In this issue there are a number of papers that signal the need for greater clarity in the way in which the basic psychopathology for autism is framed. The paper by Russell et al. raises the question of the extent to which the problems faced by such children arise purely from the lack of a theory of mind. Performance on the false belief task—first used by Wimmer and Perner in 1983—is frequently treated as an indicator of whether a child has or does not have a theory of mind. In autism research it is indeed common to separate children into those with a theory of mind and those without. While not questioning that children with autism find it difficult to think about their own and other people's thoughts, the paper by Russell et al. encourages scepticism about whether this task is an index of theory of mind and of nothing more. They demonstrate that whatever else the task requires in the way of mentalising ability, it also makes substantial executive demands. This ambiguity over precisely what is required in order to complete this task successfully should lead clinicians to be cautious about claiming that failure on such a task demonstrates the lack of a theory of mind.

Reappraisal of another aspect of the autistic child's disabilities is suggested by the paper by Buitelaar et al. It is usually expected that social and emotional understanding is associated with verbal cognitive skills. In this paper this belief is challenged in a study of mentalising an emotional recognition ability in children with autistic spectrum disorders. It was found that verbal memory rather than other aspects of verbal competence was relevant and that, in addition, visuospatial skills emerged as an important predictor of social and emotional understanding. The authors suggest that this result may explain why children with poor visuospatial skills often have serious problems in social and emotional adaptation.

This issue contains a plethora of interesting articles pertaining to socially highly relevant matters. Children in other cultures who are raised under very underprivileged circumstances, such as refugee children, confront mental health workers with issues that transcend cultural bounderies, especially since mass movements of refugees and immigrants are putting great numbers of children into unfamiliar environments. In addition, these children often face severe losses both materially and personally. In order to help these children, mental health workers require tools for identifying their needs in order to develop special interventions. Because existing assessment instruments are often not readily applicable to children and parents in cultures that differ vastly from those in the West, researchers are confronted with problems of adapting or developing new assessment procedures. Paardekooper et al., for example, were confronted with the fact that in their study on the psychological impact of war and the refugee situation on Sudanese children who lived in refugee camps in Uganda, many non-written languages were being spoken. They used trained interviewers and a cartoon-based interview to obtain information on the children's mental health. The authors compared mental health problems of Sudanese refugee children with those of Ugandan children. The refugee children reported more daily stresses, less social support, and more emotional/behavioural problems than children from the comparison group. Also, the refugee children had been confronted with many more traumatic events such as witnessing the murder of a family member. The severity of the problems and the lack of support make the introduction of supportive programmes of paramount importance. This is what the authors intend to do in the future. The findings of this study also underscore our responsibilities with regard to the mental health of the many refugee children who enter Western countries every day.

Attachment is an exciting topic where different research traditions, as diverse as psychoanalytic and cognitive psychology, have come together to reinvigorate the field. In the present issue there are two papers that indicate the fertility of this particular research area. The first of these is the paper by McCarthy and Taylor on the role of attachment style as a mediating link between abusive experiences in childhood and adult functioning. They found that avoidance/ambivalent attachment style, but not self-esteem and relationship attributions, mediated the impact of early abusive experiences on later adult functioning. A second paper by Crandell and Hobson also found that an aspect of women's accounts of their own childhood histories (in this case lack of coherence) was related to lower IQs in their children. This difference remains significant even after the influence of maternal IQ, education, and family socioeconomic status were taken into account. There was also some suggestion that the link between maternal “state of mind” and child IQ might be mediated partly by the quality of parent/child interactions. The authors suggest that although it is necessary to be cautious in interpreting the results from IQ tests with children as young as 3 years, the study highlights the need to consider how mother–infant relations may have an effect on young children's cognitive abilities. This result, if it can be replicated, represents a challenge to contemporary theories in developmental psychology that tend to downplay the role of shared environmental factors.

We are pleased to publish, soon after its delivery, the 1998 Emanuel Miller lecture by Michael Rutter on the subject of autism, a masterly review of the history of clinical practice in this condition and the way in which it has both informed and been informed by research. It is now 55 years since Kanner's seminal paper, and that is over half a century of controversy which shows no signs of abating in intensity, although perhaps the focus is changing. Nowhere is this more clearly evident than in the field of clinical practice. As Rutter's review article brings out, empirical research findings have been crucial in bringing about such change. Nevertheless, he emphasises that the traffic has been far from one-way. Many research advances were prompted by astute clinical observations and some extravagant research claims were given a more balanced perspective by being viewed in the light of clinical experience. Progress takes place through a series of fits and starts, and the two-way interplay between research and clinical practice is essential to ensure that the gains are real, rather than misleading. We are still a very long way from having an effective means of preventing or treating autism but the lessons of the past provide a useful guide on how best to move ahead in the future.

