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Objective: This study evaluates the effects of expert-assisted child abuse and neglect case management in the German child welfare and healthcare system as perceived by the case workers themselves. Methods: Case workers with different professions (social workers, counselors, clinic-based and office-based psychotherapists, and physicians) participated in the study. They were responsible for 80 child protection cases which were enrolled for the study and randomly assigned either to expert-assisted case management or to case management as usual. The sample represented a broad range of child protection problems with alleged or confirmed physical abuse, sexual abuse, emotional abuse and/or neglect. The victims were between 0 and 18 years of age. The intervention group received two to six case review sessions provided by child protection experts from outside of the case workers' own institution within 6 months after referral of the case. The case workers' satisfaction with the perceived degree of child protection, their level of certainty in the process of investigation, risk assessment and intervention planning, the quality of inter-institutional communication, and the involvement of children and families were evaluated. Results: Overall, only few between-group differences indicated effects of the intervention program. There was a statistical tendency toward more satisfaction with the perceived degree of child protection in the intervention group. Certainty in the estimation of suspected child abuse decreased significantly in the intervention group, compared with the control group, whereas certainty with respect to intervention planning increased. There were no group differences in the estimation of inter-institutional communication. Case workers in the intervention reported significantly fewer legal prosecutions of the perpetrators than case workers without expert assistance. However, the involvement of children in planning the interventions was significantly lower in the intervention group. Conclusions: Expert-assisted case management may change the case workers' perception of the evidence for abuse and guide their interventions to provide child protection. Modifications of the method should consider improved participation of the child.

This study examined the discriminant validity of the German version of CBCL in two large samples of referred and non-referred children and adolescents which were matched for age, sex and socio-economic status. The combined sample that was used for statistical analysis consists of 2,058 referred and 2,058 non-referred boys and girls between 4 and 18 years of age (mean age: referred boys=10.9 years, non-referred boys=10.9 years, referred girls=11.3 years, non-referred girls=11.1 years). Referral status was used as validity criterion. Statistical procedures included Odds Ratios, Total Predictive Values, ROC analyses and discriminant analyses. Results indicated that the discriminant validity of the German version of CBCL is comparable to the original English version. With the use of CBCL Total Problem Score as predictor (cut-off T≥ 60) 83.8 % of children and adolescents could correctly be classified (sensitivity 83.6 %, specificity 83.9 %). Symptoms of the “Attention Problems Scale” show the highest discriminative power to distinguish between disturbed and undisturbed children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Organized sexualized and ritual abuse (ORA), a contentious issue since the 1980s, remains a polarizing topic. Although there is much debate about the existence of this phenomenon, a differentiated perspective is lacking, and no representative study has yet addressed the frequency., Objective: This paper aims to investigate the frequency of ORA in Germany using two representative datasets., Participants and Setting: Data were collected from representative samples of the German population (N = 2522, N = 2515). Participants aged 16 to 96 years (50 and 53 % female) were recruited. They were selected by a random route procedure and asked to fill out a paper-pencil-questionnaire., Methods: The four aspects of ORA (severe sexual violence, perpetrator networks, commercial exploitation, ideology) were assessed based on the definition provided by an expert group. Additionally, in the second survey, a direct yes/no question about the experience of ORA as well as details on perpetrators and offense characteristics were surveyed., Results: Frequency of ORA was low. The direct question on ORA was affirmed by 0.5 % (n = 13), while according to the criteria of the definition, only 0.2 % or less of individuals experienced organized sexualized abuse, and <0.1 % experienced ritual abuse., Conclusion: Although ORA is discussed thoroughly, frequencies in the German population are low. This may be due to inconsistent terminology and operationalization of definitions with lack of precision. However, an intersection of conspiracy beliefs and the topic of ritual violence sheds another light on this issue that should receive more attention., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Large-size studies on the prevalence of female intimate partner violence (IPV) victimization in Germany are rare and partly outdated; representative data on male IPV victimization are lacking altogether. The present survey addresses these gaps. For this study, the instrument of the WHO Multi-country study on women's health and domestic violence has been translated to German and adapted to be used with females and males. A random route procedure in selecting household addresses has been used to gather data on IPV in combination with an omnibus survey on (mental) health issues. A total 2,503 respondents with a minimum age of 14 years have participated (response rate=44.1%). The resulting distribution of age and gender was representative for the German population above the age of 14 years. A total of 57.6% of female participants and 50.8% of male participants have reported victimization by intimate partners during their lifespan; gender distribution differs significantly (Chi 2 =43.43; p<0.001). Out of the different documented subtypes, psychological IPV was most prevalent (53.6% in females, 48.0% in males). Other forms ranged between 15.2% (physical IPV) and 18.6% (sexual IPV) for females, and 5.5% (sexual IPV) and 10.8% (physical IPV) for males. All forms of victimization regularly coincided, both in females and males. Experiencing any IPV was not only significantly associated with female gender, but also with older age, periods of unemployment, poverty, and IPV perpetration. The findings highlight the still much needed global efforts to prevent IPV against women - and in general. They further support previous research in underlining that fighting poverty might also be instrumental in reducing the likelihood of IPV. The discussion further addresses the issues of reciprocity in IPV.

