Rutter's Child and Adolescent Psychiatry Book 2

Green, M. J., Peterson, S. K., Baker, M. W., Friedman, L. C., Harper, G. R., Rubinstein, W. S., et al. (2005). Use of an educational computer program before genetic counseling for breast cancer susceptibility: Effects on duration and content of counseling sessions. Genetics in Medicine, 7, 221–229. Hall, M., & Olopade, O. I. (2005). Confronting genetic testing disparities: Knowledge is power. Journal of the American Medical Association, 293, 1783–1785. Harper, P. S. (1998). Practical genetic counselling. Oxford: ButterworthHeinemann. Hunter, A. G. W., Cappelli, M., Humphreys, L., Allanson, J. E., Chiu, T. T., Peeters, C., et al. (2005). A randomized trial comparing alternative approaches to prenatal diagnosis counseling in advanced maternal age patients. Clinical Genetics, 67, 303–313. Kelly, T. E. (1986). Clinical genetics and genetic counseling. Chicago: Year Book. Kendler, K. S., Heath, A. C., Martin, N. G., & Eaves, L. J. (1987). Symptoms of anxiety and symptoms of depression: Same genes, different environments? Archives of General Psychiatry, 44, 451–457. Kodish, E. D. (1999). Testing children for cancer genes: The rule of earliest onset. Journal of Pediatrics, 135, 390–395. LaRusse, S., Roberts, J. S., Marteau, T. M., Katzen, H., Linnenbringer, E. L., Barber, M., et al. (2005). Genetic susceptibility testing versus family history-based risk assessment: Impact on perceived risk of Alzheimer disease. Genetics in Medicine, 7, 48–53. Le Couteur, A., Bailey, A., Goode, S., Pickles, A., Robertson, S., Gottesman, I., et al. (1996). A broader phenotype of autism: The clinical spectrum in twins. Journal of Child Psychology and Psychiatry and Allied Disciplines, 37, 785–801. Marteau, T. M., Roberts, S., LaRusse, S., & Green, R. C. (2005). Predictive genetic testing for Alzheimer’s disease: Impact upon risk perception. Risk Analysis, 25, 397–404. McConkie-Rosell, A., Finucane, B., Cronister, A., Abrams, L., Bennett, R. L., & Pettersen, B. J. (2005). Genetic counseling for fragile X syndrome: Updated recommendations of the national society of genetic counselors. Journal of Genetic Counseling, 14, 249–270. McConkie-Rosell, A., & Spiridigliozzi, G. A. (2004). “Family matters”: A conceptual framework for genetic testing in children. Journal of Genetic Counseling, 13, 9–29. McConkie-Rosell, A., Spiridigliozzi, G. A., Rounds, K., Dawson, D. V., Sullivan, J. A., Burgess, D., et al. (1999). Parental attitudes regarding carrier testing in children at risk for fragile X syndrome. American Journal of Medical Genetics, 82, 206–211. McDonald, L., Rennie, A., Tolmie, J., Galloway, P., & McWilliam, R. (2006). Investigation of global developmental delay. Archives of Disease in Childhood, 91, 701–705. Michie, S., Bron, F., Bobrow, M., & Marteau, T. M. (1997). Nondirectiveness in genetic counseling: An empirical study. American Journal of Human Genetics, 60, 40–47. Michie, S., Lester, K., Pinto, J., & Marteau, T. M. (2005). Communicating risk information in genetic counseling: An observational study. Health Education and Behavior, 32, 589–598. Nuffield Council on Bioethics. (1998). Mental disorders and genetics: The ethical context. Oxford: Nuffield Foundation. Nuffield Council on Bioethics. (2002). Genetics and human behaviour: The ethical context. London: Nuffield Foundation. Nuffield Council on Bioethics. (2003). Pharmacogenetics: Ethical issues. London: Nuffield Foundation. Quaid, K. A., & Morris, M. (1993). Reluctance to undergo predictive testing: The case of Huntington disease. American Journal of Medical Genetics, 43, 41–45. Ratcliffe, S. (1999). Long-term outcome in children of sex chromosome abnormalities. Archives of Disease in Childhood, 80, 192– 195. Rutter, M., Bailey, A., Simonoff, E., & Pickles, A. (1997). Genetic influences and autism. In D. J. Cohen, & F. R. Volkmar (Eds.), Handbook of autism (2nd edn., pp. 370–387). New York: Wiley. Rutter, M., Silberg, J., O’Connor, T., & Simonoff, E. (1999). Genetics and child psychiatry. 2. Empirical research findings. Journal of Child Psychology and Psychiatry, 40, 19–55. Sermon, K., Van Steirteghem, A., & Liebaers, I. (2004). Preimplantation genetic diagnosis. Lancet, 363, 1633–1641. Sharkey, F. H., Maher, E., & FitzPatrick, D. R. (2005). Chromosome analysis: What and when to request. Archives of Disease in Childhood, 90, 1264–1269. Sherman, S., Pletcher, B. A., & Driscoll, D. A. (2005). Fragile X syndrome: Diagnostic and carrier testing. Genetics in Medicine, 7, 584–587. Shiloh, S., & Saxe, L. (1989). Perception of risk in genetic counseling. Psychology and Health, 3, 45–61. Silberg, J., Rutter, M., Meyer, J., Simonoff, E., Hewitt, J., Loeber, R., et al. (1996). Genetic and environmental influences on the covariation between hyperactivity and conduct disturbance in juvenile twins. Journal of Child Psychology and Psychiatry, 37, 803–816. Skinner, D., Sparkman, K. L., & Bailey, D. B. (2003). Screening for fragile X syndrome: Parent attitudes and perspectives. Genetics in Medicine, 5, 378–384. Srour, M., Mazer, B., & Shevell, M. I. (2006). Analysis of clinical features predicting etiologic yield in the assessment of global developmental delay. Pediatrics, 118, 139–145. Takeshita, N., & Kubo, H. (2004). Regulating preimplantation genetic diagnosis: How to control PGD. Journal of Assisted Reproduction and Genetics, 21, 19–25. Taub, S., Morin, K., Spillman, M. A., Sade, R. M., Riddick, F. A., & Council on Ethical and Judicial Affairs of the American Medical Association. (2004). Managing familial risk in genetic testing. Genetic Testing, 8, 356–359. van Delden, J., Bolt, I., Kalis, A., Derijks, J., & Leufkens, H. (2004). Tailor-made pharmacotherapy: Future developments and ethical challenges in the field of pharmacogenomics. Bioethics, 18, 303– 321. van Karnebeek, C. D. M., Scheper, F. Y., Abeling, N. G., Alders, M., Barth, P. G., Hoovers, J. M. N., et al. (2005). Etiology of mental retardation in children referred to a tertiary care center: A prospective study. American Journal of Mental Retardation, 110, 253–267. van Langen, I. M., Hofman, N., Tan, H. L., & Wilde, A. A. M. (2004). Family and population strategies for screening and counselling of inherited cardiac arrhythmias. Annals of Medicine, 36, 116–124. CHAPTER 73 1188 9781405145497_4_073.qxd 29/03/2008 03:00 PM Page 1188

This chapter examines educational provision for those children who, at some stage in their school lives, experience difficulties that interfere with learning. These are children who, because of developmental delays or behavioral difficulties, lack the cognitive, linguistic, attentional or social skills needed to cope with ordinary schooling and who thus require special help in order to access the wider teaching curriculum. They include children with long-term and pervasive conditions such as intellectual impairments (intellectual disability), developmental language disorders or autism; more specific learning disabilities, such as dyslexia; sensory and physical impairments or chronic illnesses; and children with severe emotional and/or behavioral difficulties. What are Special Educational Needs? Many different definitions exist, but the Special Education Needs (SEN) Code of Practice (Special Educational Needs and Disability Act, 2001) defines children with special educational needs as those who, compared with their peer group, have: 1 A significantly greater difficulty in learning; or 2 A disability that prevents or hinders them from making use of educational facilities of a kind generally provided. Further, “A child is defined as disabled if he is blind, deaf or dumb or suffers from a mental disorder of any kind or is substantially and permanently handicapped by illness, injury or congenital deformity or such other disability as may be prescribed.” The same document defines special educational provision as that “which is additional to, or otherwise different from, the educational provision made generally for children of their age in (state) maintained schools.” However, decisions about what constitutes a “significantly greater disability” vary across schools and education authorities and are influenced by the political and financial factors operating at any one time. Moreover, although the same Code of Practice notes that children with special educational needs “should have their needs met . . . and be offered full access to a broad, balanced and relevant education,” how to achieve this remains unspecified. What are the Goals of Special Education? Educational goals are affected by the nature and extent of an individual’s disabilities. Many children with sensory or physical impairments or chronic illnesses are of normal intellectual ability and, with appropriate support, should be able to progress within mainstream settings. Children with more pervasive developmental, learning or behavioral difficulties require more radical modifications to the educational environment and curriculum. For the majority of children with special needs, education should provide them with the skills required for social inclusion as adults so that they leave school with the skills needed to fit in with and be accepted by society, develop strategies to minimize their difficulties and achieve emotional stability and positive self-esteem. Although scholastic attainments and academic qualifications are important, these should be of an appropriate kind and level, and there must also be a focus on broader aspects of social, emotional and behavioral development. Moreover, some children, particularly those with severe to profound intellectual impairments, are unlikely ever to lead totally independent lives. For them, education should promote the development of effective means of communication, the acquisition of basic daily living and social skills and the minimization of behavioral problems. Does Special Education Mean Inclusive Education? During the 19th century, individuals concerned to improve education for children with special needs (Gordon, 1885; Lettsom, 1894) fought to establish specialist, disability-specific schools. However, by the latter half of the 20th century, there were increasing fears about the long-term effects of isolating these children from their typically developing peers. Pressure for integration was strengthened by significant changes in legislation. In the USA, the Education of All Handicapped Children Act, 1975 (Public Law 94-142; now the Individuals with Disabilities Education Act [IDEA], Public Law 101-476) required public schools to provide all students with special needs with access to a “free and appropriate education” in the “least restrictive environment.” The Americans with Disabilities Act, 1990 (ADA, Public Law 101-336) further outlawed discrimination against any child with special needs. UNESCO’s 1189 Special Education 74 Patricia Howlin 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1189 Rutter’s Child and Adolescent Psychiatry, 5th Edition, Edited by M. Rutter, D. V. M. Bishop D. S. Pine, S. Scott, J. Stevenson, E. Taylor and A. Thapar © 2008 Blackwell Publishing Limited. ISBN: 978-1-405-14549-7

Salamanca Statement (1994) called for all governments to “adopt as a matter of law or policy the principle of inclusive education.” In the UK, the highly influential Warnock Committee report (1978) led to the widespread view that all pupils with special needs had a “right” to mainstream education (Department for Education and Employment, 1998). However, although inclusion has often been interpreted as requiring the elimination of all segregated schooling, Public Law 94-142 states that there may be grounds for “special classes, separate schooling, or removal . . . from the regular education environment . . . (if) education in regular classes.... cannot be achieved satisfactorily.” The UK Special Educational Needs and Disability Act (2001) also notes that pupils may be educated in alternative provision if their presence in mainstream is incompatible with the provision of efficient education for other children. Moreover, Warnock herself (2005) criticized the manner in which her original report was misinterpreted as espousing mainstreaming for all children, regardless of disability level, the impact on other pupils or the availability of adequate resources. Empirical Evidence for Inclusion Empirical research on the relative effectiveness of special versus integrated education is extremely limited. Indeed, it has been suggested that such research is inappropriate because the issue is one of rights, not evidence (Gallagher, 2001). Wellconducted comparative studies are rare, randomized controlled trials virtually non-existent and research methods and analysis vary from study to study (Lindsay, 2007). A major problem is that inclusion is not a simple unambiguous concept: “special educational needs” encompass specific learning disabilities, severe and pervasive developmental disorders, and disruptive and challenging behaviors. Programs range from the highly specific to a general (often poorly defined) “whole school inclusion policy”; and monitoring treatment fidelity presents major practical difficulties (Lindsay, 2003). Heterogeneity of samples and inadequate information on children’s cognitive, linguistic, social and behavioral characteristics make it almost impossible to generalize from one study to another. Finding appropriate comparison groups also presents difficulties because children in specialist settings often tend to have more academic and behavioral problems than pupils of similar IQ in mainstream (Rafferty, Piscitelli, & Boettcher, 2003). Even terminology is a problem. Thus, “learning disability” refers to specific difficulties (e.g., reading, spelling, motor) in the USA but is used synonymously with mental retardation (now termed intellectual disability; see chapter 49) in the UK. In a review of 1373 published studies on inclusion from 2001–2005, Lindsay (2007) identified only nine that compared outcomes for children with special needs in specialized versus mainstream settings. There were no randomized controlled trials; the results of most studies were equivocal and the few that did find positive effects for mainstreaming all suffered from significant methodological limitations. Alternatives to Full Inclusion The UK Office for Standards in Education (Ofsted, 2004) recently noted that, despite the widespread policy of inclusion, the numbers of pupils being sent to referral units or special schools was rising as mainstream schools were finding it increasingly difficult to manage students with social and behavioral difficulties. Even when pupils with special educational needs were mainstreamed, much teaching was carried out by unqualified staff and the quality of education was poor, resulting in disruptive behavior, poor attendance and high staff turnover, especially in secondary school. Because of the conflicts faced by teachers trying to cope with the demands of perhaps 30 other pupils, various alternatives to full-time integration have been explored. Although critics claim these lead to increased discrimination by excluding difficult pupils from the classroom, there is some evidence of their effectiveness. Resource rooms are usually separate classrooms where children can be offered individual teaching for part of the school day. Some cater for children with specific difficulties, others for pupils with broader impairments, and a combination of resource room and regular classroom teaching has been found to improve educational progress (Marston, 1996). Placement on the same site as the mainstream school seems more likely to result in integration than placement in units that are geographically isolated (Burack, Root, & Zigler, 1997) and students with special educational needs themselves indicate a preference for receiving support in a separate environment while being able to mix with their peers at other times (Norwich & Kelly, 2004). Dual placements – in which pupils are enrolled in both mainstream and a special placement – are currently recommended by the Department for Education and Skills (2001a) in the UK as an alternative means of supporting inclusion. Dual placements can help prepare pupils for mainstream education by providing them with skilled individualized support for areas of particular need while mainstream teachers profit from the input and advice of specialist staff. Although evaluation of the benefits of dual placements is still needed, this flexibility could potentially meet the requirements of many pupils, and provides a bridge between fully inclusive and full-time special education. Specialist Teaching Programs There are vast numbers of publications offering advice on “the making of the inclusive school,” and how to improve the curriculum, environment, support structures and general attitudes. Co-operative learning (groups of students working together to achieve mutual goals) has been recommended in a number of studies although this seems to have more impact on social engagement than academic skills (Murphy, Grey, & Honan, 2005). Self-evaluation and self-monitoring programs (Sainato, Goldstein, & Strain, 1992), the Adaptive Learning Environment Model (ALEM; Wang & Walberg, 1993), Mediated Learning (Mills, Dale, Cole, & Jenkins, 1995), Instrumental Enrichment (Feuerstein, Rand, Hoffman, & Miller, 1980) and Creative Action CHAPTER 74 1190 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1190

Planning techniques (Forest, Pearpoint, & O’Brien, 1996) all have their advocates, but either experimental evaluations are small in scale or their findings are equivocal (Dale, Jenkins, Mills, & Cole, 2005; Hornby, Atkinson, & Howard, 1997). The following sections address issues related to special education for children with different types of difficulties. The earlier sections relate to children with relatively mild intellectual impairments, “specific” learning difficulties, or sensory or physical problems, for whom the crucial issue is how their needs can be better met in mainstream settings. The latter sections deal with those pupils for whom the merits of inclusive education are much less well established – children with severe emotional and behavioral problems and those with pervasive disabilities, such as developmental language problems, autism or severe intellectual disability. Education for Children with Mild to Moderate Intellectual Impairments The American Association on Mental Retardation (2002) defines intellectual disability as “characterized by significant limitations both in intellectual functioning (generally accepted as IQ below 70) and in adaptive behavior (and) refers to a particular state of functioning that begins in childhood, has many dimensions, and is affected positively by individualized supports.” Academic Attainments The majority of studies on inclusion have focused on children with mild intellectual disabilities (IQ 50–70, DSM-IV-TR; American Psychiatric Association, 2000). Once they leave school, most of these individuals will be expected to live independently and be able to socialize with and work alongside their “typically developing” peers. Thus, it is important that they are provided with the skills needed for optimum social inclusion from the earliest years. In principle at least, helping them to learn with and from their peers should enhance academic skills, social adjustment and self-esteem. There is also evidence that once children are placed in segregated provision their chances of reintegration or of achieving age-appropriate educational standards diminish with age (Farrell & Tsakalidou, 1999). European statistics over the last 2–3 decades show a significant decline in the number of special schools for children with mild to moderate intellectual impairments (Meijer, Soriano, & Watkins, 2003) and those that remain tend to cater for children with more severe social and behavioral problems. What is known about the educational progress of these pupils in inclusive settings? Baker, Wang, and Walberg (1994) summarized the findings of three meta-analyses of inclusive education 1970–1992 involving over 70 studies. The results provide only limited support for inclusion, with effect sizes for academic outcomes being generally small (range 0.08–0.44; average 0.22), albeit positive. Findings are also influenced by pupil characteristics. Mills, Cole, Jenkins, and Dale (1998) reported no main effect of classroom type for children with mild to moderate intellectual impairment but there was an interaction effect, with higher-functioning children gaining more from special integrated classes and lower-functioning children performing better in segregated classes. The choice of outcome measures further affects conclusions. Rafferty, Piscitelli, & Boettcher, (2003) found that although pupils with mild intellectual disabilities appeared to do equally well in segregated or inclusive classes, the subgroup with the lowest IQ made greater language and social progress in inclusive classes but showed higher rates of behavior problems than children in segregated classes. A further experimental confound relates to the quality of the educational settings studied. Much research into the benefits of inclusive placements has been conducted, especially in the USA, in highly resourced university-based research settings, in small classrooms (often fewer than 15 children), and with preschool or elementary school pupils. In contrast, the poor progress of many pupils in special schools may be a result, not of segregation per se, but of the poor quality of teaching provided (Giangreco, 1997; Manset & Semmel, 1997). Finally, conclusions are often limited by a lack of crucial information about the participants. One frequently cited study in support of inclusive compared with “pull-out” programs (Rea, McLaughlin, & Walther-Thomas, 2002) included only children of average IQ and provided very limited information on the preplacement skills of the pupils involved. Social Integration and Self-Esteem Writers espousing the human rights and equality arguments in favor of inclusion (Lipsky & Gartner, 1999) insist that this is essential for positive social development. Early reviews (Carlberg & Kavale, 1980; Cole & Meyer, 1991; Lakhen & Norwich, 1990) also claimed that inclusion led to more positive social outcomes and higher self-esteem. However, effect sizes for social improvements among children with mild intellectual disabilities in inclusive classrooms are typically even smaller than the effect sizes for academic attainments (range 0.11–0.28; average 0.19; Baker, Wang, & Walberg, 1994). A review of 14 studies (Nakken & Pijl, 2002) found some reported better social interactions and friendships among mainstreamed pupils; in others inclusion seemed to make little difference, whereas some reported negative effects. Other reviews (Burack, Root, & Zigler, 1997; Hornby, Atkinson, & Howard, 1997) have failed to find evidence of enhanced social skills, self-esteem or peer acceptance within inclusive settings. Moreover, for some pupils with mild to moderate intellectual impairments, the school experience can be very negative, with integrated schooling actually leading to lower self-esteem and increased stigmatization, bullying and rejection by peers (Bear, Clever, & Proctor, 1991; Norwich & Kelly, 2004). Education for Children with “Specific” Learning Disabilities Reading and spelling difficulties Around 5% of school-aged pupils have persistent and significant reading difficulties and the adverse effects on many aspects SPECIAL EDUCATION 1191 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1191

of children’s development, including emotional and behavioral disturbance, are well documented (see chapter 48). Almost any type of intervention initially seems to produce short-term gains, although these are rarely well maintained. Overall, a combination of the “Reading Recovery” approach (intensive, structured, individualized reading programs; Clay, 1985) together with training in phonological awareness and explicit work on letter–sound correspondence, has proved most consistently effective (Troia, 1999). Computerized programs, allowing self-assessment of reading ability and providing clear and immediate feedback using synthesized speech, are also reported as successful (Vollands, Topping, & Ryka, 1999; Wise, Ring, & Olson, 2000). However, the gains may be very specific to the skills taught and often fail to generalize to other literacy problems or to new situations. Thus, a computer-based Colorado remediation project (Wise, Ring, & Olson, 2000) indicated that outcome may still depend on the amount of direct monitoring by adults. This study also reported an interaction between treatment response and the nature and severity of children’s reading problems although, overall, meta-analyses have failed to demonstrate a clear relationship between basic aptitude and type of intervention (Norwich, 2003). Given the complexity of the problems of many pupils with reading difficulties, factors other than the specific literacy intervention are likely to have an impact: teacher effectiveness, classroom organization, amount of time spent on reading and adequacy of resources (human, environmental and technical). Classroom assistants can have an important role, but only if they are fully trained to implement the program. Peer tutors may also prove an effective source of intervention (Topping, 2001). Specific homework tasks can be helpful and parental participation is also important (Topping, 2001), but only if parents are given appropriate guidance in what to do; simply encouraging them to listen to their child has little effect. A major problem is the poor maintenance of reading skills once intervention ceases and research is still needed to identify the factors required to ensure continuing long-term progress. Extra tuition for children with reading and/or spelling problems often continues to be provided outside the classroom or in privately funded centers, both of which limit opportunities for participating fully in school life. Specific Language Impairments Specific language impairments are among the most frequent of childhood developmental disorders, with epidemiological studies suggesting prevalence rates in 5-year-olds of around 6–7% (see chapter 47). Co-occurring scholastic problems, related to reading, spelling and mathematics, are common and there is a significant risk of later emotional, social, behavioral and psychiatric problems. Meta-analyses of speech and language therapy interventions indicate that, although these may be helpful for children with phonological and vocabulary difficulties, the evidence for their impact on expressive syntax disorders is variable, and there is little evidence of effectiveness for children with receptive disorders (Law, Garrett, & Nye, 2003). In recent years, much of the focus of intervention programs for specific language impairments has been on the development of improved reciprocal communication strategies for parents and very young children (Pepper & Weitzman, 2004). The University of Kansas Language Acquisition Pre-school Program (Rice & Wilcox, 1991) indicated that this inclusive preschool model, involving parents and normal peers, significantly increases children’s chances of remaining with their peer group once they reach school age. School-based programs for older children (e.g., Speech Foundation of Ontario, Hayden & Pukonen, 1996; or the ECLIPSE project, Schwartz, Garfinkle, & McBride, 1998) stress the need for individual assessment and involve the creation of an environment that is designed to elicit and enhance communication, the structuring of interactions with and by peers, and the use of naturalistic teaching strategies, together with specific techniques such as modeling, turn taking, topic manipulation, conversational repair, scripts and time delay. The FastForword program (Tallal, Miller, Bedi et al., 1996) involves an intensive computerbased program designed to develop a range of language skills, although recent research has shown disappointing results (see chapter 47). Moreover, there are few interventions that can be readily used by class teachers, either in mainstream or specialist settings. The FastForword program, for example, requires a rigorous 100 min per day, 5 days per week for 4–8 weeks. Instead, for most children access to language therapy, of any kind, tends to be limited. Mainstream teachers frequently have little understanding of the wider needs and problems of these children (Lindsay, Dockrell, Mackie, & Letchford, 2005) and few receive any direct input from specialist therapists (Davison & Howlin, 1997). Lindsay and Dockrell (2000) suggested that self-esteem may be higher in children with speech and language disorders educated in special rather than mainstream schools, but generally evidence for the benefits of different placements on academic, social or even language outcomes is lacking. Lindsay et al. (2005) found widely varying practices and very different degrees of inclusion and levels of classroom support in their study of specialist language provision for children in England and Wales. The criteria for admission to language units, integrated resources or special schools also differed so it was not possible to make direct comparisons between specialist or integrated provision – each seemed to have some advantages and drawbacks. Of particular concern is the lack of any specialist provision for most children, including those with severe language impairments, when they reach junior school (at around 8 years). Once speech improves (even though many other difficulties persist) children are often transferred to mainstream school, without any additional help (Davison & Howlin, 1997). Howlin, Mawhood, and Rutter (2000), in a follow-up study of 20 individuals with receptive language impairments, found that although half had required specialist (often residential) schooling during the primary years, by secondary age 50% were in mainstream schools with little or no additional support. The remainder were in a variety of non-languagespecific placements, including schools for behavioral, learning CHAPTER 74 1192 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1192

and emotional disorders. The children also experienced frequent changes of school, often resulting in educational failure, exclusion, bullying, social rejection and low self-esteem. Education for Children with Behavioral and Emotional Problems Definitions of “emotional and behavioral disorders” (EBD) vary widely and encompass a host of different problems: conduct disorders, antisocial behaviors, hyperactivity, attention deficits, learning disabilities, psychiatric or mood disorders, or any combination of these. The US National Association of School Psychologists (2005) defines EBD as conditions in which “behavioral or emotional responses of an individual in school are so different from his or her generally accepted, age appropriate, ethnic or cultural norms that they adversely affect performance in such areas as self care, social relationships, personal adjustment, academic progress, classroom behavior, or work adjustment.” Low academic attainments, high rates of challenging behavior and increased dropout from school are typical and the controversy over segregated versus inclusive education for these pupils has been particularly marked because of the disruption they can cause in the classroom. However, the heterogeneity and complexity of problems involved make it impossible to identify any one specific form of effective educational intervention. Ideally, any treatment program should be based on detailed assessments of the child’s behavioral difficulties, family circumstances, social competence, learning strategies and academic capabilities. Successful interventions involve cognitive– behavioral therapy, interpersonal problem-solving, social skills training, counseling and play – or other individual therapies together with remedial input to enhance general academic skills, memory, auditory and visual processing, and sequencing (Cooper & Ideus, 1996; Hechtman, Kouri, & Respitz, 1996). Other approaches include preschool preventative programs and educational enrichment strategies; there are also studies indicating the importance of combining child-focused interventions with parent training (Frankel, Myatt, Cantwell, & Feinberg, 1997). Randomized controlled trials, conducted in experimental settings, indicate moderate effect sizes on reducing disruptive and/or aggressive behaviors for programs involving social competence training and cognitive–behavioral strategies. Relatively few of these programs have been successfully incorporated into routine educational practice (Wilson, Lipsey, & Derzon, 2003). However, interventions such as the “Dinosaur program” (Webster-Stratton & Reid, 2004) and Promoting Alternative Thinking Strategies (PATHS; Karn, Greenberg, & Kusché, 2004) have been shown to be effective in special education and preschool settings and to have lasting benefits. It is also important to be aware that judgments as to whether a child has behavioral or emotional problems may depend as much on the attitudes, policies and practices of the school, or the tolerance level of individual teachers, as on the child’s own characteristics. A child who shows very disruptive behavior in one setting may not do so elsewhere (Werthamer-Larsson, Kellam, & Wheeler, 1991) and the role of schools in maintaining or minimizing disruptive behaviors has been widely investigated (Reynolds, 1991; Rutter, 1983). In some cases, transfer to a different class, or a move to a school where teachers are more sensitive to the child’s needs may be sufficient to significantly reduce the level of problems. Management Techniques Within the Classroom Although school-based programs alone are likely to have only a partial impact on the child’s problems, strategies based on behavioral principles have been shown to be effective in many single-case and studies of small groups for improving disruptive, aggressive and on-task behaviors within the classroom (Gresham, Watson, & Skinner, 2001; Herbert, 1995). As with much behavioral intervention research, group sizes tend to be small and long-term follow-up or generalization measures are often lacking (Evans, Harden, Thomas, & Benefield, 2003). However, there is an increasing number of randomized controlled trials demonstrating the effectiveness of a range of classroom management techniques (e.g., Fast Track Program, Good Behavior Game and Webster-Stratton’s Teacher program; for review see Greenberg, Domitrovich, & Bumberger, 2000; see also chapter 62). Behavioral approaches have considerable advantages in that they do not require removal of the child from the class and, in principle, the basic techniques can be adapted to the particular needs of any individual child or classroom. On the whole, a focus on positive on-task behaviors is more effective than concentrating on disruptive behaviors (Barkley, 1997; Scott, 1998; Warner Rogers, 1998). Extinction and time out techniques, although extremely effective in controlled settings (Barkley, 1997), can be difficult to apply consistently in the classroom. Other pupils or staff may respond to activities that the class teacher is trying to ignore, or the behavior may escalate to such a level that ignoring is no longer an option. Time out is all too often interpreted as “time out from the classroom” – not necessarily a deterrent for many children – and there is a danger of exclusion periods becoming increasingly lengthy. Cognitive–behavioral strategies are also effective (see chapter 63; Sawyer, MacMullin, Graetz et al., 1997) but because of the variability of such programs it is generally not possible to identify which specific components are most crucial. Moreover, the more complex the program the more difficult it becomes to incorporate within the regular classroom. The use of other behavioral approaches, such as token economies, differential reinforcement or response-cost, has also been reported in many studies (Rutherford & Nelson, 1995). The most successful programs are based on a detailed functional analysis of the causes and nature of the problems involved but many of these more sophisticated studies have been conducted in specially designed or experimental classes (Gresham, Watson, & Skinner, 2001). The consistent use of such strategies is much more difficult for mainstream teachers coping with 30 or more pupils. SPECIAL EDUCATION 1193 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1193

