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Background: Rutter and colleagues' seminal observation that extended early life exposure to extreme institutional deprivation can result in what he termed quasi-autism (QA), informed both our understanding of the effects of adversity on development and the nature of autism. Here we provide the first detailed analysis of the adult outcomes of the group of institutionally deprived-then-adopted children identified as displaying QA.Methods: twenty-six adult adoptees identified with QA in childhood (Childhood QA+) were compared to 75 adoptees who experienced extended institutional deprivation (>6 months) but no QA (Childhood QA−), and 116 adoptees exposed to Low/No institutional deprivation. The outcomes were child-to-adult developmental trajectories of neuro-developmental symptoms (autism, attention-deficit/hyperactivity disorder (ADHD), disinhibited social engagement (DSE) and cognitive impairment), adult functioning, life satisfaction and mental health.Results: childhood QA+ was associated with elevated and persistent trajectories of broad-based autism-related difficulties, ADHD and DSE symptoms and low IQ, as well as adult mental health difficulties and functional impairment, including high rates of low educational attainment and unemployment. Life satisfaction and self-esteem were unaffected. Autism-related communication problems, in particular, predicted negative adult outcomes. Childhood QA+ was still associated with poor outcomes even when ADHD, DSE and IQ were controlled.Conclusions: early and time-limited institutional deprivation has a critical impact on adult functioning, in part via its association with an early established and persistent variant of autism, especially related to communication difficulties. Apparent similarities and differences to non-deprivation related autism are discussed.

Background: Using data from the English & Romanian Adoptees (ERA) study, we recently reported that early timelimited exposure to severe institutional deprivation is associated with early-onset and persistent neurodevelopmental problems and later-onset emotional problems. Here, we examine possible reasons for the late emergence of emotional problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of early-appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative pathway via sensitization to stress. Methods: The ERA study includes 165 Romanian individuals who spent their early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15 anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety were assessed by both parent and self-reports; young adults also completed measures of stress reactivity, exposure to adverse life events, and functioning in work and interpersonal relationships. Results: The path between early institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with regard to early deprivation, later life stress reactivity, and emotional problems were inconclusive. Conclusions: Our analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is explained through the effects of early neurodevelopmental problems on later social and vocational functioning. Future research should more fully examine the role of stress susceptibility in this model. Keywords: Institutional deprivation; depression; anxiety; emotional problems; developmental cascades; neurodevelopmental problems; longitudinal; prospective; natural experiment.

Autism is associated with complex and diverse needs that vary from individual to individual. Those affected, and their families, often require specialist care and support. These involve educational and clinical skills which are demanding to implement effectively, and costly, in terms of time and money, to deliver. Early screening and intervention approaches, which can improve outcomes, sometimes dramatically, require government prioritisation of investment. A coordinated, evidence-based approach to screening and support is critical for ensuring that individuals with autism thrive. Autism is, of course, a global phenomenon. Whilst its meaning and significance will inevitably vary from one culture to the next, epidemiological studies report similar presentations and rates across all nations and ethnic/racial groupings. Indeed, the provision of effective services to support people with autism is recognised as a universal human right and a global health priority (Divan et al., this issue). However, although the care needs of people with autism are largely similar across the nations of the world, they will inevitably involve a disproportionate call on the finances of less wealthy nations - and a nation's ability to meet the needs of people with autism is inevitably constrained by their financial circumstances. Countries with limited resources have very difficult choices to make between competing calls for investment that impact their ability to prioritise services for people with autism. Here we explore the implications of these constraints and the best way to address them in the light of the review by Divan et al.

Background Identifying low‐cost and easy to implement measures of infant markers of later psychopathology may improve targeting of early intervention for prevention. Because of their early manifestation, relative stability and overlap with constructs central to affect‐based dimensions of child and adolescent psychopathology, negative emotionality and self‐regulation have been the focus of this research. We conducted a meta‐analysis of longitudinal studies examining the prospective association between infant temperament measured with parent ratings and child/adolescent psychopathology. Methods A systematic literature search for prospective longitudinal studies, which included measures of questionnaire‐assessed infant temperament (negative emotionality, self‐regulation, behavioural inhibition, surgency/extraversion, activity level) and symptoms of child or adolescent mental health (externalising, internalising) and neurodevelopmental problems (attention deficit/hyperactivity disorder [ADHD], autism spectrum disorder [ASD]), was conducted. Standardised estimates of association were calculated and pooled in meta‐analyses. Results Twenty‐five studies (n = 28,425) met inclusion criteria. Small associations were seen between psychopathology aggregated across all domains and infant negative emotionality (r = .15; p < .001) and self‐regulation (r = −.19; p = .007). Effects were also significant but weaker for behavioural inhibition (r = .10; p = .027) and activity level (r = .08; p = .016). Surgency/extraversion was not significantly associated with psychopathology in general (r = −.04; p = .094); however, it was negatively associated with ASD (r = −.10, p = .015). Significant correlations were observed with some outcomes isomorphic with predictors, internalising problems and behavioural inhibition (r = .10; p = .013), ADHD symptoms and activity level (r = .19; p = .009). Conclusion Questionnaire‐based assessments of infant negative emotionality may have transdiagnostic potential to contribute to a risk index of later childhood psychopathology. Behavioural inhibition, surgency/extraversion and activity ratings may provide more specific predictive power. More data from prospective studies are required before the potential of self‐regulation and surgency/extraversion can be properly gauged.