Background: There is evidence that health care professionals are uncertain about the legal framework when suspicion of child abuse or neglect is raised. This could result in inconsistent handling of such cases, putting children at risk in further danger. The present study was intended to provide an empirical basis for examining the knowledge of the legal framework among health care professionals., Methods: A survey of child and youth physicians, child surgeons, child and adolescent psychiatrists as well as psychotherapists working in Germany was carried out to obtain information on the general conditions., Results: In all occupational groups, a majority of respondents feel insecure about the application of the legal framework on particular cases. Only a minority can correctly reflect the legal regulations of the Federal Child Protection Act ("Bundeskinderschutzgesetz"). Experience with child abuse cases doubled the odds to correctly understanding legal frameworks. Having attended training courses showed no impact., Conclusion: There is little knowledge of the legal framework in child protection. There is a need to improve training and provide low-threshold counselling services, especially for professionals with little experience in child protection cases., Competing Interests: Interessenkonflikte Prof. Dr. Jörg M. Fegert:• Forschungsförderung von EU, BMG, BMBF, BMFSFJ, DFG, G-BA Innovationsfonds, Länderministerien Baden-Württemberg und Saarland, Landesstiftung Baden-Württemberg, Porticus Stiftung, Evangelische Landeskirche Baden-Württemberg • Reisebeihilfen, Referentenhonorare, Veranstaltungs- und Ausbildungssponsoring von APK, Adenauer- und Ebertstiftung, Deutschlandfunk, DFG, DJI, DKSB, Infectopharm, med update, UNICEF, Fachverbänden, Universitäten sowie Bundes- und Landesministerien • Beratertätigkeit für APK, Bundes- und Landesministerien • Keine Industriegesponserten Vortragsreihen, kein Aktienbesitz, keine Beteiligung an PharmafirmenDie anderen Autoren erklären, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Severe mental illness in parents increases the risk of neglect, physical and sexual abuse (adverse childhood experiences, ACE) of children., Objective: Presentation of the current situation of child protection issues in psychiatric care in Germany and the derivation of needs and potential solution strategies., Material and Methods: Based on a selective literature search, the needs and the current situation in Germany are presented and potential solution strategies are pointed out. The analysis is supplemented by a descriptive evaluation of specific consultation requests to the medical child protection hotline, which were descriptively evaluated and served as a starting point for the selective literature search., Results: Despite the well-known comprehensive influence of mental illnesses of parents on their children, psychiatric patients have not yet been systematically registered regarding whether they have to care for underage children. There is a lack of systematic and comprehensive support for families at risk. Of all calls to the project medical child protection hotline, calls from the field of adult psychiatry and psychosomatics make up by far the highest proportion from the field of adult medicine., Conclusion: An increased awareness of child protection issues is necessary in the field of adult psychiatric treatment. Systematic counselling services for acute cases and also networking and structured cooperation with other medical fields, such as child and youth psychiatry, pediatrics and child and youth welfare should be addressed.

Objective: This study analyzes important variables of settings of children taken into state custody and records trauma exposure., Method: 52 children and adolescents with e~periences of removal and custody were questioned online in the social network Facebook. Traumatic stressors before removal and custody were assessed as well as the reasons that lead .to removal and custody and the subsequent burdens., Results: In more than every other case the children and adolescents reported that they were not involved in important decisions during removal and custody. After termination of the removal and custody process, 50% did not want to return to their parents. Compared to children wanting to return to their parents, children who did not want to return home display signs of severe physical and emotional neglect as well as extreme physical abuse. Even though they have no desire to return, they are often sent back to their parents against their will., Conclusions: Children who are removed and put in state custody should be included when deciding important questions. Whether or not they wish to return to their parents should be taken into consideration more strongly. Children who are sent back to theirparents against their will suffer from on going traumatization.

