Editorial: The well‐being of children: empirical findings and implications for prevention and intervention

Field: Psychology (Social Sciences)

The current issue is a faithful example of the Journal of Child Psychology andPsychiatry’s stated task–to publish reports on the mental health of children and adolescents. This is an international issue with many papers on children and their families, who are experiencing adverse life conditions. It includes contributions from Bangladesh, England, Norway, Puerto Rico, South Africa, Sweden, and the USA. The opening Practitioner Review on the applicability and benefit of using paediatric hypnosis offers an in-depth narrative summary of studies on the role of clinical hypnosis in paediatric care. Hypnosis has been successfully used to treat enuresis, food aversion, hair-pulling, sleep difficulties, tics, pulmonary conditions, asthma and other breathing difficulties, cystic fibrosis, dermatological conditions, acute procedural pain and distress associated with oncology related procedures, postoperative pain, burns, and chronic pain. The take-home message is that hypnosis is underused, and can be extremely helpful to children and their families in reducing physical and emotional discomfort and pain. Next, we have a group of four papers that focus on some heartbreaking conditions that, unfortunately, too many children are exposed to around the world. Cluver, Gardner, and Operario draw our attention to the AIDS epidemic in South Africa, where about 30% of all pregnant women are HIV-positive and an estimated 830,000 children lost one or both parents to AIDS in 2005. A paucity of research exists about orphaned children in general and about those orphaned due to AIDS in particular. Not surprisingly, the findings of this study are alarming. The participating children, orphaned and non-orphaned, who live in deprived urban settlements in Cape Town, all reveal high levels of distress and psychological symptoms. Yet the children orphaned by AIDS show the highest levels of distress and impaired functioning. Children orphaned due to AIDS are more likely to be orphaned from their mother or both parents compared to other orphans. Most distressing is the finding that 50% of the children orphaned by AIDS meet criteria for posttraumatic stress disorder, compared to only 30% and 23% of the children in the two comparison groups. Similarly, more children orphaned by AIDS reveal depression, anxiety, peer problems, conduct problems, and delinquent behavior. Results of this study indicate that the psychological difficulties only worsen with time as these children grow up. This report delineates the greater risk and vulnerability of AIDS-orphaned children and emphasizes the devastating need for specialized prevention and intervention programs for these disadvantaged youth. In the next paper, Black et al. investigated how depressive symptoms among 221 young rural Bangladeshi mothers relate to infant development. Maternal depressive symptoms, maternal perception of infant temperament, infant development, and caregiving practices were assessed by adapting well-known measures to the specific culture. The disturbing findings indicate that depressive symptoms are relatively common among these young mothers, with 52% meeting the clinical cutoff criteria for depression. Mothers who report depressive symptoms and perceive their infants as irritable have infants who acquire fewer developmental skills from 6 to 12 months compared to infants of mothers who report only depressive symptoms or only perceive irritability or neither. This study is extremely important in that it highlights the very early intergenerational transitional effect of maternal depression symptoms to the next generation and once more specifies the need for clinical prevention and intervention programs. Weiss et al. delineate the teratogenic effects of fetal drug exposure on infants’ development at ages 3 and 6 months by examining its contribution to temperament. Thirty infants whose mothers used cocaine and/or opiates were compared to 90 infants whose mothers were free of drug use. The drug-exposed infants received higher scores on 2 of the 9 temperament scales: intensity of expressivity and distractibility. The researchers discuss this greater distractibility in relation to long-lasting changes in dopamine neurons, once more revealing the longitudinal detrimental effect of prenatal drug exposure, and the need for more funding to reduce drug use among pregnant women. Hysing et al., in the last paper in this group, examine the important issue of mental health in children who suffer from chronic physical illnesses. This study is part of an ongoing longitudinal population-based survey of Norwegian 7- to 9-year-old children. These children were screened with the 25-item Strengths and Difficulties Questionnaire (SDQ), which is a behavioural screening instrument completed by parents and/or teachers, appropriate for use with children and adolescents between the ages of 4 and 16 years. It yields 5 domain scores: emotional symptoms, conduct problems, hyperactivity-inattention problems, peer relations problems, and prosocial behavior. The authors provide data regarding the specificity and sensitivity of the SDQ and highly recommend its use as a short behavioural screening instrument in paediatric settings. Screening for behavioural difficulties is important so that appropriate services and intervention programs may be implemented to alleviate the distress and difficulties experienced by these children. Going back to the opening Practitioner Review, hypnosis may be one of the modalities used to help these children. The next group of papers includes four reports related to autism. The first two papers tackle the difficult issue pertaining to the identification of prognostic characteristics in very young children with autism spectrum disorder (ASD). In the first paper, Turner and Stone report on the stability of ASD in a group of 48 young children. Using clinical judgment at age 2 years as the gold standard, 30 of the 48 children maintained an ASD diagnosis, whereas 18 children no longer received an ASD diagnosis at age 4 years. Gender, race, and intervention type and history were not associated with change in diagnostic status, but children in the changed diagnosis group received lower symptomatology scores at age 2 years. More children who were initially diagnosed