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Biomedical subjects

M Rutter

Publications and source records attributed to M Rutter.

At least 19 recordsLinked to original sources
PubMed2005

Making sense of informant disagreement for overanxious disorder.

A community sample of 2798 8-17-year-old twins and their parents completed a personal interview about the child's current psychiatric history on two occasions separated by an average of 18 months. Parents also completed a personal interview about their own lifetime psychiatric history at entry to the study. Results indicate that informant agreement for overanxious disorder (OAD) was no better than chance, and most cases of OAD were based on only one informant's ratings. Disagreement about level of OAD symptoms or presence of another disorder (mostly phobias or depression) accounted for most cases of informant disagreement: 60% of cases based only on child interview, 67% of cases based only on maternal interview, and 100% of cases based only on paternal interview. OAD diagnosed only by maternal interview was also distinguished by an association with maternal alcoholism and increasingly discrepant parental reports of marital difficulties. Given the substantial overlap in case assignments for DSM-III-R OAD and DSM-IV GAD, these findings may identify sources of informant disagreement that generalize to juvenile GAD.

Adolescent↗
PubMed2005

Aetiology of autism: findings and questions.

BACKGROUND: Although there is good evidence that autism is a multifactorial disorder, an adequate understanding of the genetic and non-genetic causes has yet to be achieved. METHODS: Empirical research findings and conceptual reviews are reviewed with respect to evidence on possible causal influences. RESULTS: Much the strongest evidence concerns the importance of susceptibility genes, but such genes have yet to be identified. Specific somatic conditions (such as tuberous sclerosis and the fragile X anomaly) account for a small proportion of cases. Over recent decades there has been a major rise in the rate of diagnosed autism. The main explanation for this rise is to be found in better ascertainment and a broadening of the diagnostic concept. Nevertheless, some degree of true rise cannot be firmly excluded. However, the epidemiological evidence on the main hypothesized environmental explanation, namely the measles-mumps-rubella vaccine, is consistently negative. CONCLUSION: Progress on the elucidation of the causes of autism will be crucially dependent on the combination of epidemiology with more basic science laboratory studies.

Anti-Infective Agents, Local↗
PubMed2005

Developmental language disorders--a follow-up in later adult life. Cognitive, language and psychosocial outcomes.

BACKGROUND: Little is known on the adult outcome and longitudinal trajectory of childhood developmental language disorders (DLD) and on the prognostic predictors. METHOD: Seventeen men with a severe receptive DLD in childhood, reassessed in middle childhood and early adult life, were studied again in their mid-thirties with tests of intelligence (IQ), language, literacy, theory of mind and memory together with assessments of psychosocial outcome. They were compared with the non language disordered siblings of the DLD cohort to control for shared family background, adults matched to the DLD cohort on age and performance IQ (IQM group) and a cohort from the National Child Development Study (NCDS) matched to the DLD cohort on childhood IQ and social class. RESULTS: The DLD men had normal intelligence with higher performance IQ than verbal IQ, a severe and persisting language disorder, severe literacy impairments and significant deficits in theory of mind and phonological processing. Within the DLD cohort higher childhood intelligence and language were associated with superior cognitive and language ability at final adult outcome. In their mid-thirties, the DLD cohort had significantly worse social adaptation (with prolonged unemployment and a paucity of close friendships and love relationships) compared with both their siblings and NCDS controls. Self-reports showed a higher rate of schizotypal features but not affective disorder. Four DLD adults had serious mental health problems (two had developed schizophrenia). CONCLUSION: A receptive developmental language disorder involves significant deficits in theory of mind, verbal short-term memory and phonological processing, together with substantial social adaptation difficulties and increased risk of psychiatric disorder in adult life. The theoretical and clinical implications of the findings are discussed.

Activities of Daily Living↗
PubMed2005

Incidence of autism spectrum disorders: changes over time and their meaning.