We commence this, the last issue of the century, nay the millennium, with a timely annotation by Overmeyer and Taylor on one of the most controversial topics in child psychiatry at present. As the diagnosis of ADHD (or, in its more limited diagnostic form, hyperkinetic disorder) becomes ever more widely recognised in all corners of the world, the use of medical management to control young children (mainly boys) whose behaviour irritates parents and teachers alike is growing almost exponentially. The authors provide a valuable review of the use of medication for hyperkinetic/ADHD disorders. They point out that the use of stimulants can reduce the severity of symptoms, although they acknowledge that merely suppressing those symptoms will not necessarily affect the prognosis; there is no evidence that long-term outcome is better for medically treated individuals. It has now been shown by several trials that medication can be relatively more effective than behavioural treatments alone: however, this conclusion should not be taken as a license to prescribe medication as a first line of treatment in all circumstances and at all ages. It is worth bearing in mind that methylphenidate and dexamphetamine are the only drugs licensed in the United Kingdom for the treatment of hyperactivity. The review also discusses the use of pemoline (now unlicensed in the United Kingdom because of risk of liver damage), antidepressants, and clonidine. It does not mention risperidone, which has recently attracted a certain vogue amongst private paediatric practitioners. Risperidone does not yet have an evidence base, but it is less prone to induce extra-pyramidal symptoms than other neuroleptics such as haloperidol. It is not, however, free of hazards, which include obesity and endocrinological disorders. Interestingly, the “elimination diet” that every other parent seemed to be demanding for their “hyperactive” child a few years ago has gone out of fashion, presumably because there was hardly any convincing evidence that it was beneficial in the first place.

Current emphasis on intriguing gains in our understanding of child psychopathology, though of major importance, should not weaken our attention as mental health professionals to “old” issues that tend to be ignored both because they render us helpless despite our increasing knowledge and because they seem so hard to remedy. I refer to those children who are subjected to severe disadvantaged conditions, both materially and psychologically, with parents who provide grossly inadequate or severely abusive care to them. These children may be considered for placement in foster care. Although there have been arguments against long-term foster care and in favour of short-term care, long-term foster care remains a persistent and important form of substitute care. The question must then arise as to whether permanent foster care can provide adequate alternatives. Practitioners are sometimes confronted with the detrimental effects of “oscillation” of children in and out of care, and reluctance as to the decision to place the child into permanent foster family care. Minty, in this issue's Annotation, provides an overview of the outcomes of long-term foster family care. Contrary to much current prejudice, Minty shows that there is ample evidence that long-term foster family care can provide a satisfactory upbringing for most children who lack adequate care in their birth families—provided that foster care begins early in life and continues at least until the late teens. Large-scale longitudinal studies have found that where psychosocial development is disturbed and educational progress deficient, these inadequacies are largely attributable to the social factors impinging on children before admission to, and discharge from, family foster care. Nevertheless, there is room for much improvement in the educational attainments of foster children, and there needs to be better training in the safe caring of children who have previously been seriously abused. Also, it is clear from Minty's overview that more methodologically sound research is needed to unravel the mechanisms that hamper or facilitate the healthy development of these children.

Child health professionals are keen to understand the origins of antisocial behaviour. Ben Lahey and colleagues, in this issue's Annotation, remind us of the evidence that it may reflect individual propensities to be impulsive, to have high activity levels with greater than average physical strength, coupled with low intelligence and a sense of daring. Youths with an earlier age of onset, before adolescence, are more likely than those with later onset to meet criteria for ADHD, but whether ADHD as such predisposes boys to engage in antisocial acts is unclear. Oppositional Defiant Disorder may be the more relevant influence. They discuss the role of “intelligence” in protecting against the development of antisocial behaviour, in particular the importance of reasonably good verbal abilities. Interestingly, Lahey et al. take the view that we are not yet in a position to be sure whether specific cognitive deficits are important predisposing factors for antisocial behaviour. They suggest that a more parsimonious way of looking at cognitive influences is to consider the global trait of intelligence without being more specific until better evidence emerges. For clinicians who wish to identify children who may be at high risk of antisocial behaviour, it is also important to think about parenting variables that may predispose to its development. These include the use of harsh discipline, lack of parental supervision, and antisocial parental attitudes. Finally, they note there is increasing interest in the influence of gender on the development of antisocial behaviour. This article is concerned exclusively with boys, and there is so far no truly convincing explanation for the remarkable differences in prevalence of such behaviour between the sexes. Girls appear to be easier to socialise, and boys have poorer communication skills in the preschool period. This aspect of sexual dimorphism is worthy of further investigation, perhaps from the perspective of gender differences in social cognitive development.