Sexual harassment among adolescents has long been neglected in Germany though it is frequent and leads to significant strain for the victims. In international studies, the prevalence of sexual harassment ranges from 10 to 80 % among students. For the development of sexual harassment individual as well as school based factors play a role. Different pathways lead to this problematic behaviour. The effect of new media in the development of sexual harassment cannot be estimated so far. Frequent consequences of sexual harassment in addition to school associated difficulties are unspecific somatic complaints. General practitioners and pediatricians are frequently consulted tn the first place. Recommendations for consultation and interventions are presented., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: EGONE is an E-Learning Forum for Gynaecology, Obstetrics, Neonatology and Reproductive Endocrinology based on the Swiss Catalogue of Learning Objectives. For two semesters, students attending the gynaecology block at the Medical Faculty of the University of Ulm have been provided with licences to use EGONE. Students can work on a specially equipped computer and practise whenever they want. The aim of this study was to generate hypotheses as to which factors favour the use of EGONE and which didactic implications for the learning success the application of EGONE has., Methods: During August 2009, 28 medical students in their 8th and 9th semester were interviewed after having completed their block of training in gynaecology. The instruments used included a questionnaire and a partially standardised interview., Results: We found that the e-learning offering EGONE was basically met with a positive response from the medical students at the University of Ulm. Regarding the integration of EGONE, three problem areas were identified: shortage of equipment, lack of dependable access and functional, but not curricular integration. Students' suggestions for better integration of EGONE were related to two subject areas: establishing an assisted learning centre (e.g., PC pool with library) and developing curricular independence and relevance (e.g., specific application to patient cases, conducting seminars with EGONE)., Conclusion: The integration of the e-learning programme EGONE presupposes a logical, didactic concept for the whole clinical block of training in gynaecology as well as dependable, sufficient infrastructure and technical equipment and providing didactic support to users., (Copyright © 2012. Published by Elsevier GmbH.)

Background: The department of ophthalmology at the medical faculty of the University of Ulm provides additionally for interested students in clinical semesters an optional activity. In small groups the students deepen their theoretical knowledge and learn more about ophthalmological diagnostic standard procedures. The "objective structured clinical examination" (OSCE) is known as a useful tool in the assessment of clinical skills. The OSCE is a well-established and valid examination method, but also time-consuming and costly. In form of a trial the OSCE was launched during the optional activity "Look into my eyes, baby"; in the summer semester 2009., Methods: By means of four examination areas established diagnostic methods in ophthalmology were tested. During the tests two simulation patients as well as two phantom heads for ophthalmological examinations were assessed. The preparation of the examination materials occurred in close collaboration with the department of ophthalmology and the division exam development of our university. In the assessment of the examinations a high value was set on good communication skills between students and simulation patients as well as on the professional handling of the student tasks. After the examinations the acceptance of the test methods was evaluated using a focused group interview between the students of the optional activity and the participating examiners., Results: We performed two OSCEs involving three students each in the last two semesters. The OSCE was to a great extent time- and resource-consuming, due to the intensive pre- and post-reviewing and the time students needed to pass the various examination areas. Students and examiners as well confirmed the validity of the assessment and acknowledged a positive effect on the students learning behaviour., Conclusions: The teaching staff members are willing to accept the OSCE, especially when the assessment procedures are thoroughly planned and well structured. The acceptance of the students can be achieved by providing valid assessment and reviewed teaching conditions. The high input in personnel and instrumental resources for the assessment and the student's individual supervision should be critically discussed in the light of the efficacy of the additional ongoing hospital and outpatient services and the personnel-relevant education budget assigned to the department of ophthalmology of a university., (© Georg Thieme Verlag KG Stuttgart · New York.)

