Biomedical subjects

H van Engeland

Publications and source records attributed to H van Engeland.

At least 73 records · Page 4Linked to original sources

PubMed1996

[Little recognition of mental problems in children by parents and family physicians].

OBJECTIVE: To determine the prevalence of psychic problems in children in the Dutch GP-practice and to determine how often parents and general practitioners (GPs) recognize psychic problems in children. DESIGN: Descriptive. SETTING: World Health Organisation Collaborating Centre for Primary Health Care (NIVEL) and Academic Hospital, Department of Child and Adolescent Psychiatry, Utrecht, the Netherlands. METHOD: In 810 children presence or absence of emotional and behavioural problems was studied by means of the Child Behaviour Checklist (CBCL) filled out by a parent at the moment of contact with a GP. The GPs findings in these were also recorded. RESULTS: 7.7% of all children obtained a total CBCL score indicating presence of emotional and behavioural problems (> P90). These children had problems at school, had repeated a school year, and followed special education more often. Nevertheless most of their parents (86%) did not experience problems with their children and 40% of the parents did not report any psychic problem in the preceding 2 weeks. Only 15% of these children were completely free of signs and symptoms, however, as against 40% of children with low scores. The percentages of children with high scores consulting a GP, social work or mental health care agency were somewhat higher than the percentages of children without these problems, but only the last-mentioned difference was significant. Children saw the GP rarely because of psychosocial problems (n = 7; less than 1%; 1 had a high CBCL score). Regardless of the presence of emotional and behavioural problems, as assessed by the CBCL, the GP seldom diagnosed psychological or social problems in children (n = 11; 1.4%; 2 had a high CBCL score) and rarely suspected the complaints had a psychosocial background. CONCLUSION: Children with a high CBCL score did not visit their GPs more often. The perception by the parent appears to be crucial in the help-seeking process. In many children in whom the screening instrument indicated the presence of emotional and behavioural problems, parents did not consider their children as problematic and did not seek the help of a GP.

Adolescent↗

PubMed1996

Event-related brain potentials in children with attention-deficit and hyperactivity disorder: effects of stimulus deviancy and task relevance in the visual and auditory modality.

It has frequently been reported that in so-called oddball tasks, children with attention-deficit and hyperactivity disorder (ADDH) show small P3 peaks of the event-related potential (ERP) in response to "targets" (task-relevant deviant stimuli) than normal children. It is not clear, however, whether this smaller P3 is due to abnormal processing of infrequent stimuli per se and/or of task-relevant stimuli and whether it is preceded by abnormalities in earlier peaks, especially those thought to be related to automatic deviancy detection [mismatch negativity (MMN) in the auditory modality and P2N2 in the visual modality]. ERPs of ADDH and normal children in response to visual and auditory stimuli were studied in a condition without task relevance as well as in a task-relevant condition. ADDH children showed smaller P3 amplitudes and (marginally) smaller MMN to auditory deviant stimuli, irrespective of task relevance, so smaller P3s in ADDH children are due to stimulus deviancy per se. In the visual modality the P3 effect failed to reach significance. Because the smaller P3s were also found in a condition not requiring task-related motivation, recent motivational interpretations of differences with normal children are not supported. ADDH children also showed smaller P1 amplitudes than normal children to all stimuli except visual novels. The ERP differences were unrelated to performance, since both groups performed equally well.

Acoustic Stimulation↗

PubMed1996

Effects of ORG-2766 on brain event-related potentials of autistic children.

A double-blind, placebo-controlled study examined the effects of 6 weeks of treatment with the adrenocorticotropin4-9 analogue ORG-2766 (40 mg/day) on brain event-related potentials (ERPs) of autistic children. In visual and auditory oddball paradigms (with task and nontask conditions), standard (80%), target (10%), and unexpected novel stimuli (10%) were presented. ORG-2766 (a) increased the occipital P3 component of the ERP to visual targets, (b) decreased the occipital P3 component of the ERP to auditory targets, (c) did not affect visual and auditory parietal target P3 components, and (d) also did not affect the A/Pcz/300 to auditory novel stimuli. In addition, ORG-2766 treatment increased the N1 component of the ERP to task-irrelevant auditory stimuli.

Adolescent↗

PubMed1996

The effects of chronic naltrexone treatment in young autistic children: a double-blind placebo-controlled crossover study.