“Co-operative learning” programs, in which students with emotional and behavioral problems work together in groups with typically developing peers, have proved popular, particularly in the USA. A review of co-operative learning programs (Sutherland, Wehby, & Gunter, 2000) indicated some limited evidence for a positive effect on on-task behavior and social skills, but not disruptive behaviors. Nelson, Johnson, and Marchand-Martella (1996) also found that direct instruction was more effective in improving on-task engagement and behavior problems than co-operative learning. Other researchers caution that children with emotional and behavior problems may lack the social and communication understanding required to benefit from these programs (Sutherland, Wehby, & Gunter, 2000). Sometimes, simple environmental modifications can have surprising effects. For example, the provision of specially designed study areas or changing sitting arrangements from groups to rows can significantly improve on-task behaviors (Hastings & Schwieso, 1995) and reduce classroom disruption (Ware, 1994). Morning teaching sessions tend to be more productive than teaching later in the day; visual aids and brightly colored materials increase attention, and the presentation of materials in small chunks, interspersed with brief breaks, is likely to improve concentration and co-operation (Warner-Rogers, 1998). Generally, however, in order to have a significant impact on severely disturbed or disruptive pupils, attention must also focus on factors outside the classroom, such as the wider school curriculum, organization and climate. Strategies for avoiding potentially high-risk situations (i.e., those when the setting, peer group or even a particular teacher is likely to exacerbate difficulties) also have an important role. Negotiating potentially difficult situations with children themselves, so that they feel part of the consultation and planning process, can increase appropriate behaviors, while remedial intervention for academic difficulties may prevent the escalation of secondary behavior problems. Finally, the involvement of parents is also crucial for the generalization and maintenance of behavior change (Desforges & Abouchaar, 2003). Children Who are Excluded from Mainstream School The push towards inclusion has coincided, in the UK at least, with government requirements for a rise in school standards, generally measured by formal examination results. However, the presence of one or more disruptive pupils in the classroom can affect the academic progress of other children and official exclusions from school on behavioral grounds have risen over recent years (from 3833 in 1991 to 9880 in 2003–2004; Department for Education and Skills, 2005). The rates of unofficial exclusions are unknown. Children registered as having special educational needs are nine times more likely to be excluded than other pupils, and exclusions from special schools are also rising (about 300 per year in the UK). Boys are almost five times more likely to be excluded than girls, with rates being highest among Afro-Caribbean boys and children in foster care. Most exclusions (around 60%) are for physical assault or persistent disruptive behavior; around 15% are for verbal abuse or threatening behavior; the remainder involve racist abuse, drugs and alcohol, theft, damage to property and bullying (Department for Education and Skills, 2005). Nevertheless, individual schools and local authorities differ widely in their reasons for and rates of exclusion, and headteachers’ attitudes, school status, policies and practices may have a greater impact than a pupil’s behavior (Hornby, Atkinson, & Howard, 1997). Overall, the outlook for children excluded from mainstream school is bleak. Around 25% receive home tuition, usually for only a few hours a week; many others attend pupil referral units (over 14,500 children in 2002–2003; UK Department for Education and Skills, 2006). These placements are generally part-time and, as they are not required to offer the full national curriculum, pupils often fall even further behind academically. Moreover, other mainstream schools are often reluctant to accept a child who has been previously excluded. Once they reach their mid-teens, little effort is made to reintroduce these pupils back into school and as many also come from unsupportive and/or disrupted homes they risk drifting into a life of continuing social exclusion. Although the cost of exclusion to pupils, their families and to society has been widely publicized, the issue of how to deal with it remains largely unsolved. There is general agreement that effective intervention requires better training and resources for teachers, together with the expertise and input of a network of interagency support (Department for Education and Skills, 2006). In practice, provision of such services is limited and many schools only seek specialist support when the classroom situation has totally broken down, rather than at an earlier stage when there is some chance of remediation. Although some specialist day and boarding schools for children with emotional and behavioral problems survive (some offering intensive therapeutic as well as educational provision), critics claim that these placements are very expensive, isolate children from their home and community and are particularly unsuitable for children from ethnic minorities (Abbott, Morris, & Ward, 2001). However, although data on long-term academic or social benefits are lacking, they may be a helpful resource for some children and their parents (Crawford & Simonoff, 2003) and residential provision can offer a vital “break” for children whose difficulties are largely a result of a severely disturbed or deprived family environment. Education for Children With Physical and Sensory Handicaps Physical Disabilities The desirability of integrating children with physical handicaps into normal classrooms has been recognized for well over a century (see Cole, 1989) but developments in medical technology now mean that increasing numbers of children are surviving with long-term and often highly complex needs. For example, children with cerebral palsy may also have incontinence or epilepsy; they may be unable to communicate effectively; sensory, CHAPTER 74 1194 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1194

behavioral, emotional and psychiatric problems are common; and 30–60% have some degree of intellectual disability (Harris, 1998). Kohn (1990) and Harris (1998) discuss the many components required for a comprehensive package of educational care but in practice “inclusion” frequently involves simply the provision of physical aids, some – often inadequate – adaptations to the school environment, and the use of support staff or classmates to assist the class teacher. Few mainstream schools have adequate access to trained nursing or physiotherapy help for children with chronic or complex physical problems and most teachers receive little guidance on how to help manage their difficulties. For example, augmentative and alternative communication systems (AAC) for children who are unable to use speech (because of physical or developmental difficulties) have improved significantly over recent years. These range from single-touch devices (e.g., a large colored square or circle that emits a prerecorded message when pressed) to multisymbol display boards, with extensive vocabularies personally tailored to individuals’ own environments, needs or interests. The development of highly sensitive switch mechanisms and greatly improved speech output software has resulted in computers becoming far more effective means of communication than in the past (Howlin, 2006). There is also evidence that the attitudes of listeners and/or observers towards people with disabilities are more favorable when complex augmentative systems, such as computers, are used (Gorenflo & Gorenflo, 1991). However, effective use of these systems is often restricted by teachers’ lack of training in their use, or awareness of the range and complexity of current AAC aids. Thus, most individuals with cerebral palsy tend to use only low-technology devices, despite much more sophisticated aids being available, and to use these only during limited periods of the day (Murphy, Markova, Collins, & Moodie, 1996). Teachers are also often poorly prepared to deal with the social and emotional difficulties associated with chronic physical conditions, particularly those related to teasing, isolation or low self-esteem. Although inclusion in elementary school may be relatively easy to achieve, at secondary school real inclusion becomes far more difficult because of increasing social, physical and academic demands (Lightfoot, Wright, & Sloper, 1999). Hearing Impairments (see chapter 59) In developed countries, approximately 1 child in 1000 has a profound hearing loss and 3–5 per 1000 have mild to moderate hearing loss that can affect language acquisition. Deafness can have a profound effect on parent–child relationships and around 25% of children with severe hearing loss show additional emotional, intellectual, physical or sensory problems (Roberts & Hindley, 1999). The issue of appropriate education for deaf children is complicated by opposing arguments within the deaf community. The poor signing skills of many hearing parents and teachers, and the fact that deaf children of deaf parents often make better academic and social progress than those of hearing parents, have led to claims that education should be provided in specialist settings (residential if necessary). Cochlear implants are criticized as depriving children of their “right” to belong to the deaf community, and fluency in signing, with its own grammar and idiom, is considered a primary educational goal (Balkaney, Hodges, & Goodman, 1996). However, studies of children with successful implants suggest that they are more likely to move into mainstream settings, are better able to communicate with hearing peers and continue to make good progress into secondary school and beyond (Beadle, McKinley, Nikolopoulos et al., 2005; Geers & Brenner, 2003). There are no well-controlled comparative studies of different models of communication teaching (signing, lip reading + speech, cued speech, in which hand signs are used to assist lip reading, or speech alone). Because a focus on signing alone can result in isolating children from their families and neighborhood (Groenveld, 1998), “total communication” (the combination of a formal signing system with written and spoken language) has become widely adopted, both in special schools and some mainstream placements (Hindley & van Gent, 2002). The success of such programs is at least partly dependent on the adequacy of parents’ signing skills: 20% of deaf children have no family members who sign and 40% have only one signing family member (Gravel & O’Gara, 2003; Preisler, Tvingstedt & Ahlstrom, 2002). Early intervention programs involving a combined oral– visual approach are suggested as being crucial for avoiding the “cultural divide” that may otherwise develop between hearing parents and their deaf children (Hindley & van Gent, 2002). Massaro and Light (2004) reported on the use of “Baldi,” a computerized talking head, which can teach children to control tongue, mouth and face movements and airflow, thereby improving both speech production and perception. Sample sizes have been small, and the effects are limited once training ceases, but this approach could potentially assist many children. Hearing impaired children have many additional problems, and poor cognitive and educational attainments, and increasing isolation from their hearing peers with age, are of major concern (Antia, Stinson, & Gaustad, 2002; Martin & Bat-Chava, 2003). Although, academically, deaf children in regular schools seem to do better than those in specialist placements (Powers, Thoutenhoofd, & Gregory, 1999), it is also evident that their difficulties may be significantly underestimated by mainstream teachers. Thus, the choice of an appropriate placement depends not only on the extent of hearing loss, but on factors such as IQ, the presence of other impairments and, most importantly, on the quality of instruction offered (Roberts & Hindley, 1999; Watson, Gregory, & Powers, 1999). Visual Problems (see chapter 59) Around 14,000 children in the UK are estimated as having significant visual impairment, although only one-third of these are registered as blind or partially sighted (Keil & CluniesRoss, 2003). Children with visual difficulties are also likely to have a range of additional problems including cerebral palsy, epilepsy, linguistic and hearing impairments, autism, intellectual disability, and emotional and psychiatric disturbance (Groenveld, 1998; Webster & Roe, 1998). The proportion SPECIAL EDUCATION 1195 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1195

educated in specialist provision has declined steadily in the UK – from 22% in 1998 to 5% in 2003 (Keil & Clunies-Ross, 2003) – and those special schools that still exist tend to cater for pupils with more complex physical or cognitive needs. For the remainder, education within mainstream settings is necessary to meet their educational and social needs and enhance future job prospects (Arter, Mason, McCall, McLinden, & Stone, 1999; Davis & Hopwood, 2002; Wagner & Blackorby, 1996). However, successful inclusion requires considerable modification to teaching materials and curriculum. Input from specialist staff is needed, with teachers, teaching assistants and specialist advisers working closely together. The teaching environment must be carefully structured in order to facilitate interactions with peers, and the successful integration of a severely visually impaired child requires careful preparation of all staff, sighted pupils and their parents. Education for Children With Severe and Pervasive Intellectual Disabilities (see chapter 49) Many different teaching strategies have been reported as effective in enhancing inclusion for this group of children. These include peer-tutoring, co-operative learning, parallel instruction, behavioral and token programs, discrete trial learning, modeling, shaping, prompting and reinforcement techniques, naturalistic teaching, embedded instruction and many more (McDonnell, 1998). Much research in this area involves singlecase or small case-series but there are some successful reports of implementing behavioral approaches within a “whole school” framework. Harris, Cook, and Upton (1996) utilized a combination of behavioral strategies, together with communication and social skills programs, to enhance overall functioning and reduce challenging behavior in pupils with severe intellectual disabilities in a mainstream school. Nevertheless, teachers found the program difficult to cope with, and many felt they lacked adequate support. Generalization to other settings or staff members was also limited. The most successful inclusion programs have generally been conducted with very young children in settings that are unrepresentative of most mainstream schools (university-based experimental units; highly skilled educators; very small classes). For preschool children with severe intellectual disability, inclusive education may produce greater gains in language and social skills (Hundert, Mahoney, Mundy, & Vernon, 1998). However, other studies have found no social or cognitive advantages of inclusive preschools, and behavior problems may actually be more frequent in these settings (Rafferty, Piscitelli, & Boettcher, 2003). For older pupils with severe intellectual impairments there is no good evidence that inclusion enhances cognitive or social development (Kavale & Mostert, 2003; Lindsay, 2003). Acceptance by peers and teachers tends to decrease with age and few studies have reported on successful integration within secondary school (Beveridge, 1996; Booth, 1996). Moreover, unless there is adequate support, children with severe disabilities may receive significantly less individualized instruction in mainstream than in segregated classes. Advocates of inclusive education for children with severe intellectual disabilities claim that it has a positive impact on both their social development and that of their typically developing peers. However, there is little evidence that simple exposure to non-handicapped peers improves either language or social skills (Lewis, 1995). Moreover, although guided contact with their disabled peers can have a positive impact on other pupils’ attitudes (Farrell, 1996), joint spontaneous interactions remain limited and close, reciprocal friendships are very unlikely to develop, particularly at secondary school (Burack, Root, & Zigler, 1997). Many studies in this area are compromised because of the tendency to treat children with severe intellectual disabilities as a homogenous group. It is thus difficult to reach conclusions on what types of inclusive setting work best for which children, at which stage of their lives and in which developmental domains. For example, in comparison with children of similar cognitive levels, pupils with Down syndrome seem to do better academically in mainstream, but social interactions are enhanced in specialist settings (Buckley, 2006). Kavale and Mostert (2003) suggest that “Empirical evidence, not existential exaggeration, should be the cornerstone of deciding where students with special needs should be served.” They note that so-called “fully inclusive” classrooms may actually increase segregation and isolation. High self-esteem in pupils depends principally on the ability to achieve academically and socially in comparison with peers (Heward, 2003). If this is not attainable, children with special needs may have lower self-esteem and feel more stigmatized in “inclusive” than in specialist provision. The primary goal must be to improve existing provision and the quality of teaching to ensure maximum opportunities for inclusion for those children who will benefit, while providing high-quality segregated or partially integrated provision for those who may not. Resource bases within mainstream settings may provide the most flexible option for many students, allowing full-time inclusion (with support as necessary) for some, while providing others with the daily opportunity to mix with mainstream peers. “Syndrome Specific” Approaches to Education for Children With Severe Intellectual Impairments (see chapter 24) There are now over 750 known genetic causes of intellectual disability (Dykens, 2000) and research into cognitive and behavioral phenotypes has greatly increased understanding of syndrome-specific deficits. Fragile X, for example, is associated with deficits in visuospatial abilities, abstract reasoning, motor coordination, memory and sequential processing. Vocabulary skills, simultaneous processing and ability to learn verbally based factual material are relatively unimpaired. Perceptual organization, visuospatial memory and fine motor skills are strengths in children with Cornelia De Lange syndrome (Kline, Stanley, Belevich-Brodsky, Barr, & Jackson, 2005). Expressive language skills are particularly poor in children with cri-du-chat CHAPTER 74 1196 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1196

syndrome (Cornish & Munir, 1998). Short-term auditory memory deficits are typical of children with Down syndrome (Jarrold, Baddeley, & Phillips, 2002). Smith–Magenis syndrome is characterized by difficulties with arithmetic, sequential processing and short-term memory; long-term memory for facts and information is relatively good (Udwin, Webber, & Horn, 2001). Individuals with Prader–Willi syndrome typically show deficits in arithmetic, writing, short-term memory and auditory attention but have strengths in visual organization and perception, long-term memory, reading and vocabulary (Cassidy & Morris, 2002). Understanding the underlying phenotype can help teachers adapt teaching strategies to suit specific profiles of skills and difficulties (Hodapp & Fidler, 1999). However, this requires acceptance by educational providers that a child’s diagnostic “label” is of value in highlighting potential strengths and weaknesses and recognition of the need for detailed individual assessment, including the use of formal psychometric measures. (For examples of teaching guides to specific syndromes see Lorenz, 1998 for Down syndrome; Lewis & Wilson, 1998 for Rett’s syndrome; Saunders, 2001 for fragile X; Waters, 1999 for Prader–Willi.) Children With Autism Spectrum Disorders (see chapter 46) Recent research indicates that not only is the prevalence of autism spectrum disorders (ASD) far higher than originally estimated, possibly as high as 1% of the population (Baird, Simonoff, Pickles et al., 2006), but also that around 40–50% of all those affected are of normal IQ (Edelson, 2006). These figures have enormous service implications and specialist educational approaches for children with ASD have been studied in particular detail. Programs may be center-based (e.g., Waldon; LEAP; Douglass); home-based (e.g., Applied Behavioral Analysis; Pivotal Response Training) or school-based (e.g., TEACCH; Denver Model; Harris, Handleman, & Jennet, 2005). Although evaluative data are limited, highly structured, visually based approaches to teaching appear to be particularly helpful. The internationally used TEACCH program, for example (Marcus, Schopler, & Lord, 2001), emphasizes the need for structure, appropriate environmental organization and the use of visual cues to circumvent communication difficulties in autism. The program stresses the importance of individually based teaching, and incorporates developmental, behavioral and cognitive approaches. A recent small-scale study of TEACCH (Panerai, Ferrante, & Zingale, 2002) reported significant gains in educational and adaptive behaviors compared with progress in an integrated classroom. Many other educational programs for children with ASD have been reported. Most are US-based, and include peertutoring programs to enhance social interactions and play; co-operative learning groups; the Bright Start Program, which concentrates on the development of cognitive and metacognitive abilities; and the STAR curriculum (for reviews see Arick, Krug, Fullerton, Loos, & Falco, 2005; Lord & McGee, 2001). The effectiveness of various developmental and behaviorally based programs has also been demonstrated (Harris, Handleman, & Jennet, 2005). In UK settings, Jordan and Jones (1999) describe a variety of innovative techniques that can be used in the classroom and Cumine, Leach, and Stevenson (1998, 1999) provide practical suggestions for teaching children with autism and Asperger syndrome within mainstream settings. One program widely used throughout the USA, Europe and Australasia is the Picture Exchange Communication System (PECS; Bondy & Frost, 1996). PECS aims to increase communication skills by means of pictures or objects and claims to improve both verbal and non-verbal skills (for review see Howlin, 2006). A large randomized controlled trial (Howlin, Gordon, Pasco, Wade, & Charman, 2007) found that children exposed to formal PECS training showed significant increases in their use of PECS symbols and in spontaneous initiations, but little change in other forms of communication. Outcome also varied according to the characteristics of the children involved. The approach that has given rise to most controversy in recent years, mainly because of claims of “recovery from autism,” is the Early Intensive Behavioral Intervention program (EIBI) of Lovaas and colleagues (Lovaas, 1993, 1996; McEachin, Smith, & Lovaas, 1993). EIBI involves 40 h per week or more of behaviorally based teaching, starting at the age of 2–3 years and lasting for at least 2 years. Initial evaluations reported IQ gains of up to 30 points with 40% of participants becoming “indistinguishable from their normal peers.” However, reanalysis of the early data, and reviews of more recent EIBI programs, indicate that although this approach is certainly effective, the overall results are neither as marked nor as universal as initially claimed (Shea, 2004). For children with ASD of average IQ, full access to the normal school curriculum is crucial for their future academic and employment prospects. In contrast, fully inclusive schooling is unlikely to succeed for children with the most severe cognitive, behavioral and communication difficulties. Although some studies have found that cognitive and linguistic development in this more severely impaired group can be enhanced by inclusion, the educational settings involved tended to be experimental in nature and/or involved very young children (Harris, Handleman, Gordon et al., 1991). Other research indicates that while mainstreaming does not necessarily improve cognitive or language skills, it may help to improve social and play behavior, at least in preschoolers (Handleman, Harris, & Martins, 2005). A number of specialized programs in the USA (e.g., Denver model, Douglass Developmental Disabilities Center, LEAP, May Center for Early Childhood Education, TEACCH and Waldon; for reviews see Arick, Krug, Fullerton et al., 2005; Handleman, Harris, & Martins, 2005; Harris, Handleman, & Jennet, 2005) now involve staged integration into inclusive schooling, together with training and support for mainstream class teachers. Harris, Handleman, & Jennet (2005) concluded that, as there is no good evidence in favor of any one specific model, the choice of program needs to be based on the needs of the individual child and his or her family. An educational program suitable for a child with Asperger syndrome, for example, is unlikely to suit a non-verbal pupil with autism and severe cognitive delays. Furthermore, children’s needs change over SPECIAL EDUCATION 1197 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1197

time, and placements should be reviewed at regular intervals. Many very young children with ASD require specialist, oneto-one teaching, but once basic communication and social skills have been acquired a gradual program of integration can begin. For some children this will mean continuing support in mainstream, for others specialized help in some settings/classes but not in others, and for others full inclusion. However, unless the very specific needs and difficulties of pupils with ASD in mainstream are recognized, these children can become extremely isolated, suffering bullying and rejection from both children and teachers (Sainsbury, 2000). General Approaches to Improving the Classroom Environment Without appropriate resources, simply placing children with special educational needs (SEN) in mainstream settings will almost certainly result in educational deprivation and social alienation (Hornby, Atkinson, & Howard, 1997). Successful inclusion requires mainstream teachers to be appropriately trained and supported (Burack, Root, & Zigler, 1997); the curriculum and teaching programs should be appropriately individualized and structured; and teaching goals must be clear to both teachers and pupils (Farrell, 1997). Time spent on learning activities, the use of directive teaching methods, together with reinforcement, feedback and monitoring techniques, are all associated with improved classroom behavior. Several reviews (Farrell, 1997; Hunt & Goetz, 1997; King-Sears, 1997; Manset & Semmel, 1997; Wehmeyer, Lance, & Bashinski, 2002) concur in suggesting a number of specific strategies related to “best academic practice”: • Co-operative learning – teaching activities structured to ensure that typically developing children and students with AEN work and learn together; • Differentiated instruction and one-to-one provision as necessary, according to individual needs and abilities; • Explicit instruction – including step-by step teaching, feedback and reinforcement; • Generalization training – to ensure that skills taught in oneto-one or small group sessions are maintained across the wider school; • Strategy instruction – teaching pupils with SEN to acquire self-directed learning strategies; • Curriculum-based assessments – to ensure that students with SEN continue to make progress in areas covered by the teaching curriculum; and • Training for teachers in SEN awareness and in the use of techniques to modify problem behaviors and enhance learning. Other factors related to “best practice” include a high staff: student ratio; help for pupils with special educational needs to acquire self-determination and self-advocacy skills; the development of social networks to facilitate peer support and friendships; collaboration between school staff, and between teachers, parents, other therapeutic agencies and the wider community. The issue of class size has provoked considerable debate (Zarghami & Schnellert, 2004) but evidence that this directly affects outcome, either for regular or special needs pupils, is limited. Blatchford, Edmonds, and Martin (2003) found no impact of class size on the educational attainments of regular primary school children, but class size did affect teaching style and modes of learning, with children in smaller groups taking a more interactive role. A review by Wilson (2002) concluded that although, overall, class size had little direct influence on progress or behavior, smaller classes benefitted younger pupils and those from disadvantaged or minority groups; they also reduced teacher stress. Moreover, in almost all successful studies in inclusive settings, class size has been far smaller than in most state schools (the average class size in the EU is 20; many experimental classes comprise only 8–10 children). It is suggested that, to maintain an effective teacher: pupil ratio within inclusive classrooms, each child with special needs should be counted as the equivalent of six typically developing pupils (Pirrie, Head, & Bryna, 2006). Structured small group teaching also appears to enhance academic and social skills (Ainscow, 1995) and may also profit typically developing peers. Improving Training and Support for Teachers While mainstream classrooms and curricula can be adapted to meet the requirements of children with SEN, this is not an easy task for most teachers who are already working under considerable pressure. Although specialist training is crucial, full-time courses have been increasingly replaced by cheaper part-time modular courses and even the best-trained teachers are unlikely to be effective without adequate support. Collaborative teamwork, a shared framework for teaching, clear role relationships among professionals, procedures for evaluating teaching effectiveness, adequate training, administrative support and effective use of support staff are among the factors identified as important in maintaining positive teaching practices in inclusive settings (Giangreco, 1997; Salend & Duhaney, 1999; Villa, Thousand, Meyers, & Nevin, 1996). Teachers’ attitudes are also crucial. In a review of 28 studies, Scruggs and Mastropieri (1996) found that although two-thirds of teachers supported the general concept of inclusion, only one-third considered they had sufficient time, experience, training or resources to implement this successfully and 30% felt inclusion could have a negative impact on typically developing peers. Negative attitudes to inclusion are greater among teachers of older pupils or pupils with severe intellectual, physical or behavioral problems. Negative attitudes are also associated with poor collaboration between staff, inadequate support, larger class sizes and lack of confidence in their own teaching competence (Salend & Duhaney, 1999; Soodak, Podell, & Lehman, 1998). Conflicts may also arise because the teaching strategies that are most effective for children with severe intellectual disabilities (i.e., highly structured and individualized) may be very different CHAPTER 74 1198 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1198

