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Some individuals with Tourette syndrome (TS) have severe motoric and vocal tics that interfere with all aspects of their lives, while others have mild tics that pose few problems. We hypothesize that observed tic severity reflects a combination of factors, including the degree to which dopaminergic (DA) and/or noradrenergic (NE) neurotransmitter systems have been affected by the disorder, and the degree to which the child can exert cognitive control to suppress unwanted tics. To explore these hypotheses, we collected behavioral and eyetracking data from 26 patients with TS and 26 controls between ages 7 and 14, both at rest and while they performed a test of cognitive control. To our knowledge, this is the first study to use eyetracking measures in patients with TS. We measured spontaneous eyeblink rate as well as pupil diameter, which have been linked, respectively, to DA and NE levels in the central nervous system. Here, we report a number of key findings that held when we restricted analyses to unmedicated patients. First, patients' accuracy on our test of cognitive control accounted for fully 50% of the variance in parentally reported tic severity. Second, patients exhibited elevated spontaneous eyeblink rates compared to controls, both during task performance and at rest, consistent with heightened DA transmission. Third, although neither task-evoked pupil dilation nor resting pupil diameter differed between TS patients and controls, pupil diameter was positively related to parentally reported anxiety levels in patients, suggesting heightened NE transmission in patients with comorbid anxiety. Thus, with the behavioral and eyetracking data gathered from a single task, we can gather objective data that are related both to tic severity and anxiety levels in pediatric patients with TS, and that likely reflect patients' underlying neurochemical disturbances.

Changelings contains proceedings from two panels occasioned by Maurice Sendak's visit to the UC Berkeley campus as visiting Avenali Professor in the Humanities in the Spring of 1996. Best known as a writer and illustrator of children's books (Where the Wild Things Are, In the Night Kitchen, Chicken Soup with Rice), Mr. Sendak's appearances on campus provoked lively discussion on a broad range of topics. In "They Know Everything: Children and Suffering," Dr. Herbert Schreier of Oakland's Children's Hospital highlights clinical knowledge about the durability of trauma and the frequent inability of onlookers, especially parents, to see the effects of trauma both on children and on adults. Maurice Sendak follows this talk with a discussion of how his own awareness, as a child, of the Lindbergh kidnapping led, finally, to the writing and illustrating of Outside Over There, a work in which the theme of the stolen child plays an important role. The open discussion that follows this panel returns to the issues of personal and community trauma, and the transformation of such suffering in art created for children.In the second part of this volume, "Mozart, Shakespeare and the Art of Maurice Sendak," Professors Stephen Greenblatt and Wye Allanbrook engage with Maurice Sendak in a discussion of Mozart and Shakespeare that is also an exploration of how Sendak's interpretation of the themes of childhood, adolescence and transformation into adulthood enhances our experience of these canonical artists. The panel begins with Stephen Greenblatt's discussion of folkloric tales of changelings (the ugly creatures left in place of the beautiful stolen children), and the role of changelings in Shakespeare's imagination. Focusing on the peculiar role of the changeling boy in the dispute between Oberon and Titania in A Midsummer Night's Dream, Professor Greenblatt asks why the thematic of the stolen and the replaced child so captured Shakespeare's attention, why the boy is so important even though he never appears on stage. Wye Allanbrook's discussion examines the similarities between Mozart's The Magic Flute and Sendak's playfully erotic In the Night Kitchen. She traces Mickey's mysterious transformation from mere material, Aristotelian hule, to mensch, a process which she sees as parallel with the growth experienced by Pamina and Tamino in The Magic Flute. The following conversation between Sendak and the presenters draws out these themes and focuses on the importance of a child's ability to see and understand meanings that often escape disbelieving adult eyes. Finally, questions from the audience expand further the consideration of Maurice Sendak's perspectives on opera, ballet, and other art forms.

In cases of Munchausen Syndrome by Proxy, the perpetrator (generally the mother) simulates or fabricates child abuse in order to maintain an intense relationship with hospital personnel, police personnel, child protection workers, lawyers, or school personnel. A case involving law enforcement agents as a primary "target" illustrates this, and clues are offered for diagnosing Munchausen by proxy. (CR)

Roy Meadow first described Munchausen by proxy (MBP) in 1977 in England. Since then, there have been over 400 reports in the world s pediatric and child psychiatry literature. Although [...]

The recent trial and conviction of Kathy Bush for abusing her daughter is used to illustrate (1) the nature of the motivation, in at least some cases of MBP, and (2) the importance of distinguishing the motivation found in MBP from that found in other forms of child abuse and other conditions involving factitious illness production. Keywords: Munchausen Syndrome by Proxy; Psychopathology

Munchausen by proxy syndrome, wherein a caretaker (most often a mother) simulates or fabricates illness in a child in order to assume the sick role through another, has now been described involving a variety of psychiatric problems and false allegations of sexual abuse. Given that a proposed dynamic appears to be a need in a dependent and/or hostile relationship with powerful transferential people from the past, it was expected that professionals (school psychologists, social workers, lawyers) other than doctors would be involved. A case involving law enforcement agents as a primary 'target' is described and its significance discussed. Key Words - Munchausen by proxy, Sexual abuse allegations, Sheriffs.

A review of the literature and a survey of pediatric neurologists and gastroenterologists yield data indicating that the prevalence of Munchausen syndrome by proxy is greater than is generally estimated. This possibility is further supported by follow-up data on siblings of victims, together with wide variability among practitioners in case identification.

Clinicians should reevaluate their perceptions about childhood hallucinations and these psychological episodes should not be treated with alarm except in the most serious cases. Hallucinations have been associated with childhood psychiatric syndromes such as schizophrenia and reactive psychoses following stress and trauma. However, normal children who have hallucinations should not be dealt with as psychotic cases since they are not delusional, have no language problems and do not show any signs of reduced motor activity.

Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD. There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field. Expert participants were identified through a comprehensive international search process and invited to participate in a two-stage Delphi procedure to form clinical consensus statements. The Delphi Method is a well-studied research methodology for obtaining consensus among experts to define appropriate clinical care. Of 30 potential experts identified, 22 met criteria as expert in co-occurring ASD and GD youth and participated. Textual data divided into the following data nodes: guidelines for assessment; guidelines for treatment; six primary clinical/psychosocial challenges: social functioning, medical treatments and medical safety, risk of victimization/safety, school, and transition to adulthood issues (i.e., employment and romantic relationships). With a cutoff of 75% consensus for inclusion, identified experts produced a set of initial guidelines for clinical care. Primary themes include the importance of assessment for GD in ASD, and vice versa, as well as an extended diagnostic period, often with overlap/ blurring of treatment and assessment. [ABSTRACT FROM AUTHOR]

In an article I wrote, "Munchausen by Proxy Defined," (1) I quoted a study of the epidemiology of Munchausen by proxy (MBP) from England (2) and extrapolated those results to [...]

Discusses the dynamics of the Munchausen syndrome by proxy in which a seemingly caring mother is simultaneously harming her child. Development of the perversion of mothering; Historical and psychological factors contributing to the development of the syndrome; Denial of its reality.