AIM: Several reviews have noted a huge increase in the rate of diagnosed autism spectrum disorders. The main aims of this paper are: 1) to use published empirical findings to consider whether the rise reflects a true increase in incidence, as distinct from the consequences of better ascertainment and a broadening of the diagnostic concept; and 2) to consider how epidemiological data may be used to test hypotheses about possible causal influences, using MMR and thimerosal as examples. METHODS: Search of the literature for studies with a large epidemiological base population, systematic standardized screening, a focus on an age group for which diagnostic assessments are reliable and valid, and diagnosis by trained professionals using high-quality research assessments. Also, search of a broader literature to consider the evidence from all epidemiological studies with respect to the hypothesized causal effect of MMR and thimerosal on autism spectrum disorders. RESULTS: The true incidence of autism spectrum disorders is likely to be within the range of 30-60 cases per 10 000, a huge increase over the original estimate 40 years ago of 4 per 10000. The increase is largely a consequence of improved ascertainment and a considerable broadening of the diagnostic concept. However, a true risk due to some, as yet to be identified, environmental risk factor cannot be ruled out. There is no support for the hypothesis for a role of either MMR or thimerosal in causation, but the evidence on the latter is more limited. CONCLUSION: Progress in testing environmental risk hypotheses will require the integration of epidemiological and biological studies.

Autistic Disorder↗
PubMed2003

Endoscopic snare polypectomy for bleeding postinflammatory polyps.

We describe a patient with ulcerative colitis and protracted rectal bleeding who had required several blood transfusions and who was unresponsive to medical therapy, whose symptoms resolved after endoscopic resection of multiple giant postinflammatory polyps. This case report highlights the fact that postinflammatory polyps can occasionally cause significant symptoms, such as rectal bleeding, and that in these circumstances careful endoscopic polypectomy can be performed safely and result in a significant improvement in symptoms over a prolonged period of follow-up.

Adult↗
PubMed2003

Outbreaks of infectious disease associated with private drinking water supplies in England and Wales 1970-2000.

In England and Wales over the last 30 years there have been 25 reported outbreaks of infection, associated with private water supplies (PWS). The majority (16 outbreaks) were reported after the introduction of enhanced surveillance. Although PWS only serve 0.5% of the population, 36% of drinking water outbreaks are associated with PWS. The main pathogen, campylobacter, was implicated in 13 (52%) outbreaks. Most reported outbreaks (88%) occurred in commercial or Category Two supplies, which potentially affect larger populations. The main factors implicated in these outbreaks are temporary or transient populations, treatment (lack or failure), the presence of animals and heavy rains. The public health problem associated with PWS could be prevented by the identification and understanding of risk factors, by the proper protection of water sources and adequate treatment and maintenance. This could be facilitated through the introduction of a risk assessment as part of a scheme for PWS.

Communicable Disease Control↗
PubMed2002

Genetic effects on the variation and covariation of attention deficit-hyperactivity disorder (ADHD) and oppositional-defiant disorder/conduct disorder (Odd/CD) symptomatologies across informant and occasion of measurement.

BACKGROUND: Previous studies have shown that the presence of conduct disorder may contribute to the persistence of attention deficit-hyperactivity disorder (ADHD) symptomatology into adolescence; however, the aetiological relationship between the two phenotypes remains undetermined. Furthermore, studies utilizing multiple informants have indicated that teacher ratings of these phenotypes are more valid than maternal reports. METHODS: The genetic structure underlying the persistence of ADHD and oppositional-defiant disorder/conduct disorder (ODD/CD) symptomatologies as rated by mothers and teachers at two occasions of measurement was investigated on a sample of 494 male and 603 female same sex adolescent twin pairs participating in the Virginia Twin Study of Adolescent Behavioral Development (VTSABD). RESULTS: Using structural modelling techniques, one common genetic factor was shown to govern the covariation between the phenotypes across informants and occasion of measurement with additional genetic factors specific to ODD/CD symptomatology and persistence of symptomatology at reassessment. Genetic structures underlying the phenotypes were, to some extent, informant dependent. CONCLUSIONS: The findings indicate that it is unlikely that the co-morbidity between ADHD and ODD/CD is due to environmental influences that are independent of ADHD. Rather it is likely to be due to a shared genetic liability either operating directly, or indirectly through gene-environment correlations or interactions. The covariation between phenotypes across informants and time is governed by a common set of genes, but it seems that ODD/CD is also influenced by additional genetic factors. Developmentally, different forms of genetic liability control ADHD in males and inattention in females.