to those utilized in typical mainstream classrooms (i.e., experiential, group learning). Similarly, whereas the communication skills of children with severe language and/or cognitive impairments are enhanced by teaching styles that encourage initiations and spontaneous language, in mainstream classes the interactional styles of both teachers and other pupils are mainly directive (Bayliss, 1995). Moreover, because the educational goals for this group of pupils often involve developing very basic self-help and independence skills, it is difficult to accommodate these within the more academic National Curriculum, especially in secondary schools. Role of Para-professionals Almost by definition, children with special needs require some one-to-one teaching, especially when learning new skills. The role of para-professional support staff is crucial here but they are frequently assigned to students with the most challenging behavioral and learning needs. They are expected to: work collaboratively with other staff and pupils; foster the child’s academic and social progress; plan and carry out individually tailored educational programs; teach basic life skills; take care of feeding and toileting; and deal with very difficult behaviors. Rarely are they adequately trained or supported to meet these demands and all too often their role focuses on the minimization of behavioral difficulties. Moreover, assigning the least powerful staff within the school hierarchy to the least powerful students may simply perpetuate the “underclass” status of both groups (Giangreco, Edelman, Broer, & Doyle, 2001). Working individually with a pupil with special needs in the corner of the classroom (or in the library or medical room) may actually increase rather than decrease segregation and without close liaison between teaching and support staff children can become over-dependent on the teaching assistant, which in turn becomes a further barrier to inclusion (Marks, Schrader, & Levine, 1999). Although it is clear that paraprofessionals can be trained successfully to carry out and monitor a range of different behavioral, educational and social interventions and that they gain personal satisfaction from so doing, if training and support are inadequate, both they and their pupils will be disadvantaged (Giangreco, Doyle, Halvorson, & Broer, 2004). Consultation Services Consultation by outside agencies may be required for a number of different reasons: to improve teachers’ general skills in dealing with children who have special needs; to train them in the use of specific intervention techniques; or to assess or treat children directly, thereby reducing the need for referrals to external psychiatric or psychology agencies. Consultation services may be requested at times of crisis although increasingly they are part of a planned contractual service to schools. The relationship between the consultant and consultee is a complex one and requires careful clarification of the expectations and roles of all concerned. Effective consultation can have a positive effect on teachers, individual children and the classroom as a whole, resulting in a reduction in behavioral problems and in referrals to outside agencies (Dyson, 1990; Fuchs, Fuchs, & Bahr, 1990; Jordan, 1994). However, inadequate preparation may simply undermine teacher status and independence (Dockrell & Lindsay, 2001; Law, Dockrell, Williams, & Seeff, 2002). The quality of research on school-based consultancy for children with mental health problems is generally poor, but there is some evidence for the value of consultancy services in providing cognitive–behavioral therapy, social skills training and general support for teachers (Hoagwood & Erwin, 1997). Nevertheless, pupils themselves often indicate that they would prefer to receive additional help from their own teacher rather than from a specialist, because this makes them feel less conspicuous (Jenkins & Heinen, 1989). There is also a need to extend specialist support into the home setting if any advantages are to generalize. A report for the UK National Foundation for Educational Research (FletcherCampbell & Cullen, 2000) noted the very variable effects of introducing external support agencies into schools and cautions that, when collaboration between mainstream and specialist staff was weak, “it was the pupil who was disadvantaged.” The benefits derived from consultancy services may also be short-lived. For example, in a randomized controlled trial, using specialist consultants to introduce the use of specific communication strategies into classrooms for non-speaking, low IQ children with autism, the positive treatment effects were not maintained once consultations ceased (Howlin, Gordon, Pasco, 2007). The provision of specialist support teachers (not untrained classroom assistants) working alongside the class teacher may be more beneficial in the longer term, but again, support teaching often fails because of inadequate liaison and planning (Thomas, 1992). Parental Roles and Views Ensuring generalization of treatment effects is a crucial issue for any intervention. Many of the more successful special educational or inclusion programs have actively involved parents (Desforges & Abouchaar, 2003; Frankel, Myatt, Cantwell et al., 1997; McEachin, Smith, & Lovaas, 1993) and family-centered models for curriculum development have become increasingly popular (Skrtic, Sailor, & Gee, 1996). Without parent involvement, and often parent training, the benefits of intervention are unlikely to generalize to non-school settings, and inconsistent or ineffective parental strategies may weaken the impact of successful school programs. However, the involvement of parents, and indeed the wider community, in SEN programs cannot be expected to occur without adequate planning, resources and full understanding of the background of pupils with special needs. There is little evidence to suggest that parents are either overwhelmingly for or against inclusive education and around 65–80% of parents of SEN children in either mainstream or segregated settings express satisfaction with the placement. Many parents of children in inclusive placements believe that this facilitates both social and academic progress but others express concerns about the lack of individualized instruction, SPECIAL EDUCATION 1199 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1199

inadequate support (for both pupils and teachers) and the risk of teasing or rejection by other children. Parental views are also likely to be affected by the age of their child, the nature of his or her disability and their own educational background (Duhaney & Salend, 2000). Impact on Other Pupils Overall, the available evidence does not support concerns that the progress of typically developing pupils is negatively affected by the presence of children with special needs. A review of 26 (mostly US-based) studies (Dyson, Farrell, Polat, Hutcheson, & Gallannaugh, 2004) found that 23% reported a positive academic and/or social impact on “typical” pupils; 15% suggested a negative impact; 53% a neutral impact; and 10% a mixed impact. Studies involving the inclusion of children with physical, sensory or communication difficulties were generally positive but there were more negative effects when pupils had behavioral or emotional problems. However, the authors noted that few data were available on secondary schools and they stressed the need to study the relationship between inclusion and the achievements of classmates over time. Data from British schools indicated a small but negative relationship between the level of inclusivity in schools and pupil attainments, but the schools with higher levels of inclusion tended to be those serving more disadvantaged, lower-achieving populations (Dyson, Farrell, Polat et al., 2004). Improving Acceptance by Peers Without specific intervention, integration is unlikely to improve acceptance by peers. Social interactions may occur more frequently in integrated settings but children with developmental delays still remain relatively isolated, spontaneous joint play is infrequent, close friendships are rare and bullying is a significant problem (Burack, Root, & Zigler, 1997; Norwich & Kelly, 2004; Siperstein & Leffert, 1997). Programs that have focused on training typically developing peers to initiate interactions or implement co-operative learning strategies have been successful in increasing the frequency and quality of social responses and in enhancing academic skills (Hornby, Atkinson, & Howard, 1997). Peer tutoring appears to be more effective than attempts to change attitudes by indirect methods, such as teaching tapes, stories or simulations, and also improves peers’ academic attainments, social maturity and empathy (Hornby, Atkinson, & Howard, 1997; Topping, 2001). “Circles of friends” or carefully structured pairings of typical pupils and children with special needs are also claimed to promote social inclusion, but evaluations are few and generalization is often limited (Newton, Taylor, & Wilson, 1996). Early Prevention Programs For children at risk of learning or behavioral problems because of social disadvantage, the best known, and best funded, community-based interventions are the Head Start and Early Headstart Programs. The short-term effects on children’s cognitive, social and physical development are well established and early interventions of this kind can produce improvements in mother–child interaction and a reduction in problem behaviors (Bailey, Aytch, Odom, Symons, & Wolery, 1999; Barnett, 2004; Reid, Webster-Stratton, & Hammond, 2004). There is less agreement about the longer-term benefits. In a detailed review, Barnett and Hustedt (2005) noted the lack of adequately controlled, long-term follow-up studies and despite positive effects on academic achievements and social adjustment, effect sizes are smaller than for some other model programs, such as the Abecedarian Project (Campbell, Ramey, Pungello, Sparling, & Miller-Johnson, 2002) or the Chicago Child Parent Centers (Reynolds, Temple, Robertson, & Mann, 2002). Other criticisms include the very variable timespan and quality of these programs, the relatively small number of children involved (under 1.7% of the total infant population), the racial imbalance (poor Blacks are significantly more likely to be enrolled than poor Whites) and the often poor standards of teaching (fewer than 30% of teachers have a Bachelor’s degree and salaries are far lower than in public school kindergartens). Sure Start is the UK version of Head Start, but variations in the quality and funding of programs in different areas, and arguments concerning the most appropriate means of delivery, mean that the findings remain inconclusive. The program seems to benefit those parents who are less socially disadvantaged or have greater personal resources, but there may be adverse effects for the most disadvantaged families (Belsky, Melhuish, Barnes, Leyland, & Romaniuk, 2006; Rutter, 2006). Moreover, recent government-directed changes in the focus of (and funding for) Head Start, Early Head Start and Sure Start mean that many questions remain about the effectiveness of their various components, the real long-term benefits and the types and ages of children for whom they prove most effective. Post School The difficulties and social exclusion experienced by many children with special educational needs frequently extend into adult life. Dropout rates from school are often double those of other students, and fewer than half obtain any formal qualifications or go on to further education. Outcome is particularly poor for pupils with intellectual disability, learning disability or emotional disturbance. Unemployment is as high as 60–70%, even for individuals with mild intellectual disability or sensory problems, and earnings, job status and stability are low (Lipsky & Gartner, 1996; Wagner & Blackorby, 1996). Long-term dependence on parental support is also typical (Howlin, 2004; Lipsky & Gartner, 1996). Although there has been an increase in post-school vocational training programs over recent years, few such courses are of an appropriate academic or vocational level. Many students may find it difficult to gain access to courses that adequately meet their needs CHAPTER 74 1200 9781405145497_4_074.qxd 29/03/2008 03:00 PM Page 1200

(Harrison, 1996) and improved transition services to facilitate the transition from school to college to work are essential for all pupils with special educational needs. Clinical Recommendations Education has a major influence on the life of any child but for pupils with disabilities the quality of schooling they receive is likely to have an even greater and longer lasting impact. Clinicians can play an important part in providing schools with guidance on how to help these children because failure to meet their educational needs will undermine the effects of any other forms of treatment. Attention to the following guidelines may be helpful. • Placement in appropriate education from the earliest years is crucial. Early failure in mainstream settings can result in the need for much more expensive intervention subsequently, while early success in a specialist setting can provide children with greater chances of later inclusion. A “let’s try it and see” approach to mainstream is unlikely to be helpful. • Children with special educational needs are a broad and heterogenous group and require a range of different educational provision. This should include highly specialist placements for those with the most severe and handicapping conditions. For some older children, particularly those who will require residential care as adults, residential schooling may also be needed. • Families need to be offered detailed information on the full range of educational and other provision available locally. Lack of information and the feeling that they have no choice in educational decisions are significant factors in leading parents to seek out alternative, expensive and often unproven therapies. • Appropriate placement will depend on a thorough assessment of children’s and families’ needs, and of children’s profiles of skills and difficulties. Standardized assessments of cognitive, linguistic and other abilities are not a waste of time, and can prove highly valid and reliable indicators of children’s potential, as well as highlighting areas of deficit and skill. • Understanding the nature of the underlying condition and any associated behavioral, social, emotional or cognitive impairments is crucial for optimal educational provision. The view that “We don’t label children here” is of no help to the child, parents or teachers, and recognition of the characteristics associated with particular disorders can be of great help in informing educational practice. • The number of children requiring specialist educational help and advice greatly outweighs the number of professionals who are able to offer this – educational psychologists, speech and language therapists and occupational therapists are particularly thin on the ground. Thus, professionals in child and adult mental health services (CAMHS) teams need to work together to develop a group expertise that can assist different children with different problems in a variety of different ways. • Most of the conditions described in this chapter are both pervasive and persistent. Parents care more for professional consistency than professional background, and need to have long-term access to staff who can continue to offer individualized help or advice over the years. • Similarly, these conditions do not disappear when children reach puberty or school leaving age – indeed, new problems may emerge at these times. Ongoing support for young people and their families at these transitional stages is vital, as are careful planning and close inter-professional liaison. • Finally, when clinicians are involved in advising schools as to how pupils with special needs should, or should not, be managed, it is important that they are aware of the realities of the local situation – unrealistic and impractical recommendations will not enhance working relationships or benefit the children or families involved. Conclusions Warnock (2005, p. 38) suggested that the correct view of special education is one that: “Maximizes the entitlement of all pupils to a broad, relevant and stimulating curriculum. All schools whether special or mainstream should reflect a culture in which the institution adapts to the needs of its pupils. The most appropriate setting is . . . one in which children can be most fully included in the life of their school community and which gives them a sense of both belonging and achieving.” Warnock stressed that the pursuit of equality should be directed at ensuring that children with special needs have equal opportunities as adults – this does not mean that they should all be educated under one roof. Instead, the concept of “special school” should be replaced by “specialist school” along the lines of those now being designed for children with particular gifts in music, art or technology. The goal should be to ensure that all children with special needs are provided with an education that enables them to make optimum academic, social and emotional progress and offers them the best chance of inclusion as adults. 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22q11 deletion syndrome, 366–7 behavioral phenotype, 366–7 features, 323, 366–7 ABAB designs, 253 ABC model, 302 abdominal pain, investigations, 333 Aberrant Behavior Checklist (ABC), 765, 829 ability scores, measurement errors in, 117–19 Abnormal Involuntary Movements Scale (AIMS), 750 abuse, child see child maltreatment; child sexual abuse academic child and adolescent psychiatry, growth, 10–11 academic engagement, interventions to promotion, 557 Acceptance and Commitment Therapy (ACT), 1010 accessibility of services, 1162–3 of test items, 305 achievement personality trait effects, 190–1 tests, 309 acquired epileptic aphasia (AEA) (Landau–Kleffner syndrome), 461, 789 differential diagnosis, 764, 789 acquired immunodeficiency syndrome see HIV/AIDS action potentials, 234 activity disorders see attention and activity disorders activity level (AL), in gender identity disorder, 867 acute confusional states, 460 acute life stresses, 392–402 adjustment disorders, 398–9, 587 bereavement as specific kind, 398–9 chronic adversity and, 395–6 clinical practice implications, 401–2 future research, 402 historical background, 392–3 mechanisms moderating and mediating responses, 399–401 as risk factor deliberate self-harm, 656 depression, 592 suicidal behavior, 656 sensitizing effects, 397–8 specificity of stress effects, 396 see also life events acute lymphoblastic leukemia (ALL), 935 acute stress disorder, 689–90 adaptation, 385, 1037–8, 1040 additives, food, 527, 531 ADHD antisocial behavior and, 165 as catecholamine disorder, 529–30 clinical assessment, 533–4 combined type, 521, 523 comorbidity, 34, 524–6 anxiety disorders, 525, 630 autism, 524 bipolar disorder, 525–6 conduct disorders, 525, 546, 853, 1180 depression, 588 dyslexia, 35 intellectual disability, 524–5 language disorders, 793–4 neurodevelopmental disorders, 524–5 oppositional disorders, 525 pediatric bipolar disorder, 615 perinatal HIV infection, 947 psychopathy, 853 reading disorders, 805 schizophrenia, 526 substance misuse, 525, 532 Tourette disorder, 525, 721–2 definition, 521–2 developmental findings, 164–5 in early childhood, 884, 888–9 environmental factors, 527–8 epidemiology, 530–2 etiology, 526–30, 531 as fronto-striatal/executive function disorder (FS/ED), 528–9 genetic factors, 347, 526, 1180 investigations, 331–2 longitudinal course, 532–3 as multifaceted condition, 526 as neurodevelopmental disorder, 33 and offending, 1107 parenting behavior and, 1051, 1055–6 pathophysiology, 526–30, 531 predominantly hyperactive-impulsive type, 523 predominantly inattentive type, 523 rating scales, 1010 sleep disturbance in, 900, 902 subtypes, 522–4 and suicidal behavior, 653 susceptibility gene, 372 syndromal assessment, 1099 temperament and, 193 treatments, 534–6 behavioral parent and teacher training, 257, 536 behavioral therapies, 1018–19 biofeedback, 257 cognitive–behavioral therapy, 257, 534–5, 1033 dietary, 536 non-stimulant medications, 216–17 pharmacotherapy with coexisting tic disorder, 731 pharmacotherapy in PBD, 621 relaxation training, 257 stimulant medications, 213–16, 256–7, 534, 535–6, 832 see also attention and activity disorders; impulsiveness; overactivity adherence see fidelity ADI-R, 276–7, 765 ADIS, 277, 631, 693 adjustment disorders, 398–9, 587 administration, classification in, 18 adolescence ethical dilemmas, 102–9 medical confidentiality, 105 saying no to medical treatment, 106–9 saying yes to medical treatment, 103–5 adolescent partner violence, 547 Adolescent Transitions program (ATP), 1038, 1120 Adolescents Coping With Depression program, 1035 adoption, 502–14 birth parent and birth children search, 506–7 by non-traditional families, 505–6 clinical services, 513 compulsory, 102 with contact, 503–4 future challenges, 514 gay and lesbian, 506 intercountry, 502, 509–10, 511 kinship care, 504, 512 open, 502–3, 512 outcomes, 507–10 domestic adoption, 508–9 factors contributing to risk and resilience, 507–8 intercountry, 509–10 post-adoption services, 511–13 and professional community, 514 selection and preparation of children and families, 510–11 single-parent, 506 sources of children for, 502 special needs, 508, 511, 512 transracial, 504–5 trends in, 502–5 adoption studies, 66, 349 alcoholism, 572–3 designs to test for gene–environment interaction, 352 ADOS see Autism Diagnostic Observation Schedule adult plasticity, 151–2 developmental plasticity vs, 152 Adult Self Report Scale, 533 advanced practice nurses (APNs), 1175 adversity see psychosocial adversity affective psychoses, 747–8 affiliativeness, 183 age at onset of exposure, 61 for various disorders, 160 age effects, 61–2 agenesis of corpus callosum, 152 aggression sleep disorders and, 896 see also conduct-related disorders; violence agreeableness, 183 description, 185 influences on achievement, 190 on health trajectories, 191 on relationships, 189–90 personality change pattern in, 189 and psychological disorders, 192–3 agreement indices, 283 Aicardi X syndrome, features, 323 AIDS see HIV/AIDS AIMS, 750 alcohol use/abuse child sexual abuse and, 447 compulsive use, 569 continued use despite negative consequences, 569 harm reduction initiatives, 581 legislative approaches, 580 1207 Index 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1207 Rutter’s Child and Adolescent Psychiatry, 5th Edition, Edited by M. Rutter, D. V. M. Bishop D. S. Pine, S. Scott, J. Stevenson, E. Taylor and A. Thapar © 2008 Blackwell Publishing Limited. ISBN: 978-1-405-14549-7

alcohol use/abuse (cont’d) media campaigns, 580 and offending, 1108 prenatal, 575 prevalence, 566 risk factors associated with early use, 570–1 familial, 571–2 treatment of alcoholism, 578–9 brief interventions, 580 withdrawal, 568 Alcoholics Anonymous (AA), 578 algorithm, prototype vs, 22 alleles, 340 alliance, therapeutic see therapeutic alliance allostasis, 930 allostatic load, 930 Alzheimer disease economic studies, 131 population screening, 1184 ambulatory EEG recording, 237 amino acid systems, Tourette syndrome, 725 amphetamine (AMP) in ADHD treatment, 213–15 brain PD analysis, 227 controlled-release (CR) formulations, 215, 219 immediate-release (IR) formulations, 213–15 amygdala, dysfunction in psychopathy, 858 analysis of covariance (ANCOVA), 114 analysis of variance (ANOVA), 114 anencephaly, 152 Angelman syndrome, 365, 825 behavioral phenotype, 365 features, 325, 365, 825 Anger Coping program, 1040 anger management, 1115 anhedonia, 587 animal studies anxiety, 638–9 developments, 6 increasing use of, 372 maternal separation, 383 anniversary reactions, 398 anorexia nervosa (AN) clinical features, 671 course, 673–4 as culture-bound syndrome, 205 development, 168, 673–4 diagnostic criteria, 670–1 distribution, 672 etiology, 674–6 investigations, 333 management, 677, 678–82, 1149 ethical issues, 683 family therapy, 679–80, 1069 pharmacological, 682 physical, 681–2 psychological, 682 medical complications, 676–8 neurological findings, 676 pediatric consultation, 1149 prevalence, 168 risk factors genetic, 674–5 other, 675–6 see also eating disorders antenatal effects, in risk transmission, 411–12 antiandrogens, in paraphilia treatment, 876–7 antianxiety medications, 217 anticholinergic medication in daytime wetting treatment, 922 in nocturnal enuresis treatment, 919 anticipation, 361 anticonvulsants in autism spectrum disorders treatment, 769 in intellectual disability, 832 antidepressant medications, 217, 595–7 adverse effects, 596–7, 660 approach to use, 176–7 brain PD analysis, 224, 226 brain PK analysis, 223 efficacy, 595–6 in intellectual disability, 831 in paraphilia treatment, 877 in personality disorder treatment, 848 predictors of response, 597 role in continuation, 597 see also SSRIs antiepileptic drugs (AEDs), in pediatric bipolar disorder treatment, 620 antilibidinal agents, in intellectual disability, 832 antipsychotic medications, 217–18, 750–1 in autism spectrum disorders treatment, 218, 769 in conduct disorder treatment, 557–8 dosage, 1100 in intellectual disability treatment, 831 and obesity, 751 in pediatric bipolar disorder treatment, 620 in schizophrenia treatment, 750–2 antiretroviral treatment (ART), 945–7, 948–9, 951 combination regimens, 946 and neurodevelopment, 947 antisocial behavior ADHD and, 165 adolescent onset, 169, 170 adverse outcome risks, 169 autonomic reactivity and, 549 chains of risk, 170 costs of not addressing, 126 developmental findings, 169–70 dyslexia and, 165 early onset, 169, 170 and employment outcomes, 126–7 ethnic group differences, 203 genetic effects, 169–70, 346, 855, 1113 groups in relation to, 119 instrumental, 859 life-course persistent, 33 neurotransmitters and, 548 parenting and, 1048, 1053–4 risk factors lower IQ, 856 lower socioeconomic status, 856–7 physical maltreatment, 427, 429 substance use/abuse and, 172 and suicidal behavior, 654 see also conduct-related disorders; disruptive behavior disorders; juvenile delinquency antisocial behavior orders (ASBOs), 96, 1114 antisocial personality disorder (ASPD), 842, 844, 852, 1107 in childhood and adolescence, 847 comorbidity, anxiety disorders, 854 and offending, 1107 treatment, 847 Antisocial Process Screening Device (APSD), 852, 853 anxiety disorders, 628–42 assessment, 630–1 child sexual abuse and, 447, 453 cognition and, 640 comorbidity, 630, 636 ADHD, 525, 630 antisocial personality disorder, 854 conduct disorder, 630 depression, 588, 630 obsessive-compulsive disorder, 704 pediatric bipolar disorder, 615 psychopathy, 854 substance abuse, 630 Tourette syndrome, 722 developmental progressions, 171–2 diagnosis, 628 diagnostic interviews, 631 epidemiology, 631–5 gender differences, 634, 635 longitudinal course, 635 neuroimaging, 640 nosology, 628 observational assessment of behavior, 281 and offending, 1108 parental psychopathology and, 636, 637 INDEX 1208 parenting and, 1048 pathophysiology, 636–40 family genetics, 636–8 psychobiology, 638–40 pediatric consultation, 1149 presentation, 628–31 prevalence, 631–4 rating scales, 630–1 risk factors, 634–5 genetic, 636–8 structured interviews for, 276–7 and suicidal behavior, 653–4 treatments, 254–6, 640–1, 1149 behavioral therapies, 1016 cognitive–behavioral therapy, 255–6, 640–1, 1035–7, 1070 family therapy, 1069–70 modeling, 254–5 pharmacotherapy, 217, 641 primary care role, 1168, 1172 psychodynamic psychotherapy, 1085 reinforced exposure, 255 see also cognitive–behavioral therapy see also acute stress disorder; generalized anxiety disorder; obsessive-compulsive disorder; panic disorder; phobic disorder; post-traumatic stress disorder; separation anxiety disorder; social anxiety disorder Anxiety Disorders Interview Schedule for Children (ADIS), 277, 631, 693 anxiety management training and extinction, 710 anxiolytics, in intellectual disability, 831 apoptosis, 146 applied behavioral analysis, 302 APSD, 852, 853 arginine vasopressin (AVP), 917, 918, 919 arithmetic difficulties see numeracy problems arson, 1111 ART see antiretroviral treatment; assisted reproductive technology articulation drills, 786 artificial insemination surrogacy, 505 ascertainment bias, 349 ASD see autism spectrum disorders (ASD) ASPD see antisocial personality disorder Asperger syndrome, 759 comorbidity, psychopathy, 853–4 definition, 760, 761 differential diagnosis, 704, 763 educational needs, 1197 epidemiology, 761 offending by people with, 762 risk factors, environmental, 770 see also autism spectrum disorders assertive community treatment (ACT), 1135 assertive outreach, 1134, 1135 assessment for court reports, 53–5 see also clinical assessment; interviews; pediatric consultation; psychological assessment; psychometric assessment; psychosocial assessment; specific disorders Assessment Framework, 425, 431 assisted reproductive technology (ART), 505–6, 507 associational identity, 200 associative logic, 1146 asthma, 933–4, 1151 asylum seekers, 474–5 see also refugee and asylum seeking children asylums, 1126 “ataque de nervios”, 204–5 athetosis, 327 atmospherics, 89–90 atomoxetine (ATX) in ADHD treatment, 216, 535, 536 in autism treatment, 218 effects, 216 atopic dermatitis, 934 attachment classifications, 907, 1046 and conduct disorders, 550–1 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1208