Child protection can only be successfully solved by interdisciplinary cooperation and networking. The individual, heterogeneous, and complex needs of families cannot be met sufficiently by one profession alone. To guarantee efficient interdisciplinary cooperation, there should not be any gaps in the network. In addition, each actor in the network should be placed at an optimal position regarding function, responsibilities, and skills. Actors that serve as allocators, such as pediatricians or youth welfare officers, should be in key player positions within the network. Furthermore, successful child protection is preventive and starts early. Social network analysis is an adequate technique to assess network structures and to plan interventions to improve networking. In addition, it is very useful to evaluate the effectiveness of interventions like round tables. We present data from our pilot project which was part of "Guter Start ins Kinderleben" ("a good start into a child's life"). Exemplary network data from one community show that networking is already quite effective with a satisfactory mean density throughout the network. There is potential for improvement in cooperation, especially at the interface between the child welfare and health systems.

Objective: The aim of this study was to identify the "real-life" prevalence of psychotropic medications in children and adolescents in Germany and related behavioral and emotional problems. Data from the nationwide representative National German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analyzed., Method: A total of 17,450 subjects aged 0-17 years from 167 communities were examined as part of the KiGGS in Germany between 2003 and 2006 to determine their use of antidepressants, antipsychotics, anxiolytics, and sedatives within the 7 days prior to being interviewed. Medication use was assessed by a medical doctor who conducted a computer-assisted personal interview (CAPI) with the parents, and related emotional and behavioral problems were assessed using the Strength and Difficulties Questionnaire (SDQ)., Results: The overall prevalence for these medications was moderate (4.81/1000; 95% confidence interval [CI], 3.70-6.26), but prevalence varied across the different classes of drugs (sedatives > antipsychotics > antidepressants > anxiolytics). Rates of off-label use were high for antipsychotics and antidepressants. About 30% of the medication, especially sedatives, was used without prescription. Subjects using psychotropic medication obtained higher scores in the screening for emotional or behavioral problems than the total sample, but 40% of the children did not show abnormal scores., Conclusion: The indication for antipsychotics was mostly behavioral symptomatology, while antidepressants were used for a wide variety of symptoms. The high proportion of children and adolescents using psychotropic medication with normal scores in the emotional and behavioral screening was remarkable. It cannot be determined whether in these cases low scores were related to improvement in symptoms or whether medication was being misused.

Background: This study examined the prevalence of non-suicidal self-injury (NSSI), suicide attempts, suicide threats and suicidal ideation in a German school sample and compared the rates with a similar sample of adolescents from the midwestern USA by using cross-nationally validated assessment tools., Method: Data were provided from 665 adolescents (mean age 14.8 years, S.D.=0.66, range 14-17 years) in a school setting. Students completed the Self-Harm Behavior Questionnaire (SHBQ), the Ottawa Self-Injury Inventory (OSI) and a German version of the Center for Epidemiological Studies-Depression Scale (CES-D)., Results: A quarter of the participants (25.6%) endorsed at least one act of NSSI in their life, and 9.5% of those students answered that they had hurt themselves repetitively (more than four times). Forty-three (6.5%) of the students reported a history of a suicide attempt. No statistically significant differences were observed between the German and US samples in terms of self-injury or suicidal behaviors., Conclusions: By using the same validated assessment tools, no differences were found in the prevalence and characteristics of self-injury and suicidal behaviors between adolescents from Germany and the USA. Thus, it seems that NSSI has to be understood as worldwide phenomenon, at least in Western cultures.

Off-label use is an ongoing problem in child and adolescent psychiatry. Except methylphenidate and atomoxetine for attention-deficit/hyperactivity disorder (ADHD), most substances used to treat children and adolescents with psychiatric disorders are prescribed off-label. In additional to aspects of drug safety and efficacy the widespread off-label use raises issues of liability in the case of adverse events. In Germany off-label use also poses problems of reimbursement by the health insurance. In the future we expect, driven by written request of the FDA, numerous new indications for novel antipsychotics in the USA for the treatment of so-called childhood bipolar disorders. Given another diagnostic framework in context in Europe, these so-called bipolar disorders in children are very rarely diagnosed. Anyhow, antipsychotics are widely used in the USA and in Europe to treat impulsivity or aggressiveness in children and adolescents. There is still a lack of European labelling of novel antipsychotics for the treatment of schizophrenia. In clinical practice given the risk of liability and other forensic issues in the treatment of schizophrenic patients, this is still one of the major hindrances in the treatment of young schizophrenic patients in Europe. Whereas these drugs may urgently be needed for treatment of psychotic disorders and of impulsivity or aggressiveness, the indication of bipolar as used in the USA leads to a misconception and does not increase availability of licensed modern antipsychotics for minors.