The search for objective biological tests, sufficiently reliable, and predictive enough to be diagnostic of psychiatric disorders, continues apace – yet their discovery remains a distant dream. It seems increasingly unlikely that current diagnostic structures and concepts map biologically in a straight forward way – with heterogeneity within, and sharing across, existing diagnostic boundaries being the biological rule rather than the exception. Indeed, it now appears that the science of biological psychiatry is more likely to redraw those boundaries than it is to confirm and mark them (Sonuga‐Barke, Journal of Child Psychology and Psychiatry, 2016, 57, 1). Clinical identification of childhood psychiatric disorders therefore remains, for the foreseeable future at least, an exercise in regulated social perception – reliant on the fallible and subjective judgements of parents, teachers and clinicians. Social perception of this sort is an active and motivated process and therefore prone, like all social perception, to bias and distortions – both systematic and idiosyncratic. Progress has certainly been made over the last 50 years in reducing such judgement bias by, for instance filtering perceptions through the lens of standardised instruments (questionnaires and interviews) with carefully operationalised items and a degree of reliability and validity. However, such instruments often play only a peripheral role in actual diagnostic encounters and when they are used, there is still sufficient ambiguity to leave open plenty of room for interpretation. When we acknowledge that psychiatric diagnoses are social constructions – we are not saying that symptoms of inattention, impulsivity and hyperactivity are not real or do not cluster together in meaningful ways or that they do not cause real distress and disability but that their interpretation and meaning are often informed by social constructs such as ethnic or gender norms and stereotypes (Meyer, Stevenson, & Sonuga‐Barke, Journal of Attention Disorders, 2019).

As in life generally, so in scholarly publishing, the turn of the year inevitably encourages editors to reflect soberly and take honest stock of the progress their journals have made over the previous 12 months. In this frame of mind, my own thoughts turned to our beloved Journal of Child Psychology and Psychiatry. Of course I say ours because we who currently work at the journal, know it actually belongs to you, the world-wide community of child and adolescent psychologists and psychiatrists: We are only its stewards. We hold it in trust for the whole field. We understand the important role that it has served, in shaping the field of scientific child psychology and psychiatry. We know it has a special place in both your intellectual and working lives. We are aware how important it is to you that the journal continues, on your behalf, to help drive the promotion of science-driven and evidence-based solutions to the great, and, in some aspects, growing, burden of suffering imposed by childhood mental and neuro-developmental disorders. It is vital that we have your confidence that we do this in a transparent and fair way - without fear or favour - not letting our own preconceptions, prejudices or vested interests influence the content of what we publish - unless it is our prejudice towards, and vested interest in, finding out 'the truth of the matter'. We are acutely aware of the responsibility that all this places on our shoulders - a yoke we feel privileged to bear.

Science is not a linear process of accumulating knowledge. To the contrary, progress in understanding is most likely to occur, especially in less 'mature' disciplines, when healthy debate between opposing points of view create a dialectic in which thesis and antithesis force a new synthesis. In developmental psychopathology, such tension between opposing schools of thought continue to play a vital role in driving discovery across a wide range of topics.

Developmental language disorders (DLD) are common and have far-reaching developmental consequences. Nevertheless, public awareness of DLD is poor, and one goal of this special issue is to showcase a set of papers that provide a clear and coherent message about the nature and impact of DLD, and the potential of intervention to mitigate these impacts. In this editorial, we highlight seminal papers JCPP has published on language disorders over the last 40 years. Many of the issues raised then are still relevant now; however, the papers that comprise this special issue exemplify how far the field has come in achieving consensus on terminology and diagnostic criteria, and producing highly consistent findings on the stability and impact of DLD, and the potential for language change in response to targeted interventions. The editorial concludes with a road map for future research and clinical priorities that includes the need for randomised controlled trials that specifically address the impact of co-morbidities on response to treatment, impacts of intervention on broader developmental outcomes, and the experiences of adults with DLD.