INDEX 1209 development, 906–7 disorganized, 906–7, 1046 and later social functioning, 174 and psychopathology, 907 attachment disorders, 906–13 in adoptees, 513 assessment, 44, 911–12 interviews, 911 observations, 912 course over time, 911 definitional challenges, 906 differential diagnosis, 909–10 emotionally withdrawn/inhibited, 908–9, 910 etiology, 910–11 foster family care and, 494–5 future directions, 913 historical considerations, 907–8 indiscriminately social/disinhibited, 909, 910 interventions, 912 measurement issues, 909 phenotype, 908–9 prevalence, 910 reactive (RAD), 494–5, 910 as relational construct, 906 residential care and, 488, 494, 907–8, 910, 912 role in human development, 1083 attachment failures, 382–3 attachment relationships, in adoptees, 508, 509–11, 513 attachment theory, 382, 513, 1046–7, 1083 dominance, 145 origins, 550 parenting programs based on, 1051–3 content, 1051–2 current status, 1052 effectiveness, 1052 attention assessment, 308–9 deficits reflected in P3 potentials, 246 and emotional disorders, 192–3 in post-traumatic stress disorder, 690 attention and activity disorders, 521–36 clinical assessment, 533–4 coexistent disorders, 524 diagnostic definitions, 521–2 epidemiology, 530–2 etiology, 526–30 longitudinal course, 532–3 pathophysiology, 526–30 presentation, 521, 522 subtypes, 522–4 treatment, 534–6, 1160 see also ADHD; hyperkinetic disorder attention deficit/hyperactivity disorders see ADHD attraction effects, 190 attributional retraining, 1115 attrition, 190–1 auditory cortices maturation, 245 aberrant, 245 auditory development, 37 auditory impairment, in language disorders, 788–9, 796 auditory processing disorder (APD), 788–9 augmentation, 1100, 1101 augmentative and alternative communication systems (AAC), 1195 autism, 154–7, 759–74 assessment, 764–6, 1185 atypical see PDD-NOS brain growth dysregulation in, 155 cognitive theories, 766–7 comorbidity ADHD, 524 conduct-related disorders, 546 psychopathy, 853–4 sensory impairment, 963 Tourette syndrome, 722 connectivity disorders in, 141–2 course, 762 definition, 156, 760 differential diagnosis, 763–4, 790–1 epidemiology, 761–2 etiology, 769–74, 1185 developmental findings, 164–5, 770 genetics, 773–4, 794, 1180 head circumference, 770–1 neural basis, 770 neurochemistry, 772 neuroimaging, 771 neuropathology, 771 neurophysiology, 771–2 face processing in, 139, 141, 246 genetic counseling for, 1185–6 heterogeneity, 156 history, 759 investigations, 332 IQ importance, 164 language regression in, 331 offending by people with, 762 outcome predictors, 762–3 playtimes and, 301 pre- and postnatal insults and, 155–6 probabilities of associated medical disorders, 319 risk factors environmental, 156, 769–70 genetic, 773–4, 794, 1180 obstetric, 770 sibling recurrence risk, 1185 syndromes associated with features of, 370–1 treatment, 767–9 medication, 218, 769 see also autism spectrum disorders Autism Diagnostic Interview–Revised (ADI-R), 276–7, 765 Autism Diagnostic Observation Schedule (ADOS), 44, 276, 281, 765 verbal IQ and, 115–16 autism spectrum disorders (ASD), 461, 759–74 assessment, 764–6 diagnostic instruments, 765 early detection, 765–6 classification, 760–1 clinical characteristics, 759–60 communication impairment, 760 restricted behaviors and interests, 760 social impairment, 760 cognitive theories, 766–7 central coherence theory, 767 executive functioning, 767 mentalizing ability, 766–7 comorbidity, 762, 764 costs, 125 course, 762 differential diagnosis, 748, 763–4, 790–1 educational needs, 1196–8 epidemiology, 761–2 etiology, 769–74 developmental findings, 164–5, 770 genetics, 773–4 head circumference, 770–1 neural basis, 770 neurochemistry, 772 neuroimaging, 771 neuropathology, 771 neurophysiology, 771–2 future directions, 764 gender differences, 761 history, 759 low verbal IQ and, 115–16 as neurodevelopmental disorder, 33 and offending, 1107–8 outcome predictors, 762–3 prosodic disorders and, 787 rise in, 77 risk factors environmental, 156, 769–70 genetic, 773–4 obstetric, 770 treatment, 767–9 behavioral therapies, 768–9, 1019–20 early intervention, 768 education, 768 family support, 768 ineffective/unproven, 769 medication, 218, 769 parental counseling, 768, 823 skills training, 768 vocational training, 769 see also Asperger syndrome; autism; PDDNOS; pervasive developmental disorders autistic disorder see autism; autism spectrum disorders (ASD) autonomic nervous system (ANS), formation, 146 autonomic reactivity, and antisocial behavior, 549 autosomes, 340 aversion conditioning, 877 avoidance training, 1013 AVP, 917, 918, 919 awareness training, 729 axonal myelination, 137 axons, 234 development, 146 backward digit span, 808 Batten disease, 469 battered child syndrome, 422 Beck Depression Inventory (BDI), 588, 868 Becker muscular dystrophy, behavioral phenotype, 361 behavior change, as family therapy target, 1116 behavior codes, complexity, 280 behavioral activation, 597 behavioral avoidance test, 281 behavioral competition, 833 behavioral control, 187 behavioral function assessment, 302, 1010–12 behavioral inhibition, 184, 460, 886 cross-cultural differences, 206 as endophenotype, 638 and later anxiety, 635 behavioral interventions see cognitive–behavioral therapy behavioral momentum, 833 behavioral phenotypes, 322, 323, 359–73 22q11.2 deletion syndrome, 366–7 Angelman syndrome, 365 Becker muscular dystrophy, 361 Down syndrome, 369–70 Duchenne muscular dystrophy, 361–2 fragile X syndrome, 362–3 genetic mechanisms leading to, 359–61 history of research, 371–2 history-taking, 322, 323 Klinefelter syndrome, 368–9 Prader–Willi syndrome, 364–5 Rett syndrome, 363 Smith–Magenis syndrome, 365–6 tuberous sclerosis, 362 Turner syndrome, 367–8 velocardiofacial syndrome, 366–7 Williams syndrome, 363–4 XYY syndrome, 369 behavioral therapies, 1009–22 in ADHD, 1018–19 in anxiety disorders, 1016 in autism spectrum disorders, 768–9, 1019–20 basic tenets, 1010 cognitive–behavioral therapy vs, 1021 in conduct disorders, 1018 in gender identity disorder, 870–1 indications, 1021 in intellectual disability, 1020 limitations, 1021 methods, 1010–16 behavioral assessment, 302, 1010–12 fading, 1016 generalization, 1016 techniques to decrease behavior, 1014–16 techniques to increase behavior, 1012–14 in nocturnal enuresis, 1019 in obsessive-compulsive disorder, 1016–17 origins, 1009–10 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1209

behavioral therapies (cont’d) in post-traumatic stress disorder, 1017 service issues, 1022 therapist variables, 1021–2 traditional psychotherapy vs, 1010, 1011 see also cognitive–behavioral therapy behaviorism, 1009 benefit measurement, 130–1 bereavement, 1152–3 in HIV-affected children, 952 issues in low-resource countries, 952 as risk factor of depression, 592 as specific kind of life stress, 398–9 Berger’s rhythm, 234 Berkeley Puppet Interview, 194 betrayal, sense of, 448 binary dummy categorical variables, 114 Binet–Simon Scale, 304 binge eating disorder, 671, 676, 677 biofeedback in ADHD, 257 in daytime wetting, 921–2 in fecal soiling, 925, 926 biological findings, in category validation, 23–4 biological insults, 152–4 biological moderators, of stress, 386 bipolar disorders (BD) ADHD and, 525–6 age of onset, 615 in children and adolescents see pediatric bipolar disorder not otherwise specified, 614 parental, impact, 407 prevalence, 616 risk in depression, 590 risk factors, 615–16 schizophrenia and, 745 and suicidal behavior, 653 treatment of youth at risk for, 604 see also pediatric bipolar disorder bipolar spectrum disorders, 615 birth complications see perinatal risk factors birth parents, search for, 506–7 birth weight, low, as risk factor, 154 bladder training, 919 blindness see visual impairment blood oxygenation level dependent (BOLD) contrast, 135, 227 blood transfusions, 98 body dysmorphic disorder, 700 booster interventions, 1040 boot camps, 1021, 1112, 1119 borderline personality disorder (BPD), 842, 844–6 in adolescence, 847 attachment difficulties in, 845 child maltreatment and, 845 and deliberate self-harm, 658, 846 emotion dysregulation in, 845 genetic factors, 844 and other personality disorders, 843–4 remission, 842 and suicidal behavior, 658 treatment, 848 boundary making, 1069 bowel training, 925, 926 brain activation, redundancy in, 247 brain arousal states, 235 brain development, 145–9 abnormal, 459–60 brain imaging and, 138–9 in adolescent period, 149 basic embryology, 146 functional studies, 138 pre- and postnatal, 147–9 prenatal, 146–7 stress effects on, 400 structural studies, 137–8 brain disorders, 459–70 future research, 469 prevalence, 72–3 psychopathology in young people with, 459–60 see also specific disorders brain function, 136–7 effects of drugs on, 227–8 brain imaging, 134–42, 328–9 and abnormal development, 138–9 of adults with developmental disorders, 139–40 clinical use, 328–9 connectivity disorders, 141–2 and convergent evidence from other disciplines, 140–1 data analysis, 136 developments, 7 difficulties in using with children, 136 improvements, 142 inconsistent findings, 142 techniques, 134–6 see also brain development brain lesion studies, 137 brain tumors, 935 presenting features, 334 brief therapies, 1070, 1083 Bright Start Program, 1197 British Ability Scales (BAS) tests, 306 Brown Adult Attention Deficit Disorder Scale, 533 Bucharest Early Intervention Project (BEIP), 150–1, 911 bulimia nervosa (BN) clinical features, 671, 672 course, 674 as culture-bound syndrome, 205 development, 168, 673, 674 diagnostic criteria, 670–1 distribution, 672–3 etiology, 674–6 management, 678, 679, 680, 682–3 ethical issues, 683 pharmacological, 682 physical, 682–3 psychological, 682 medical complications, 676 neurological findings, 676 prevalence, 168 risk factors genetic, 674–5 other, 675–6 see also eating disorders bullying, 546–7 as risk factor in depression, 592 burns, 937 business plan, collaboration, 980 CAFAS, 295 calcium-regulated transcriptional activator (CREST), 146–7 callous–unemotional traits, 853, 854 genetic factors, 855 Cambridge Somerville Youth Study, 994, 1003, 1120 Cambridge Study of Delinquent Development, 126–7, 545 CAMHS Outcome Research Consortium (CORC), 1164 Campbell Collaboration Crime and Justice Group, 1115 canalization, 65 cancer, 935, 1151–2 see also brain tumors cannabis legislative approaches, 580 pharmacotherapies, 579 risk factors, 1181 early-onset use, 570–1 and schizophrenia risk, 166, 354, 740–1, 750 capability enhancement, 848 CAPA, 275, 631, 749, 1161 Cardinal Needs Schedule, 1109 care orders, 101 carers children as, 416 communication with, classification in, 18 INDEX 1210 careworkers, residential, skills, 494 carrier detection, 1183–4 CAS, 306–7 CASA, 275 cascade screening, 1184 case–control designs, 161–2 case management, 1134, 1135–6 catecholamines, in ADHD, 529–30 categories, 19–20, 21 validation, 23–5 inferences, 25–6 Cattell–Horn–Carroll (CHC) model, 306 causal analysis, 119–21 causal hypotheses, testing, 6, 163–4 causal inference generalized, 59–60 specific, 59 causality, kinds, 59–60 causation, 58–9 correlation and, 60 CBCL see Child Behavior Checklist CBT see cognitive–behavioral therapy CCDP, 973, 983, 984, 985 CD see conduct-related disorders cell migration, 146 Center for Epidemiological Studies–Depression Scale (CES-D), 588 Center for the Study of Prevention and Violence, 993 central nervous system (CNS), formation, 146 cerebellar function tests, 327 cerebral imaging see brain imaging cerebral palsy, 462–4 classification, 462 definition, 462 educational needs, 1194–5 epidemiology, 462 etiology, 462–3 psychopathology, 463–4 C-GAS, 295, 750 CHAMP+, 950 “champions”, 986 Checklist for Autism in Toddlers (CHAT), 766 chemical imaging, 135 Chester the Janitor study, 84–5 child abuse see child maltreatment Child and Adolescent Functional Assessment Scale (CAFAS), 295 Child and Adolescent Psychiatric Assessment (CAPA), 275, 631, 749, 1161 Child and Adolescent Services Assessment (CASA), 275 Child Behavior Checklist (CBCL), 630, 864, 872, 962, 964 Child Impact of Traumatic Events Scale Revised (CITES-R), 692, 1010 child maltreatment, 421–35 and antisocial outcomes, 175 assessment, 429–31 by child mental health practitioners, 429–30, 431 decision-making, 430 interdisciplinary working, 431 legal work, 430–1 purpose, 431 recognition, 430 and borderline personality disorder, 845 conceptual framework, 425 and conduct disorders, 552 definitions, 421 effects, 427–9 epidemiology, 424–5 factors associated with occurrence, 425–7 community and social influences, 426–7 family, 426 individual, 425–6 family violence, 423–4 genetic risk, 427 incidence, 424 intergenerational continuity, 426 international perspective, 421 interventions, 176, 431–3 and mental health, 421 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1210

INDEX 1211 mortality rates, 425 outcomes, 427–9 pediatric consultation, 1150 physical effects, 174, 1049 and post-traumatic stress disorder (PTSD), 690–1 poverty and, 426 presentation, 322, 327 prevalence, 424–5 prevention, 433–5 primary, 433–4 secondary, 434 psychological interventions, 176 and psychopathy, 856 and psychosis, 741 as public health issue, 421–2 recurrence factors associated with, 433, 434 rates, 433 reporting practices, 421 serious and life-threatening, 425 and stress response systems dysfunction, 400 and substance use/abuse, 575–6 and suicidal behavior, 655 treatment, 176, 431–3 types, 422–3 see also child sexual abuse child mental health practitioners, 429–30 child–parent psychotherapy (CPP), 432, 1084 child pornography, 442, 444 child protection, 451 conference, 451 disputes, 54 Child PTSD Recovery Index, 692 Child PTSD Symptom Scale, 692 child sexual abuse, 440–54 abuser characteristics, 443 preconditions for potential abusers, 444–5 abuser–child relationship, 443–4, 447 age of victims, 443 behavioral symptoms, 84 by clergy, 444 case example see suggestibility, case example causation, 444–5 child risk factors, 445 commercial sexual exploitation, 442 contact, 441 conviction rates, 440 cultural practices, 441–2 culture and, 444 definitions, 441 denial and recantation, 84 disability and, 443 effects, 445–7 in adulthood, 446–7 in childhood and adolescence, 445–6 factors contributing to, 447–8 models for, 448 patterns and continuities, 446 epidemiology, 442–4 ethnicity and, 444 frequency and duration, 443 gender of victims, 443 initial professional encounters with, 449–51 investigation, 450–1 legal considerations, 441, 451 long-term effects, 173 maintaining factors, 445 mental health service role, 448–9 nature of, 441–2 non-contact, 441–2 organized, 444 outcomes, 429 and paraphilias, 875–6 and post-traumatic stress disorder, 446, 447, 452–3, 688, 690–1 treatment, 692–3, 1017–18, 1087 presentation, 327 prevalence, 442–3 prosecution rates, 440 psychological interventions, 176 and psychopathy, 856 recognition of, 449–50 reporting of, 450 delay, 84 socioeconomic status and, 444 and substance use/abuse, 575–6 and suicidal behavior, 655 suspicion of, 449 therapeutic work, 451–3, 692–3 with abusers, 453 with caregivers and family, 453 with child, 452–3 validation, 451 child sexual abuse accommodation syndrome (CSAAS), 83–4 Child Sexual Behavior Inventory (CSBI), 445, 873, 876 Child Social Behavior Questionnaire (CSBQ), 765 child soldiers, 480, 481 Childhood Autism Rating Scale (CARS), 281 childhood disintegrative disorder (CDD), 331, 461 differential diagnosis, 763–4 childhood-onset X-linked adrenoleukodystrophy, 470 childrearing goals, cultural variations in, 206 Children and Adults with Attention Deficit Disorder, 729 Children at Risk program, 996–7 children of twins (COT) design, 351 Children’s Anxiety Sensitivity Index (CASI), 634 Children’s Communication Checklist-2 (CCC-2), 792 Children’s Depression Inventory (CDI), 588 Children’s Depression Rating Scale–Revised (CDRS-R), 588 Children’s Global Assessment Scale (C-GAS), 295, 750 children’s hearings, 96 children’s role in decision-making, developments, 11 children’s services, legal position, 97–8 children’s testimony, 81–93 see also suggestibility children’s understanding, 11 cholinergic systems, Tourette syndrome, 725 chromosomal aneuploides, 367–70 chromosomal anomalies, 360 numerical, 360 structural, 360 chromosomes, 340 chronic fatigue syndrome/myalgic encephalitis (CFS/ME), 936 investigations, 333 chronic motor tic disorder (CMT), 720, 722 chronic vocal tic disorder (CVT), 720 chronotherapy, 899 Circle of Security Intervention, 912 circular questions, 1066 cis modulators, 341 classic conditioning, 1010 classification, 18–29 co-occurrence of different symptom patterns, 27–9 developments, 5 diagnostic agreement, 26–7 future developments, 29, 354 general vs child-specific, 22–3 hierarchical, 21–2 multiaxial systems, 21 public impact, 29 purposes, 18 transcultural issues, 23 types, 19–23 see also categories, validation Cleveland Inquiry Report, 99 clinical assessment, 42–55 elements in, 43–6 family observations, 42–3 mental disorder nature, 48–50 presence/absence of clinically significant psychopathology, 46–8 purposes, 271–2 standardization, 46 see also diagnostic formulation; interviews; psychological assessment; structured interviews clinical case management, 1136 clinical pharmacology, basic principles, 218–23 clinical practice classification in, 18 science and, 265 clinical services co-ordination across, 177 organization development, 12–13 clinician–patient interaction, 1102–4 clinician respect for rights of patient, 1104 clinician responsibility for patient, 1103 clozapine in schizophrenia treatment, 218 side-effects, 218 coercive exchanges, 258 Cognitive Assessment System (CAS), 306–7 cognitive–behavioral therapy (CBT), 130, 1026–40 in ADHD, 257, 534–5, 1033 in anxiety disorders, 255–6, 640–1, 1035–7, 1070 mediation and moderation, 1037 outcome research, 1036–7 behavioral therapy vs, 1021 booster interventions, 1040 in child maltreatment, 432 in child sexual abuse, 453 comorbidity considerations, 1040 in conduct-related disorders, 258, 556, 1031–4 mediation and moderation, 1033–4 outcome research, 1032–4 prototypical parent intervention, 1032 prototypical youth intervention, 1031–2 contemporary models, 1028–31 in daytime wetting, 921 in deliberate self-harm treatment, 659 in depressive disorders, 176, 256, 597–600, 659, 1034–5 combined with medication, 599 effectiveness, 599 efficacy, 597–9 mediation and moderation, 1035 outcome research, 1034–5 predictors of outcome, 599–600 prevention packages, 600 treatment components, 1034 in early childhood problem behavior, 889 early treatments, 1028 in eating disorders, 680, 682, 683 factors influencing outcomes, 1037–9 therapeutic alliance, 1038 treatment fidelity and adaptation, 1037–8, 1040 in fecal soiling, 925 future directions, 1040 historical cognitive processing models, 1026–8 iatrogenic effects, 1038–9 in juvenile delinquency, 1115 multicomponent, 255–6 multimedia programs, 1040 in obsessive-compulsive disorder, 710 origin, 251 in paraphilias, 877 in pediatric bipolar disorder, 621 in post-traumatic stress disorder, 690, 692–3 in schizophrenia, 752 school level organizational influences, 1039 in sexually abusive behavior, 1111 in smoking cessation, 578 in substance abuse, 578–9 training effects, 1039–40 Trauma Focused (TF-CBT), 690, 692 uniqueness, 1028 cognitive correlates, in diagnostic validation, 25 cognitive deficits, study developments, 7 cognitive distortions, 1030–1 cognitive flexibility, 460 cognitive functioning, context specificity, 206–7 cognitive moderators, of stress, 386 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1211

cognitive problem-solving models, 1027–8 cognitive processing, stages, 244 cognitive psychology, 372 cognitive remediation, in schizophrenia, 752 cognitive restructuring, 597 cognitive skills deficits, 1030–1 cognitive social learning, 1026 cognitive therapy, 380 origin, 251 see also cognitive–behavioral therapy Cohen’s d, 112 cohort effects, 61–2, 305 colic, 886–7, 889–90 collaborative language approaches, 1071 Colorado Home Intervention Program, 960 combined behavioral intervention (CBI), in alcoholism, 578–9 communication definition, 782 techniques, 796 communication disorders see language disorders community, cultures and, 201 community-based interventions and services, 971–86 budget, 982–3 collaboration, 979–80 characteristics, 977–8, 980 in implementation, 983 membership, 979 operation, 980–1 university–community relations models, 979–80 definitions, 971–2 evaluation, 983–5 central vs decentralized, 984 independent vs participant/collaborative, 983–4 intention-to-treat analyses, 985 overemphasis on randomized trials, 984–5 participatory/empowerment, 984 rush to evaluate outcomes, 984 evidence-based, 975–9 assessment of evidence, 975–7 characteristics of successful collaborations, 977–8, 980 consensus groups, 978 proven program vs principles, 978 research-to-practice gap, 978 services replication requirements, 975 technology transfer, 978–9 when evidence is not sufficient, 977–8 goals, 981–2 short-term, 982 implementation, 983 program development, 980–3 business plan, 980 logic model approach, 981–3 needs assessment, 981 operation of collaboration, 980–1 planning document, 981 preparation, 981 structured formats, 981 quasi-universal program examples, 972–4 replication, 985, 986 sustainability, 985–6 funding, 985–6 program benefits, 985 timeline, 982 comorbidity, 27, 34 as challenge, 264 concurrent, 171 sequential, 160 twin studies to examine, 352 comparative genomic hybridization (CGH), 1182 compensation, 139 abnormality vs, 139 competence, therapist, 1022, 1057–8 “complex disorders”, 638 Comprehensive Child Development Program (CCDP), 973, 983, 984, 985 compulsions, 701–2 behavioral formulations, 708 tics vs, 704 computational models, of brain, 247–8 computed tomography (CT), 134 concentration-controlled paradigm, 219 concentration–effect relationship, 221 concussion, 466–7 conditioning, in paraphilias, 874–5 conditioning theory, 1009 conduct-related disorders, 543–58 adolescent-onset, 545 childhood-limited, 545–6 childhood-onset, 545 classification, 543–4 clinical assessment, 552–3 comorbidity, 546–7 ADHD, 525, 546, 853, 1180 anxiety disorders, 630 autism, 546 depression, 588 developmental subtypes, 545–6 diagnosis, 552–3 epidemiology, 544–5 etiology, 547–52 future research, 558 gender differences, 544–5 genetic factors, 547–8, 550 guidelines, 554 and offending, 1107 prevalence, 544–5, 854 risk factors, 547–52 causal status, 552 family level influences, 550–2 individual level, 547–9 outside the family, 549–50 and suicidal behavior, 654 treatments, 553–8, 1160 behavioral parent training, 258–9, 555, 1018 behavioral therapies, 1018 child therapies, 556 cognitive–behavioral therapy, 258, 556, 1031–4 family interventions, 555 in-patient, 1133 medication, 557–8 multisystem treatments, 259 operant procedures, 258 parent–child interaction treatments, 259, 555 planning, 553 principles of intervention, 554–5 prototypical parent intervention, 1032 prototypical youth intervention, 1031–2 psychodynamic psychotherapy, 1086 school-based interventions, 556–7 video-guided parent group approach, 259 see also antisocial behavior; disruptive behavior disorders confidence intervals, 111 confidentiality, see medical confidentiality conflict, negotiation of, 185 confounding, 62, 113 dealing with, 113–14, 119–21 effects of, 164 congenital adrenal hyperplasia (CAH), 866 conjoint analysis, 131 connectivity, brain region, 135 Conners’ ADHD Rating Scales, 533 conscience development, 188, 193 conscientiousness, 183 description, 185 influences on achievement, 190–1 on health trajectories, 191 personality change pattern in, 189 and psychological disorders, 192–3 underlying process, 185 consciousness, limitations, 1079–80 consensus groups, 978 consensus trait measures, 186 consent to treatment, 1131 adolescents and, 103–4, 1131, 1146 constipation, 922, 925 with overflow, 923, 924, 925 INDEX 1212 construct validity, 59–60, 305 consultation see pediatric consultation consultation liaison models, 1171 consultation model, 310 Contextual Emotion-Regulation Therapy (CERT), 602 contextual threat, 392 long-term, 395 contingency planning, 693–4 contingent negative variation, 234 contingent relationships, 385–6 Continuous Performance Test (CPT), 743 conversion disorders, 939–40 see also dissociative identity disorder co-operative learning, 961, 1190, 1194, 1198 coping, styles, 932 Coping Cat program, 255, 264, 1035, 1036, 1037 Coping with Depression for Adolescents (CWD-A), 597–8 Coping Koala program, 1036 coping moderators, of stress, 386 Coping Power program, 556, 1001, 1033, 1038, 1115 coprolalia, 719, 721 copy number variants (CNVs), 345 Cornelia de Lange syndrome, 303 features, 323, 1196 corporal punishment, cross-cultural differences, 206 correlation, and causation, 60 cortical heterotopias, 152 cortical neurons, 235 cortical tumors, 152 cortico-cortical interaction, 247–8 cost–benefit analysis, 128, 130–1 cost-consequences analysis, 129 cost-effectiveness, 123, 127–31 benefit measurement, 130–1 body of evidence, 131 cost measurement, 128–9 effectiveness measurement, 129 foster family care, 497 perspective, 128 question addressed, 128 residential care, 497 trade-offs, 129–30 utility measurement, 130 cost-effectiveness acceptability curves (CEAC), 129–30 cost-effectiveness analysis (CEA), 129 cost-of-illness studies, 123, 132 cost-offsets, 123, 127 cost–utility analysis (CUA), 130 counterfactuals, 59 counting span, 808 Course of Bipolar Youth (COBY) study, 613, 614 course of disorder, in diagnostic validation, 25 court orders, 101 court reports, assessment for, 53–5 covariate adjustment, 120 covert sensitization, 877 Creutzfeld–Jakob disease (CJD), 240 new-variant, 240 Cri-du-chat syndrome, features, 323, 1196–7 crime, concentration in families, 550 crime victimization, 547 criminal justice system, 96–7 crisis centers, 661 cross-fostering, 400 cultural practices, 441 cultural therapies, 208 culturally accepted behaviors, carrying serious risks, unacceptability, 207 culture, 200–2 beliefs and psychopathology, 205 and community, 201 effects, 201 of poverty, 201 culture-specific syndromes, 204–5 curriculum-based assessments, 1198 cutpoints, effectiveness, 294 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1212

INDEX 1213 CWD-A program, 256 cystic fibrosis (CF), 934 genetic factors, 359 cytomegalovirus (CMV) infection, in utero, 153 DARE program, 978 day units, 1129–33 adapting treatments to settings, 1130–1 assessment strategies, 1130 consent, 1131 developmental disorders, 1129 disruptive behavior, 1129 education, 1129 family functioning, 1129 motivation, 1131 staff team, 1131–2 therapeutic alliance, 1130 treatment effectiveness, 1132–3 generic outcomes, 1132 outcome for specific disorders, 1132–3 predictors of outcome, 1132 treatment goal planning, 1130 daycare, and early childhood problem behavior, 885 daytime wetting, 916–17, 920–2 assessment, 920–1 comorbidity, 916 definition, 920 etiology, 921 management, 921 prevalence, 916 treatment, 921–2 types, 920, 921 DBC see Developmental Behavior Checklist DBT see dialectical behavior therapy DCD see developmental co-ordination disorder Deaf culture, 961 Deaf Mental Health Charter, 964 deafness see hearing impairment death of child in hospital, 1152–3 communication about, 950–1, 1152–3 see also bereavement deep brain stimulation (DBS), 731 DeFries and Fulker method, 353 delayed sleep phase syndrome (DSPS), 898, 899–900 deliberate self-harm (DSH), 648–62 clinical assessment following, 658 definition, 648 emergency consultations, 1148 environmental factors availability of means, 656–7 life stressors, 656 sexual orientation, 655 future directions, 662 hospitalization following, 660 impact on parents, 657 methods, 651, 656–7 motives, 648–9 and offending, 1108–9 outcome following, 657–8 prevalence, 650–1 prevention, 660–1, 1160 psychiatric disorders associated, 653–4 borderline personality disorder, 658, 846 risk of repetition, 657–8 suicide following, 658 treatment following, 659–60, 1160 access and engagement issues, 660 see also self-mutilation delinquency definition, 1106 see also juvenile delinquency delirium, 460 delusions, 737 assessment, 829 see also schizophrenia dementia, childhood, 460–1 see also neurodegenerative disorders dementia praecox, 746 dendrites, 234 development, 146–7 denial, 1080 depersonalization disorder see personality disorders deployment-focused model (DFM), 262 depression, 587–604 adult onset, 167 age factor, 589 assessment, 588–9 bipolar disorder risk in, 590 child sexual abuse and, 446, 447, 453 classification, 587 clinical management, 593–5 cognitive factors, 167–8 comorbidity, 588 ADHD, 588 anxiety disorders, 588, 630 conduct disorder, 588 obsessive-compulsive disorder, 710 substance abuse, 588, 590 Tourette syndrome, 722 continuities in, 167 course of, 589–90 as degenerative disorder, 1095 developmental findings, 166–8, 171–2, 589 differential diagnosis, 587–8 early adversities as risk factors, 167 economic studies, 131 education, patient and family, 594 epidemiology, 589 future challenges, 603–4 gender differences, 589 cognitive vulnerability–transactional stress theory, 398 genetic factors, 167 incomplete recovery, 603 juvenile onset, 167 major depressive disorder (MDD), cortisol levels in, 400 Maudsley study, 126 neuroimaging studies, 593, 603 not otherwise specified (NOS), 587 and offending, 1108 parenting and, 1048 pediatric consultation, 1148–9 postnatal, 408–9, 412, 416–17 presentation, 587 prevalence, 589 protective factors, 592 public health burden, decreasing, 604 recurrence risk, 589–90 risk assessment, 593–4 risk factors, 590–3 bereavement, 592 bullying, 592 cognitive bias, 591 comorbid diagnoses, 591 comorbid medical illness, 592 emotional regulation, 591 family environmental, 591–2 genetic, 590–1 hemispheric lateralization, 593 neuroendocrine, 592–3 same sex attraction, 592 sleep complaints, 593 stressful life events, 592 substance use/abuse and, 172 and suicidal behavior, 590, 653 syndromal assessment, 1099 therapeutic identification techniques, 1172 treatments, 176, 595–603 antidepressant medication, 595–7, 660, 1149, 1171–2 best practice recommendations, 602–3 cognitive–behavioral therapy, 176, 256, 597–600, 659, 1034–5 contextual factors, 594–5 electroconvulsive therapy, 602 family interventions, 601–2 family therapy, 1071 in-patient, 1132–3 interpersonal therapy for adolescents (IPT-A), 256, 600–1 pharmacotherapy in PBD, 621 planning, 594–5 prevention packages, 600, 601 primary care role, 1168, 1171–3 psychodynamic psychotherapy, 1085–6 relaxation training, 256 type 1 diabetes and, 935 depressive disorders see adjustment disorders; depression; dysthymic disorder deprivation, residential care and, 907–8 deprivation dwarfism see failure to thrive deprived neighborhoods, effects, 381 deselection processes, 190–1 desmopressin, in nocturnal enuresis treatment, 919, 920 detrusor–sphincter dyscoordination, 920, 921 developing countries, parental psychiatric disorder in, 417 Development and Wellbeing Assessment (DAWBA), 1161 Developmental Behavior Checklist (DBC), 765, 829 DBC-Monitoring, 830 DBC-Parent/Primary Carer, 829 DBC-Teacher, 829 developmental co-ordination disorder (DCD), 809–10 assessment, 812 classification, 810 comorbidity, 810 etiology, 810 explanations, 810 balance and postural control, 810 kinesthetic perception problems, 810 visual perceptual deficits, 810 incidence, 810 interventions, 813–14 nature, 809–10 psychosocial outcomes, 812 developmental delay investigations, 330 with motor signs, 330 without motor signs, 330 Developmental, Dimensional and Diagnostic Interview (3di), 277 developmental examination, skills expected at varying ages, 320–1 developmental perturbation, 770 developmental plasticity, 150–1 adult plasticity vs, 152 developmental psychopathology developments, 10 emotional development and, 150–1 life course perspective, 160–77 clinical implications, 175–7 developmental findings, 164–70 future challenges, 175 heterotypic continuity, 160, 171–2 long-term effects of early experience, 172–5 methodological considerations, 161–4 psychopathological progressions, 171, 172 neurological perspectives, 145–57 autism, 154–7 biological insults, 152–4 future research, 157 see also brain development; neural plasticity social development and, 150–1 developmental verbal dyspraxia, 785 deviancy training, 1000, 1002, 1038–9, 1120 diabetes mellitus juvenile onset, 934–5, 1151 type 1, 934–5, 1151 and depression, 935 type 2, 934 diagnosis agreement, 26–7 attacks on, 29 developments, 5 problems composition difficulties, 1092–3 threshold problems, 1093 diagnostic boundaries, 354 Diagnostic Classification: 0–3 (DC:0–3), 883, 908 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1213

