Early Intervention in Mood and Anxiety Disorders: The First Episode Mood and Anxiety Program (FEMAP).

The First Episode Mood and Anxiety Program (FEMAP) was developed for youth with mood and/or anxiety concerns in London, Ontario, to provide early intervention for these disorders, similar to the first-episode psychosis programs across Ontario and Canada. The logic and causal models of the pathway to and through FEMAP are described and inclusion/exclusion criteria are delineated. Results of the process evaluation of the model and preliminary data from a treatment-effectiveness evaluation and ongoing cost-comparison evaluation are provided.

Mentoring and role models in recruitment and retention: a study of junior medical faculty perceptions.

Purpose: This study explored the views of junior faculty toward informing mentorship program development.

Method: Mixed sampling methodologies including questionnaires (n = 175), focus groups (female, n = 4; male, n = 4), and individual interviews (female n = 10; male, n = 9) of junior faculty were conducted in clinical departments at one academic health sciences center.

Results: Questionnaire results indicated that having role models increased commitment to an academic career; mentorship experience during residency training was a high incentive to pursue an academic career; and junior faculty did have identifiable mentorship experiences.

Managing depression in primary care: community survey.

Objective: To investigate family physicians' practice patterns for managing depression and mental health concerns among adolescent and adult patients.

Design: Cross-sectional survey.

Setting: London, Ont, a mid-sized Canadian city.

International consensus statement on attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBDs): clinical implications and treatment practice suggestions.

Researchers and clinicians worldwide share concerns that many youngsters with attention-deficit/hyperactivity disorder (ADHD) and/or disruptive behaviour disorders (DBDs) do not receive appropriate treatment despite availability of effective therapies. At the request of Johnson and Johnson (sponsor), 11 international experts in child and adolescent psychiatry were selected by Professor Stan Kutcher (chair) to address these concerns. This paper describes the experts' consensus conclusions, including treatment practice suggestions for physicians involved in the early treatment of youngsters with ADHD (or hyperkinetic disorder, in countries preferring this classification) and/or DBDs internationally: suggested first-line treatment for ADHD without comorbidity is psychostimulant medication aided by psychosocial intervention.

Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs.

Objective: To determine whether risperidone is effective in reducing symptoms of disruptive behaviors (such as aggression, impulsivity, defiance of authority figures, and property destruction) associated with conduct disorder, oppositional defiant disorder, and disruptive behavior disorder-not otherwise specified in children with subaverage IQs.

Method: The trial consisted of a 1-week, single-blind, placebo run-in period and was followed by a 6-week, double-blind, placebo-controlled period. One hundred ten children (aged 5-12 years inclusive) with an IQ of 36-84 with a disruptive behavior disorder and a score of at least 24 on the Conduct Problem subscale of the Nisonger Child Behavior Rating Form (NCBRF) were enrolled.

Long-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs.

Objective: The objective of this study was to investigate the long-term safety and efficacy of risperidone in disruptive behavior disorders in children with subaverage IQs. Disruptive behavior disorders were defined as oppositional defiant disorder, disruptive behavior disorder, and conduct disorder as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.

Methods: This was a 48-week open-label (OL) extension study of risperidone in 77 children diagnosed with a disruptive behavior disorder, and either borderline intellectual function or mild or moderate mental retardation who had participated in a previous 6-week, double-blind (DB) study and completed at least 2 weeks of DB therapy.

A longitudinal study of siblings of children with chronic disabilities.

Objective: To examine the unaffected siblings of 2 different groups with chronic disabilities, pervasive developmental disorder (PDD) and Down syndrome (DS), over 3 years, comparing their adjustment with each other and with the siblings of a nondisabled group.

Method: This study examines 137 siblings of children with PDD, children with DS, and developmentally normal children (control group) initially and 127 siblings at follow-up 3 years later. Their adjustment is measured by the Survey Diagnostic Instrument (SDI), completed by caregivers and teachers.

Effect of sibling perception of differential parental treatment in sibling dyads with one disabled child.

Objective: To examine sibling perception of parental differential treatment in families of children with pervasive developmental disorder (PDD), Down syndrome (DS), and nondisabled controls.

Method: Sibling self-concept and social support were studied in the context of sibling perceptions of parental differential treatment and caretaker plus teacher evaluations of sibling behavioral adjustment. Measures were completed at time 1 and time 2.

Bipolar disorder in children and adolescents: current challenges.

Objective: To demonstrate the diagnostic and treatment challenges in juvenile-onset bipolar disorder.

Method: Three case vignettes are outlined to demonstrate different bipolar presentations in children and adolescents.

Results: These case examples illustrate important issues in the diagnosis and management of juvenile-onset bipolar disorder.

Teaching child and adolescent psychiatry to family medicine trainees: a pilot experience.

Objective: To develop learning objectives for teaching child psychiatry to family medicine trainees and to evaluate the best method of teaching these objectives.

Method: For this descriptive study, knowledge, attitude, and skill objectives were presented to trainees at the start of a 6-month rotation, and an evaluation mechanism was developed based on the learning objectives. The method of instruction in each of the training locations was described independently by the child psychiatry consultant and attending family physician.

Risk and protective factors affecting the adjustment of siblings of children with chronic disabilities.