Neuroplasticity, the brain's capacity to be shaped in response to environmental experience, has been claimed to resemble a double-edged sword - potentiating growth and healing when individuals are exposed to normative, benign or therapeutic environments on the one hand, mediating mental disorder development in those exposed to adversity, on the other. However, questions about the scope and limits of neuroplasticity and, especially, its clinical significance, remain unanswered.

In this short overview we have illustrated 30 years of progress in the field of ADHD neuropsychology through a selective presentation of studies published in the JCPP. Clearly this is not an exhaustive list of papers (we had to leave many excellent studies out) and obviously many studies published in other journals have had an equally significant impact on the field. Nevertheless, it is clear that the JCPP has contributed in important ways to providing the empirical and intellectual foundations of the next generation of ADHD neuropsychological models in terms of insight regarding context dependence, complexity and heterogeneity, and diagnostic specificity and sensitivity. Furthermore, articles have highlighted the importance of a developmental perspective on neuropsychological deficits in ADHD as well as the possibility that they could be targeted with new and novel treatments. Our hope is that we will continue to witness similar growth in understanding over the next 30 years, and that the JCPP will continue to be at the forefront of this progress.

Background: Emotional lability (EL) is commonly seen in patients with attention-deficit/hyperactivity disorder (ADHD). The reasons for this association remain currently unknown. To address this question, we examined the relationship between ADHD and EL symptoms, and performance on a range of neuropsychological tasks to clarify whether EL symptoms are predicted by particular cognitive and/or motivational dysfunctions and whether these associations are mediated by the presence of ADHD symptoms. Methods: A large multi-site sample of 424 carefully diagnosed ADHD cases and 564 unaffected siblings and controls aged 618 years performed a broad neuropsychological test battery, including a Go/No-Go Task, a warned four-choice Reaction Time task, the Maudsley Index of Childhood Delay Aversion and Digit span backwards. Neuropsychological variables were aggregated as indices of processing speed, response variability, executive functions, choice impulsivity and the influence of energetic and/or motivational factors. EL and ADHD symptoms were regressed on each neuropsychological variable in separate analyses controlling for age, gender and IQ, and, in subsequent regression analyses, for ADHD and EL symptoms respectively. Results: Neuropsychological variables significantly predicted ADHD and EL symptoms with moderate-to-low regression coefficients. However, the association between neuropsychological parameters on EL disappeared entirely when the effect of ADHD symptoms was taken into account, revealing that the association between the neuropsychological performance measures and EL is completely mediated statistically by variations in ADHD symptoms. Conversely, neuropsychological effects on ADHD symptoms remained after EL symptom severity was taken into account. Conclusions: The neuropsychological parameters examined, herein, predict ADHD more strongly than EL. They cannot explain EL symptoms beyond what is already accounted for by ADHD symptom severity. The association between EL and ADHD cannot be explained by these cognitive or motivational deficits. Alternative mechanisms, including overlapping genetic influences (pleiotropic effects) and/or alternative neuropsychological processes need to be considered.

The question of whether child and adolescent mental disorders are best classified using dimensional or categorical approaches is a contentious one that has equally profound implications for clinical practice and scientific enquiry. Here, we explore this issue in the context of the forth coming publication of the DSM-5 and ICD-11 approaches to classification and diagnosis and in the light of recent empirical studies. First, we provide an overview of current category-based systems and dimensional alternatives. Second, we distinguish the various strands of meaning and levels of analysis implied when we talk about categories and dimensions of mental disorder ‐ distinguishing practical clinical necessity, formal diagnostic systems, meta-theoretical beliefs and empirical reality. Third, we introduce the different statistical techniques developed to identify disorder dimensions and categories in childhood populations and to test between categorical and dimensional models. Fourth, we summarise the empirical evidence from recent taxometric studies in favour of the ‘taxonomic hypothesis’ that mental disorder categories reflect discrete entities with putative specific causes. Finally, we explore the implications of these findings for clinical practice and science. Keywords: Assessment, classification, diagnosis, DSM, factor analysis, ICD, taxometrics.

Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by problems with attention, impulsivity, and hyperactivity. The diagnosis derives from 18 symptoms indexing these behavioural domains [American Psychiatric Association (APA), DSM-IV-TR, 2000]. There is substantial continuity in maintaining a diagnosis of ADHD from childhood to adolescence (Faraone, Biederman, & Mick, 2006); however the phenotypic expression is highly variable within the diagnosed group and across time (Barkley, 2006; Nigg, 2006). Current diagnostic formulations distinguish between symptoms of inattention and those of hyperactivity-impulsivity. Three ADHD subtypes are recognized in the DSM-IV: the predominantly inattentive type, the predominantly hyperactive-impulsive type, and the combined type (where patients meet criteria on both the inattention and the hyperactive/impulsivity domains). This formulation is currently under review as part of the deliberation of the DSM-5 panel. Indeed, this current characterization remains controversial (Barkley, 2001; Diamond, 2005; Hinshaw, 2001; Lahey, 2001; Milich, Balentine, & Lynam, 2001). Here we focus on factor models of co-occurrence among ADHD symptoms. Two major types of factor models, correlated factor models and hierarchical models, have been used to examine coherence and distinctness among ADHD symptom domains. Hierarchical models provide a way to simultaneously conceptualize both the coherence and separability of symptoms from separate domains. These models include a single general factor accounting for covariation among all symptoms along with separate, specific factors of inattention, hyperactivity, and impulsivity that vary orthogonally from the general factor. These models are also termed as bifactor models in the statistical literature. Hierarchical models are different from correlated factor models that only have factors for the symptom domains of inattention and hyperactivity and/or impulsivity (see Figure 1). Several studies have shown hierarchical models with a general factor as having a better fit than correlated models for reported symptoms of ADHD (e.g., Dumenci, McConaghy, & Achenbach, 2004; Gibbins et al., in press; Martel, Von Eye, & Nigg, 2010; Toplak et al., 2009). These papers span clinical and community samples, and child, adolescent, and adult samples with ADHD. A one-factor model has also been considered, but thus far it has no empirical support (Dumenci et al., 2004). Figure 1 Generic example of a correlated two-factor model for 10 observed symptoms Hierarchical models explicitly acknowledge the common covariation among all ADHD symptoms, which is consistent with the conceptualization of ADHD as a single disorder. There are several lines of evidence suggesting that there is substantial commonality between the domains of inattention and hyperactivity-impulsivity. Inattentive symptoms tend to be more highly correlated with hyperactivity and impulsivity than with other domains of psychopathology (Adams, Kelley, & McCarthy, 1997; Conners, 2008; Strickland et al., 2011), with the exception of oppositional defiant disorder in some studies (Lahey et al., 2008). Current models of ADHD also highlight how the symptom domains of inattention, hyperactivity, and impulsivity likely interact to give rise to the heterogeneous expression of ADHD (Nigg & Casey, 2005; Sagvolden, Johansen, Aase, & Russell, 2005; Sonuga-Barke, 2005; Sonuga-Barke, Sergeant, Nigg, & Willcutt, 2008). To replicate and extend these findings, the current study examined different factor models in a large sample of ADHD patients recruited from a broad age range and from diverse national groupings. We were thus able to test whether a hierarchical model held for the whole sample and whether it also was invariant across different age groups and nationalities. A developmental perspective is important to integrate into models of individual ADHD symptoms, such that a single set of factors could parsimoniously explain the changes that occur over development. Age differences in scores from ADHD measures may reflect true differences in the constructs being measured or may simply reflect measurement differences due to age. Therefore, establishing measurement invariance across age groups is important. The behavioural presentation of ADHD changes considerably from childhood to adolescence. For instance, the expression of hyperactivity seems to decrease from childhood to adolescence and inattention commonly appears later in development than hyperactivity and impulsivity (Biederman et al., 2000; Hart et al., 1995; Larsson et al., 2006; Nigg, 2006). This developmental change introduces complex issues with respect to diagnosis. Subtypes have been used to characterize these different symptom presentations, and the instability of ADHD subtypes in developmental samples has also been well demonstrated (Lahey, Pelham, Loney, Lee, & Willcutt, 2005; Todd et al., 2008). Some of this instability of subtypes may be attributable to measurement variability (Lahey et al., 2005; Valo & Tannock, 2010); however some of this variability would be expected from a developmental perspective, which would presume that children’s symptom presentations change over the course of development. What is needed is a coherent model that can represent these shifts and changes in symptoms. In addition to the question of developmental change and continuity in ADHD symptoms, the current sample also had the unique characteristic of having recruited participants from seven European countries and Israel by 12 different research centers. Most studies examining cross-national samples have been concerned with whether there are comparable rates of prevalence across different countries (Faraone, Sergeant, Gillberg, & Biederman, 2003; Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007) rather than consistency in symptom patterns across countries. In addition to testing the five different factor models in the full sample, invariance analyses were also conducted to examine consistency of the best overall model across countries. Thus, in the current study we first estimated five different factor models to determine which model best accounted for ADHD symptoms pooling all ages and locations using a sample of children and adolescents with ADHD and their siblings. The five factor structures included: a) a one-factor model of inattention/ hyperactivity/impulsivity; b) a non-hierarchical two-factor model with correlated inattention and hyperactivity/impulsivity factors (the correlated 2-factor model); c) a non-hierarchical three-factor model with correlated inattention, hyperactivity, and impulsivity factors (the correlated 3-factor model); d) a hierarchical model of a general ADHD factor with two specific factors of inattention and hyperactivity/impulsivity (the hierarchical 2-factor model); and e) a hierarchical model of a general ADHD factor with three specific factors of inattention, hyperactivity, and impulsivity (the hierarchical 3-factor model). Based on previous research, we expected that a hierarchical model with a general ADHD factor would provide the best fit to observed ADHD symptoms in both the ADHD and sibling samples and across instruments and informants. We then examined whether these modeled relationships among symptoms are equivalent across different groups by formally assessing measurement invariance in the ADHD group. Group differences in observed scores on measurement instruments can be attributed to true differences on the constructs being measured only if measurement invariance or equivalence holds across groups (e.g., Widaman & Reise, 1997). Based on the best fitting model, we conducted invariance analyses to determine whether the measurement parameters relating the constructs implied by the model to the observed symptoms are equivalent across age groups and locations in the ADHD group.

