increased difficulties with initiating new relationships appeared to be more common among the teens who were born prematurely, especially among the boys. While the explanations for these differences in social behavior between the two groups of teens is not unclear, they are nonetheless intriguing and worthy of further study.
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity.
Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center
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Copyright 2008. Robert A. Wascher, MD, FACS. All rights reserved.
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5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
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2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
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