Diagnostic Confidence Index (DCI), 720 diagnostic formulation, 50–3 standards for practice, 53 see also clinical assessment Diagnostic Interview for Borderline Parents, 868 Diagnostic Interview for Children and Adolescents (DICA), 631, 749, 1093 Diagnostic Interview Schedule for Children (DISC), 274, 631 Diagnostic Interview for Social and Communication Disorders (DISCO), 276, 765 dialectical behavior therapy (DBT), 1010 in personality disorder treatment, 848 in suicidal behavior treatment, 659, 848 diary, in behavioral assessment, 1010 diathesis–stress model, 386 DICA, 631, 749, 1093 diet, in fecal soiling treatment, 925, 926 dieting, and eating disorder development, 673 Differential Ability Scales (DAS) tests, 306 differential attention, 1012 differential reinforcement, 833 of alternative behavior (DRA), 834 of incompatible behavior (DRI), 834, 1015 of other behavior (DRO), 833, 1014, 1015 differential social action, 870–1 differentiation, 146–7 diffusion tensor imaging (DTI), 134, 617 digit dyslexia, 807 dimensions, 19, 20 Dinosaur program, 556, 889 disability and child sexual abuse, 443 see also intellectual disability disability adjusted life years (DALYs), 1160 DISC, 274, 631 DISC-IV, 274 discipline, and conduct disorders, 551 DISCO, 276, 765 discrimination, effects, 201 disinhibited attachment disorder, 909, 910 residential care and, 488, 910 see also reactive attachment disorder disobedience, consequences for, 1054 disorder conceptualization, 354 manifestations, variations across sociocultural/ethnic groups, 205 patterns of, 74–5 variation across groups, 76 rates of, variations across sociocultural/ethnic groups, 203–4 disorders of sex development (DSDs), 866, 867, 868 displaced persons, 474 see also refugee and asylum seeking children disruptive behavior disorders personality traits and, 192–3 see also ADHD; conduct-related disorders dissociation, in post-traumatic stress disorder, 689–90 dissociative disorders, 939–40 dissociative identity disorder (DID), 205, 846 diurnal enuresis see daytime wetting divorce, parental see parental divorce dizygotic (DZ) twins, 67 DNA pooling, 345 donor insemination (DI), 505–6 dopaminergic systems, Tourette syndrome, 725 dose–response measures, 63–4 dosing rate (DR), 220 “double robustness”, 120 Down syndrome, 369–70, 824–5 behavioral phenotype, 369–70 educational needs, 1196, 1197 pharmacological treatment, 831 population screening, 1184 prenatal diagnosis, 1182 psychopathology, 827 DPICS, 281 DRO, 833, 1014, 1015 drug abuse child sexual abuse and, 447 harm reduction initiatives, 581 legislative approaches, 580 prevalence, 566 school-based interventions, 580 testing procedures, 580 see also substance use/abuse drug courts, 579 drug–drug interactions, 1100, 1102 drug psychoses, 749 drug response, in diagnostic validation, 24 DSH see deliberate self-harm DSM-III, 182 DSM-IV, 19 anxiety disorders, 628 attachment disorders, 908, 910 attention and activity disorders, 521–2 Axis I vs Axis II disorders, 842–3, 847 bereavement reactions in, 398 conduct-related disorders, 543–4 eating disorders, 670 gender identity disorder, 865 ICD-10 vs, 19, 28 language disorders, 792 neurodevelopmental disorders, 32 obsessive-compulsive disorder, 700 paraphilias, 872–3 personality disorders, 842, 843 Primary Care, 1170 schizophrenia, 749 substance use disorders, 568 DSM-V, 182, 567 DSPS, 898, 899–900 dual placements, 1190 Duchenne muscular dystrophy, 361–2 behavioral phenotype, 361–2 duplication syndromes, 363–7 duration of disorder, 48 duration of exposure, 60–1 dyadic developmental psychotherapy, 495 Dyadic Parent–Child Interaction Coding Scheme (DPICS), 281 dyadic therapy, in psychodynamic therapy, 1084 dynamic assessment, 309 dynamic causal modeling, 248 dysfluency, 786–7 dysfunctional voiding, 920, 921, 922 dyslexia ADHD and, 35 antisocial behavior and, 165 assessment, 812 brain bases of, 805–6 developmental, 139–40 genetic factors, 794 neuroimaging studies, 139–40 developmental findings, 164–5 double deficits, 804 genetic influences, 805 interventions, 812–13 psychosocial sequelae, 811 rate deficits, 804 spelling difficulties in, 805 theories of, 803–5 auditory deficits, 804 automatization, 804 perceptual, 804–5 phonological deficit, 803–4 visual deficits, 804 dysmorphology, 324–5 dysphonia, 787 dyspraxia see developmental co-ordination disorder dyssomnias see sleep disorders dysthymic disorder, 587 dystonia, 327 E-Risk longitudinal twin study, 551, 552 early childhood problem behavior, 882–91 clinical problems, 884–7 comorbidity, 883 developmental perspectives, 882–3 disruptive behavior, 884–5, 888–9 ADHD, 884, 888–9 INDEX 1214 causes and correlates, 884–5 interventions, 888–9 oppositional problems, 884 eating and feeding problems, 886–7, 889–90 classification, 886 failure to thrive (FTT), 887, 890, 936–7 food refusal, 887, 890 infant colic, 886–7, 889–90 interventions, 889–90 pica, 886 prevalence, 886 rumination disorder, 886 emotional problems, 885–6, 889 causes and correlates, 886 classification systems, 885 interventions, 889 prevalence, 886 stability, 885–6 future directions, 890–1 risk factors, 883, 884 theoretical perspectives, 883–4 treatment, 887–90 evidence overview, 888 selection principles, 887–8 Early Head Start (EHS), 972–3, 983, 984, 1200 Early Intensive Behavioral Intervention program (EIBI), 1197 Early Intervention in Psychosis teams, 1135 Early Risers program, 995, 996 Early Screening for Autistic Traits, 766 early years interventions, development, 417 eating disorders, 670–84 assessment, 680 binge, 671, 676, 677 child sexual abuse and, 446, 447 classification, 670 clinical features, 671–2 course, 673–4 development, 168–9, 673–4 diagnostic criteria, 670–1 distribution, 672–3 etiology, 674–6 in-patient treatment, 1132–3 management, 677, 678–83 clinical recommendations, 680–3 ethical issues, 683 legal issues, 683 psychodynamic psychotherapy, 1086 research evidence, 678–9 maternal, effects on child, 1063–4 medical complications, 676–8 neurological findings, 676 not otherwise specified see EDNOS prevention, 683–5 psychological processes postulated, 676 risk factors genetic, 674–5 other, 675–6 and suicidal behavior, 654 see also anorexia nervosa; bulimia nervosa echolalia, 721 ecological validity, 60 economics, health see health economics ECT see electroconvulsive therapy eczema, 934 EDNOS clinical features, 672 course, 674 development, 168, 674 diagnostic criteria, 670–1 distribution, 673 genetic factors, 674 management, 679, 680, 683 medical complications, 676 prevalence, 168 education attainment, ethnic differences in, 204 in day units, 1129 in in-patient units, 1127 legal position, 95–6 see also parent education; psychoeducation; special education EEG see electroencephalography 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1214

INDEX 1215 effect-controlled paradigm, 219 “effect erosion”, 1001 effect estimation, 111–12 effect mediation, 117 effect modification, 62 effect size (ES), 253 effective environment, 380 effectiveness, 1000–1 efficacy vs, 263 trials of, 1001 effects scales, 116–17 efficacy effectiveness vs, 263 trials of, 1001 efficiency, 1000 effortful control, 183, 185 improvement, 194 and psychological disorders, 192–3 egocentricity, 1046 electrical dipoles, 235 electroconvulsive therapy (ECT), in depression, 602 electrocorticography, 237 electroencephalography (EEG), 134–5, 234–48, 329–30 activation procedures, 238–9 application in clinical research, 242–3 clinical use, 329–30 consent, 239 development, 7 discovery, 234 ethical issues, 239 future directions, 247–8 interpretation, 240, 241–2 maturation of activities, 235 neurophysiological origins, 234–5 normal features, 239 pathological features, 239–40 EEG slowing, 239–40 epileptiform activity, 240 loss of activity, 239 quantitative, 242 coherence analysis, 242 in developmental disorders, 242–3 maturation from infancy to adulthood, 242 spectral analysis, 242 topographical analysis, 242 recording techniques, 237–8 rhythms classification, 235 functional roles, 236 neurophysiological origins, 235–6 transition into electrical seizures, 236–7 variants in children and adolescents, 239 see also event-related potentials; evoked potentials elimination disorders see daytime wetting; encopresis; fecal soiling; nocturnal enuresis embryology, basic, 146 emotion system, 380 emotional abuse, 423 outcomes, 429 treatment, 432–3 see also child maltreatment emotional arousal, and social information processing, 1030 emotional and behavioral disorders (EBD) definition, 1193 see also conduct-related disorders; emotional disorders emotional development and developmental psychopathology, 150–1 sensory impairments and, 958 emotional disorders in early childhood, 885–6 parenting and, 1048 personality traits and, 192–3 emotional dysfunction, in psychopathy, 852, 853, 859–60 emotional neglect, 423 differential diagnosis, 764 empathizing–systemizing (E-S) theory, 766–7 empathy deficit, in psychopathy, 859 empirical research, developments, 4–8 enactments, 1069 encephalocele, 152 encopresis, 923–4, 925, 926 see also fecal soiling endophenotypes, 246, 342, 638 in anxiety disorders, 638 engagement, in family therapy, 1116 English Romanian Adoptees (ERA) study, 488 enuresis diurnal see daytime wetting nocturnal see nocturnal enuresis enuresis alarm, 919, 920, 921, 1019 environmental construal, temperament differences and, 186–7 environmental elicitation, temperament differences and, 186 environmental interventions, nature of, 355 environmental manipulation, temperament differences and, 187 environmental mediation, 344 genetic determinism vs, 354 twin designs to examine, 351–2 environmental selection, temperament differences and, 187 enzymes, 212–13 epidemic hysteria, 939–40 epidemiology in causality study, 58–68 research designs, 61–4 classification in, 18 definition, 72 developments, 4 in diagnostic validation, 25 generalizability of findings, 76 highly focused studies, 77 in service planning, 71–8 of services, 74 see also longitudinal studies; natural experiments epigenetic mechanisms, 360, 413 future research, 417 epilepsy, 464–6 benign, with centrotemporal spikes, 239 diagnosis, 241, 329, 330–1 differential diagnosis, 748–9 epidemiology, 465 etiology, 465 intellectual disability and, 827 juvenile myoclonic, 239 prevalence, 465 pseudoseizures, 464–5, 940 psychopathology, 465 etiology of, 465–6 schizophrenia and, 749 seizures associated, 236, 464 stigma associated, 464, 465 epileptiform activity, 240 epiphenomenal associations, 171 episodic disorders, personality disorders and, 842–3 ERP see event-related potentials error-related negative potentials (ERN), 244, 246 in ADHD, 246 escape training, 1013 establishing operations, 833 ethics, developments, 11–12 ethnic groups disorder manifestation variations, 205 disorder rate variations, 203–4 future research directions, 208–9 risk factors across, 205–6 ethnicity, 202–3 self-descriptive approach, 202 social construction, 202 see also race euphoria, in bipolar disorder, 614 European Convention on Human Rights and adolescents’ rights, 109 on children’s services, 97 on education, 95 on family, 99, 101 event encoding deficits, 246 event-related desynchronization (ERD), 243 event-related potentials (ERP), 242 application in clinical research, 242–3 at interface of neurophysiology and cognitive neuroscience, 243 auditory, 245 components, 243 and cognitive processing stages, 244 developmental changes from infancy to adulthood, 244–5 in developmental disorder investigation, 245–6 discovery, 234 estimation of generators, 243–4 future directions, 247–8 interpretation considerations, 246–7 intracranial (iERP), 243–4 as marker of liability to disorder, 246 methods, 243–4 event-related synchronization (ERS), 243 evidence-based, definition, 971 evidence-based treatments (EBTs), usual clinical care vs, 262–3 evoked potentials (EPs), 234, 237–8 brainstem auditory (BAEPs), 238 somatosensory (SSEPs/SEPs), 238 visual (VEPs), 238 examination, physical see physical examination excitatory postsynaptic potentials (EPSP), 236 exclusion, from school, 95–6 executive functions assessment, 308–9 deficit and autism spectrum disorders, 767 and conduct disorders, 548–9 and psychopathy, 858–9 and schizophrenia, 746 definition, 308 exhibitionism, 872, 874, 876, 877 expectations, setting, 1054 expert witness, role, 98–9 exploitation, 422 exposure and response prevention (ERP), 709–10 expressed emotion (EE), parental, 741 Expressive Language Disorder, 792 extended twin family design, 352 external validity, 59 externalizing behavior/disorders see disruptive behavior disorders extinction, 834, 1014 extinction burst, 1014 extraversion, 183 description, 184 influences on achievement, 190 on health trajectories, 191 on relationships, 189 personality change pattern in, 189 and psychological disorders, 192–3 Eyberg Inventory, 1010 eye abnormalities, 326 eye movement desensitization and reprocessing (EMDR), 693 eye tracking dysfunction (ETD), 746 fabricated or induced illness (FII), 422 face processing, 150 in autism, 139, 141, 246 development, 246 Facilitated Communication, 54–5, 302–3 factitious illness/disorder, 327, 938–9 presentation, 322, 327 failure to thrive (FTT), 887, 890, 936–7 false belief, in blind children, 958 familial risk, 349 family assessment by consultant, 1147–8 impact of individual problems on, 1064 in-patient admission effect on, 1129 intervention in life of, 100–1 legal position, 99–102 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1215

family (cont’d) observations of, 42–3 reconfiguration after loss of parent, 952 role in psychological difficulties, 1063–4 of sexually abused children, 453 and state, 99–100 as system, 1062–3 Family Check-Up, 282 family interviews, 1064–8 beliefs and meanings attached to behaviors, 1065 individual vs conjoint sessions, 1068 intervening in family interaction process, 1067 involving children and adolescents in, 1067–8 observing interaction patterns, 1064–5 presenting problem in developmental context, 1065 social and cultural contexts, 1065 style of dealing with problems, 1065 techniques, 1066–7 see also questions Family Life Cycle model, 1062–3 Family Preservation, 1134 family studies, 349 findings in diagnostic validation, 24–5 top-down, 349 family support, in autism spectrum disorders, 768 Family Systems Theory, 1062 family therapy, 555, 1009, 1062–74 in anorexia nervosa, 679–80, 1069 in anxiety disorders, 1069–70 attachment-oriented, 1074 behavioral family therapy, 1069–70 brief therapies, 1070 collaborative language approaches, 1071 in depression, 1071 emotion-focused, 1084 empirical developments, 1062–4 frameworks for intervention, 1069–73 influencing, 1070 maintenance, 1069–70 meaning creating, 1070–1 multidimensional and integrative, 1071–3 Functional Family Therapy, 555, 1009, 1072, 1116–17 future directions, 1074 in in-patient unit context, 1131 integrative approaches, 1073 Multidimensional Family Therapy (MDFT), 1072 multiple family approaches, 1072–3 narrative therapies, 1062, 1071 in pediatric bipolar disorder, 621 psychodynamic therapy and, 1084, 1086 role of family therapist in team, 1068 in schizophrenia treatment, 752 solution-focused, 1070 strategic therapies, 1070 structural family therapy, 555, 1069–70 in substance misuse treatment, 1073 in suicidal behavior treatment, 659 systemic behavioral (SBFT), 659, 1035 theoretical developments, 1062–4 therapist as participant observer, 1071 in youth offender treatment, 1073 see also family interviews; Multisystemic Therapy family violence, 423–4 “family work”, in psychodynamic therapy, 1084 FAS see fetal alcohol syndrome fasciculations, 327 Fast Track, 991 components, 993–4 combining targeted and universal, 995 evaluation results, 994 innovative intervention strategies, 1000 session spacing, 999 FastForWord, 796, 1192 fatigue, investigations, 333 fear neural development and, 639 system impairment in psychopathy, 854, 859 see also anxiety disorders; panic disorder; phobic disorder fear-circuit dysfunction, 638 fear conditioning experiments, 639 FEAR plan, 1036 fecal soiling, 48–9, 916–17, 922–6 assessment, 922–4 comorbidity, 916 definition, 922 etiology, 924 management, 924 prevalence, 916 relapse prevention, 926 treatment, 924–6 composite programs, 925–6 predictors, 925 types, 923 feedback connections, 137–8 feedforward connections, 137–8 feeding disorder of infancy and early childhood, 886, 887 feeding and eating disorders, 886–7, 889–90 classification, 886 failure to thrive (FTT), 887, 890, 936–7 food refusal, 887, 890 infant colic, 886–7, 889–90 interventions, 889–90 pica, 886 prevalence, 886 rumination disorder, 886 female delinquents, interventions for, 1111–12 fetal alcohol syndrome (FAS), 153, 408, 461–2 indiscriminate behavior in, 911 fetal–fetal transfusion syndrome, 351 fetishism, 872, 875, 876, 877 fidelity, to treatment procedures, 265, 1021, 1022, 1037–8, 1057 Fidelity of Implementation (FIMP), 282 field independence, 767 “findings”, natural history of, 112–13 firearms, restricting access to, 661 firesetting, 1111 FISH studies, 329 fitness to stand trial, 1109–10 Five Factor Model, 841 Flexibility Questionnaire, 1037–8 flooding, 1015–16 fluorescence in situ hybridization (FISH), 1182 fluoxetine in anorexia nervosa treatment, 679 in autism spectrum disorders treatment, 769 in depression treatment, 217, 595–6, 597, 602, 1172 with cognitive–behavioral therapy, 599, 1035 fluvoxamine, in anxiety disorder treatment, 217 FMR1 testing, 329, 332 fMRI see functional magnetic resonance imaging follow-up studies, of clinical groups, 162 food additives, 527, 531 food refusal, 887, 890 Fort Bragg Demonstration, 127 Fort Bragg study, 1160–1 foster family care, 487, 491–8 assessment of psychological problems, 493–4 breakdown rates, 492 cost-effectiveness, 497 educational outcomes, 493 efficacy, 150–1 future directions, 497–8 leaving, 496 mental health of children in, 492–3 interventions to improve, 494–6 moving to adoption from, 503–4 Multidimensional Treatment Foster Care (MTFC), 495–6, 1013, 1072, 1112, 1119 providing, 491–3 residential care vs, 496–7 treatment foster care (TFC), 259, 495–6, 497, 1137 fragile X syndrome (FXS), 362–3, 825 behavioral phenotype, 362–3 cause, 361 INDEX 1216 features, 323, 325, 362–3, 1196 genetic tests for, 329 population screening, 1184 psychopathology, 827 “Fraser guidelines”, 104 Freudian theory, 145 FRIENDS program, 1036, 1161 friendship groups, visually impaired students in, 961 friendships, establishment, 189 frontal lobes, dysfunction in psychopathy, 857–8 FTT see failure to thrive functional analysis, 1012 functional candidate gene studies, 346–7 functional displacement, 833, 1020 Functional Family Therapy, 555, 1009, 1072, 1116–17 functional integration, 135 functional magnetic resonance imaging (fMRI), 135 data analysis, 136 future directions, 247 functioning targets, 1098, 1099 funnel plots, 112 FXS see fragile X syndrome gait assessment, 327 gamma binding hypothesis, 236 gang membership, violence and, 61 gastro-esophageal reflux (GER), 303 gateway hypothesis, 570–1 gay families, 506 gender effects, twin studies to test, 353 gender identity disorder, 864–72 assessment, 865–6 diagnosis, 865–6 reliability, 865 validity, 865 distress in, 866 environmental factors, 867 epidemiology, 864–5 etiological influences, 866–8 activity level, 867 biological mechanisms, 866–8 birth order, 867–8 general psychopathology, 868 prenatal gender preference, 868 psychosocial mechanisms, 868 sex assignment at birth, 868 sibling sex ratio, 867–8 social reinforcement of cross-gender behavior, 868 genetic factors, 867 impairment in, 866 legitimacy as disorder, 865–6 long-term follow-up, 868–70 persistence and desistance in comparativedevelopmental perspective, 870 studies of boys, 868–9 studies of girls, 869–70 as normal variation in gender-related behavior, 865–6 phenomenology, 864 prevalence, 864 psychopathology associated, 866 sex differences in referral rates, 864–5 sexual orientation and, 869, 872 treatment, 870–2 adolescents, 872 children, 870–1 ethical considerations, 870 parents, 871–2 supportive, 871–2 gene–environment correlation (rGE), 67–8, 343–4, 413 active, 67 evocative, 344 passive, 66, 68 reactive, 67 gene–environment interactions (G × E), 343, 413 for ADHD, 528 in behavioral inhibition, 638 in depression, 638 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1216

INDEX 1217 and substance use/abuse, 577 twin and adoptee designs to test for, 352 generalization, in family therapy, 1116 generalization training, 1198 generalized anxiety disorder comorbidity, 630 genetic factors, 636 parental depression and, 636 presentation, 629 prevalence, 631, 632–3 generalized linear model (GLM), 114–16 generalized periodic complexes, 240 generativity, 992 genetic counseling, 1180–7 child mental health specialist role, 1185 future directions, 1187 genetic counselor role, 1180–5 carrier detection, 1183–4 diagnosis of genetic disorders, 1181–2 pharmacogenomics, 1184 population screening, 1184 pre-adoption counseling, 1184–5 pre-conception counseling, 1182 pre-implantation genetic diagnosis (PGD), 1183 prenatal diagnosis, 1182 presymptomatic testing, 1183 genetic testing in research contexts, 1187 nature in child psychiatry, 1180–1 practical aspects, 1185–6 assessment, 1185–6 communication, 1186 referral, 1185 problems and limitations, 1186 social aspects, 1181 genetic determinism, environmental mediation vs, 354 genetic epidemiology, 65–8 designs for causal research in, 66–8 genetic investigations, 329 genetic mediation, 344 genetic study findings, in diagnostic validation, 24–5 genetics, 339–55 animal studies guidance, 347 of brain malformations, 153 clinical implications, 354–5 developments, 8 environmental influences on gene expression, 342 gene inheritance, 344 genes at molecular level, 339–42 inherited genetic factors affecting gene expression, 341 molecular genetic research methods, 344–7 involving testing specific hypotheses, 346–7 parent-of-origin effects, 341 pathway from gene to psychiatric disorder, 342–4 phenotype definition, 347–9 quantitative strategies to study causal processes, 349–53 quasi-experimental studies of genetic effects, 348–9 genomic imaging, 136 genotypes, 340 Getting to Outcomes (GTO) process, 981 giggle micturition, 921 Gillick competence, 103–4 gllamm, 119 GLM, 114–16 Global Assessment of Functioning Scale, 1099 glucose metabolism, 213, 227 Good Behavior Game, 1004, 1013 goodness-of-fit, 187–8 graded exposure, 1015, 1016 grammar, 787, 795, 796 “grand mal” seizures, 464 group therapy child sexual abuse, 452 in deliberate self-harm treatment, 659 possible iatrogenic effects, 1000, 1038–9 in psychodynamic therapy, 1083–4 growth cones, 146 growth curve models, 118, 119, 379 growth suppression, stimulant-related, 215 GTO process, 981 habit reversal training, 729 hallucinations, 737, 747 misdiagnosis, 829 in traumatic brain injury, 468 see also schizophrenia haloperidol brain PD analysis, 224, 226 brain PK analysis, 223 in schizophrenia treatment, 218 side-effects, 218 Hamilton Anxiety Scale (HAS), 631 Hanen program, 796 Haplotype Relative Risk (HRR) method, 345 harm, definition, 101 harmful dysfunction, 21 harsh parenting, effects, 173 Harvard Trauma Scale, 475 HD see hyperkinetic disorder head circumference, measurement, 326 Head Start preventive program, 1052, 1200 headaches diagnosis, 333–4 investigations, 333–4 health, personality trait effects, 191 health economics, 123–32 cost-offsets, 123, 127 costs in childhood, 123–5 costs continuing into adulthood, 125–7 pertinent questions, 124 see also cost-effectiveness health insurance, genetic testing and, 1181 health promotion, 990 health services see clinical services; day units; in-patient treatment; primary health care; services hearing impairment ability and achievement, 959 causes, 956 Deaf culture, 961 and early language development, 957 educational needs, 1195 and emotional development, 958 mediating variables in child’s environment, 959–61 early parenting, 959–60 socioemotional interventions for children, 961 support and training for parents, 960–1 mental health disorders in children with, 962–4 autism, 963 interventions and services, 964 mental health assessment issues, 963–4 prevalence, 962–3 outcomes, 961–2 and play, 958–9 prevalence, 956 types, 956 Heller syndrome see childhood disintegrative disorder hemiballismus, 327 hemispheric lateralization, as risk factor of depression, 593 hemodynamic response, 135 Henle–Koch principles, 59 heritability, 350 variations by social context, 352 herpes simplex encephalitis, 240 heterotypic continuity, 160, 171–2 High/Scope Perry Preschool Study, 127 hindsight bias, 87–8 historical developments, 3–13 history-taking, 318–22 behavioral phenotypes, 322, 323 birth and neonatal history, 319 early developmental history, 319–22 family history, 318 pregnancy, 318–19 systematic enquiry, 322 HIV/AIDS, 945–52 epidemiological overview, 945–6 parental, mental health issues, 951–2 perinatal HIV infection, 946–7 differential diagnosis of neuropsychological deficits, 947 emotional and behavioral disorder in HIV-infected children, 947–8 neurodevelopmental sequelae, 946–7 treatment issues, 946 psychotherapeutic issues, 948–51 adherence to medical regimens, 948–9 in adolescence, 949–50 communication about health, 948 education issues, 949 promotion of optimal development, 949 psychopharmacological management, 950 therapeutic support in end-stage disease, 950 HIV-associated encephalopathy, 469, 946–7 Hodgkin’s disease, 935 holding therapies, 495, 513 Holocaust survivors, 480 holoprosencephaly, 152 home treatment, 1134–5 home visiting, 1174 for maltreatment risk families, 434 homeostatic mechanisms, 222 Homestart, 1052 homoscedasticity, 114 homosexuality see sexual orientation homotypic continuity, 160 “honeymoon effect”, 1132 hopelessness, and suicidal behavior, 652, 653, 658 Hopkins Motor and Vocal Tic Scale, 728 hormone replacement therapy (HRT), 113 hospitalization, and suicidal behavior, 660 hot lines, 661 5-HTT, 136 human rights influence on adolescent autonomy, 104–5, 108–9 on child care law, 101–2 Huntington disease, 470 prenatal diagnosis, 1182 presymptomatic testing, 1183 trinucleotide repeats in, 361 hygiene hypothesis, 933 hyperactivity, methylphenidate treatment, 130 hyperbilirubinemia, 154 hyperkinetic disorder (HD) definition, 521–2 epidemiology, 530–2 prevalence, 203 treatment, 534, 1173 see also ADHD; attention and activity disorders hypocalcemia, 154 hypochondriasis, 700 hypofrontality, 743, 744 hypoglycemia, 154 hypothesis testing, 111 in diagnostic assessment, 46, 48, 52 hypoxic ischemic encephalopathy (HIE), 153–4 hysterical conversion reactions, 46, 205, 939 see also dissociative disorders ICD-10, 19 anxiety disorders, 628 attachment disorders, 908, 910 attention and activity disorders, 521–2 Axis 2 disorders, 32 bereavement reactions in, 398 conduct-related disorders, 543–4 DSM-IV vs, 19, 28 eating disorders, 670 mixed categories, 28 obsessive-compulsive disorder, 700 paraphilias, 873 personality disorders, 842, 843 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1217