In a double-blind placebo-controlled crossover trial 23 autistic children, aged 3-7 years, were treated with a mean daily dosage of 1 mg/kg naltrexone for 4 weeks. Drug effects were monitored with behavior checklists rated by parents and teachers, and ethological playroom observations. On average, parents' checklists and playroom data could not differentiate between naltrexone treatment and placebo treatment; however, teachers significantly favored naltrexone treatment. They reported a decrease in hyperactivity and irritability. No effects of naltrexone on social and stereotypic behavior could be demonstrated.

Autistic Disorder↗

PubMed1996

Expressed emotion and the prediction of outcome in adolescent eating disorders.

OBJECTIVE: This study examines whether parental Expressed Emotion (EE) ratings, based on the Camberwell Family Interview (CFI), are predictive of the course of illness in a sample of Dutch families with an adolescent eating disorder patient. Levels of EE at first assessment and at the termination of treatment are reported. METHOD: The study was designed as a prospective follow-up study and involved 49 adolescent eating disorder patients (DSM-III-R) and their parents. Patient and family assessments were conducted at intake (T1), at the termination of treatment (T2), and at follow-up (T3) 1 year later. The Morgan-Russell Outcome Assessment Schedule, which was adjusted to accommodate bulimics, yielded the average outcome score (AOS) which served as our outcome measure. RESULTS: The levels of parental EE at first assessment were low. During the treatment period the levels decreased further. We used a stepwise multiple regression analysis, with the parental EE variables as independent variables, to predict the AOS at T2 and T3. This way we showed that the mothers' Critical Comments (CC) rating explained 28 to 34% of the outcome variance. The mothers' CC rating was also the best predictor of outcome when compared to other possible predictor variables. DISCUSSION: The results underscore the importance of involving the family in the treatment of adolescent eating disorders. Specific attention should be given to the mother's thoughts, feelings, and behavior concerning her ill daughter. Helping the mother and daughter to differentiate and separate through a constructive noncritical approach to the presenting problems may be a crucial factor in breaking through the perpetuating cycle of criticism and illness.

Adolescent↗

PubMed1996

A controlled trial with ORG 2766, an ACTH-(4-9) analog, in 50 relatively able children with autism.

The aim of the present study was to replicate earlier findings of beneficial effects of ORG 2766, an ACTH-(4-9) analog, in autistic children. Fifty children with autism, 7-15 years old and with a Performance IQ of more than 60, participated in a double-blind placebo controlled parallel trial. Active treatment was 40 mg ORG 2766 for 6 weeks. The outcome was assessed on the basis of the Aberrant Behavior Checklist completed by parents and teachers, and by means of a detailed behavioral observation (30 subjects). ORG 2766 failed to improve social and communicative behavior at a group level. The rate of individual response, defined as a reliable change in social withdrawal at home and at school, to ORG 2766 (10 out of 30) and placebo (4 out of 20) was not significant either. The children who responded to ORG 2766, but not those who responded to placebo, manifested significant improvements outside the changes in the defining variables, including a decrease in hyperactivity at school. The responders to ORG 2766 were characterized mainly by a relatively lower PIQ; further by more initial hyperactivity, stereotypies and abnormal speech, and less initial eye contact. The responders to placebo could not be differentiated from the non-responders to placebo. Future studies should examine whether ORG 2766 differentially affects various subtypes of autism.

Adolescent↗

PubMed1996

Long-term behavioral sequelae of prematurity.

OBJECTIVE: Longitudinal evaluation of the competence and the prevalence of behavior problems in preterm children with serious neonatal complications. METHOD: Prospective follow-up of nonhandicapped preterm children who had been hospitalized in a neonatal intensive care unit (n = 177). The follow-up extended from early school age to early adolescence and was conducted with the help of the Child Behavior Checklist (CBCL) (parent form). RESULTS: The preterm children had lower scores on the Social and School Competence scales than did controls (n = 276). They also were more likely to attend special schools than were children in the general population. With regard to behavior problems, the preterm children had more social problems. The very preterm children and the children who were small for gestational age (SGA) were the ones who contributed to the significant findings. The children who were appropriate for gestational age did not differ from controls. No differential changes in CBCL ratings were found between the preterm and control children. The stability with regard to internalizing problems, attention problems, and social problems was high among the very preterm children and SGA children. CONCLUSION: Very preterm and preterm SGA children are at increased risk of problems in social functioning and functioning at school. These problems persist with age.

Achievement↗

PubMed1995

Placebo-controlled acute dosage naltrexone study in young autistic children.

