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.

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.

The assessment and treatment of somatisation in childhood require explicit recognition that many families frequently hold strong belief in the presence of physical disorders. Engaging the family, recognising and focusing on their beliefs and concerns, and paediatric/psychiatric liaison are usually required. Our knowledge on the management of children with somatisation is largely based on clinical reports but a number of open trials and methodologically increasingly stronger studies show that somatisation can respond to family treatments involving cognitive-behavioural techniques as well as to sensitive, psychologically sound advice by paediatricians. Antidepressants should be considered when there are comorbid mood disorders.

A conceptual model has recently been hypothesized in which parallel but correlated developmental pathways exist for attention deficit behaviors and conduct problems. An important component of this model suggests that attention deficit behaviors are related to later scholastic underachievement, whereas conduct problems are unrelated to scholastic underachievement except by their common correlation with attention deficit and intelligence. The present study replicated the general model using a cross-sectional sample of 325 children, and examined whether hypothesized dual pathways (behavioral and cognitive) better account for the relationship between attention deficit, intelligence, and later scholastic achievement. Results of the structural equation modeling analysis were consistent with the hypothesized dual pathway model and suggest that school behavior and select cognitive abilities serve as important mediators between attention deficit, intelligence, and later scholastic achievement. Implications of these results for understanding the developmental trajectory of children with attention deficit and general theoretical models of ADHD are discussed.

Research on the role of parenting styles in the development of disruptive behaviour problems has focused primarily on how parents handle conflict once it has occurred. This home observational study examined strategies used by 52 mothers to prevent conflict with 3-year-olds. It was predicted that mothers of children with behaviour problems would use fewer “positive” strategies to resolve conflict, and would use reactive rather than pre-emptive strategies. Results showed frequency of positive strategies did not differ between the groups. Mothers of children with behaviour problems were less likely to use pre-emptive, and more likely to use reactive, strategies. Further analysis showed child conduct problems, rather than other characteristics, best discriminated pre-emptive from reactive strategy users. Follow-up of a subsample found that reactive strategies at age 3 predicted age 5 behaviour problems, even after controlling for age 3 behaviour problems.

This study examined the role of ADHD in the association between physical aggression and two types of executive functions. Boys received a cognitive-neuropsychological test battery over the ages of 13, 14, and 15 years. Diagnostic Interview Schedule for Children (DISC 2.25) data were collected from the boys and one parent between ages 14 and 16, and an IQ estimate was obtained at age 15. Three groups, differing in stability and level of physical aggression since kindergarten, were formed: Stable Aggressive, Unstable Aggressive, and Non-aggressive. Composite scores of validated executive function tests of working memory representing subjective ordering and conditional association learning were formed. A MANCOVA (N=149) using ADHD status, teacher-rated negative emotionality, general memory abilities, and IQ as covariates was performed on the two composite scores. ADHD and teacher-rated emotionality did not provide significant adjustment to the dependent variables. Number of ADHD symptoms was negatively associated only with general memory and IQ. General memory contributed significantly to adjusting for conditional association test scores. Group differences indicated lower conditional association scores for Unstable Aggressive boys relative to the other groups. Both IQ and general memory abilities interacted with subjective ordering within the groups. Specifically, Stable Aggressive boys performed poorly on this measure and did not benefit from increases in IQ whereas Nonaggressive boys performed best and were not disadvantaged by lower general memory abilities. This suggests a relationship exists between aspects of working memory and a history of physical aggression regardless of ADHD and IQ.

Using data from the Montreal Longitudinal-Experimental Study, we examined the impact of poverty (and its correlate, family configuration status) on academic placement and self-reported delinquency in boys at age 16. We then investigated whether the relation between family economic hardship and antisocial behaviour is direct or indirect by considering the value of parenting practices and academic failure as process variables in the model. Data included official records, and parent, teacher, and self-reports. The temporal intensity of poverty was classified into five categories: never-poor; always-poor; poor-earlier; poor-later; and transitory-poverty. Family configuration status was classified by both temporal characteristics and number of marital transitions: intact-family; short-term-single; long-term-single; short-term-remarried; long-term-remarried; and multiple-marital-transitions. Results revealed that when maternal education and early childhood behaviour were controlled, poverty had an effect on both academic failure and extreme delinquency. This effect was independent of family configuration status. Although they both significantly predicted extreme delinquency on their own, academic failure and parental supervision did not mediate the relationship between poverty and delinquency. Divorce increased the risk of theft and fighting at age 16, regardless of financial hardship. Parental supervision only helped explain the effects of divorce on boys' fighting.

The implications of adoption for the emotional and behavioral adjustment of children have been an issue in child welfare for many years. Past research has suggested that adopted children are over-represented in mental health settings. In addition, some studies have suggested that adopted and nonadopted children differ on measures of social, emotional, behavioral, and cognitive functioning. The current study used data from a large, representative sample in the United States to examine whether adopted children are more likely to have had mental health contacts or emotional or behavioral problems than nonadopted children. Age of placement in the adoptive home was examined as a variable contributing to the adjustment of adopted children. Results suggest that adopted and foster children are more likely to have mental health contacts than nonadopted children. Results are mixed regarding whether adopted and foster children have more behavior problems than nonadopted children. However, significant differences between adopted, foster, and nonadopted children disappeared when a small group of influential cases were removed. This suggests that the differences seen between the groups reflect a small number of cases and are not representative of the groups of adoptees and foster children as a whole. The vast majority of adopted children showed patterns of behavior problems similar to those of nonadopted children. These results are discussed in relation to the past literature and areas for future research.

