Autism is not a condition that I have studied and at times I have been concerned that this Journal may have published a disproportionate number of studies on a condition that is relatively rare and primarily determined by genetic factors, and for these reasons, perhaps of less relevance to most clinicians. Having read Pat Howlin's Practitioner Review I realise just how wrong I have been on both counts! Not only are autism, autism spectrum disorders, and Asperger syndrome far more common than I realised (the prevalence estimate of Wing for autism spectrum disorders of just under 1 per 1000 is quoted) but it is also clear that the recent research effort focused on these children has paid dividends in the development of approaches to treatment for the disorders. As Howlin emphasises, these advances have not led to a cure for autism, as claimed by some proponents of therapies such as holding therapy and facilitated communication, and even those producing some change may require an unacceptable burden of commitment for families, for example the home-based behavioural programmes of Lovaas and colleagues. However, as she clearly indicates, we have learned how to guide the management of challenging behaviour and have methods both to enhance communication and to reduce obsessional behaviour in children with autism. A recurrent theme running through this Practitioner Review is the value of early intervention with these children. This, in turn, gives new impetus to both the research concerned with the basic deficits experienced by children with autism and the studies on the detection of early signs of the disorder by, amongst others, Baron-Cohen and colleagues. An example of the former is the paper in this issue by Leevers and Harris into the ability of the child with autism to conceptualise and image “impossible” entities, for example a man with two heads. This study showed that the imagination of children with autism is not as impaired as once thought. Care should be taken not to interpret poor performance on such tests as reflecting lack of creativity or imagination when a problem with understanding the nature of the task or with certain task demands, such as planning, may be responsible.

Human interest in and concern about inheritance is very far from new. It is reasonable to assume that ideas about physical resemblances and behavioural characteristics running in families are as old as concepts of family and kinship. We can be rather more certain that from the dawn of agriculture selective breeding has been used to change the characteristics of plant crops and domesticated animals. Indeed, selective breeding may well be viewed as the first step required to create agriculture. However, a knowledge of genetics is not required to apply selective breeding to animals or plants (or humans). All that is needed is the assumption that parental characteristics are likely to be passed to offspring. Then one can breed from superior stock, or those which have desired characteristics, and avoid breeding from inferior stock.

The review discusses various interventions that have been used in the treatment of children with autism. It concludes that no single mode of treatment is ever likely to be effective for all children and all families. Instead, intervention will need to be adapted to individual needs and the value of approaches that involve a functional analysis of problems is explored. It is suggested that many so called “challenging” behaviours result from the child's fundamental difficulties in communication and social understanding, or from the ritualistic and obsessional tendencies that are also characteristic of autism. Possible ways in which parents and teachers might deal with problems in these areas are discussed. The importance of early diagnosis, and with it early, practical advice for families is stressed.

In adolescence, antisocial and depressive symptoms are moderately stable and modestly correlated with each other. We examined the genetic and environmental origins of the stability and change of antisocial and depressive symptoms and their co-occurrence cross-sectionally and longitudinally in a national sample of 405 adolescents. Monozygotic (MZ) and dizygotic (DZ) twins and full, half, and unrelated siblings 10–18 years of age from nondivorced and stepfamilies were studied over a 3-year period. Composite measures of adolescent self-reports, parent reports, and observational measures of antisocial and depressive symptoms were analysed in multivariate behavioural genetic models. Results indicated that the majority of the stability in and co-occurrence between dimensions could be accounted for by genetic factors. Nonshared environmental risks and, for antisocial symptoms, shared environmental risks also contributed to the stability. Genetic influences on change were observed, but only for antisocial behaviour. In addition, the longitudinal association between antisocial behavioural and later depressive symptoms was also found to be genetically mediated, but this effect was nonsignificant after controlling for stability. Results are discussed in light of the potential contributions of developmental behavioural genetic research in understanding individual differences in the stability and change of maladjustment.

Several twin studies of children and adolescents have found significant heritability of depressive symptoms. In contrast, the sole adoption study of biologically related and biologically unrelated adopted siblings found no evidence for genetic influence. The present study attempts to confirm these results in middle childhood using two adoption designs. The sample, from the Colorado Adoption Project, included 180 adopted children (77 with adoptive siblings) and their biological and adoptive mothers, and 227 nonadopted children (93 with biological siblings) and their mothers. Mothers reported their own neuroticism, and children's depressive symptoms were reported by the parents and by the children themselves. For both the sibling adoption and the parent-offspring designs heritability was negligible, shared environment modest, and nonshared environment substantial, irrespective of child gender. Although the power of the sibling data is low, the combined findings from the two designs suggest that genetic effects on depressive symptoms in childhood may be somewhat smaller than previously estimated in twin studies.

A representative sample of 328 children with hemiplegia was assessed by behavioural screening questionnaires completed by parents and teachers; just under half were also individually assessed. Four years later, 90% of the sample were followed up by questionnaire. There was substantial continuity across time for most measures of psychopathology. Depending on the measures used, around 70% of children who were psychiatric “cases” initially were still cases 4 years later. In addition, around 30% of children who were not psychiatric cases initially had become cases 4 years later. In the preschool years, externalising symptoms were predictive of later conduct and hyperactivity problems, whereas emotional symptoms were not predictive of later problems. In the school years, hyperactivity was particularly predictive of continuing psychiatric problems. Neurological, cognitive, demographic, and family factors did not add much predictive power once allowance had been made for the severity and type of the initial psychiatric problems. Since the psychiatric complications of childhood hemiplegia are persistent as well as common, they warrant increased clinical and research attention. All children with hemiplegia deserve careful monitoring for psychiatric problems, with a view to early intervention or the deployment of preventative approaches.