In a double-blind, placebo-controlled crossover trial 23 autistic children were treated with a single 40-mg dose of the opiate antagonist naltrexone. Drug effects were monitored by detailed playroom observations, actometers, and parents' checklist ratings (Aberrant Behavior Checklist, social items and target behaviors). Naltrexone treatment failed to produce significant changes in social behavior, but it did reduce irritability and target scores on behavior checklists. The playroom data indicated that naltrexone significantly affected indices of activity and attention.

Attention↗

PubMed1995

Auditory event-related brain potentials in autistic children and three different control groups.

ERPs to auditory stimuli, generated during an oddball task, were obtained in a group of autistic children and three control groups (normal, ADDH, and dyslectic children, respectively). The task included the presentation of standards, deviants, and novels and had a (between-group) passive vs. active (counting) condition. It was examined whether 1) it was possible to replicate several earlier findings, 2) autistics manifest an abnormal lateralization pattern of ERPs, 3) autistics have an abnormal mismatch negativity (MMN), and 4) differences between autistics and normals are really specific to the autistic group. The only finding that could be replicated was that autistics have a smaller A/Pcz/300. There was no evidence for abnormal lateralization or abnormal MMN; however, there was an unexpected effect of the task manipulation on the amplitude of the P3: in autistics, the occipital P3 to deviant stimuli was significantly larger in the active than in the passive condition, a finding, like the replication of the smaller A/Pcz/300, specific to the autistic group. It was suggested that the auditory occipital task effect is related to understimulation of the occipital lobe by visual stimuli in autistic children.

Adolescent↗

PubMed1994

Methylphenidate influences on both early and late ERP waves of ADHD children in a continuous performance test.

Although it has frequently been reported that hyperactive children have abnormally small P3 amplitudes of the event-related potential (ERP), which are normalized by the stimulant drug methylphenidate (MPH), the literature is inconsistent concerning earlier ERP waves. The aim of the present study was to investigate whether the normalizing effect of a 10-mg dose of MPH was also apparent on earlier waves, such as the N1, the P2, and the N2, besides the P3. Twelve attention deficit with hyperactivity disorder (ADHD) children performed a Continuous Performance Test involving a button-press response to the letter X (CPT-X) under the influence of MPH in a double-blind placebo controlled acute dosage design. ERPs were recorded at Oz, Pz, Cz, and Fz. The expected increase of the parietal P3, both to targets and nontargets, was apparent, as well as a significant increase in percentage of hits. There also was a significant increase of an earlier, negative going, wave, the N2, with a frontal maximum, under the influence of MPH. This wave was probably a manifestation of an increase in processing negativity for target stimuli only, after the intake of the stimulant drug. No effect of MPH was found on the N1 or the P2.

Adolescent↗

PubMed1994

A four-year prospective follow-up study of 49 eating-disordered adolescents: differences in course of illness.

In a 4-year prospective follow-up study of 25 anorectic and 24 bulimic adolescents (DSM-III-R criteria), we studied fluctuations and differences in the course of illness, using repeated measurement. Morgan & Russell general outcome categories on the Outcome Schedule were more favourable than in adult studies. Of all patients, 47% had good, 43% intermediate and 10% poor outcome scores after 4 years. The groups differed significantly as to the kind and severity of disturbed eating behaviour and its consequences, but were rather similar in mental, psychosocial and psychosexual symptoms during the course of the illness. Eight percent of the anorectic patients became bulimic. We conclude that anorexia nervosa and bulimia nervosa can be considered as different symptom patterns of one basic eating disorder, in which preoccupation with food and a disturbed body image are core symptoms.

Adolescent↗

PubMed1993

The validity of the Five-Minute Speech Sample as an index of Expressed Emotion in parents of eating disorder patients.

This article examines the concurrent validity of the Five-Minute Speech Sample (FMSS) as an index of Expressed Emotion in a Dutch sample of 84 parents of adolescents suffering from anorexia or bulimia nervosa. The Camberwell Family Interview (CFI), the criterion measure of EE, and the FMSS were conducted on the same day. The levels of Expressed Emotion in these families were low when compared with the EE ratings from the schizophrenia studies. The FMSS and CFI-EE ratings showed a limited degree of overlap. Whether the limited association between the two methods is due to the low levels of criticism in our sample, to cultural differences and/or to differences in the psychopathology under study remains unclear.

Adolescent↗

PubMed1993

Pharmacotherapy and behaviour therapy--competition or cooperation?