A group of 4–7-year-old war orphans were examined for the first time while living in an institution (the Solomuna Orphanage) during a protracted war between Eritrea and Ethiopia. At that time, they were compared to a group of refugee children living in a nearby camp with one or both parents. The orphans exhibited significantly more behavioral symptoms than the refugee children, but performed the cognitive tests at a more advanced level. Five years later, the orphans were re-examined; and they were compared to unaccompanied 9–12-year-children living in one of two residential settings that differed qualitatively in their social climate, principles of child care, and patterns of staff–child interactions. Although the severity of their behavioral symptoms had diminished, the orphans still exhibited many symptoms of emotional distress. On the other hand, they performed the cognitive measures as well as, or better than, unaccompanied children who had been protected from the terrors of war. The cross-sectional comparisons indicated that a residential setting that respects the individuality of children and promotes their close personal ties with at least one staff member can ameliorate many of the more serious psychological sequelae of having lost both parents and being exposed to the physical dangers of the war. The implications for war orphans in other Third World countries are discussed.

Sweden has now around 38,000 individuals who have been adopted from other countries. Most often they are transracially adopted and have a different appearance from their new parents—“visible” adoptions. This study was made to explore the mental health of a teenager/young adult group that arrived with their families in the southernmost county of Sweden between 1970 and 1977. They were placed through the largest Swedish adoption agency at that time. One hundred and forty-seven families and their 211 adopted children, who were 13 years of age or older at the time of the investigation, were interviewed in their homes. CBCL, SCL-90, a self-esteem questionnaire, and two family relations inventories were also completed. Compared to nonadopted Swedish young persons of the same ages, who had been investigated with the same inventories in earlier epidemiological studies, the adoptees had as good mental health. The adoptees also reported good self-esteem. The pre-adoption conditions were more important than the age of arrival in itself for the risk of later maladaptation. Family relations, various aspects of identity, and peer relations explained much of the variance of mental health and self-esteem. Those who were most engaged in questions about their identity and felt mostly non-Swedish had more behaviour problems. The association, however, between the factor “Identity” and the mental health variables approached zero for the older subjects (18–27 years of age). The majority (about 90%) of the adoptees felt mostly Swedish. Seventy per cent didn't feel any connection to their country of origin.

Correlates of parents' ratings of behavioural problems were explored in a sample of 93 British families, in which mothers and fathers rated their children at the time of the fourth birthday on the Achenbach Child Behavior Checklist. As in other samples, there was moderate convergence in mothers' and fathers' total problem scores, but also signs that they were reporting different sorts of problems linked to different influences. The father's rating was primarily associated with the child's cognitive ability. The mother's rating was primarily affected by her own mental state and view of her marriage. The father's but not the mother's rating provided unique information that predicted teachers' reports of the children's problems 7 years later. In general, parents' ratings of preschool children's problems reflect particular informants' perspectives on family life.

A community sample of depressed and well mothers, recruited at 2 months postpartum and assessed through to 18 months, was followed up at 5 years. The quality of mother–child interactions was assessed, as was the children's behavioural and social adjustment, using maternal reports and observations of child behaviour during free play at school. Several aspects of child outcome were found to be associated with postnatal depression, even when taking account of current adverse circumstances (maternal depression and parental conflict). These included the child's behaviour with the mother, the presence of behavioural disturbance at home, and the content and social patterning of play at school. These associations with postnatal depression were independent of the child's gender. The child's relationship with the mother appeared to be mediated by the quality of infant attachment at 18 months. The mother's behaviour with her child was more affected by current difficulties, in particular by conflict with the child's father. Together these findings suggest that, while maternal behaviour varies with changing circumstances, exposure to maternal depression in the early postpartum months may have an enduring influence on child psychological adjustment.

Self-reported anxiety and depression symptoms in children and adolescents have been shown to be heritable, and are also highly correlated. Furthermore, there have been indications in the literature of sex and age differences in the aetiologies of these two types of symptoms. This study set out to ascertain to what extent the genetic and environmental factors that influence anxiety symptoms also influence depression symptoms, and whether these are the same in children and adolescents, and males and females. Four hundred and ninety pairs of twins aged 8 to 16 years completed the Children's Depression Inventory and the Trait scale of the State-Trait Anxiety Inventory for Children. There were significant effects of age and sex on the variance in and covariance between these two types of symptom. Bivariate genetic analyses of the measures indicated that the genetic influences on anxiety and depression were shared for all four groups, a finding that has been consistently demonstrated for adults.

A recent finding that individuals with autism are not susceptible to illusions has been explained by Happé (1996) as a sign of “weak central coherence” at lower levels of processing. We investigated the phenomenon with a more sophisticated measure. In Experiment 1, individuals with autism, Asperger's syndrome, moderate learning difficulties, and typical development adjusted certain comparison lines and circles to make them appear to be the same size in four visual illusions. With a minor exception, the participants with autism and Asperger's syndrome evinced a systematic bias in their judgements in the illusion condition. The extent of this was no different from control participants. In a second experiment, a similar finding was obtained in a task where participants made verbal judgements about the stimuli. The results suggest that lower-level coherence in visual processing in autism is intact.