ICD-10 (cont’d) Primary Health Care, 1170 prototypic approach, 28 schizophrenia, 749 substance use disorders, 568 ICSI, 505 identity development, 649 identity problem see dissociative identity disorder; gender identity disorder idiopathic hypersomnolence, 902–3 ignoring, 1054 iGTO, 981 immune dysfunction, 726–7 see also HIV/AIDS impairment assessment, 47–8 measures, 295 imprinting, genomic, 341, 361 impulse control, 858–9 impulsiveness, 521, 523 in vitro fertilization (IVF), 505 and psychopathology, 351 inattentiveness, 521, 523 incest, 440, 441 incidence, standardization, 113–14 incidental correlates, 991 Incredible Years program, 889, 994–5, 1032–3, 1057 incremental cost-effectiveness ratio, 129 Individual Education Plans (IEPs), 312 infancy, behavioral problems of see early childhood problem behavior infant psychiatry, growth, 12 infection, in utero, 153 information sharing, 431 information technology, in service provision, 1163, 1164 inhibition, behavioral see behavioral inhibition inhibitory postsynaptic potentials (IPSP), 236 Inner London Longitudinal Study, 125–6 in-patient treatment, 1126–9, 1130–4 adapting treatments to settings, 1130–1 admission practice, 1127–8 aftercare, 1128 alternatives to, 1134 assessment strategies, 1130 consent, 1131 discharge, 1128 education, 1127 emergency admission, 1128 historical roots, 1126 motivation, 1131 social functioning, 1127 staff team, 1131–2 therapeutic alliance, 1130 treatment effectiveness, 1132–3 generic outcomes, 1132 outcome for specific disorders, 1132–3 predictors of outcome, 1132 treatment goal planning, 1130 unwanted effects, 1128–9 ward as therapeutic milieu, 1126–7 see also residential care insomnia, 896–8 assessment, 897 conditioning model, 897 treatment, 897–8, 900 vigilance–avoidance model, 897, 898 institutional care see residential care instrumental variables, 120–1 “insular” mothers, 1047 Integrative Problem-Centered Therapy (IPCT), 1073 intellectual disability, 820–35 assessment, 828–30, 832–3, 1182 behavioral, 832–3 developmental issues, 829–30 issues with psychopathology syndromes, 829 behavioral assessment, 832–3 behavioral intervention, 833–4 causes, 824–6 perinatal, 824 postnatal, 824 prenatal, 824 definitions, 820 functional levels, 821 future directions, 835 health complications, 826–7 epilepsy, 827 general health, 826–7 sensorimotor impairments, 827 health impact, 823–4 incidence, 822 mental health services, 834–5 issues across developmental phases, 834–5 prevalence, 821–3 age factors, 822 ethnicity impact, 822 gender differences, 822 in low-income countries, 822, 824 possible changes in, 822–3 socioeconomic factors, 822 prevention, 826 psychopathology, 827–8 assessment, 828–30 classification, 828 conceptual issues, 828 course of, 828 influences on, 828 risk factors for, 827 risk factors, 826 social impact, 823–4 terminology, 820 treatment behavioral therapies, 1020 pharmacological, 830–2 psychological, 832–4 typology, 820–1 see also learning disorders; specific disorders intellectualization, 1080 intelligence and antisocial behavior, 856–7 in autism spectrum disorders, 762, 763, 764 definitions, 304 in schizophrenia, 738, 746–7 Intelligence Test for Visually Impaired Children, 959 intelligence tests of general intelligence, 306–7 history, 304–5 psychometric properties, 305–6 intensive case management, 1135–6 intensive treatment provision, 1126–39 future directions, 1138–9 see also day units; in-patient treatment; out-of-hospital care models intention-to-treat analyses, 985 intention-to-treat estimator, 120–1 interactions SEM path models and, 119 statistical, 116–17 substantive, 116 interictal epileptiform discharges (IEDs), 329 internal validity, 60 internalizing disorders see emotional disorders International Classification of Functioning (ICF), 820 International Classification of Primary Care (ICPC-2), 1170 Internet in child sexual abuse, 442 and suicidal behavior, 656 interneurons, 235 Interpersonal Cognitive Problem Solving (ICPS), 1027 interpersonal psychotherapy (IPT), 1083 in bulimia nervosa, 680 interpersonal relationships, internal representations, 1080 interpersonal therapy for adolescents (IPT-A), in depression, 256, 600–1 interpreters, working with, 482 intervention effectiveness assessment, 302–3, 310–11 primary, 989, 1173–4 INDEX 1218 secondary, 989, 1174 tertiary, 989 see also targeted preventive interventions; universal preventive interventions interviewer bias, 84 examples, 85–8 scientific studies, 84–5 suggestive interviewing techniques, 88–91 interviews in attachment disorder assessment, 911 in behavioral assessment, 1010 with child, 43–4 in depressive disorder assessment, 588 developments, 5 emotional tone, 89–90 in life event assessment, 392 in paraphilia assessment, 873 parental, 44–5 protocols, 92 rating scales vs, 292–3, 294 repeated, 88–9 rewards and punishments in, 90–1 in sexual abuse investigation, 450–1 see also family interviews; structured interviews intimate partner violence (IPV), 423–4 intracerebral hemorrhage, 153 intracytoplasmic sperm injection (ICSI), 505 introspections, 1009 inverse problem, 135 iodine deficiency, 824, 826 IPCT, 1073 IQ see intelligence irritability, in pediatric bipolar disorder, 613–14 IVF see in vitro fertilization Journal of the American Academy of Child and Adolescent Psychiatry, 10 Journal of Child Psychiatry and Psychology (JCPP), 10 juvenile, definition, 1106 juvenile delinquency, 1106–21 assessment, 1109–10 fitness to stand trial, 1109–10 general principles, 1109 needs, 1109 risk, 1109 future directions, 1120–1 historical context, 1106–7 interventions, 1110–20 assessment need, 1114 effectiveness, 1114–15 family-based, 1116–17 female delinquents, 1111–12 firesetting, 1111 foster care, 1119 with individual youths, 1115 ineffective, 1119–20 juvenile homicide, 1110 multiple component, 1117–19 pharmacological therapies, 1120 political and social context, 1114 prevention, 1114 rational targets for, 1112–14 sexually abusive behavior, 1110–11 special education, 1116 psychiatric disorders and offending, 1107–9 ADHD, 1107 antisocial personality disorder, 1107 anxiety, 1108 autism spectrum disorders, 1107–8 conduct disorders, 1107 deliberate self-harm, 1108–9 depression, 1108 early onset psychosis, 1108 post-traumatic stress disorder, 1108 prevalence, 1107 psychopathic traits, 1107 substance misuse, 1108 suicidal behavior, 1108–9 risk factors, 1112–13 implications for treatment, 1113–14 see also antisocial behavior 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1218

INDEX 1219 juvenile homicide, interventions for, 1110 juvenile onset neuronal ceroid lipofuscinosis, 469 K-complexes, 235, 238, 894 KABC-II test, 306 Kauai Recovery Index, 692 Kayser–Fleisher ring, 749 kernicterus, 154 Kiddie Formal Thought Disorder Scale, 750 Kiddie-PANSS, 750 Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS), 274–5, 631, 749, 1093 KidsHelp, 1163 kinesthesis, 810 kinship care, 504, 512 Kleine–Levin syndrome, 903 Klinefelter syndrome (XXY syndrome), 368–9 behavioral phenotype, 368–9 K-SADS, 274–5, 631, 749, 1093 Landau–Kleffner syndrome, 461, 789 differential diagnosis, 764, 789 language, 782 components, 787–8 language development delayed/impaired, investigation, 330 effects of early focal lesions on, 150 sensory impairment and, 957–8 language disorders, 782–3, 787–97 assessment, 783, 784, 791–2 decision-tree approach in assessment, 49 differential diagnosis, 748, 764, 788–91 language-learning impairments, 806–7 psychometric assessment, 307 receptive-expressive, 764 see also specific language impairment; speech disorders language therapy, in autism spectrum disorders, 767 late-talkers, 789–90 latent class models, 119 latent growth distribution, 119 latent variables, 118 lateralized motor potentials, 244 law see legal issues learning co-operative, 961, 1190, 1194, 1198 explicit, 708 implicit, 708 sleep in, 895–6 temperament differences and, 186 learning difficulties see learning disorders learning disability see intellectual disability learning disorders, 802–14 clinical implications, 812–14 assessment, 812 interventions, 812–14 emotional and behavioral adjustment in, 811–12 future directions, 814 general see intellectual disability see also developmental co-ordination disorder; language disorders; non-verbal learning disabilities; numeracy problems; reading disorders learning tests, 309–10 legal competency, 1131 legal issues, 95–109 child sexual abuse, 441, 451 children’s services, 97–8 criminal justice system, 96–7 education, 95–6 families and their children, 99–102 individual child, 102–9 mental health services, 98 Leiter International Performance Scale–Revised, 959 Leiter-R test, 307 length of stay (LOS), as outcome predictor, 1132 lesbian families, 506 Lesch–Nyhan syndrome, 304 features, 323 Life Book, 512 life challenges, changes in pattern of, 402 life events dependent, 392 independent, 392 individual differences in exposure to, 394–5 individual differences in response to, 396–8 positive aspects, 394 risk effects, 393–4 see also acute life stresses Lillie & Reed case, 82–92 lineal questions, 1066 linkage disequilibrium, 344 linkage studies, 345–6 lissencephaly, 152, 153 literacy normal development, 803 problems see reading disorders lithium in intellectual disability, 831 in pediatric bipolar disorder treatment, 619–20 “Living with Chronic Illness” questionnaire, 932 log-link functions, 114 logic model approach, 981–3 logistic regression model, 114 London cab drivers study, 152 longitudinal studies in causal hypothesis testing, 60–1 comparison group creation, 61 developments, 4 see also epidemiology LONGSCAN project, 429 low-income countries, intellectual disability prevalence in, 822, 824 Lowe syndrome, features, 323 lumping, splitting vs, 22 MacArthur Communicative Development Inventory, 789 macrocephaly, 152 conditions associated, 326 magical thinking, 1146 magnetic resonance imaging (MRI) in brain development study, 147 limitations, 136 structural, 134 value, 328–9 see also functional magnetic resonance imaging magnetic resonance spectroscopy (MRS), in schizophrenia, 744 magneto-encephalography (MEG), 134–5, 237 advantages, 237 future directions, 247 maintenance associations, 192 major depressive disorder (MDD) cortisol levels in, 400 see also depression maladjustment, 3 maltreatment, child see child maltreatment management, classification in, 18 management information systems (MISs), 982, 985 mania pharmacotherapy, 618–19 see also bipolar disorders marginal structural model (MSM), 120 marginal zone, 146 marginalized, access to services, 1163 marital conflict and conduct disorders, 552 as psychopathology risk factor, 384 and substance use/abuse, 576 markers, 991 masochism, 872 mastery motivation, 460 maternal deprivation, 3 mathematics disorder see numeracy problems matrix management, 1132 “Matthew effect”, 37, 995 maturational lag, 36–7, 243 Maudsley Depression Study, 126 Maudsley method, 679, 680 Meadow–Kendall Social and Emotional Adjustment Inventory, 963–4 meanings, complex, 1080 measurement, developments, 4–5 measurement error, 117–19 measures, universal meaning, 206–7 MECP2 testing, 329, 332 mediating mechanisms, 174–5 mediators, 991, 1002–3 medical confidentiality, rights of adolescents, 105 medical investigation, 327–34 benefits, 328 drawbacks, 328 economics, 328 genetic investigations, 329 harm from testing, 328 metabolic investigations, 329 numbers needed to test, 328 purpose, 317 specific clinical scenarios, 330–4 testing schema, 328 see also brain imaging; electroencephalography; history-taking; physical examination; specific investigations medical treatments see physical treatments medication age-related differences in response, 177 decisions on, 52 “off-label” interventions, 1093 see also physical treatments MEG see magneto-encephalography melatonin, in sleep disorder treatment, 899–900 memory assessment, 309 in post-traumatic stress disorder, 690 postnatal neurogenesis and, 148 Mendelian disorders, 344 Mendelian inheritance, 359–60 Mendelian randomization, 65, 120 Mendel’s Laws, 344 mental disorder see brain disorders mental health legislation, use to force treatment on adolescents, 107–8 mental health services see services mental retardation see intellectual disability mentalization, 845, 1082 Merrill–Palmer scale, 300 metabolic investigations, 329 metabolic syndrome, 620 metabolism, drug, 1101 metabolism genes, and alcohol abuse, 574 metachromatic leukodystrophy, 749 Metaphon, 786 methylphenidate (MPH) in ADHD treatment, 213–15, 220, 534, 535 brain PD analysis, 222, 224, 225–6, 227 brain PK analysis, 222 controlled-release (CR) formulations, 215, 219, 221 in hyperactivity treatment, 130 immediate-release (IR) formulations, 213–15, 219, 220 metabolic response to, 228 Metropolitan Area Child Study, 994 “MHSPY”, 1161 microcephaly, 152 conditions associated, 326 microdeletion syndromes, 360, 363–7 migration, as schizophrenia risk factor, 741 migration studies, 66–7 Milan group, family interviewing form, 1070 milestone moments, 319 mind-blindness, 766 Mindfulness-Based Cognitive Therapy (MBCT), 1010 minimal brain dysfunction (MBD), 3, 32 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1219

minor physical anomalies (MPAs), as psychopathy risk factor, 856 mirtazapine, brain PK analysis, 223 mismatch negativity (MMN), 245–6 Mixed Receptive-Expressive Language Disorder, 792 MMR vaccination, and autism spectrum disorders, 761 mobile phone technology, in child sexual abuse, 442 modafinil (MFL), in ADHD treatment, 216–17 model forensic services, trials of, 1121 modeling, 254–5 in anxiety disorders, 254–5 in behavioral therapy, 1013, 1016 live, 255 participant, 255 symbolic, 255 moderators, 991 Modified Checklist for Autism in Toddlers (M-CHAT), 766 Monitoring the Future Survey, 566 monothetic classes, 22 monozygotic (MZ) twins, 67 Montreal longitudinal prevention program, 1001–2 Mood and Feelings Questionnaire (MFQ), 588, 1010 mood stabilizers in autism spectrum disorders treatment, 769 in intellectual disability, 831–2 in personality disorder treatment, 848 moral socialization, 859 motivation in family therapy, 1116 in residential context, 1131 motivational enhancement therapy (MET), 578, 848 motivational interviewing, 1070 motor abnormalities, in schizophrenia, 737 motor skills disorder see developmental co-ordination disorder Move to Opportunity (MTO) program, 381 movement disorders diagnosis, 325–6 see also periodic limb movement disorder moyamoya syndrome, 238 MPlus, 119 MRI see magnetic resonance imaging MRI spectroscopy (MRS), 135 MST see Multisystemic Therapy MTA Cooperative Group trial, 1019 MTFC, 495–6, 1013, 1072, 1112, 1119 Multidimensional Anxiety Scale for Children (MASC), 630–1 Multidimensional Family Therapy (MDFT), 1072 Multidimensional Treatment Foster Care (MTFC), 495–6, 1013, 1072, 1112, 1119 multidimensionally impaired syndrome (MDI), 748 Multimodal Treatment Study of ADHD (MTA), 214–15 multiple baseline designs, 253 multiple personality disorder see dissociative identity disorder multiple sleep latency test (MSLT), 239 multiplex developmental disorder, 748 multiplex ligation-dependent amplification (MLPA), 329 multisensory impairment prevalence, 957 support and training for parents, 960 Multisystemic Therapy (MST), 259, 659, 1072, 1117–19, 1136–7 in antisocial personality disorder treatment, 847 behavioral methods taken up in, 1009 effectiveness, 1118, 1136–7 in paraphilias, 877 in suicidal behavior treatment, 659–60 training, 1039–40 treatment principles, 1117 Münchausen syndrome by proxy see factitious illness/disorder mutations, 359 myalgic encephalitis (ME), 936 investigations, 333 myelination, 147–8 MRI studies, 147 myelomeningocele, 152 myoclonus, 327 myoinositol (mI), 617 N-acetyl aspartate (NAA), 135, 617 “N of One” assessment methodology, 1101–2 narcolepsy, 239, 902–3 diagnosis, 902 differential diagnosis, 902–3 treatment, 902 Narrative Exposure Therapy (NET), 690, 693 narrative therapies, 1062, 1071 National Institute for Health and Clinical Excellence (NICE), 130 natural experiments in epidemiology, 64–5 in genetic and environmental cause examination, 65–8 nature–nurture interplay see gene–environment correlation (rGE); gene–environment interactions (G × E) “nay-saying”, 829 near-infrared spectroscopy (NIRS), 135 Nebraska Diagnostic Early Intervention Program, 960 negative affectivity, 183 negative emotionality, 183 traits associated, 187–8 negative reinforcement, 1013 neglect of child, 422–3 cognitive, 423 definition, 422 emotional, 423 differential diagnosis, 764 outcomes, 429 physical, 422–3 poverty and, 430 prenatal, 422 supervision, 423 treatment, 432–3 see also child maltreatment neighborhood, influence in conduct problems, 549 neural networks, effects of drugs on, 227–8 neural plasticity, 149–52 neural signature, 138 neurochemistry developments, 7–8 see also neuropsychopharmacology neuroconstructivist approach, 38 neurodegenerative disorders, 460–1 differential diagnosis, 749 key details, 469–70 neurodevelopmental disorders with ADHD, 524–5 causal models, 35–8 cognitive deficits, 35–6 etiological influences, 38 neurobiological bases, 36–8 clinical practice implications, 39, 176 commonalities among, 33–4 conceptual issues, 32–9 definitions, 32–3 developmental findings, 164–6 as distinct conditions, 33 male preponderance, 38 research implications, 38–9 “syndrome” of, 34–5 neurofibromatosis, features, 325 neurogenesis, postnatal see postnatal neurogenesis neuroimaging see brain imaging neuroleptic malignant syndrome, 831 neuroleptics brain PD analysis, 224, 226 brain PK analysis, 223 in personality disorder treatment, 848 INDEX 1220 neurological examination, 325–7 neurophysiology, 234–48 future directions, 247–8 history, 234 investigation selection, 240–1 see also electroencephalography; event-related potentials neuroplasticity, 37 neuropsychopharmacology, 212–29 effects of drugs on brain function and neural networks, 227–8 imaging studies, 223–7 psychiatric disorders and psychotropic medications, 213–18 see also clinical pharmacology neuroticism, 183, 841 description, 184–5 influences on achievement, 190 on health trajectories, 191 on relationships, 189–90 personality change pattern in, 189 and psychological disorders, 192–3 underlying process, 184 neurotransmitters and antisocial behavior, 548 concentration, 227 neurulation, 146 Newborn Hearing Screening Programme (NHSP), 956, 957, 960 nicotine replacement therapy (NRT), 577–8 night terrors, 900–1 NLD see non-verbal learning disabilities nocturnal enuresis, 916–20 assessment, 917–18 comorbidity, 916 definition, 917 etiology, 918 management, 918–19 monosymptomatic (MSNE), 917, 918, 919 polysymptomatic (PSNE), 917, 918, 919 prevalence, 916 relapse prevention, 919–20 treatment, 919–20, 1019 non-compliance, 1150 non-conscious mental states, influence, 1079–80 non-directive supportive therapy (NST), 659 non-parametric maximum likelihood (NPML) estimator, 119 non-polyglutamine (PolyQ) diseases, 361 non-stimulant medications, in ADHD treatment, 216–17 non-verbal learning disabilities (NLD), 35, 810–11 cognitive deficits in, 811 definition, 810–11 psychosocial outcomes, 812 noradrenergic systems, Tourette syndrome, 725 nucleotides, 339 number fact dyscalculia, 807 number line, 809 number needed to harm (NNH), 1096 number needed to treat (NNT), 112, 121, 1096 number sense, 808 numeracy problems, 807–9 assessment, 812 classification, 807 cognitive explanations, 808–9 executive deficits, 808 number processing deficits, 808 spatial deficits, 808–9 speed of processing impairments, 808 verbal impairments, 809 working memory impairments, 808 definition, 807 etiology, 809 brain bases of arithmetic disorders, 809 genetic effects, 809 incidence, 807–8 interventions, 813 psychosocial outcomes, 812 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1220

INDEX 1221 Nurse–Family Partnership (NFP), 972, 1052 Nurse Home Visitation program, 997 obesity, antipsychotic medications and, 751 objective environment, 380 observational learning, 1026 observational methods, 278–84 advantages, 278–9 assessment purposes child behaviors, 281–2 feedback to families, 282 global judgments about behaviors, 282 parent behaviors, 281 physical environment, 282 social environment factors, 282 therapy process, 282–3 developments, 5 limitations, 279 piloting, 279 reactivity to being observed, 279 reliability of measures, 283 selection considerations, 279–80 behavior code complexity, 280 behaviors to observe, 280 idiographic vs “off the shelf”, 279–80 tasks, 280 unit of analysis, 280 service context, 271 structured, 278 structured interviews and, 283–4 training, 284 validity of measures, 283 Observer Rating Scale of Anxiety, 281–2 obsessions, 701–2 obsessive-compulsive disorder (OCD), 698–712 as anxiety disorder, 701 biological factors, 704–7 neuroanatomical anomalies, 705–7 brain changes with therapies, 136 case illustrations, 703–4 childhood onset subtypes, 701 comorbidity, 703–4 anxiety disorders, 704 depression, 710 tic disorders, 703, 722 Tourette syndrome, 704, 722 course, 702–3 current issues, 698 definition, 698 diagnostic issues, 699–701 continuity with normal development, 699–700 continuity with obsessive-compulsive spectrum disorders, 700–1 differential diagnosis, 704 informant history importance, 700 epidemiology, 698–9 etiology, 704–9 genetic factors, 709 investigation, 332–3 natural history, 702–3 neurochemistry, 707–8 neuroendocrinology, 708 neuroimaging, 706, 707, 708 neuropsychological models, 708–9 presentation, 701–2 prevalence, 698–9 rating scales, 699, 1010 religious, 205, 208 and Sydenham’s chorea , 701 treatment, 709–12 augmenting strategies for partial responders, 711–12 behavioral therapies, 1016–17 combination, 710–11 immunomodulatory, 712 in-patient, 1133 maintenance therapy, 712 pharmacotherapy, 710, 711 pharmacotherapy with coexisting tic disorder, 731 physical therapies, 712 psychological, 709–10 triggers, 702 Obsessive Compulsive Foundation, 729 obsessive-compulsive spectrum disorders, 700–1 obstetric complications, 36 obstructive sleep apnea syndrome (OSAS), 901 OCD see obsessive-compulsive disorder ODD see Oppositional Defiant Disorder odds ratios (OR), 114 Odyssey Project, 497 “off-label” medication interventions, 1093 olanzapine, in schizophrenia treatment, 218 oligodendroglia, 147 openness to experience, 183 influences, on achievement, 190 personality change pattern in, 189 operant behavior, 832 operant conditioning, 1010 operant procedures, in conduct-related disorders, 258 operants, 1010 opioid agonist maintenance agents, 579 oppositional behavior in early childhood, 884 observational assessment, 281 Oppositional Defiant Disorder (ODD), 543–4, 555 pediatric bipolar disorder and, 615 oppositional disorders, ADHD and, 525 OR see odds ratios Oregon Social Learning Center (OSLC) foster program, 1056 organ transplantation, 937–8, 1152 orienting, 183 orthography, 803 otitis media with effusion (OME), 788 prevalence, 956 out-of-hospital care models, 1134–7 staffing, 1137 overactivity, 521, 523 with stereotyped movements, 523 overanxious disorder, 629 comorbidity, 629 prevalence, 631, 632–3 see also generalized anxiety disorder overbreathing, 238 overcorrection, 1015 overdoses, preventative approaches, 661 overshadowing, 334 Oxfordshire Home Visiting project, 1052 “P” drug dose, 1099 duration of treatment, 1099 selection, 1096 P3 potentials, 246, 248 palilalia, 721 PANDAS, 701, 704, 726–7 course, 703 etiology, 705, 706 treatment, 712, 731 panic disorder and deliberate self-harm, 654 genetic factors, 636 presentation, 629–30 prevalence, 631, 632–3 respiratory dysregulation and, 634–5, 639–40 separation anxiety and, 172 and suicidal ideation, 654 syndromal assessment, 1099 PANSS, 750 PAPA, 275–6, 883 paralimbic hypothesis, for psychopathy, 858 paraphilias, 872–8 assessment, 873–4 developmental course, 876 diagnosis, 872–3 epidemiology, 873 etiology, 874–7 conditioning, 874–5 neurological perturbations, 875 sexual abuse cycle, 875–6 future directions, 878 psychopathology associated, 874 treatment, 876–7 pharmacological, 876–7 psychosocial, 877 parasomnias, 900–1 assessment, 901 treatment, 901 PARCHISY, 282 parent–child interaction therapy (PCIT) in child maltreatment, 432 in conduct-related disorders, 259, 555 Parent–Child Model, 1085 parent education, for maltreatment risk parents, 433 Parent Management Training (PMT), 889, 1069 parent training behavioral in ADHD, 257, 536 in conduct-related disorders, 258–9, 555, 1018 parental counseling, in autism spectrum disorders, 768, 823 parental divorce and offspring substance use/abuse, 576 as psychopathology risk factor, 384 parental physical disorders effects on children, 409–10, 416 cancer, 409, 416 clinical implications, 416 HIV/AIDS, 409–10 parental psychiatric disorders in developing countries, 417 direct involvement of child, 413 effects on children, 49, 407–9, 410–17 alcoholism, 408 anxiety disorders, 407, 415, 636 bidirectional effects, 413 bipolar disorder, 407 clinical implications, 414–16 confounding effects, 413 depression, 407, 414–15, 636 developmental/age-specific effects, 413 eating disorders, 408, 412, 415 future considerations, 416–17 gender effects, 414 postnatal psychiatric disorders, 408–9, 412, 416–17 schizophrenia, 408 substance abuse, 408 suicidal behavior, 655 mechanisms of intergenerational transmission of risk, 411–13 environmental, 411–13 gene–environment interplay, 413 genetic, 411 and parental relationships, 412–13 primary care role, 1174 as psychopathology risk factor, 384–5 as risk factor, assessment of risk, 415 studies of parents of children with disorders, 410 treatment, 415–16 parental responsibility, 100 parental subsystem, strengthening, 1069 parental support, 187 parenting and adolescent substance use/abuse, 576, 581 child characteristics influence on, 1050–1 and child outcomes and psychopathology evidence linking, 1048–9 limitations of effects, 1049–51 theories linking, 1046–7 and conduct disorders, 551 differential, 383 and early childhood problem behavior, 884–5 failures of, as risk in childhood, 382–3 genetic influences on, 1050 poverty effects on, 382 quality, 383 social influences, 1050 styles of, 1047 parenting behavior, 187 observational assessment, 281 personality effects on, 190 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1221