Purpose of the Study: The availability of licensed medication for children and adolescents depends on the frequency of clinical trials within this age group. In Germany legislation the framework for clinical trials was changed essentially in 2004 by the 12th amendment on the German Drug Code (AMG). This paper studies the changes in applications to the IRBs for clinical trials in adults and minors before and after implementation of the 12th amendment., Methods: In total four IRB were included in the study. All IRB were located in one German state, all were located at universities or medical schools. Two of the universities have a clinical research unit (CRU) funded by the German Ministry of Research, one of these CRUs has additionally a unit specialised on conducting trials with minors (PadNET). All data were assessed by the applications to the IRB between 2002 and 2006 and analysed by the number of applications, inclusion criteria (with minors or without) and the funding status (investigator initiated trials=IIT or funded by industry)., Results: The total number of applications was stable over the observation period (2002: 1192; 2006: 1231). The number of applications according German Drug Code showed no essential changes (2002: 484; 2006: 504). The number of applications for trials which included minors was low and remained on this low level (2002: 41; 2006: 28). Immediately before and after implementation of the amendment the number of applications increased or, respectively, decreased. IIT with minors constituted a higher proportion of all clinical trials with minors, but in total the number of IIT with minors was low., Discussion: The 12th amendment to the German Drug Code had only slight effects on the number of clinical trials in general and especially on the number of clinical trials with minors. Overall, clinical trial with minors make only a small proportion of all applications for clinical trials to the IRB in Germany. The EU regulation on medical products for children may cause an increasing number of clinical trials with minors in the future.

As a medical discipline Child and Adolescent Psychiatry and Psychotherapy has gained increasing importance within society since given the epidemiological importance of behavioural problems in childhood and adolescence, it has verifiably improved the developmental chances of children at high risk. Child and Adolescent Psychiatry and Psychotherapy therefore should be systematically integrated into the German Medical Curriculum. The bio-psycho-social model provides us with a comprehensive paradigm of psychiatric disorders and has to face the problem of hermeneutics. An equilibrium between Evidence-based Medicine and the individual clinical experience with patients (Experience-based Medicine) must be established within medical teaching, rather than playing one against the other. Ethical dilemmas of medical therapy have to be taken into account.

Infants and toddlers are at high risk of neglect and maltreatment, as they are especially dependent on the care and the safeguard of their parents. Child protection can only succeed if early and preventive support for families at risk and their infants is provided. The project "A good start to life" helps to promote parental sensitive behaviour and care giving competence of parents in precarious life settings and in high risk situations and is aimed to prevent child neglect and abuse at an early age. A relevant prerequisite for child protection is interdisciplinary networking between the involved systems. The main focus of the project is the establishment of collaboration and network structures between the infant and youth welfare system and the health-care system and their services in eight communities in four states in Germany by using so-called round tables as communication platforms. Preliminary results of the round tables are reported in this article together with the results of the evaluation process.

Objective: This study evaluates the effects of expert-assisted child abuse and neglect case management in the German child welfare and healthcare system as perceived by the case workers themselves., Methods: Case workers with different professions (social workers, counselors, clinic-based and office-based psychotherapists, and physicians) participated in the study. They were responsible for 80 child protection cases which were enrolled for the study and randomly assigned either to expert-assisted case management or to case management as usual. The sample represented a broad range of child protection problems with alleged or confirmed physical abuse, sexual abuse, emotional abuse and/or neglect. The victims were between 0 and 18 years of age. The intervention group received two to six case review sessions provided by child protection experts from outside of the case workers' own institution within 6 months after referral of the case. The case workers' satisfaction with the perceived degree of child protection, their level of certainty in the process of investigation, risk assessment and intervention planning, the quality of inter-institutional communication, and the involvement of children and families were evaluated., Results: Overall, only few between-group differences indicated effects of the intervention program. There was a statistical tendency toward more satisfaction with the perceived degree of child protection in the intervention group. Certainty in the estimation of suspected child abuse decreased significantly in the intervention group, compared with the control group, whereas certainty with respect to intervention planning increased. There were no group differences in the estimation of inter-institutional communication. Case workers in the intervention reported significantly fewer legal prosecutions of the perpetrators than case workers without expert assistance. However, the involvement of children in planning the interventions was significantly lower in the intervention group., Conclusions: Expert-assisted case management may change the case workers' perception of the evidence for abuse and guide their interventions to provide child protection. Modifications of the method should consider improved participation of the child.