Background:?Children with attention deficit/hyperactivity disorder (ADHD) display abnormalities in reward processing. Most reward studies have focused on the effects of material or monetary rewards. Studies with autism spectrum disorder (ASD) have focused on social rewards. In this study we compared the effects of amount and type of reward in children with ADHD and those with ASD. Methods:?Two adapted versions of the Monetary Incentive Delay Task were used to study the effects of monetary and social reward anticipation on performance in 40 typically developing (TD) children and adolescents (8–16y), 35 children and adolescents with ADHD and 31 children and adolescents with ASD. Results:?Monetary and social reward improved accuracy and response time (RT) in all groups. The higher the anticipated reward, the more accurate and faster were responses. Independent of these effects, there was a differential effect of reward type. Both clinical groups, but not TD, responded faster for monetary than social rewards. Conclusions:?The results, while not supporting hyposensitivity to changes in reward amount in ADHD and ASD, do suggest that both groups are generally less motivated in settings where social as opposed to monetary rewards can be earned.

Early intervention approaches have rarely been implemented for the prevention of attention deficit/hyperactivity disorder (ADHD). In this paper we explore whether such an approach may represent an important new direction for therapeutic innovation. We propose that such an approach is most likely to be of value when grounded in and informed by developmental models of the dynamic, complex and heterogeneous nature of the condition. First, we set out a rationale for early intervention grounded in the science of ADHD viewed through developmental models. Second, we re-examine the concept of disorder-onset from the perspective of developmental trajectories and phenotypes. Third, we examine potential causal pathways to ADHD with regard to originating risk, pathophysiological mediators, environmental moderators and developmental continuities. Finally, we explore the potential value of strategies for identifying young children at risk for ADHD, and implementing interventions in ways that can target these underlying pathogenic processes. The utility of such an approach represents an important area for future research but still requires 'proof of concept'. Therefore prior to widespread clinical implementation, far greater knowledge is required of (i) developmental pathways into ADHD, (ii) the value of identifying neuropsychological mediators of these pathways, and (iii) the extent to which targeting mediating mechanisms will improve treatment outcomes for children with ADHD.

Background: a common polymorphism in the serotonin transporter gene (SLC6A4, 5HTT) has been repeatedly shown to moderate the influence of childhood adversity and stressful life events on the development of psychopathology. Using data from the English and Romanian Adoptee Study, a prospective-longitudinal study of individuals (n = 125) exposed to severe early institutional deprivation (ID), we tested whether the effect of ID on adolescent emotional problems is moderated by 5HTT genotype and stressful life events in adolescence. Methods: emotional problems were assessed using questionnaire data (age 11), and on the basis of the CAPA diagnostic interview (age 15). Additionally, the number of stressful life events was measured. Results: there was a significant effect for genotype (p = .003) and a gene x environment interaction (p = .008) that was independent of age at testing. Carriers of the s/l and s/s genotype who experienced severe ID showed the highest emotional problem scores, while l/l homozygotes in the severe ID group showed the lowest overall levels. Furthermore, s/s carriers in the severe ID group who experienced a high number of stressful life events between 11 and 15 years had the largest increases in emotional problem scores, while a low number of stressful life events was associated with the largest decrease (4-way interaction: p = .05). Conclusions: the effects of severe early ID on emotional problems in adolescence are moderated by 5HTT genotype, and influenced by stressful life events in adolescence.