before 30 months of age revealed change than those diagnosed after age 30 months. The important take-home message is that clinicians who make early diagnoses should be aware that about 30% of the children who are given a diagnosis of ASD and 60% of the children who are given a PDD-NOS diagnosis at age 2 do not retain their ASD diagnoses at age 4 years. Although the great majority of these children continue to show various delays in language and/or cognition, clinicians and parents should be aware and have their children re-assessed periodically so that appropriate services may be implemented. The next paper, by Magiati, Charman and Howlin, presents a 2-year prospective intervention outcome study. In contrast to some earlier reports, home-based Early Intensive Behavioral Interventions (EIBI) was not advantageous over autism-specific nursery programs for young children with autism. These findings corroborate those of Turner and Stone (see above), who also found that type of intervention was not associated with change in diagnostic status for young children with ASD. This study supports the call for more funding and investment in establishing various educational and intervention programs so that families may have more alternatives as to what kind of treatment they choose for their young children with ASD. Next, Smith and Bennetto reveal evidence of audiovisual integration impairment in high-functioning individuals with autism. These adolescents needed a louder volume of speech in order to comprehend it in both the audio only and audiovisual conditions and they were less successful in the lipreading-only condition compared to their typically developing peers. Yet, similar to typically developing adolescents, adding visual information enhanced their ability to perceive auditory information. Thus, individuals with autism may benefit from training in lipreading and in audiovisual integration, as so many interactions with others are dependent on verbal social communication. In the fourth paper, Whitehouse, Barry and Bishop investigate whether autism and specific language impairment (SLI) share a common genetic aetiology by investigating the linguistic and social-communicative abilities of parents of children with autism, SLI, and typical development. Their findings indicate no overlap in that parents of children with autism perform better than parents of children with SLI on most measures, and they also perform as well as parents of children with typical development on all linguistic measures employed. In contrast, parents of children with autism report a higher level of autistic symptomatology than parents of children with SLI. Finally, two papers focus on attention-deficit/hyperactivity disorder (ADHD). The first, by Bauermeister et al., examines possible differences in the clinical picture of ADHD between 4- and 17-year-old boys and girls. This is another international study carried out in Puerto Rico as part of an island-wide probability household community sample. Altogether, findings demonstrate that boys reveal higher scores indicating greater global impairment as well as disruptive behaviours, more speech and sleep problems, grade failure, and school suspension. They are also more likely to receive treatment than girls. Yet, when the data were analysed comparing boys and girls with ADHD to boys and girls without ADHD, only school suspension emerged as a significant difference, with boys suspended from schools more often than girls. Examination of the various subtypes of ADHD reveals that boys with both inattention and hyperactivity-impulsivity symptoms are at a greater risk for a comorbid mood diagnosis compared to girls with both sets of symptoms, whereas girls with inattentive symptoms are at a greater risk for anxiety disorders compared to boys with inattentive symptoms. Altogether, the researchers conclude that boys and girls with ADHD reveal more similarities than differences. In the final paper, Soderlund, Sikstrom and Smart, in a trail-making study, challenge the prevailing notion that cognitive processing is impaired by noise in children with ADHD. They propose that the phenomenon of stochastic resonance, which refers to the fact that detection of a subthreshold signal is enhanced by addition of noise in a nonlinear system, accounts for the noise-induced improvement in children with ADHD because it raises the level of dopamine. Using elegant experiments, these researchers demonstrate for the first time that noise indeed enhances performance for the group with ADHD, whereas it impairs performance for the typically developing children. These findings are of great importance because they suggest that, counterintuitive to the notion that all external noise should be reduced or eliminated when children with ADHD are trying to concentrate, actually children with ADHD should be allowed to listen to music when studying. These findings may be used to create more optimal environments for children with ADHD. This is my first editorial for the journal and, as such, I had direct input only to few papers in this issue. As a joint editor, I hope to see more and more papers that are based on solid empirical methodologies while aiming to enhance the well-being of children and adolescents, and their families, wherever they may reside. On the methodological side, I invite authors to report on effect sizes that are independent of sample size. This is particularly important for studies with relatively small sample sizes, such as some of the studies included in this issue. Effect size indices may reveal meaningful group differences that have not attained statistical significance due to low power, secondary to small sample size. Furthermore, effect sizes assist in confirming that a lack of statistically significant differences is due to small differences between groups, rather than simply an artifact of low power. This is even more important when the finding of interest is one of null results. On the more applied side, the current status and well-being of children is the harbinger of our future. Thus, papers such as those included in this issue can have a direct impact on the lives of children because they provide an outline for future empirical studies as well as draw the attention of empiricists as well as policy makers to the much needed prevention and intervention programs that can enhance the well-being of many children and families.