Helen Rushforth offers a Practitioner Review whose purpose is to offer guidance to practitioners who are responsible for communicating with hospitalised children. She presents not only a literature review, which is derived from the theories pertaining to children's conceptualisation of health and illness, but her paper also gives guidance to practitioners on how to communicate effectively with children of different ages, and in different clinical situations. The paper focuses on a range of contemporary issues including pre-procedural preparation, children's health promotion, and the need to convey health promotion messages to young children. She discusses the competence of children to give consent for surgery, and the criteria by which their competence to gain contraceptive advice without parental consent may be judged.

It is again my pleasure to work with an outstanding group of contributors in the production of this, the 10th Annual Research Review. As always our goal is to solicit reviews from authorities in the field, which will serve to update the readership on aspects of current research and emerging research trends. Authors are encouraged to be selective, rather than comprehensive, in coverage and to focus on the aspects of research they feel are most important. In addition to thanking the authors, I am also grateful to the various referees who provided thoughtful and detailed commentary to the authors, which has enriched the papers further. As noted in last year's editorial, we are now beginning to return to topics covered in previous reviews.

It is a particular pleasure to have Professor Rutter and colleagues provide an update of his earlier (1990) review of genetics and child psychiatry. The first of their two papers provides a summary of advances in quantitative psychiatric genetics with particular attention to both conceptual and methodological advances. Important shifts in research strategies are noted. In the second paper Rutter and colleagues focus more specifically on advances relative to specific disorders. It is clear that work in this area is likely to advance our knowledge substantially in the years ahead in ways that we can now only begin to appreciate. Angold, Costello, and Erkanli have provided a very helpful review of the topic of comorbidity in the psychiatric disorders of childhood adolescence. This is an area of some controversy and their review provides a valuable summary of current knowledge. Stevenson addresses issues in the treatment of the long-term sequelae of child abuse; he notes that while considerable progress has been made, important questions regarding treatment and prevention remain to be answered. Filipek reviews the current state of knowledge on neuroimaging in the developmental disorders. Advances in the field have given us the opportunity to understand fundamental aspects of brain-behavior relationships. Finally, Hetherington and Stanley-Hagan review current knowledge regarding the effects of divorce on children; this topic is an increasingly important one in terms of both research and intervention.

For the 11th edition of the Annual Research Review we anticipate that topics covered will include language acquisition, substance abuse, intersubjectivity, child abuse, effects of HIV infection on children, and advances in psychological assessment methods.

Open almost any recent social work magazine, or child protection text, and some reference to the abuse of disabled children will be included. Yet awareness of abuse within this group has resulted from a relatively recent growth of interest on the part of psychologists and social work and child protection professionals. Previously, sociocultural and political factors contributed to an otherwise muted response to research dating back to the 1960s, which clearly documents abuse of children who have an impairment or “developmental disability” of some kind. Reviewing this research reveals as much about society's reaction to disability and to disabled children, as it does about the abuse itself. This Annotation presents research in relation to three issues: (1) prevalence of abuse of disabled children; (2) responding to abuse; and (3) preventing abuse.

Repetitive behaviour is widely known to be one of three core and defining features of autism (ICD-10, World Health Organisation, 1990; DSM-IV, American Psychiatric Association, 1994). Any clinician who is told that a child repetitively flaps his arms, spends hours lining up Lego bricks, will not tolerate changes in routine, and has a peculiar fascination with the many varieties of electric fan available on the market will, before hearing anything about the social functioning or communicative abilities of that child, be deeply suspicious that the child is autistic. However, the literature on repetitive behaviour in autism reveals several paradoxes and inconsistencies. First, given the significant challenge that this class of behaviour can pose, the literature devoted to the study of this behaviour in autism is relatively small in comparison with the extensive literature on other aspects of autistic symptomatology. Whilst certain classes of repetitive behaviour have been described as nonspecific to autism (e.g. Prior & Macmillan, 1973), others have been suggested to be of particular significance to the disorder (e.g. U. Frith, 1989; Kanner, 1943; Wing & Gould, 1979). Finally, although repetitive behaviour is commonly defined as behaviour with no obvious goal or function (e.g. Hutt & Hutt, 1970), much of the literature concerning repetitive behaviour in autism has sought to explore what function this behaviour serves.