Background: The goal of this study was to investigate the occurrence, severity and clinical correlates of emotional lability (EL) in children with attention deficit/hyperactivity disorder (ADHD), and to examine factors contributing to EL and familiality of EL in youth with ADHD. Methods: One thousand, one hundred and eighty-six children with ADHD combined type and 1827 siblings (aged 6–18 years) were assessed for symptoms of EL, ADHD, associated psychopathology and comorbid psychiatric disorders with a structured diagnostic interview (PACS) as well as parent and teacher ratings of psychopathology (SDQ; CPRS-R:L; CTRS-R:L). Analyses of variance, regression analyses, ?2-tests or loglinear models were applied. Results: Mean age and gender-standardized ratings of EL in children with ADHD were >1.5 SD above the mean in normative samples. Severe EL (>75th percentile) was associated with more severe ADHD core symptoms, primarily hyperactive-impulsive symptoms, and more comorbid oppositional defiant, affective and substance use disorders. Age, hyperactive-impulsive, oppositional, and emotional symptoms accounted for 30% of EL variance; hyperactive-impulsive symptoms did not account for EL variance when coexisting oppositional and emotional problems were taken into account, but oppositional symptoms explained 12% of EL variance specifically. Severity of EL in probands increased the severity of EL in siblings, but not the prevalence rates of ADHD or ODD. EL and ADHD does not co-segregate within families. Conclusion: EL is a frequent clinical problem in children with ADHD. It is associated with increased severity of ADHD core symptoms, particularly hyperactivity-impulsivity, and more symptoms of comorbid psychopathology, primarily symptoms of oppositional defiant disorder (ODD), but also affective symptoms, and substance abuse. EL in ADHD seems to be more closely related to ODD than to ADHD core symptoms, and is only partly explainable by the severity of ADHD core symptoms and associated psychopathology. Although EL symptoms are transmitted within families, EL in children with ADHD does not increase the risk of ADHD and ODD in their siblings.

The adoption into the UK of children who have been reared in severely deprived conditions provides an opportunity to study possible association between very early negative experiences and subsequent brain development. This cross-sectional study was a pilot for a planned larger study quantifying the effects of early deprivation on later brain structure. We used magnetic resonance imaging (MRI) to measure the sizes of three key brain regions hypothesized to be sensitive to early adverse experiences. Our sample was a group of adoptee adolescents (N = 14) who had experienced severe early institutional deprivation in Romania and a group of non-institutionalised controls (N = 11). The total grey and white matter volumes were significantly smaller in the institutionalised group compared with a group of non-deprived, non-adopted UK controls. After correcting for difference in brain volume, the institutionalised group had greater amygdala volumes, especially on the right, but no differences were observed in hippocampal volume or corpus callosum mid-sagittal area. The left amygdala volume was also related to the time spent in institutions, with those experiencing longer periods of deprivation having a smaller left amygdala volume. These pilot findings highlight the need for future studies to confirm the sensitivity of the amygdala to early deprivation.