parenting contracts, 96 parenting models, 884–5 parenting orders, 96 parenting programs, 1046–58 based on attachment theory, 1051–3 based on social learning theory, 1053–5, 1113 dissemination, 1056–8 future directions, 1058 mediators of change, 1056 moderators, 1055 predictors, 1055–6 child age and gender, 1055 child psychopathology, 1055–6 family factors, 1056 theoretical basis, 1046–51 Parents’ Checklist, 962 partial arousals, 900–1 participant bias, 984 passivity phenomena, 737 paternal age effects, 770 pathogenic care, 910 pathologic gender mourning, 868 PATHS curriculum, 961, 995 Pathways Mapping Initiative (PMI), 978 pattern recognition, purposes, 58 PDD-NOS definition, 761 differential diagnosis, 763, 764, 790 risk factors, environmental, 770 Pediatric Anxiety Rating Scale (PARS), 631 pediatric bipolar disorder (PBD), 613–21 assessment, 614–15 comorbidity ADHD, 615 anxiety disorders, 615 ODD, 615 substance abuse, 615 course, 613–14 diagnosis, 613–14 differential diagnosis, 614–15 pathophysiology, 616–18 behavioral data, 616–17 neuroimaging, 617 phenomenology, 613–14 in preschoolers, 616 presentation, 613–16 prevalence, 616 risk factors familial, 617–18 genetic, 618 treatment, 618–21 family therapy, 621 psychopharmacology, 618–21 psychotherapy, 621 pediatric consultation, 1143–53 approach to requests, 1145–6 assessment of child, 1146 –8 challenges associated with medical condition, 1147 developmental perspective, 1146–7 mental status examination, 1147 premorbid functioning of child and family, 1146 presentation to treatment team, 1148 assessment of family, 1147–8 barriers to requesting, 1144 chronic illness, 1150–2 collaboration between pediatricians and mental health consultants, 1144 dying in hospital, 1152–3 emergency consultations, 1148 history, 1143 models, 1144–5 case-by-case, 1144 protocol-driven, 1144 for non-compliance, 1150 primary psychiatric illnesses, 1148–50 psychological distress in pediatric population, 1144 Pediatric OCD Treatment Study (POTS), 1017 pedophilia, 441, 444, 872–3 diagnosis, 873 etiology, 875 treatment, 876 pedunculopontine neurons, 235 peer group effects, 200, 549–50, 1120 peer nomination measures, 194 peer relationships contamination, 91 deviant peer association, 1112 family–peer links, 1048–9 rejection, 549, 1112 and substance use/abuse, 577 and suicidal behavior, 655 peers, as proximal risk, 383–4 perceptual development, 149–50 performance, work, personality trait effects, 190–1 performance anxiety, 629 perinatal injury, as risk factor, 153 perinatal risk factors conduct disorders, 548 psychopathy, 856 schizophrenia, 740 period effects, 61–2 period prevalence, 113 periodic lateralized epileptiform discharges (PLEDs), 240 periodic limb movement disorder (PLMD), 901–2 treatment, 902 periodic limb movement in sleep (PLMS), 901–2 periodic phenomena, 240 periventricular leukomalacia (PVL), 153, 154 permanency planning, 952 Perry Preschool program, 1001 Personal Questionnaire Rapid Screening Test (PQRST), 303 personality, 182–95 assessment, 193–4 continuity and change differential, 188–9 mean-level, 189 definition, 182 genetic influences, 185–6 influences on life outcome, 189–91 and psychopathology development, 191–3 disruptive behavior disorders, 193 emotional disorders, 192–3 trait development, 185–8 elaboration, 186–7 traits in childhood and adolescence, 182–5 descriptions, 184–5 structure, 183–4 and treatment, 194–5 see also temperament personality-by-context interactions, 187–8 personality disorders, 841–8 categorical vs dimensional characterizations, 844 concepts, 841–2 diagnosis in childhood and adolescence, 846–8 clinical implications, 847–8 differentiations among, 843–4 dissociative identity disorder (DID), 205, 846 emergence, 658 episodic disorders and, 842–3 schizoid personality disorder, 846 social dysfunction and, 842 stability, 842–3 treatment, 847–8 validation, 842–4 see also antisocial personality disorder; borderline personality disorder; schizotypal personality disorder pervasive developmental disorders (PDD), 700–1, 759 comorbidity, Tourette syndrome, 722 neurodegenerative disorder in, 461 not otherwise specified see PDD-NOS psychodynamic psychotherapy in, 1086 sibling recurrence risk, 1185 structured interviews for, 276–7 see also Asperger syndrome; autism; autism spectrum disorders; Rett syndrome PET see positron emission tomography INDEX 1222 petit mal status, 464 phallometry, 873–4 pharmacodynamics (PD), 221–2 pharmacokinetic/pharmacodynamic model of drug in body, 212 pharmacokinetics (PK), 219–21 pharmacological treatments, developments, 9 phase delay chronotherapy, 899 phenotypes definition for genetic studies, 347–9 examination by twin studies, 353 intermediate, 342 presentation, modifying factors, 348 see also behavioral phenotypes; endophenotypes phenotyping, improvement, 157 phenylketonuria, 355, 1184 phobic disorder genetic factors, 636 longitudinal course, 635 parental depression and, 636 presentation, 628–9 phonemes, 785, 803 phonological-core variable-difference model, 804 phonological disorder, 785 phonological processing, 786 phonology, 787–8, 803 photic stimulation, 238 physical abuse of child, 422 outcomes, 429 see also child maltreatment physical environment, observational assessment, 282 physical examination, 45–6, 322–7 child abuse presentation, 322, 327 dysmorphology, 324–5 general, 324 neurological, 325–7 purpose, 317 value, 318 see also medical investigation physical illness see somatic disease physical treatments, 1092–104 addressing treatment needs, 1095 assessment and measurement, 1097–8 baseline, 1098–9 continued effectiveness, 1097 goals, 1097 human interface, 1102–4 “N of One” trial, 1101–2 non-physical treatments vs, 1095 outcome evaluation and maximization, 1099–101 polypharmacy, 1102 selecting treatment, 1095–7 availability, 1097 comparative risk–benefit profile, 1096 cost, 1097 ease of administration, 1096–7 patient acceptability, 1096 practitioner familiarity, 1095–6 selecting treatment target clinician knowledge, 1094 patient need, 1093–4 social factors, 1094 therapeutic evidence, 1094–5 selecting treatment target, 1092–5 physiological functioning, abusive parenting impact on, 1049 pica, 886 Picture Exchange Communication System (PECS), 767, 1197 play, sensory impairments and, 958–9 point prevalence, 113 poisons, detection, 327 Poisson distribution, 114 polyglutamine (PolyQ) diseases, 361 polymorphisms, 359 polypharmacy, 1102 polythetic classes, 22 population attributable fraction, 121 population movements, 474–5 population screening, 1184 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1222

INDEX 1223 positional candidate gene studies, 346 Positive and Negative Syndrome Scale (PANSS), 750 Positive Parenting Program (Triple P), 555, 889 positive reinforcement, 1012 positron emission tomography (PET), 135 brain function studies, 227–8 brain PD studies, 221, 223–7 brain PK studies, 221, 222–3 post-institutional autistic syndrome, 156 post-traumatic amnesia, 467, 468 post-traumatic stress disorder (PTSD), 686–94 after burns, 937 child maltreatment and, 690–1 child sexual abuse and, 446, 447, 452–3, 688, 690–1 treatment, 692–3, 1017–18, 1087 cognitive aspects, 689–90 concept, 686–7 cortisol levels in, 400 developmental aspects, 687–8 diagnosis, 686 exposure–response relationship, 689 exposure to war and, 381, 475–6, 480 family influences, 689 incidence, 688 and offending, 1108 physiological reactions, 690–1 prevalence, 688 prospective longitudinal studies, 688 protective factors, 690 risk factors, 688–90 single event traumas and, 692 stress reaction manifestations, 687 treatment, 691–4, 1009–10, 1017–18 behavioral therapies, 1017 cognitive–behavioral therapies, 690, 692–3 contingency planning, 693–4 early interventions, 691–2 eye movement desensitization and reprocessing, 693 medication, 693 Narrative Exposure Therapy, 690, 693 psychodynamic psychotherapy, 1086–7 posterior probabilities, 119 postnatal neurogenesis, 148–9 and memory, 148 postnatal psychiatric disorders, 408–9, 416–17 and parent–child interaction, 412 postpartum psychosis, 409 postsynaptic potentials, 234–5 see also excitatory postsynaptic potentials; inhibitory postsynaptic potentials post-test probabilities, 318 poverty and child maltreatment, 426 and childhood conduct problems, 550 culture of, 201 effects, 382 on parenting, 382 neglect and, 430 powerlessness, 448 Prader–Willi syndrome, 364–5, 825 behavioral phenotype, 364–5 features, 323, 325, 364–5, 825, 1197 pharmacological treatment, 832 psychopathology, 827 pragmatic language impairment, 790 treatment, 796 pragmatics, 788 praise, parent training on, 1054 prediction, 354–5 predictive values of negative test (PV−), 294 of positive test (PV+), 294 pregnancy complications, as schizophrenia risk factor, 740 sexual abuse and, 446 pre-implantation genetic diagnosis (PGD), 1183 Premack Principle, 1013 premature birth, as risk factor, 154 prenatal effects alcohol use/abuse, 575 brain development, 146–7 famine as schizophrenia risk, 740 gender preference, 868 intellectual disability, 824 neglect of child, 422 smoking, 173 stress, 401 substance use/abuse, 575 vascular injury, 153 prepulse inhibition abnormalities, 724 Preschool Age Psychiatric Assessment (PAPA), 275–6, 883 preschool children, behavioral problems of see early childhood problem behavior Preschool Feelings Checklist, 589 pretest probabilities, 318 prevalence period, 113 point, 113 preventive interventions, 989 adaptive, 991, 1000 personality relevance, 194 primary, 989, 1173–4 secondary, 989, 1174 tertiary, 989 see also targeted preventive interventions; universal preventive interventions primary health care, 1167–76 capacity building, 1174–5 care coordination, 1173 diagnosis of disorder, 1169–70 early intervention role, 1173–4 as first point of contact, 1167–9 associated psychiatric disorder, 1168 frequency of contact, 1167–8 functional somatic symptoms, 1168–9 presentation modes, 1168 psychosomatic presentations, 1168–9 future directions, 1175–6 intervention demand clarification, 1169–70 prevention role, 1173–4 recognition rates, 1169 referral to specialist services, 1173 service models, 1167 training, 1174–5 treatment, 1170–3 by primary care team, 1170–1 chronic condition management, 1173 complex interventions for depression, 1172–3 consultation liaison models, 1171 psychotropic medication for depression, 1171–2 shifted out-patient clinics, 1170 primary mental health workers (PMHWs), 1175 print exposure, 806 privation training, 1013 problem-solving deficits in, 1027 social, 1115 Problem-Solving Skills Training (PSST), 258, 1115 problem-solving therapies, 1027–8 in deliberate self-harm treatment, 659 procedural dyscalculia, 807 Process C, 895 Process S, 895 processes, development, 146 program fidelity, 982 progressive encephalopathy, 946, 947 progressive intellectual and neurological degenerative (PIND) diseases, 331, 332 Project COMBINE, 578–9 Project MATCH, 578 projection, 1080 proliferation, 146 prompting, 1013–14 propensity score weighting, 119–20 prosodic disorders, 787 and autism spectrum disorders (ASD), 787 prosody, 787 prospective measures, 163 retrospective measures vs, 163 prospective studies of clinically defined groups, 162 of general population epidemiological studies, 162 of high-risk groups, 162–3 prostitution, 442 protective factors, 385, 991–2 prototype, algorithm vs, 22 proxies, 991 pseudoepilepsy/pseudoseizures, 464–5, 940 PSST-P, 556 psychic defenses, 1080 psychoanalytic theory, 698 psycho-drama, 1084 psychodynamic psychotherapy, 1079–89 in anxiety disorders, 1085 assumptions, 1079–81 in chronic physical illness, 1086 in depression, 1085–6 developmental perspective, 1081, 1082 in disruptive disorders, 1086 in eating disorders, 1086 empirical basis, 1085–7 randomized controlled trials, 1085 family involvement, 1086 family therapy and, 1084, 1086 future directions, 1089 integration into mental health services, 1087–8 limitations, 1089 monitoring, 1088 outdated assumptions, 1081 in pervasive developmental disorders, 1086 relational approach, 1082–3 risks, 1081–2 theoretical frameworks, 1082–4 traditions, 1082 training, 1088 in trauma, 1086–7 see also attachment theory psychoeducation, 1104 psychological assessment, 45, 299–312 behavioral function assessment, 302, 1010–12 of children with rare disorders, 303–4 clinic-based, 299–301 intervention effectiveness assessment, 302–3, 310–11 non-clinic-based, 301–2 pre-assessment assessments, 299 reports, 311–12 single case research value, 304 testing environment considerations, 311 see also clinical assessment; psychometric assessment psychological causation, 1079 psychological conflict, 1080 psychological control, 187 psychological treatments see psychotherapy psychological unavailability see emotional neglect psychometric assessment, 304–10 achievement tests, 309 applicability determination, 305 attention, 308–9 children with language impairments, 307 children with low IQ, 307 executive functioning, 308–9 intelligence tests of general intelligence, 306–7 history, 304–5 psychometric properties, 305–6 memory, 309 other abilities, 307–8 practical issues, 309 preschool children, 307 reports, 311–12 standardized assessments, 305 unstandardized assessments, 309–10 see also psychological assessment psychopathological progressions, 171, 172 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1223

psychopathy, 546, 852–60 affectionless, 852, 856 assessment, 852–3 behavioral manifestation development, 854 in childhood, 852–60 traits associated, 187, 853 classification, 852 utility and validity of, 853 as clinical entity, 852–5 comorbidity ADHD, 853 anxiety and mood disorders, 854 Asperger syndrome, 853–4 autism, 853–4 epidemiology, 854 as extending into normal distribution, 854–5 fearlessness and, 854, 859 future research, 860 and offending, 1107 origins, 855–7 environmental factors, 855–7 genetic factors, 855 pathophysiology, 857–9 cognitive function level, 858–9 neural system level, 857–8 prevalence, 854 recidivism and, 853 treatment, 859–60 Psychopathy Checklist (PCL), 852 Psychopathy Checklist–Revised (PCL-R), 852–3 Psychopathy Checklist: Youth Version (PCL-YV), 852–3 psychosis affective, 747–8 atypical, 748 child maltreatment and, 741 differential diagnosis, 747–8 drug use and, 749 in-patient treatment, 1133 investigations, 333, 1182 and offending, 1108 postpartum, 409 schizoaffective, 747–8 and suicidal behavior, 654 see also schizophrenia psychosocial adversity, 377–87 chronic, acute life stresses and, 395–6 effects on children, 379–85 conceptual issues, 379–81 distal vs proximal influences, 379–80 empirical findings on distal risk factors, 381–2 empirical findings on proximal risk factors, 382–5 future research directions, 387 response differences to, 177 see also resilience; risk and resilience research psychosocial assessment, 49–50 Psychosocial Assessment of Childhood Experiences (PACE), 392 psychosocial influences, developments, 5–6 psychosocial risk factors, in diagnostic validation, 25 psychosomatic illness, 1149–50 pediatric consultation, 1149–50 see also family therapy psychostimulant treatment, of HIV-infected children, 950 psychotherapy, 251–65 assessing effects, 252–4 evidence forms, 252–3 meta-analyses, 253 narrative reviews, 253 child vs adult, 251–2 developments, 9 future research directions, 260–3 history, 251 mediation, 261–2 meta-analytic review findings, 259–65 critical tensions, 263–5 evidence base limitations, 260–3 evidence base strengths, 260 gap between research and clinical conditions, 262–3 moderation, 261 treatments showing replicated success, 254–9 ADHD and related problems, 256–7 anxiety-related disorders, 254–6 conduct-related disorders, 257–9 depressive disorders, 256 psychotropic medications neurochemical targets, 214 and psychiatric disorders, 213–18 PTSD see post-traumatic stress disorder public health, classification in, 18 publication bias, 112, 253 punishment, 1014 in challenging behavior treatment, 834 pupil referral units, 1194 PVL, 153, 154 pyramidal cells, 235 quality adjusted life years (QALYs), 130, 1160 quality assurance, 1163–4 quantitative trait loci (QTL) studies, 348 quasi-experiments, 63–4 Queensland Early Intervention and Prevention of Anxiety Project, 997 questionnaires developments, 5 in life event assessment, 392 in paraphilia assessment, 873 screening, 1169 in temperament assessment, 193–4 questions circular, 1066 lineal, 1066 reflexive, 1066–7 relative influence, 1067 repeated, 88, 89 strategic, 1066 quick Benson, 256 race, 202 randomization, 113 Mendelian, 65, 120 randomized clinical trials (RCTs), 252, 253 overemphasis on, 984–5 randomized controlled experiments, 62–3 developments, 8 rating scales, 289–97, 1010 abnormality, 291 advantages, 292 categorical vs quantitative approaches, 291–2 developmental considerations, 290–1 disadvantages, 292 empirical vs a priori approaches, 292 future challenges, 297 Internet-based assessments, 297 interviews vs, 292–3, 294 multicultural issues, 293–4 multisource data issues, 289–90 norms use, 291 as screening tools, 294 selection criteria, 296 use in clinical practice, 294–6 diagnostic assessment, 294 diagnostic formulation, 294–5 impairment measures, 295 outcome evaluations, 296 referral, 294 treatment effect monitoring, 295–6 treatment planning, 295 validity, 293 RCTs see randomized clinical trials reactive attachment disorder (RAD), 494–5, 910 see also attachment disorders reactive disappointment, 984 reactivity, 279 Read Codes, 1170 readiness potentials, 244 reading disorders, 802–7 assessment, 812 classification, 802 comorbidity, 811–12 INDEX 1224 comprehension impairments, 805 cross-linguistic manifestations, 806 decoding problems, 803–5 definition, 802 emotional and behavioral adjustment in, 811–12 etiology, 805–6 brain differences, 805–6 gene–environment correlation, 806 genetic influences, 805 social and environmental influences, 806 incidence, 802–3 interventions, 813 language-learning impairments, 806–7 normal literacy development, 803 susceptibility locus, 346 see also dyslexia; language disorders reading practice, 806 “Reading Recovery” approach, 1192 “reasoning and rehabilitation” programs, 1116 rebound, 1097 receptors, 213, 225 recidivism, psychopathy and, 853 recovery definition, 1099 treatment continuation after, 1101 recruitment effects, 190 refeeding syndrome, 682 referral, initial questions regarding, 42 reflexive questions, 1066–7 refugee and asylum seeking children definition of refugee, 474 psychopathology in, 474–83 clinic and service-based studies, 478 community studies, 476–8 conceptual issues, 475–6 epidemiological findings, 476–8 intergenerational effects, 480 intervention implications, 481–2 methodological considerations, 475 persistence, 480 resilience for, 478–9 risk for, 478–9 service implications, 481–2 unaccompanied asylum seeking children, 480–1 regions of interest (ROIs), 136 regression (medical) causes, 331 investigation, 331 regression (statistical), 114–16 toward the mean, 296 regulation, 183 Reimer, David, 867 reinforced exposure, 255 reinforcement contingencies, 833 negative, 1013 positive, 1012 schedules of, 1012–13 social, 870–1 see also differential reinforcement relapse prevention, as treatment goal, 1097 relationships as moderators of stress, 387 personality traits as predictors, 189–90 relative influence questions, 1067 relaxation training in ADHD, 257 in depression, 256 relevance, of test items, 305 reliability split-half, 305 test–retest, 305 religion, 201–2 beliefs and psychopathology, 205 sensitivity to, in service provision, 207–8 religious problems, 202, 205, 208 REM sleep, 239, 593 remission, as treatment goal, 1097 repartnering, and offspring substance use/abuse, 576 repeated questions, 88, 89 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1224

INDEX 1225 repetitive behaviors, observational assessment, 281 research, classification in, 18 Research Diagnostic Criteria–Preschool Age (RDC-PA), 883, 908 residential care, 487–98 assessment of psychological problems, 493–4 and attachment disorders, 488, 494, 907–8, 910, 912 continued use for very young children, 488 cost-effectiveness, 497 and deprivation, 907–8 educational outcomes, 493 effects in early life, 487–8 foster family care vs, 496–7 future directions, 497–8 group homes for children, 490–1 guidance for practitioners on use of, 491 improving environments of young children in, 489 leaving, 496 longer-term consequences on young children, 488–9 mental health of children in, 489–91, 492–3 interventions to improve, 494, 495–6 quality of evidence, 491 residential treatment centers, 491 Tizard’s study, 908 types, 489 see also in-patient treatment resilience, 377, 385–7, 396–7 in adoptive children, 508 associations, 192 in child maltreatment, 427 conceptual issues, 385–6 empirical findings child-specific attributes, 386–7 on relationships as moderators of stress, 387 future research directions, 387, 417 sibling comparisons, 401 see also risk and resilience research resistive wetting, 921 resource rooms, 1190 respiratory dysregulation, and panic disorder, 634–5, 639–40 response, as treatment goal, 1097 response cost, 1015 response covariation, 833 response prevention (RP), 256, 1017 response reversal, 857–8 response set modulation, 858–9 Response to Instruction model, 309 responsibility, assessment, 54 restless legs syndrome (RLS), 901–2 treatment, 902 “restorative justice”, 1113, 1116 restraint, mechanical, 1130–1 retrospective measures, 163 prospective measures vs, 163 Rett syndrome, 363, 461 behavioral phenotype, 363 differential diagnosis, 763 features, 323, 363 genetic tests for, 329 Revised Children’s Manifest Anxiety Scale (RCMA), 630 Revised Fear Survey Schedule for Children (FSSC-R), 630 reward training, 1013 rewards application, 1012 parent training on, 1054 and punishments, in interviews, 90–1 social, 1012 tangible, 1012 see also reinforcement Reynell–Zinkin Developmental Scales for Visually Handicapped children, 959 Reynolds Adolescent Depression Scale (RADS), 589 rGE see gene–environment correlation rheumatic fever, 726 risk–benefit ratio, 1096 risk factors across sociocultural/ethnic groups, 205–6 distal, 379–80 empirical findings on, 381–2 family level vs child-specific, 380 proximal, 379–80 empirical findings on, 382–5 roles in developmental pathways, 991–2 risk and resilience research designs that disambiguate effects, 377–9 disentangling genetic from environmental influence, 378 experimental design, 377–8 longitudinal models, 378–9 natural experiments, 379 testing competing models of mechanism, 379 see also psychosocial adversity risk-taking behavior, 466 risperidone (RIS) in autism treatment, 218 in conduct disorder treatment, 558 rituals, 701 “Robbers’ Cave” experiment, 199 role playing, 1016 Roots of Empathy, 1161 Rubinstein–Taybi syndrome, features, 323 rumination disorder, 886 sadism, 872 safe houses, 496 Safer Custody Group, 1109 Salford Needs Assessment Schedule for Adolescents (SNASA), 1109 same sex attraction, as risk factor of depression, 592 Sanfilippo syndrome, 470 SANS, 750 SAPS, 749 SB–5 test, 306 SBFT, 659, 1035 Scale for Assessment of Negative Symptoms (SANS), 750 Scale for Assessment of Positive Symptoms (SAPS), 749 “scapegoating”, 1129 scarcity, 123 “Scared Straight” program, 1119 scarring associations, 192 SCD, 937 schemas, 1029–30 schizencephaly, 152 schizoaffective disorder, 747–8 schizoid personality disorder, 846 schizophrenia, 737–53 ADHD and, 526 assessment, 747–50 developmental issues, 747 differential diagnosis, 747–9 interviews and rating scales, 749–50 bipolar disorders and, 745 child sexual abuse and, 447 childhood precursors, 161, 166 clinical characteristics in childhood and adolescence, 739 clinical features, 737–9 clinical phases, 738–9 premorbid impairments, 738 prodromal symptoms, 166, 738–9 concepts, 741–2 course, 739 diagnosis, 739 diagnostic criteria, 739 early detection, 750 economic studies, 131 epidemiology, 740 epilepsy and, 749 ethnic differences in rate, 204 etiology, 740–1 genetics of, 744–5 cytogenetic abnormalities, 745 multigene models of risk, 744 positional candidate genes, 745 incidence, 740 MMN as marker of, 245 mortality, 740 neurobiology, 742–4 functional brain imaging, 743–4 neuropathology, 742 structural brain abnormalities, 742–4 as neurodevelopmental disorder, 33, 741 neurodevelopmental models, 741–2, 744 neuropsychology, 746–7 cognitive deficits course, 746–7 cognitive deficits pattern, 746 outcome, 739–40 prevalence, 740 prevention, 176, 750 risk factors, 740–1 cannabis use, 166, 354, 740–1, 750 pregnancy and birth complications, 740 prenatal famine, 740 psychosocial risks, 741 schizotypal personality disorder and, 844 sex ratio, 740 subtypes, 739 and suicidal behavior, 654 susceptibility gene, 346 treatment, 750–3 antipsychotic medications, 217–18 family therapy, 752 organization of treatment services, 752–3 pharmacological, 750–2 psychosocial interventions, 752 schizotypal personality disorder (SPD), 748, 842, 846 schizophrenia and, 844 schizotypy, 842 school balance, effects, 200 school-based mental health service, 1161 for refugees, 481–2 School-Based Trauma/Grief Intervention Program, 1086–7 school cards, 258 School Development Program (SDP), 973–4 school ethos, effects, 200 school phobia, 629 school reports, 45 Schwann cells, 147 science, and practice, 265 Science of Prevention, 989 scientific maturity, progress of, 58, 68 screening general population, 77–8 programs, 317–18 questionnaires, 1169 seizures, 236–7 differential diagnosis, 330–1 see also epilepsy selection effects, 113 selective exposure, 113 selective mutism (SM), 791 self-control problems, 1028 and disruptive behaviors, 193 self-harm see deliberate self-harm self-monitoring, in gender identity disorder, 871 self-mutilation definition, 648 motives, 648 self-regulation development, 883 in gender identity disorder, 871 Self Report for Child Anxiety Related Disorders (SCARED), 630–1 semantics, 787, 803 sensitive periods, 151 sensitivity, 294 sensory development, 149–50 sensory impairments ability and achievement, 959 in autism spectrum disorders, 764 definitions, 956 and early language development, 957–8 and emotional development, 958 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1225