Recent reports and recommendations from national and international health care regulatory authorities have informed us that serotonin reuptake inhibitors (SSRI) are contraindicated as new treatment for those under 18 years of age with depressive illness. They conclude that SSRI carry the risk of increased suicide-related behavior; although there was no completed suicide. The European Medicine Agency (EMEA) and German regulatory agency (BfArM) advise that these components generally should not be used in this age group except in their other, approved indications. However, it is acknowledged that they may sometimes be chosen, depending on individual clinical needs. Based on these data, the Commission for Child and Adolescent Developmental Psychopharmacology of the German Scientific Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy is trying to give recommendations for the use of SSRI in clinical practice. Recent studies demonstrate that combining SSRI with psychological treatment such as cognitive behavioral therapy may reduce the risk of suicidal behavior in depressed children and adolescents.

Guidelines as recommendations by the medical associations concerning the diagnosis and treatment of certain diseases do not have the character of judicial norms. However, they may have an impact on decision-making in court. Within social security insurance law, and especially in medical malpractice litigation, the medical standard has become a legal term. As far as statements in guidelines render the actual standard as affirmed, the more binding is their character with respect to judicial questions. This article deals with this interplay between medical quality assurance and the legal demands on medical action. As a basis for discussion of this issue the relevant jurisdiction will be represented. Its impact on the guidelines for child and adolescent psychiatry will be pointed out as a concrete example.

Failure of incentive to investigation in infantile pharmaceutical trials has lead to insufficient supply with drugs within pediatrics and child- and adolescent psychiatry in Germany. In practice, drugs that are approved for adults are used to treat minors as a remedy. In many areas such "off label use" has become the medical standard and is therefore owed by the doctor under medical malpractice law. The principle of economy, that rules the law of public health insurance, forbids the prescription of drugs, that are not tested. However, as minors have the right to equal protection, the principle of economy can not prohibit off label use to the determent of minors. By virtue of the European orphan drug direction we can expect an improvement of drug supply in the field of pediatrics and child- and adolescent psychiatry in the long run. But meanwhile it would be unethical and unlawful to deny minors through restrictions on drug prescription a standard treatment, where the medical standard demands off label use of a pharmaceutical product.

Unlabelled: Research in the field of the impact of chronic illness is nowadays often based on concepts such as coping and stress adaptation. From the point of view of the family chronic illness influences family functioning, while coping behavior is influenced by the families resources. There is little research done on this interaction. This article focuses on atopic eczema., Methods: Qualitative free interviews of more than two hours duration each, had been done with all family members of families with a child suffering from severe chronic atopic eczema until the age of (pre-) puberty. A family interview with all members of the family has also been transcribed. The interpretation of the data is based on the qualitative content analysis and the grounded theory. The results from 5 families (24 interviews) lead to a typology of familial coping. The implications of this typology are discussed.

This article describes experiences of parents of sexual abused children and their evaluations of institutional interventions on sexual child abuse. Results are presented of a study investigating 'individual and institutional reactions on sexual child abuse'. The number of contacted institutions, personnel experiences with these institutions and resulting requirements are described. The results are based on a sample of 47 (82.5%) girls and 10 (17.5%) boys (range 6-18 years) and interviews with their 'non-abusing' parents. 28 (49.1%) of these children were abused by a member of the family, 29 (50.9%) children by non-familiar persons. It could be shown that 70.2% of the children had contacted four or more different institutions soon after the sexual abuse had been revealed. In cases of sexual abuse by a family member the first contacted institution was the Youth-and-Health-Care-System whereas in cases of sexual abuse by non-familiar persons mostly the police was contacted. Nevertheless in most cases both judicial and supporting approach were chosen. Additionally to concrete advices and professional competences the interviewed parents reported that emotional warmth was a very helpful aspect of the professional intervention. Generally the perspective of the parents seems to give some interesting informations about 'consumer satisfaction'.

The progress of work in adaptation axis I of OPD (operationalized psychodynamic diagnostic) to axis I OPD-CA (children and adolescents) is delineated. The items are now classified as subjective dimensions, resources and preconditions for treatment. Overlapping with the multi-axial classification for children and adolescents as used in Germany (MAS) was eliminated and important items for child and adolescent psychiatric and psychotherapeutic treatment were added. In the field of personal dimensions only subjective impairment will be covered. Resources were accentuated for the benefit of peer relationships. Motivation for treatment is now differentiated between a more global motivation for change and motivation for psychotherapeutic treatment. In order to reduce ambiguity the term of compliance was transformed into ability for therapeutic agreement. The possibility of realization of therapeutic indication was added.