Objective: To examine the adjustment of nondisabled siblings of handicapped children.

Method: In a 3-year longitudinal study, 46 siblings of children with pervasive developmental disorder (PDD), 45 siblings of children with Down syndrome, and 46 siblings of developmentally normal children (serving as controls) were examined at time 1 using the sibling, primary caretaker, and teacher as informants. Both direct and indirect variables related to sibling adjustment were considered.

Use of risperidone in pervasive developmental disorders: a case series.

A series of 14 children and adolescents (ages 9-17 years, 10 males) were treated with risperidone for pervasive developmental disorder. The rationale for using an atypical neuroleptic agent is based on its ability to target both positive and negative symptoms of schizophrenia. It was postulated that symptoms similar to the positive and negative symptoms of schizophrenia may be observed in the pervasive developmental disorders and might respond favorably to risperidone.

Erythromycin interaction with risperidone or clomipramine in an adolescent.

An adverse event is described which appeared when the macrolide antibiotic erythromycin was added to a regimen of risperidone 0.5 mg bid and clomipramine 50 mg tid in a 15-year-old male being treated for Tourette's, obsessive-compulsive, and attention-deficit hyperactivity disorders. An acute onset of behavioral symptoms, including agitation, labile mood, incessant talking, and argumentativeness, began within 24 h of starting the erythromycin and persisted for 9 days after its discontinuation.

Case study: anorexia nervosa and autistic disorder in an adolescent girl.

The development of anorexia nervosa in a high-functioning, early adolescent, autistic female is described. This case raises the issue of co-occurrence of childhood-onset disorders sharing the phenomena of obsessions and compulsions. The role of dysregulation of the serotonergic neurotransmitter system as a common underlying mechanism in these disorders is suggested.

Asperger's syndrome and autism: differences in behavior, cognition, and adaptive functioning.

Objective: To determine whether subtypes of children with pervasive developmental disorder (PDD) differed on variables that were relatively independent of distinguishing criteria.

Method: Higher-functioning children with PDD, 4 through 6 years of age, were differentiated into those with autism (n = 47) and those with Asperger's syndrome (n = 21) on the basis of delayed and deviant language development. The groups were then compared on a wide range of measures including PDD symptoms, adaptive behaviors in communication, socialization, and activities of daily living, and an assessment of verbal and nonverbal cognitive skills.

Parents and collateral relatives of children with pervasive developmental disorders: a family history study.

The objective of this study was to see whether, using the family history method, the risk for pervasive developmental disorder (PDD), cognitive impairments, and other psychiatric symptoms is greater in the parents and collateral relatives of probands with PDD compared to a control group. A semistructured family history interview was carried out with the parents of 52 probands with PDD and 33 parents of controls. Rates of cognitive impairments and psychiatric problems were not found more frequently in parents or relatives of PDD probands compared to relatives of controls, but four cases of PDD were reported among the extended families of the PDD probands.

Parent and teacher agreement in the assessment of pervasive developmental disorders.

Although it is well known that informants often disagree about the degree of psychopathology in children, this issue has not been systematically evaluated in children with autism. The objective of this paper is to estimate the extent of agreement between parents and teachers on the assessment of autistic symptoms and adaptive behavior skills. We assessed 83 children, 4-6 years of age, with a diagnosis of pervasive developmental disorder (PDD), using the Autism Behavior Checklist (ABC) and the Vineland Adaptive Behavior Scales (VABS).

Obsessive-compulsive disorder and fear of AIDS contamination in childhood.

Two cases of obsessive-compulsive disorder (OCD) in prepubertal children are described in which the predominant obsessive ruminations relate to fear of acquired immune deficiency (AIDS) contamination. The findings in these cases are discussed in relation to known demographic and clinical profiles of OCD in children and adolescents. Fear of AIDS contamination in childhood OCD may reflect the effect of the current emphasis on AIDS in potentially vulnerable children with environmental influences giving the symptoms their specific content.

Lack of cognitive impairment in first-degree relatives of children with pervasive developmental disorders.

Objective: The objective of this study was to test the hypothesis that mild cognitive impairments aggregate in the unaffected first-degree relatives of probands with autism or pervasive developmental disorders (PDD).

Method: The unaffected siblings and parents of 52 PDD probands and 33 Down syndrome and low birth weight controls were administered a battery of psychometric tests. The tests included measures previously found to be depressed in siblings of autistic children as well as cognitive deficits seen in PDD subjects of normal IQ.

Salivary cortisol in children: correlations with serum values and effect of psychotropic drug administration.

This study compares the paired serum and salivary cortisol levels of 60 children and adolescents, obtained while performing a routine Dexamethasone Suppression Test. The results reveal significant correlations between serum and salivary cortisol levels in both drug-free (r = 0.90, p less than .

The handicapped child: psychological effects of parental, marital, and sibling relationships.

Although the nature and severity of a handicapping condition are not the sole determinants of family functioning, the presence of a child with a pervasive developmental disorder has a significant effect on family members. Maternal mental health suffers, and the resulting depression affects her role as mother and marriage partner. Unlike other handicapping conditions with obvious physical stigmata, the invisible handicap of the autistic child and the frequent delay in diagnosis contribute to the mother's self-doubt about her parental competence.