Severe retardation in a child surely has an effect on all family members. Studies of nondisabled siblings in these families have indicated both emotional risks and perceived benefits. Little is known about how out-of-home placement of the child with retardation affects the siblings. Adolescent siblings of children with retardation living at home (N=25) or in residential placement (N=20) were contrasted with siblings of children without retardation (N=28), on measures obtained from their mothers and themselves. Despite their different situations, these siblings were highly similar on measures of psychological adjustment, self-esteem, and family environment. Sibling relationships, however, were less intense, with less warmth but also lower conflict, in families where the child lived out of the home. Most siblings of children with retardation reported positive personal growth experiences while also expressing realistic concerns about the future. Siblings of children with retardation had beliefs and attitudes about placement that were highly consistent with the child's current living situation.

Health visitors and Clinical Medical Officers (CMOs) were trained in parent counselling and worked at home in a highly deprived area with parents of preschool children with multiple psychosocial problems. Their basic aims were to establish a mutually respectful partnership and to support parents in managing their diverse problems. Detailed evaluation indicated that the Service was highly valued by both parents and referrers, and suggested significant changes, including: improvements in the severity of problems; increased parental self-esteem; decreased levels of parental stress and emotional difficulties; more positive constructions of their children; improvements in the home environment; and decreased child behavioural problems.

This study tested whether proactive and reactive aggression were differently predictive of later externalizing problems such as delinquency and DSM-related disruptive behaviors (i.e. oppositional defiant and conduct disorders). It also tested whether these two subtypes of aggressive behaviors interacted in predicting externalizing problems. A community sample of low SES boys participated in the study. Proactive and reactive aggression were rated by teachers when boys were 12 years old. Delinquency, oppositional disorders, and conduct disorders were assessed during mid-adolescence. Proactive but not reactive aggression predicted delinquency and disruptive behaviors. Moreover, high levels of reactive aggression weakened the link between proactive aggression and delinquency. Reactive aggression, however, did not moderate the link between proactive aggression and disruptive behaviors. We conclude that reactive and proactive aggression are two distinct types of aggressive behaviors with different predictive abilities. We also offer tentative explanations to account for the present findings.

Alcohol use and nicotine use were investigated in a representative sample of 1110 study participants aged 10 to 17 years. In addition to questions on substance use, the participants responded to questionnaires covering behavior and emotions, life events, self-related cognitions, coping capacities, perceived parental behavior, perceived school environment, and the social network. The gender gap in substance use tended to close with increasing age. Parental substance use served as a model for substance use in the participants. Substance users had more abnormal scores on almost all variables as compared to abstaining controls. Lack of acceptance and control, pressure to achieve at school, and life events significantly predicted substance use. The latter served as a moderating risk variable for delinquent behavior under stress.

Contemporary findings suggest that the imagination of autistic children is not as limited as was once thought. In contrast, Scott and Baron-Cohen (1996) claim that children with autism are unable to draw pictures of impossible entities. An experiment showed that children with autism, children with moderate learning disabilities, and normal 4-year-olds were equally successful at identifying real and impossible pictures and at completing pictures to make them look either real or impossible. The previously reported inability to draw “impossible” pictures is unlikely to reflect an imaginative deficit and may instead result from a misunderstanding of the task or limitations in the executive abilities required to plan and draw an unusual picture for the first time.

The aim of this study was to investigate whether impaired response inhibition is uniquely related to AD/HD or whether deficits in response inhibition are also evident in other psychopathological disorders. Furthermore, the suggestion was examined that anxiety disorders are associated with abnormally high levels of response inhibition. This paper presents the results of a meta-analysis of eight studies in which response inhibition was assessed with the so-called stop task in five groups of children: children with attention deficit/hyperactivity disorder (AD/HD), children with conduct disorder (CD), children with AD/HD+CD, children with anxiety disorders, and control children. A total of 456 children participated in the 8 studies. All children were in the age range 6–12 years. Consistent and robust evidence was found for a response inhibition deficit in AD/HD. However, response inhibition deficits did not distinguish children with AD/HD from children with CD, nor from children with comorbid AD/HD+CD. Contrary to predictions, anxious children did not demonstrate enhanced levels of response inhibition.

There are mixed research results in the literature regarding a possible association between Attention Deficit Hyperactivity Disorder (ADHD) and atopic disorders. If such an association were supported, the implications for underlying pathophysiology would be significant. We evaluated level of atopic responsiveness (based on IgE-mediated response to skin prick tests) in 312 referrals to a pediatric allergist. Based on the atopy code, children were categorized as non-atopic, or moderately or severely atopic. Parents completed the Child Behavior Checklist (CBCL). Univariate analyses on the eight CBCL subscales revealed no differences between the atopic groups. Our results do not support an association between IgE-mediated atopic responsiveness and ADHD, but they do not rule out an association between allergic symptoms and ADHD based on some other mechanism.