Subject of the study is the situation of 12- to 25-year-old girls and women from Berlin with a mental handicap who have experienced sexualised violence. 367 residential institutions of the Behindertenhilfe Berlin (aid for the handicapped) as well as 15 selected advice and consultancy facilities with amongst others a range of offers on problems of sexual violence. The return from the residencies was 68.7%. The gained individual data for the first time show the belonging to a sex for the residents. The group that was relevant for the study--altogether 147 girls and young women--was cared for in 31 institutions. The heads of the institutions provided information about more than 116 of these inhabitants. Every third to fourth resident (32 out of 116) was concerned by sexualised violence. This high extend of experience of sexualised violence in mentally handicapped female residents is directly opposed to an utterly insufficient psychosocial care situation. On one side the access to the questioned advice and consultancy centres is considerably limited for this clientele. Furthermore, heads of institutions of the Behindertenhilfe rather fall back on experts with medical-psychiatric knowledge, but not necessarily with knowledge of the handling of problems of sexual violence. Suggestions for the necessary improvement of the care situation of concerned girls and women with a mental handicap are being made.

Objectives: To analyze the frequency of behavioral/emotional problems and somatic complaints of children aged four to ten as rated by their parents., Method: The analysis is based on the PAK-KID study on behavioural and emotional problems and psychosocial competencies of children and adolescents in Germany. In a nationally representative sample of N = 1030 children aged four to ten years the parents rated their child using the Child Behavior Checklist., Results: The prevalence rates of the symptoms are presented. Additionally global prevalence rates based on three different models were calculated and compared. They range from 13.1% to 28.3%. The issues of defining cutoffs necessary for the calculation of prevalence rates are discussed.

Method: A study on behavioral and emotional problems and competence in children and adolescents in Germany (PAK-KID study) is described. It is the first nationwide representative survey of this kind of children and adolescents aged 4 to 18 years in Germany. For children aged 4 to 10 years the parents completed the German version of Achenbach's Child Behavior Checklist (CBCL 4-18) developed by the Arbeitsgruppe Deutsche Child Behavior Checklist. Children and adolescents aged 11 years and older filled out the German version of the Youth Self-Report that is part of Achenbach's CBCL in addition to the parents completing the German version of the CBCL. A total of 2856 parent questionnaires and 1798 self-report questionnaires completed by children and adolescents were analyzed., Results: The sample was representative with respect to the main sociodemographic variables. On all problem scales children and adolescents aged 11 to 18 years reported significantly more problems than their parents did. The frequency of internalizing problems (social withdrawal, somatic complaints, anxiety/depression) and delinquent behavior of children and adolescents reported by parents increased with the children's age, whereas aggressive behavior and attention problems decreased with age. Girls reported significantly more problems than boys on all internalizing scales of the Youth Self-Report. The effect was not totally replicated in the parent reports. In the parent reports, boys had more attention problems and more aggressive and delinquent behavior than girls.

A review of the literature on sleeping "disorders" in infants and toddlers shows that sleep problems are very common. We report the results of a German multicenter epidemiological study on a birth cohort (N = 1314). The children had medical examinations at 4 weeks, 3 months, 6 months, 1 year, 18 months, 2 years and 3 years. Most of the information on the sleeping behavior was gathered by structured interview and questionnaires. This paper gives information on the prevalence and the persistence of sleep problems in one to three year old children in Germany. Statistical analysis of correlations between breastfeeding and sleep and the place of sleep are reported. The consequences of sleep problems on the family overall well-being are also examined.

In the context of pre-school and school medical examinations in the public health service in Germany general rating of the cognitive and motor skills of a child is often included. In contrast thereto, emotional development and emotional situation of children are still a domain of intuition. The present article reviews the developmental psychology and psychopathology of emotions. Data of a video analysis of non-verbal emotional behaviour during a verbal task are presented with respect to shame and associated motor behaviour. In a child psychiatric recourse population (n = 2353), the developmental aspect of major child psychopathology, is pointed out in the context of the ICD-10 diagnostic system.