Background: Some young children reared in profoundly depriving institutions have been found to show autistic-like patterns, but the developmental significance of these features is unknown. Methods: A randomly selected, age-stratified, sample of 144 children who had experienced an institutional upbringing in Romania and who were adopted by UK families was studied at 4, 6, and 11 years, and compared with a non-institutionalised sample of 52 domestic adoptees. Twenty-eight children, all from Romanian institutions, for whom the possibility of quasi-autism had been raised, were assessed using the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) at the age of 12 years. Results: Sixteen children were found to have a quasi-autistic pattern; a rate of 9.2% in the Romanian institution-reared adoptees with an IQ of at least 50 as compared with 0% in the domestic adoptees. There were a further 12 children with some autistic-like features, but for whom the quasi-autism designation was not confirmed. The follow-up of the children showed that a quarter of the children lost their autistic-like features by 11. Disinhibited attachment and poor peer relationships were also present in over half of the children with quasi-autism. Conclusions: The findings at age 11/12 years confirmed the reality and clinical significance of the quasi-autistic patterns seen in over 1 in 10 of the children who experienced profound institutional deprivation. Although there were important similarities with ‘ordinary’ autism, the dissimilarities suggest a different meaning. Despite the evidence that autism constitutes a disorder that is strongly influenced by genetic factors, patterns that appear similar to autism have been reported in both congenitally blind children (Brown, Hobson, & Lee, 1997) and in children exposed to profound early institutional deprivation (Hoksbergen, ter Laak, Rijk, vanDijkum, & Stoutjesdijk, 2005; Rutter et al., 1999). At 4 years of age, the pattern of autistic-like behaviour was indistinguishable from that seen in a prospectively studied sample of ‘ordinary’ children with autism investigated by Catherine Lord and her colleagues. By age 6 years, the quasi-autistic features in the sample of children from Romanian institutions had diminished and a number of atypical features were noted. The children showed more flexibility in communication than would ordinarily be expected with autism; several showed substantial social approach (albeit of an abnormal kind), and a few showed indiscriminately friendly behaviour of a kind that is more ordinarily associated with disinhibited attachment. Three of the children with quasi-autistic patterns were also severely mentally retarded, but the remainder were not. The quasi-autistic pattern seen in one girl was quite transient and it was regarded as not falling into the same group. Thus, the overall sample at that time comprised 3 children with quasi-autistic patterns associated with severe mental retardation, 7 with similar patterns that were not accompanied by severe retardation, and 1 child with a transient pattern who was excluded from further consideration. In addition there were another 10 cases on whom less information was available, who seemed to show milder quasi-autistic patterns. A systematic follow-up of this group of children was necessary in order to examine a number of outstanding issues concerning the meaning of the observed pattern. The original report commented on the high frequency of very marked circumscribed interests of a repetitive stereotyped pattern that had developed after the children had left institutions and joined their adoptive families. These interests made the picture rather different from the social deficits seen in severely deprived children within an institutional setting. We hypothesised that the impaired social relationships might have something in common with the so-called indiscriminate friendliness associated with disinhibited attachment seen in children who have experienced institutional rearing (Rutter et al., 2007), and the current follow-up tests the hypothesis that, by the time the children had reached age 11 years, the distinctively autistic features would have faded away and be replaced by disinhibited attachment disorder. Second, the quasi-autistic pattern might be a non-specific consequence of the cognitive impairment seen in some of the children. If so, the persistence of the quasi-autistic pattern should be evident only in those who showed cognitive impairment at age 11. Third, the profound deprivation might have led to an impairment in mentalising skills and in psychological perspective taking (see Frith, 2003), and that it was these features that had underpinned the quasi-autistic pattern. If so, any persistence of the quasi-autistic pattern should be confined to the children who showed such problems in social cognition. A further query was whether or not the quasi-autistic pattern constituted a categorically distinct syndrome or, rather, whether it was simply the end of a continuum of similar features seen in the institution-reared children as a whole. The follow-up of the children with milder features, together with the characteristics of the children with raised scores on the Social Communication Questionnaire (a scale devised to assess autistic-like features – Berument, Rutter, Lord, Pickles, & Bailey, 1999; Rutter, Bailey, & Lord, 2003a) should provide the answer. Because the possible association between institutional deprivation and autism became evident only after the study had started, the sampling for the children to be studied in detail at age 6 using standardised diagnostic instruments for autism was less thorough with the older children at the beginning of the study than it was later on. Therefore, a prior methodological point that needed to be dealt with before proceeding with the more substantive issues was whether or not cases with quasi-autistic features had been missed. Accordingly, for the follow-up at age 11 years, all children who received scores at or above 14 on the Social Communication Questionnaire (SCQ), and/or for whom any of the research assessments suggested the possibility of autism, were routinely included in the special follow-up sample.

Background: There is uncertainty about the extent to which language skills are part of general intelligence and even more uncertainty on whether deprivation has differential effects on language and non-language skills. Methods: Language and cognitive outcomes at 6 and 11 years of age were compared between a sample of 132 institution-reared Romanian children adopted into UK families under the age of 42 months, and a sample of 49 children adopted within the UK under the age of 6 months who had not experienced either institutional rearing or profound deprivation. Results: The effects of institutional deprivation were basically similar for language and cognitive outcomes at age 6; in both there were few negative effects of deprivation if it ended before the age of 6 months and there was no linear association with duration of deprivation within the 6 to 42 month range. For the children over 18 months on arrival (range 18–42 months), the presence of even very minimal language skills (imitation of speech sounds) at the time of arrival was a strong beneficial prognostic factor for language and cognitive outcomes, but not for social/emotional/behavioural outcomes. Individual variations in adoptive parent characteristics were unrelated to differences in language or cognitive outcomes, possibly as a consequence of the limited variability in the adoptive family group. Conclusions: Minimal language probably indexes some form of cognitive reserve that, in turn, indexes the degree of institutional deprivation.