sensory impairments (cont’d) intellectual disability and, 827 mediating variables in child’s environment, 959–61 early parenting, 959–60 socioemotional interventions for children, 961 support and training for parents, 960–1 mental health disorders in children with, 962–4 autism, 963 interventions and services, 964 mental health assessment issues, 963–4 prevalence, 962–3 outcomes, 961–2 and play, 958–9 prevalence, 956–7 see also hearing impairment; multisensory impairment; visual impairment separation, as psychopathology risk factor, 384 separation anxiety disorder comorbidity, 630 in early childhood, 885 longitudinal course, 635 and panic disorder, 172 parental disorders and, 636 pharmacotherapy, 641 presentation, 629 prevalence, 631, 632–3 septo-optic dysplasia, 152 sequential comorbidity, 160 seretonergic systems, Tourette syndrome, 725 serotonin dysregulation, and suicide behavior, 652 sertraline, in anxiety disorder treatment, 217 service evaluators, young people as, 1164 service organization, 1156–64 accessibility promotion, 1162–3 evidence base, 1158–61 limitations, 1159 intervention prioritization, 1159–60 organizational structure prioritization, 1160–1 quality assurance, 1163–4 responding to need, 1156–8 access to provision, 1158 children “at risk”, 1156, 1157 children with diagnosable mental health problems, 1156, 1157 children in difficult circumstances, 1156, 1157 children with impairment caused by mental health difficulties, 1156, 1157–8 prioritizing needs, 1158 workforce building, 1161–2 service planning age variations, 73–4 epidemiology in, 71–8 family perception of need, 73 information needed, 71–2 referral patterns, 75–6 services appropriateness, 207–8 clinical see clinical services cultural sensitivity, 207–8 epidemiology of, 74 legal position, 98 policy decision-making on, 78 quasi-universal, 972 targeted, 972 trauma, 481 universal, 971–2 usage patterns, 75–6 see also community-based interventions and services; primary health care; service organization; service planning setting events, 833 severe injurious behavior (SIB) psychological assessment in, 303–4 self-restraint in, 304 severe mood and behavioral dysregulation, (SMD), 615 sex chromosomes, 340 sexual abuse of child see child sexual abuse sexual disorders, paraphilic see paraphilia sexual orientation and deliberate self-harm, 655 and gender identity disorder, 869, 872 and suicidal behavior, 655 see also gender identity disorder sexualized behavior, 445–6, 453 sexually abusive behavior, interventions for, 1110–11 shaping, 1013 Shapiro Tourette Syndrome Severity Scale, 728 shared environment, 349 shelters, 496 shift ratios, 1131 shifted out-patient clinics, 1170 SIB see severe injurious behavior siblings as proximal risk, 383–4 relationships, and early childhood problem behavior, 885 of sexually abused children, 453 suffering by, 1147–8 see also family sickle cell disease (SCD), 937 side-effects, 1097–8, 1099 silo budgeting, 125 Simpson–Angus Neurological Rating Scale, 750 single nucleotide polymorphisms (SNPs), 345 single-parent adoption, 506 site randomized experiments, 62–3 situationality, 523 skill, therapist, 1022, 1057–8 sleep developmental progression, 895 and emotion regulation, 896 in learning, 895–6 non-rapid eye movement (NREM) sleep, 894, 900 physiological processes in, 894–5 rapid eye movement (REM) sleep, 894, 901 sleep disorders, 894–903 and aggression, 896 in blind children, 963, 964 daytime sleepiness/difficulty waking up, 898–900 circadian and scheduling disorders, 899–900 inadequate sleep, 898–9 treatment, 899–900 future directions, 903 genetic contributions, 896 idiopathic hypersomnolence, 902–3 insomnia, 896–8 assessment, 897 conditioning model, 897 treatment, 897–8, 900 vigilance–avoidance model, 897, 898 Kleine–Levin syndrome, 903 and mood disturbance, 896 narcolepsy, 239, 902–3 diagnosis, 902 differential diagnosis, 902–3 treatment, 902 parameters, 897 parasomnias, 900–1 assessment, 901 treatment, 901 periodic limb movement disorder (PLMD), 901–2 treatment, 902 periodic limb movement in sleep (PLMS), 901–2 pharmacological treatment, 900, 901 prevalence, 895 restless legs syndrome (RLS), 901–2 treatment, 902 sleep-disordered breathing, 901 sleep recording, 238–9 sleep spindles, 235, 894 sleeper effects, 117, 997, 1085 sleepwalking, 900–1 SLI see specific language impairment slow cortical potentials (SCP), 243, 244 INDEX 1226 SMART Talk, 1040 Smith–Magenis syndrome, 365–6 behavioral phenotype, 365–6 features, 323, 365–6, 1197 smoking, prenatal, 173 Snijders–Oomen Non-verbal Intelligence Scale (SON-R), 959 social anxiety disorder comorbidity, 630 longitudinal course, 635 parental depression and, 636 presentation, 629 prevalence, 631, 632–3 social brain, 766 social causation, 66 social class, as schizophrenia risk factor, 741 social cognition, and conduct disorders, 549 social communication, observational assessment, 281 Social Communication Questionnaire (SCQ), 765 social competence parenting and, 1048–9 personality traits as predictors, 189 residential treatment and, 1127 social constructionism, 1062 social development, and developmental psychopathology, 150–1 social disinhibition after traumatic brain injury, 467 in disruptive disorders, 193 social dominance, 189 social dysfunction, personality disorders and, 842 social environment, observational assessment, 282 social groups, 199–200 social information processing model, 1029–31 automatic vs controlled information processing, 1030 cognitive distortions vs cognitive skills deficits, 1030–1 emotional arousal factors, 1030 role of schemas, 1029–30 social learning theory, 1018, 1026, 1047, 1113 parenting programs based on, 1053–5, 1113 effectiveness, 1055 features, 1053 format, 1053–4 social pedagogy model, 491 social problem-solving, 1115 social reinforcement, 870–1 Social Responsiveness Scale (SRS), 765 social rewards, 1012 social selection, 66 social skills observational assessment, 282 training, 1018, 1115 Social Stories, 768 social support, as moderator of stress, 387 social vitality, 189 sociocultural groups disorder manifestation variations, 205 disorder rate variations, 203–4 future research directions, 208–9 risk factors across, 205–6 socioeconomic status (SES) and antisocial behavior, 856–7 and language impairment, 794 Socratic method, 251 soiling see fecal soiling somatic disease, psychiatric aspects of, 930–40, 1150–2 asthma, 933–4, 1151 atopic dermatitis, 934 burns, 937 cancer, 935, 1151–2 chronic fatigue syndrome, 936 cystic fibrosis, 934 disease role in psychiatric disorder, 930–1 factitious illness by proxy, 938–9 factors increasing risk of psychiatric disorder, 931–3 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1226

INDEX 1227 age at onset of illness, 931 child’s personality attributes, 932 diagnosis accuracy and timelessness, 931 hope for recovery, 932 impact on physical appearance, 931–2 interference with function, 931 non-illness-related psychosocial stress, 932–3 parental responsibility for treatment of illness, 932 protective factors and mechanisms, 933 psychiatric aspects of child’s reactions to disease, 932 failure to thrive (FTT), 936–7 impact on physical appearance, persistence of symptoms, 932 juvenile onset diabetes mellitus, 934–5, 1151 organ transplantation, 937–8, 1152 pediatric consultation, 1150–2 physical symptoms without evidence of somatic etiology, 938 presentation of psychiatric disorders in form of somatic symptoms, 939–40 dissociative disorders, 939–40 epidemic hysteria, 939–40 family factors, 940 pseudoepilepsy, 940 psychodynamic therapy, 1086 psychosocial stress role in disease development, 930 sickle cell disease (SCD), 937 somatic treatment see physical treatment somatization disorder, 938 SON-R, 959 spastic hemiplegia, 462 special education, 1189–201 alternatives to full inclusion, 1190–1 behavioral and emotional problems, 1193–4 classroom management techniques, 1193–4 children excluded from mainstream school, 1194 class size, 1198 classroom environment improvement approaches, 1198 clinical recommendations, 1201 consultation services, 1199 early prevention programs, 1200 goals, 1189 impact on other pupils, 1200 inclusive education, 1189–90 attitudes to, 1198 empirical evidence for, 1190–1 mild to moderate intellectual impairments, 1191 academic attainments, 1191 self-esteem, 1191 social integration, 1191 para-professional support staff, 1199 parental roles and views, 1199–200 peer acceptance, 1200 physical disabilities and, 1194–5 post school, 1200–1 severe and pervasive intellectual disabilities, 1196–8 “syndrome specific” approaches, 1196–8 specialist teaching programs, 1190–1 “specific” learning disabilities, 1191–3 reading and spelling difficulties, 1191–2 specific language impairments, 797, 1192–3 teacher training and support, 1198–9 young offenders, 1116 special educational needs definition, 1189 statement of, 95 special educational needs and disability tribunal (SENDIST), 95 specific language impairment (SLI) in bilingual language learners, 795 cognitive factors, 795–6 comorbidity, 34, 792, 793–4 psychiatric disorders, 793–4 developmental findings, 164–5 differential diagnosis, 788–91 environmental factors, 794–5 genetic factors, 794 neurobiology, 795 non-verbal ability and, 788 prevalence, 792–3 prognosis, 797 special educational needs, 797, 1192–3 treatment, 796–7 specific reading disability (SRD), comorbidity, 34 specificity, 294 spectrum associations, 192 speech, 782 delayed/impaired development, investigation, 330 speech disorders, 782–7 assessment, 783, 784, 785–6 developmental verbal dyspraxia, 785 differential diagnosis, 783–5 fluency disorders, 786–7 phonological disorder, 785 prosodic disorders, 787 voice disorders, 787 see also language disorders speech sound disorders (SSD), 785 assessment, 785–6 comorbidity, 786 intervention, 786 prevalence, 786 prognosis, 786 risk factors, 786 speech therapy, in autism spectrum disorders, 767 spelling difficulties, 805 spike–wave complexes, 236, 240 spiritual problems see religious problems splitting, 1080 lumping vs, 22 SRD see specific reading disability SSRIs in anxiety disorder treatment, 217, 641 brain PD analysis, 226 in depression treatment, 217, 596–7, 601–2, 1100, 1171–2 in intellectual disability, 831 in obsessive-compulsive disorder treatment, 710, 711–12, 1100 in paraphilia treatment, 877 in personality disorder treatment, 848 side-effects, 217 and suicidality, 596, 660 staff hypothesis, 1130 stakeholders, 979 stammering, 786–7 stance assessment, 327 standardization, 113–14 Stanford–Binet tests see SB-5 test STAR curriculum, 1197 Stark County study, 1160, 1161 startle reflex, 639 State-Trait Anxiety Inventory for Children (STAIC), 630 static encephalopathy, 946–7 statistical methods, 111–21 causal analysis, 119–21 effects scales, 116–17 interactions, 116–17 measurement error, 117–19 misunderstandings, 112 natural history of “findings”, 112–13 regression, 114–16 reporting of results, 121 selection, 113 study design, 112 trajectory models, 119 see also confounding; randomization statistical parametric mapping (SPM), 136 “steeling” effects, 396 stem-cell donation, 1183 stereotyped behaviors, observational assessment, 281 stereotypic movement disorder see movement disorders stigmatization, 448 stimulants in ADHD treatment, 213–16, 256–7, 534, 535–6, 832 brain PD analysis, 222, 224, 225–6, 227 brain PK analysis, 222–3 in conduct disorder treatment, 557 effects, 213–15 in intellectual disability, 832 in Prader–Willi syndrome treatment, 832 stimulus control, 1014 stimulus–reinforcement associations, 859 Strange Situation Procedure, 282, 906, 909, 912, 958 strategic questions, 1066 strategy instruction, 1198 Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis, 981 stress mechanisms involved, 380–1 moderators of, 386–7 prenatal, 401 reaction manifestations, 687 response differences, 177 in somatic disease development, 930 in viral infections, 401 see also acute life stresses; acute stress disorder; post-traumatic stress disorder stress incontinence, 921 stress inoculation, 396 stress reactivity, 188 structural equation model (SEM), 118, 119 and interactions, 119 structural variations, 360 structured interviews (SIs), 272–7, 1093 advantages, 273 definition of structure, 272 in general psychiatric practice, 274–6 investigator-based, 273 limitations, 273–4 and observational methods, 283–4 reliability of measures, 283 respondent-based, 272–3 for specific disorders, 276–7 training, 284 validity of measures, 283 Sturge–Weber syndrome, features, 325 stuttering, 786–7 subacute sclerosing panencephalitis (SSPE), 469 sublimation, 1080 substance-induced psychotic disorder see substance use/abuse; tolerance; withdrawal syndromes substance use/abuse, 565–81 ADHD and, 525, 532 age at onset as marker, 170 and antisocial behavior, 172 assessment, 567 comorbidity anxiety disorders, 630 depression, 588, 590 pediatric bipolar disorder, 615 psychiatric disorders, 577 and depression, 172 developmental findings, 170 diagnosis, 567–70 dependence syndrome, 567–9 reconceptualizing adolescent disorder, 569–70 disorder prevalence, 566–7 epidemiology, 565–7 etiology, 571–7 harm reduction initiatives, 581 multiphase pathway, 175 and offending, 1108 parental, 1174 prenatal exposure, 575 prevention, 580–1, 978–9 risk factors, 570–7 associated with early use, 570–1 clustering of, 577 environmental, 574–7 genetic, 571–4 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1227

substance use/abuse (cont’d) and suicidal behavior, 654 treatment, 577–80, 1160 brief interventions, 579–80 coerced, 579 family therapy, 1073 in-patient, 1133 variation of effects with age, 176 see also alcohol use/abuse; drug abuse; tobacco use substitution, 1100 subtypes, conceptualization, 354 suggestibility case example, 82–92 hypotheses, 83–4 interviewer bias examples, 85–8 parents’ biases, 86–8 scientific analysis, 83–92 suggestive interviewing techniques, 88–91 definition, 81 developmental differences, 92 experimental measures, 81 focus on preschool-aged children, 82 misconceptions, 92 social context of research, 81–2 suicidal behavior, 648–62 ADHD and, 653 clinical assessment, 658–9 following deliberate self-harm, 658 screening, 659 cognitive characteristics, 652–3 definitions of terms, 648 developmental context, 649 emergency consultations, 1148 environmental factors, 654–7 availability of means, 656–7 childhood physical and sexual abuse, 655 exposure to suicide in media/music/Internet, 656 family history of suicidal behavior, 655 life stressors, 656 parental mental health disorders, 655 peers, 655 school, 655–6 sexual orientation, 655 future directions, 662 genetic aspects, 651–2 hospitalization and, 660 introduction to “suicidal process”, 649 management, 603–4 family therapy, 659 motives, 648–9 neurobiological aspects, 651–2 and offending, 1108–9 physical illness and, 654 prevalence, 649–51 prevention, 603–4, 660–1 protective factors, 657 psychiatric disorders associated, 653–4 antisocial behavior, 654 anxiety, 653–4 bipolar disorders, 653 borderline personality disorder, 658 conduct-related disorders, 654 depression, 590, 653 eating disorders, 654 psychosis, 654 psychological characteristics, 652–3 range, 648 risk factors, 651, 652 substance abuse and, 654 suicidality in-patient treatment, 1133 SSRI use and, 596, 660 suicide definition, 648 following deliberate self-harm, 658 impact, 657 media reporting guidelines, 661 methods, 651, 656–7 reducing access to, 661 prevention, 660–1, 1174 rates of, 649–50 ethnic group differences, 203, 649 suicide clusters, 655 suicide ideation definition, 648 depression and, 653 prevalence, 650 superconducting quantum interference devices (SQUIDs), 237 superstition, 702 supervision orders, 101 Sure Start, 75, 983, 984, 985, 1200 Sure Start Local Programmes (SSLPs), 974 guidelines, 977 surgency, 183 Surprise Party study, 85 survivor guilt, 687, 823 SWOT analysis, 981 Sydenham’s chorea, 701, 705, 726 symptom patterns, co-occurrence of different, 27–9 symptom treatment targets, 1098–9 synapses, 147 pruning, 147 synaptic plasticity, 247 synaptogenesis, 137–8, 147 syndromal checklists, 1098 syndromal targets, 1098 syndromes, 292 synergy, 116–17 systematic desensitization, 1010, 1015, 1016 systemizing, 766–7 TADS see Treatment of Adolescents with Depression Study tailored variables, 991 “talking therapies”, 832 tangible rewards, 1012 targeted preventive interventions (TPI), 989–1004 adaptive, 991, 1000 appropriately timed, 994 comprehensive, 994–5 coordinated, 997 cost-effectiveness optimization, 1000–1 cumulative modular strategy, 1003 developmentally sensitive, 994 dissemination, 1001 dosage and intensity, 995–6 ensuring potent causal mediators set in motion, 996–7 factorial approach, 1002 future directions, 1002–4 historical overview, 989–90 indicated, 990, 991 integration, 997, 1003 chronological level, 1003 outcome level, 1003 service delivery level, 1003 low participation consequences, 998 maximizing impact, 992–8 meta-analyses, 992–3, 1004 mobilization strategies, 998–1000 modes of intervention, 996 narrative reviews, 992, 993, 1004 parent engagement, 998–1000 risk determination strategies, 990–1 cumulative, 990 interactive, 990 weighted additive, 990 segmentation approach, 991 selective, 990, 991 sleeper effects in, 997 sociocultural relevance, 997 sociopolitical issues, 998–1002 teaching methods, 996 theory-driven, 993–4 theory illumination by, 1001–2 with universal preventive components, 995, 1002 what to target, 991–2 when to target, 992 INDEX 1228 TEACCH, 768, 1020, 1197 Teachers’ Checklist, 962 technology transfer, 978–9 Telefono Azzuro, 1163 telephone helplines, 1163 television, and suicide, 655 temperament assessment, 193–4 and conduct disorders, 548 definitions, 182 and psychopathology development, 191–3 study developments, 6–7 traits in childhood and adolescence, 182–5 descriptions, 184–5 structure, 183–4 and treatment, 194–5 see also personality temperament and character inventory (TCI), 183 temperament moderators, of stress, 386–7 temporal lobe epilepsy (TLE), 464 Test of Pretend Play, 958 test–retest attenuation, 295–6 thalamic reticular cells, 235 thalamocortical relay cells, 235 theories, developments, 9–10 theory of mind, development, in deaf, children, 958 theory of mind hypothesis, in autism spectrum disorders, 766 therapeutic alliance, 1021, 1022, 1038, 1057 importance, 1080–1 in in-patient and day unit care, 1130 “therapeutic milieu”, 1126–7 therapeutic relationship, importance, 264–5 therapist variables, 1021–2, 1057–8 thimerosal, and autism spectrum disorders (ASD), 761 threat perception, 400 threats, extreme, exposure to, 855–6 tic disorders, 719–32 assessment, 728 chronic motor (CMT), 720, 722 chronic vocal (CVT), 720 clinical descriptions, 720–1 comorbidity, 721–2 obsessive-compulsive disorder, 703, 722 diagnostic categories, 720 differential diagnosis, 727–8 etiology, 722–7 gender-specific endocrine factors, 725–6 genetic factors, 722–3 neural circuits, 723–4 neurochemical/neuropharmacological data, 725 neurophysiology, 724 perinatal risk factors, 726 post-infectious autoimmune mechanisms, 726–7 psychological factors, 727 future directions, 731 natural history, 720–1 prevalence, 720 transient, 720 treatment, 728–31 behavioral, 729–30 educational and supportive interventions, 728–9 neurosurgical interventions, 731 pharmacological, 730–1 pharmacotherapy of coexisting ADHD, 731 pharmacotherapy of coexisting OCD, 731 see also Tourette syndrome tics, 327, 332–3 complexity, 719 compulsions vs, 704 pharmacotherapy of, 730–1 phenomenology of, 719 time out, 258, 834, 1014–15, 1054 timing of disorder, 48 timing of exposure, 61 TMS, 137 repetitive (rTMS), 137 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1228

INDEX 1229 tobacco use compulsive, 569 continued use despite negative consequences, 569 legislative approaches, 580 media campaigns, 580 prevalence, 565–6 risk factors, familial, 571 tolerance, 568–9 treatment of dependency, 577–8 brief interventions, 580 withdrawal, 568–9 toddlerhood, behavioral problems of see early childhood problem behavior token systems, 1013 tolerance, drug, 568 tongue tie, 785 “total communication”, 1195 Tourette Syndrome Association, 729 Tourette syndrome (TS), 719–32 assessment, 728 clinical description, 720–1 comorbidity ADHD, 525, 721–2 anxiety disorders, 722 autism, 722 depression, 722 obsessive-compulsive disorder, 704, 722 pervasive developmental disorders, 722 Diagnostic Confidence Index (DCI), 720 differential diagnosis, 704, 727–8 etiology, 722–7 genetic factors, 722–3 neural circuits, 723–4 neurochemical/neuropharmacological data, 725 neurophysiology, 724 perinatal risk factors, 726 post-infectious autoimmune mechanisms, 726–7 psychological factors, 727 future directions, 731 gender-specific endocrine factors, 725–6 investigations, 332–3 natural history, 721 neurophysiological findings, 722 prevalence, 720 treatment, 728–31 behavioral, 729–30 educational and supportive interventions, 728–9 neurosurgical interventions, 731 pharmacological, 730–1 see also tic disorders; tics toxins, fetus exposure to, 153 TPI see targeted preventive interventions trace alternant, 235 trace discontinu, 235 trafficking, 442 trait measures, 348 TRAJ, 119 trajectory models, 119 trans modulators, 341 transcranial magnetic stimulation (TMS), 247 transcultural issues, in classification, 23 transference, 1081 transient tic disorder, 720 transitory cognitive impairment (TCI), 240 Transmission Disequilibrium Test (TDT), 345 transporters, 212, 223–5 blockade, 225–7 transvestic fetishism, 877 Trauma Focused Cognitive–Behavioral Therapy (TF-CBT), 690, 692 trauma services, 481 traumatic brain injury (TBI), 466–9 behavioral sequelae, 467–8 closed, 467 cognitive sequelae, 467–8 concussion, 466–7 family adjustment and support, 468 open, 467 severe, 467 treatment, 468–9 traumatic sexualization, 448 treatment advances, 8–9 common factors vs specific techniques, 264–5 contra-advised, 1096 contraindicated, 1096 effect monitoring, 295–6 modular approaches vs linear treatment manuals, 264 personality relevance, 194–5 responsivity to, 75 skill measurement in, 265 see also evidence-based treatments; pharmacological treatments; physical treatments; psychotherapy Treatment of Adolescents with Depression Study (TADS), 595–6, 597, 599, 603, 1035 NNT analysis, 1096 Treatment of Depression Collaborative Research Program (TDCRP), 1022 Treatment and Education of Autistic and related Communication-handicapped CHildren program (TEACCH), 768, 1020, 1197 treatment emergent adverse events, 1097–8, 1099 treatment fidelity, 265, 1021, 1022, 1037–8, 1057 treatment foster care (TFC), 259, 495–6, 497, 1137 see also Multidimensional Treatment Foster Care treatment manuals, modular approaches vs, 264 treatment planning, 51–3, 1130 treatment resistors, 813 treatment targets adverse effect, 1098, 1099 functioning, 1098, 1099 selection, 1092–5 symptomatic, 1098–9 syndromal, 1098 tremors, static/intention, 327 Triangle model, 803, 805 trichotillomania, 700 trinucleotide repeat expansions, 361 Triple P program, 555, 889 trisomy 21 syndrome see Down syndrome trouble, strategies for avoiding, 1054 tuberous sclerosis, 362 behavioral phenotype, 362 features, 325, 362 Turner syndrome, 367–8, 809 behavioral phenotype, 367–8 twin studies, 67–8, 349–53 alcoholism, 573–4 comorbidity, 352 comparability of twins to singletons, 351 designs blended families, 351 to examine environmental mediation, 351–2 to test for gene–environment interaction, 352 developmental questions, 353 equal environment assumptions (EEAs), 350 gender effects, 353 phenotype definition examination, 353 placental heterogeneity within MZ pairs, 350–1 variations in heritability by social context, 352 zygosity, 67 UNCRC see United Nations Convention on the Rights of the Child uniparental disomy, 329 UNIT, 307 United Nations, 474 United Nations Convention on the Rights of the Child (UNCRC) on child offenders, 97 on education, 95 on family, 99, 100 universal preventive interventions (UPI), 990, 1004 with targeted preventive components, 995, 1002 university–community relations models, 979–80 UPI see universal preventive interventions “urban war zones”, 1108 urge incontinence, 920, 921, 922 urinary tract infection (UTI), 916, 917, 921, 923 users, communication with, classification in, 18 UTI, 916, 917, 921, 923 utility, 128, 130 measurement, 130 vaccine damage see MMR vaccination; thimerosal vagal tone, 386 validity concurrent, 283 construct, 59–60, 305 ecological, 60 external, 59 internal, 60 predictive, 283 vascular injury, prenatal, 153 velocardiofacial syndrome (VCFS), 366–7, 825–6, 1182 behavioral phenotype, 366–7 genetic tests for, 329 ventricular zone, 146 verbal deficits, and conduct disorders, 548 verbal dyspraxia, developmental, 785 verbal IQ and ADOS score, 115–16 and autism spectrum disorders, 115–16 very low birth weight (VLBW), 154 video-EEG telemetry, 237 video-guided parent group approach, 259 video surveillance, 422, 939 viewing time, 874, 878 vigilance–avoidance model, 897, 898 Vineland Adaptive Behavior Scales, 765, 962, 964 violence adolescent partner, 547 domestic, and conduct disorders, 552 exposure to, 381 family, 423–4 gang membership and, 61 intimate partner (IPV), 423–4 organized, 474 traumatic brain injury and, 468 see also child maltreatment Visual Analog Scale, 1098, 1099 visual function, sensitive period for, 150 visual impairment ability and achievement, 959 “autistic features” in blind children, 959 and early language development, 957–8 educational needs, 1195–6 and emotional development, 958 mediating variables in child’s environment, 959–61 early parenting, 959–60 socioemotional interventions for children, 961 support and training for parents, 960–1 mental health disorders in children with, 962–4 autism, 963 mental health assessment issues, 963, 964 prevalence, 963 outcomes, 961–2 and play, 958 prevalence, 956 Voice Diagnostic Interview Schedule for Children (Voice DISC), 274 voice disorders, 787 voiding postponement, 920, 921 voxel, 136 voxel-based morphometry (VBM), 136 voyeurism, 874, 876 vulnerability association, 191–2 vulnerability factors, 385–6, 991–2 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1229

war, 474 effects, 474–5, 1108 exposure to, 381–2 assessment of, 475 see also refugee and asylum seeking children wardship jurisdiction, 98 websites, support, 1163 Wechsler Intelligence Scale for Children (WISC), 304–5, 959 Wechsler scales, 306, 812 welfare co-ordinator, 1128 Wender Utah Rating Scale, 533 wetting see daytime wetting; nocturnal enuresis white matter hypoplasia, 152 whole-genome association (WGA) studies, 346 wilderness programs, 1119 Williams syndrome (WS), 140–1, 363–4, 825, 1182 assessment example, 300–1 behavioral phenotype, 363–4 brain imaging studies, 140–1 incidence, 140 psychopathology, 827 social disinhibition in, 140, 911 spatial language understanding deficit, 373 Wilson disease, 469 differential diagnosis, 749 Kayser–Fleisher ring, 749 WISC, 304–5, 959 Wisconsin Card Sorting Test, 808 withdrawal, 1097 withdrawal syndromes, 409, 568 WJ-III-COG tests, 306 working memory, 460 wraparound services, 1134, 1135, 1136, 1161 INDEX 1230 X monosomy, 367 XXY syndrome see Klinefelter syndrome XYY syndrome, 369 behavioral phenotype, 369 Yale–Brown Obsessive-Compulsive Scale, 1010 Yale Global Tic Severity Scale (YGTSS), 728, 1098 “yea-saying”, 829 Young Autism Project, 1020 young offenders institutions for, 97 treatment, 1114 family therapy, 1073 YoungMinds Parent Information Service, 1163 Youth Offending Teams (YOTs), 1114 zoophilia, 872 9781405145497_6_ind.qxd 29/03/2008 03:01 PM Page 1230