The aim of this Annotation is to provide a review of what is known about repetitive behaviour in autism, its specificity to the syndrome, and the functions or mechanisms that might underlie this behaviour at the psychological level.

This annotation presents an integrative model of the origins and development of antisocial behavior during childhood and adolescence. Like all theoretical models, it both summarizes what is known and states hypotheses that go beyond the current data. Our goal is to add to the impetus created by other theories to conduct the critical studies necessary to test models and advance knowledge. The present model offers some new hypotheses regarding precursors to antisocial behavior but seeks primarily to integrate antisocial propensity theories (Gottfredson & Hirschi, 1990) and developmental theories (Loeber, 1988; Moffitt, 1993; Patterson, Reid, & Dishion, 1992). Our model focuses on enduring propensities to antisocial behavior but also places antisocial propensity within a developmental perspective. Like Loeber (1991) and Sroufe (1997), we posit that changing manifestations of problem behavior over the course of the development result from successive transactions of the growing child with changing social environments. As such, roles for person variables, developmental variables, and environment variables are specified, as are interactionsWe use the term "interaction" broadly in discussing the interplay between predisposing variables and social experiences. We have not advanced hypotheses at this point that distinguish between additive, multiplicative, or other joint effects of these classes of variables, but joint effects beyond additive combinations would be most consistent with the intent of our model (cf. Pennington & Bennetto, 1993). among these classes of variables. The age of onset of antisocial behavior is a key element of the present model as the levels of influences from the multiple causal factors vary with the age of onset of antisocial behavior. Because much more is known about antisocial behavior in boys than girls, the present model may be applicable only to boys. As discussed in this annotation, there may be important gender differences that will require different models for girls and boys. Therefore, when sufficient data are available, it will be important to test the applicability of the model to girls.

Historically there has long been an interest in establishing whether children's reading levels have declined or improved in comparison with previous years. This would seem to be a valid research question and a potentially useful area of investigation. However, in reality it is a minefield. There are several reasons for the explosive nature of this topic.

First, reading holds a central position in children's education. Producing young people who are literate is the sine qua non of an adequate education system—the necessary if not sufficient demonstration that schools are doing their job. Thus, the measure of reading standards is seen as a proxy measure for educational standards more generally.

Second, the rise and fall of reading standards provides a focus for fierce debates about teaching methods, which typically crystallise around traditional versus progressive methods. Currently, the traditionalists champion methods of teaching reading that involve explicit phonics tuition. The progressive movement, sometimes referred to as “the real books approach”, emphasises the importance of purposeful reading for meaning and enjoyment. In practice it is established that eclecticism rules.

Third, there are differences of opinion concerning the most appropriate ways to assess reading levels. In order to plot reading standards over time, both valid and reliable methods of assessment are required. Preferably, too, the same test should be repeated, although parallel versions of valid tests can also be used. In practice this has frequently meant that tests involve either decontextualised word reading or sentence completion. There is agreement that such forms of assessment do not measure all the aspects of reading or literacy. There are those who argue that assessment that fails to take into account a wider range of higher-order skills, such as skimming, scanning, interpretation, and comprehension monitoring, and that uses only a narrow range of decontextualised text, will tell us little that is valuable about the level of children's reading. From this position it is difficult to measure reading standards validly over time. It is also argued that assessment should measure the areas of literacy covered by the curriculum and that as this changes, tests must also change, making comparability over time problematic.

Despite these debates, children's reading levels have been measured over time and even across countries. The question is how valid such exercises are and what conclusions we can draw from the results.

The recognition and drug treatment of hyperkinetic disorder have been increasing in the U.K. during the late 1990s, but are still at a low rate by comparison with many other countries. This article will describe some clinical conclusions, taken mostly from recent research, that should be relevant to clinicians in countries such as the U.K., where there is little current use of the diagnosis of Attention Deficit or stimulant drug treatments. It includes some practical recommendations for therapy that go beyond the evidence base; but space does not allow full protocols, and more detailed guidelines for European practitioners are available elsewhere (Taylor et al., 1998). The recommendations are not necessarily appropriate for other cultural settings, and should not be taken to apply to countries where stimulant drugs are unavailable or where they are widely used in primary care.