The aim of the study was to clarify the developmental risk associated with hyperactive behaviour in girls in a longitudinal epidemiological design. Methods: This was investigated in a follow-up study of girls who were identified by parent and teacher ratings in a large community survey of 6- and 7-year-olds as showing pervasive hyperactivity or conduct problems or the comorbid mixture of both problems or neither problem. They were later investigated, at the age of 14 to 16 years, with a detailed self-report interview technique. Results: Hyperactivity was a risk factor for later development, even allowing for the coexistence of conduct problems. Hyperactivity predicted academic problems and interpersonal relationship problems. Relationships with parents, by contrast, were not portrayed to be as problematic as relationships with peers and the opposite sex. Their psychological, social and occupational functioning was objectively rated to be more deviant and their self-report showed them to be more ambivalent about their future. There was a trend for hyperactivity to be self-reported as a risk for the development of continuing symptomatology but neither hyperactivity nor conduct problems were self-reported to be a risk for antisocial behaviour, substance misuse or low self-esteem in adolescence. However, they were at risk for the development of state anxiety. Conclusions: The results suggested girls’ pattern of functioning may differ from that of boys because girls self-report a more pervasive range of social dysfunction than that previously reported in boys.

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

In this review we explore the clinical and scientific status of categorical models of childhood disorder. Three themes are developed. First, the practical origins of standardised category-based diagnostic schemes are examined along with their contemporary philosophical and psychological significance. Next, the impact that these systems have had on the science of child psychopathology is explored. We look at their link to the medical model and the assumption that childhood disorders are categorical, endogenous, and dysfunctional in nature. We argue that these assumptions underpin the dominant paradigm in child psychopathology and so constrain empirical study and theory development. In the final section, the different ways in which researchers have responded to this link and its impact on science are presented. We present the sort of scientific realism associated with Meehl (1995) as the most appropriate basis for a philosophically respectable child psychopathology. Following this approach means unpacking the paradigmatic assumptions, including the assumption of the categorical structure of disorder, into hypotheses that are then put to empirical test. The sorts of data that would allow us to test the categorical hypothesis are identified. We conclude by discussing the results from three recent studies using behaviour genetic analysis of twin data that, in fact, lead us toward a rejection of this hypothesis. The implications for diagnostic and clinical practice of such a rejection are discussed.

The present annotation explores the impact of grandmother involvement on their grandchildren's adjustment. A review of relevant research suggests that the impact of such involvement is conditional on a range of factors, including (a) the level of need experienced by the mother and child, (b) the mother-grandmother relationship history, (c) the developmental stage and life circumstances of the grandmother, (d) the levels of disagreement between mother and grandmother over child-related issues, and (e) the perceived appropriateness of involvement in cultural and interpersonal terms. Under most circumstances grandmother involvement is not a pre-requisite for grandchild adjustment. Where a genuine need for support exists and the support offered is tailored to meet that need, then grandmother involvement can represent a protective feature of the family environment. However, in situations where no such need exists, or the grandmother-mother relationship history precludes a harmonious relationship, then grandmother involvement can represent a risk factor and have a negative effect on family functioning and child adjustment.

Two experiments are reported in which hyperactive and control children repeatedly chose between small immediate and large delayed rewards. In experiment 1, the best choice option was manipulated by varying levels of delay after reward delivery. In experiment 2 it was manipulated by changing the economic constraint (10 minutes or 20 trials). Both groups were equally efficient at earning points under most conditions, but hyperactive children exhibited a maladaptive preference for the small reward under the trials constraint. The results suggest that hyperactive children were more concerned to reduce overall delay levels than either to maximize reward amount or immediacy.

The memory of hyperactive and non-hyperactive children for "attended" and "unattended" picture cards was compared under two conditions. Under Self Imposed Presentation (SI) conditions children set their own limits on presentation time while under Externally Imposed Presentation (EI) conditions children were encouraged to spend 30 seconds attending to the cards. Hyperactive children selected shorter presentation times than non-hyperactive children and recognized fewer "attended" cards under SI conditions, while the two groups performed equally well under EI conditions. These findings suggest that a major determinant of memory deficits in hyperactivity is a self imposed limitation on presentation time rather than more specific cognitive process limitations. Language: en