A broad spectrum of very different institutions is confronted with the problem of sexual child abuse. So far, only a few systematic descriptions of institutional interventions and their impact on sexually abused children exist. In this article, first results are presented of a study investigating "individual and institutional reactions on sexual child abuse'. In dealing with this problem legal provisions are of special importance. The results presented are based on data obtained from questionnaires and qualitative interviews with experts (median of vocation experience: 8 years) in two german cities (berlin/cologne). Questionnaires were filled in by 195 experts from the entire institutional spectrum (counselors, clinical centres, youth welfare departments, public prosecutors, courts of justice, police), of whom 40 additionally took part in a detailed interview. This article focuses on the question, how different institutions handle legal provisions. The use of criminal law exemplarily shows the different impact of legal provisions on the interventions of counselors. The close connection between the assessment of legal interventions and counseling concepts could be shown at the example of the allegedly homogeneous group of specific counselors.

The present article gives a literature review on rating scales and psychometric instruments used for behavior rating in infants and toddlers. The results of gender specific factor analysis in a German normative sample of 2 1/2 year old children (N = 751) are compared to Achenbach's syndrome scales of the CBCL 2-3. In contrast to psychiatric diagnostic manuals (DSM-IV, ICD-10), which currently do not provide correct descriptions of the developmental psychopathology in this age group an empirically derived classification of age specific behavior is presented. Our own factor analysis replicated identically Achenbach's sleep-problem-scale for this age group and came very next to Achenbach's syndrome scales. A comparison of the published international normative samples for the CBCL 2-3 shows, that the results in the Netherlands, in the United States and Canada are not statistically different from our German group. In the context of developmental psychopathology we prognose gender specific factor solutions derived from a normative sample and not from a clinical population. Psychometric data of these different versions are presented and discussed from a child psychiatrists view on developmental psychopathology.

Since January 1995 the new German Social Aid and Child Care and Protection Legislation (KJHG, Kinder-und Jugendhilfegesetz) is applied in all parts of Germany (Federal Legislation), for children and adolescents with psychiatric disturbances and special support system is created. These children have the right to get different sorts of help for their integration in school, in the peer-group, and in the society. The fact, that a child and adolescent psychiatric diagnosis is necessary to get these different kinds of help, has been criticized. Especially social-workers fear the negative effects of a so-called psychiatric "labeling". More information and cooperation between child psychiatrists and social-workers is necessary with regard to the new legislation. We analysed different measures (N = 1329) supported by this new legislation in our recourse population in 1992 and 1993. Effects of age, sex and socioeconomic status on the indication of psychotherapy within the health care-system or within the new (KJHG) legislation system are described. The follow-up part of the study reports results of these new forms of help for children in 140 of pour patients. We found more symptom reductions in the former diagnosed psychiatric disturbances than an improvement in the psychosocial and family life conditions of the children.

An analysis of a survey on public child and adolescent psychiatric services in Berlin shows that three years after the collapse of the Berlin Wall a psychosocial gap between the two cities still exists. After the reunification the new Child Help and Child Protection Law in Germany (Kinderund Jugendhilfegesetz) presented a common regulation for therapeutic and psychosocial interventions for children and adolescents. For the moment the advantages of this new legislation have no consequences in the daily practice of child psychiatrists in East Berlin. The consequences of these differences for child psychiatrists in the Public Health System are discussed in this article.

The fall of the Berlin wall caused a sudden increase in migration from East-Germany to West-Berlin. In our sample we compared 155 Berlin elementary school children to 17 children from East-Germany now living in Berlin and 25 immigrant children most oft them coming from Turkey and Poland. Although many authors expected short-term disorders of adaptation, we found a constancy of psychiatric diagnosis in the migration group. We noticed important differences particularly in the new psychosocial situation of the former East German mothers, with many single-mother-families, where the mothers now were often unemployed.

This sociohistorical essay attempts to trace back to the enlightenment the roots of contemporary child psychiatry. Five examples are used for illustrative purposes: the emergence of the concepts of human development, classification, compensation for deficits and psychohygiene (now mental hygiene), and the problems arising from the differentiation of schooling. Historical considerations provide numerous reasons for regarding child psychiatry as a medical specialty. These arguments would seem to outweight any need, deriving from economic pressure, to defend this field as an entity separate from its "parent disciplines" (pediatrics, psychiatry and psychosomatic medicine).