Recognition is increasing that suicide in young people poses an important public health challenge. Suicide in prepubertal children is very rare, but it increases for both genders in each of the adolescent years (McClure, 1994). In England and Wales, for example, the 1990 suicide rates per million for males and females aged 15 to 19 years were 57 and 14 respectively (McClure, 1994). Mortality rates in this age group were higher only for accidents. Since the Second World War, there has been an increase in male youth suicide rates in most European countries and in North America. In England and Wales, the suicide rate of males aged 14 to 24 years increased by 78% between 1980 and 1990! (Hawton, 1992). This increase is particularly striking when seen in comparison to the stable rates for other age groups and for young females (Diekstra, Kienhorst, & De Wilde, 1995).

Based on hospital statistics, it is estimated that the rate of nonfatal suicide attempts is 50 to 100 times higher than fatal attempts (Flisher, Ziervogel, Chalton, Leger, & Robertson, 1993). Evidence is emerging that the increase in rate of completed suicide is accompanied by an increase in the rate of attempted suicide (Hawton, Fagg, Simkin, Bale, & Bond, 1997). The rates of 15–24-year-olds presenting at the general hospital in Oxford with deliberate self-harm increased by 194% for males and 36% for females between 1985 and 1995 (Hawton et al., 1997).

Fifty years ago the Children Act (1948) created the modern child care service in England and Wales. Then, as now, the preferred form of state-provided care for children was foster, rather than residential, care. However, the nature of foster family care has changed considerably over the past 50 years and, in some respects, so have the children fostered. Then the predominant form of foster care was long-term care, in keeping with the prevailing ideology of “rescuing” children from intolerable home conditions. Now, by contrast, foster care is a much more diverse service, and the commonest form is short-term care, which is generally understood as care intended to last less than roughly 3 months. This is in keeping with a strong ideology in both the U.S.A. and the U.K. that foster care is not parenting, and that almost all children are best off with their biological parents.

Advances in quantitative psychiatric genetics as a whole are reviewed with respect to conceptual and methodological issues in relation to statistical model fitting, new genetic designs, twin and adoptee studies, definition of the phenotype, pervasiveness of genetic influences, pervasiveness of environmental influences, shared and nonshared environmental effects, and nature–nurture interplay. Advances in molecular genetics are discussed in relation to the shifts in research strategies to investigate multifactorial disorders (affected relative linkage designs, association strategies, and quantitative trait loci studies); new techniques and identified genetic mechanisms (expansion of trinucleotide repeats, genomic imprinting, mitochondrial DNA, fluorescent in-situ hybridisation, behavioural phenotypes, and animal models); and the successful localisation of genes.

Pseudoseizures or their possibility remain a troublesome clinical issue with serious implications as, particularly in older children and adolescents, they can take various forms so that their differential diagnosis is wide. Many of the traditional criteria do not, in fact, discriminate well between pseudoseizures and other episodic disorders, especially those involving dramatic behavioural manifestations. These include certain forms of epilepsy (notably mesial frontal seizures) and some other organic and psychiatric conditions. A number of more reliable diagnostic criteria remain. These include selective clinical criteria and certain findings from carefully conducted EEG monitoring with informed analysis of the results.

Key substantive findings from quantitative and molecular genetic research are reviewed in relation to affective disorder, schizophrenia, autism, hyperkinetic/attention deficit disorder, oppositional and conduct disorders, drug/alcohol problems, and Tourette's syndrome/chronic tics.

There is increasing interest regarding electroconvulsive therapy (ECT) in young persons but limited information about its optimal use. This paper reviews the indications, effectiveness, and side effects of the treatment in the teenage population and their implications for everyday clinical practice. There is particular reference to factors influencing the clinician to recommend or advise against convulsive therapy, steps in the assessment of patients, and consent issues. Practical aspects of ECT administration are also examined, including treatment locale, anaesthesia, electrode position, stimulus characteristics, EEG monitoring, and use of psychotropics during and after the ECT course.

Much of the relevant literature has focused on the assessment of dangerousness in adults. Up-to-date thinking and research has now taken on the alternative concept of risk and looks not at all-or-nothing long-term predictions, but at short-term frequent decisions about risk, which then assist in the management of the individual and their situation. For this reason it is essential that those presenting evidence for other professionals or for Court should not attempt, or be persuaded, to make long-term predictions. Current research is now showing that some factors, which can be ascertained clinically, are significantly associated with the risk of future violence.