This paper is part of a special section on 'psychopharmacotherapy in children'. The latter may be combined with behavioural treatments, but in children only in the field of attention deficit hyperactivity disorder treatment studies has this combination been investigated and proved to be more effective than any single treatment alone. As to the treatment of depressive disorder, school phobia and obsessive-compulsive disorder in children and adolescents, no controlled empirical studies on combined therapies exist. Nevertheless, positive results from adult studies (e.g. depressive disorder, obsessive-compulsive disorder) may be, with some modification, paralleled in children and adolescents. So far, there are no indications that the combination of medication and behavioural treatment has antagonistic effects. Thus, we would make a plea for combining psychopharmacotherapy and behaviour therapy in child and adolescent psychiatry.

Adolescent↗

PubMed1992

The use of adrenocorticotrophic hormone (4-9) analog ORG 2766 in autistic children: effects on the organization of behavior.

In a double-blind placebo-controlled crossover trial, 14 autistic children were treated with the neuropeptide ORG 2766, a synthetic analog of adrenocorticotrophic hormone (ACTH) (4-9). ORG 2766 treatment (20 mg per day during 4 weeks) was associated with an increased amount and an improved quality of the social interaction of the autistic children with a familiar experimenter. These changes in interaction were clinically relevant. Following treatment with ORG 2766 gaze and smile behaviors of child and experimenter showed stronger temporal contingencies. Further, after ORG 2766, stereotypies were temporally disconnected from verbal initiatives. The data supported the notion of a stimulating effect of ORG 2766 on social interaction. The implications of these findings for the endogenous opioid theory of autism are discussed.

Adrenocorticotropic Hormone↗

PubMed1992

Deficits in social behavior in autism and their modification by a synthetic adrenocorticotrophic hormone (4-9) analog.

When charting the structure of the social behavior of autistic children by means of an ethologically analyzed playroom session, deficits appeared in the reciprocity of eye-contact and in the location of verbal initiatives. These deficits in social behavior were beneficially influenced by treatment with the adrenocorticotrophic hormone (4-9) analog ORG 2766.

Adrenocorticotropic Hormone↗

PubMed1992

The adrenocorticotrophic hormone (4-9) analog ORG 2766 benefits autistic children: report on a second controlled clinical trial.

In a second controlled crossover trial, 20 autistic children received 40 mg/day of the neuropeptide ORG 2766, a synthetic analog of ACTH (4-9), for 8 weeks. Parents' checklist ratings (ABC) as well as clinicians' ratings (CGI) pointed to significant improvements after the course of treatment; improvements were clearest on the ABC social withdrawal subscale. The analysis of individual target symptoms and the parents' treatment preferences substantiated the beneficial effects of ORG 2766. In an ethologically analyzed playroom session, ORG 2766 treatment was associated with an improvement in the children's play behavior and a significant increase in the social interaction between child and experimenter. Gaze coordination between child and experimenter also was improved.

Adolescent↗

PubMed1991

Abnormal visual event-related potentials of autistic children.

This study compared the visual ERPs and concurrently measured fixation times of autistic children with those of normal children and two psychiatric control groups (so-called "externalizers" and "internalizers"). Autistic children had, in contrast with normal control groups, smaller P3 waves (occipital maximum) to visual target stimuli but did not differ in this respect from the two psychiatric control groups. When the autistic group was split into "good" and "bad" performers, the latter group had significantly smaller amplitudes than the former. No difference was found between the groups in electrophysiological reactivity to the first, novel stimulus of a habituation series. However, an unexpected change in stimulus location induced an increased Fz N400 in the normal group but not in the autistic group or the two psychiatric control groups. In addition, in a non-task-relevant habituation condition, the autistic group fixated complex visual stimuli for shorter times and had smaller occipital P3 waves than the control groups. Analysis of covariance showed that the smaller P3s could not be explained by the shorter fixation times. In none of the ERP parameters were there differences in habituation rate between the controls and the autistic children.

Arousal↗

PubMed1991

Abnormal electrodermal reactivity to novel visual stimuli in autistic children.

Skin conductance responses and eye-fixation behavior to visual stimuli were measured in high-functioning autistic children, normal children, children with externalizing disorders, and children with internalizing disorders. Novelty, complexity, and subjective significance of the stimuli were manipulated. Autistic children were electrodermally hyporesponsive to novel stimuli. In all groups, manipulation of stimulus complexity only influenced fixation time. Manipulation of subjective significance influenced fixation time as well as skin conductance response in all groups. In the autistic group, adding subjective significance to a stimulus changed electrodermal nonresponders into responders, indicating that nonresponsiveness or hyporesponsiveness in autistic children does not imply a loss of (novel) stimulus detection, filtering, or orientation reaction capability, per se.

Arousal↗