Adolescent↗
PubMed2002

Assessment of genetic and environmental influences on differential ratings of within-family experiences and relationships in twins.

BACKGROUND: Although there is evidence that genetic factors influence individual differences in environmental risk exposure, there are few findings on genetic effects on differential parenting. The present study sought to examine this issue. METHODS: The sample comprised 1,117 pairs of like-sex male and female twins, aged 8-16 years, and their parents, recruited from the school population of Virginia. Differential ratings of the within-family experiences were provided by the Twin Inventory of Relationships and Experiences (TIRE). RESULTS: Dimensions describing the within-family environment based on differential ratings contrasting the twins with one another, were influenced, to an approximately equal extent, by both genetic and environmental factors. CONCLUSIONS: The findings suggest that genetic differences between like-sex siblings lead them to experience their family environment differently, but also that environmental influences significantly affect interactions within the family.

Adolescent↗
PubMed2001

Genetic and environmental influences on the temporal association between earlier anxiety and later depression in girls.

BACKGROUND: The purpose of the present study was to investigate the role of genetic and environmental factors in the association between depressive symptoms and symptoms of overanxious disorder, simple phobias, and separation anxiety in 8-13-year-old and 14-17-year-old girls. METHODS: Multivariate genetic models were fitted to child-reported longitudinal symptom data gathered from clinical interview on 415 MZ [corrected] and 194 DZ [corrected] female twin pairs from the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) [corrected]. RESULTS: Model-fitting results suggest there are distinct etiological [corrected] patterns underlying the association between depression and the different anxiety syndromes during the course of development: 1) specific genetic influences on depression after age 14 reflect liability to symptoms of earlier overanxious disorder (OAD) and simple phobias; 2) aspects of the shared environment that influence symptoms of depression before age 14 contribute to symptoms of separation anxiety and simple phobias later in adolescence [corrected]; 3) the shared environmental influence on [corrected] depression in 14+ girls also affects liability to symptoms of concurrent OAD and persistent separation anxiety. CONCLUSIONS: These results suggest that depression before and after age 14 may be etiologically distinct syndromes. Earlier symptoms of OAD and (to a lesser extent phobic symptoms) [corrected] reflect the same genetic risk, and separation anxiety symptoms both before and after age 14 reflect the same environmental risk that influence liability to depressive symptoms expressed in middle to late adolescence.

Adolescent↗
PubMed2001

A family genetic study of autism associated with profound mental retardation.

We sought to determine if the family loading for either the broader autism phenotype or for cognitive impairment differed according to whether or not autism was accompanied by severe mental retardation. The sample comprised 47 probands with autism meeting ICD-10 criteria, as assessed by the Autism Diagnostic Interview and the Autism Diagnostic Observation Schedule. Family history interview and findings were compared with those for the higher IQ autism and Down syndrome samples in the Bolton et al. (1994) study. The familial loading for autism and for the broader phenotype was closely comparable to that in the study of higher IQ autism, and different from that for Down syndrome. The family loading for scholastic achievement difficulties was slightly, but significantly, higher when autism was accompanied by severe retardation.

Adolescent↗
PubMed2001

Can inattention/overactivity be an institutional deprivation syndrome?

Elevated rates of attention deficit and overactivity have been noted previously in samples of institution-reared children. This study examined the hypothesis that inattention/overactivity(I/O) might constitute a specific deprivation syndrome. One hundred and sixty five children adopted at varying ages (e.g., 0-42 months of age) into the UK following severe early deprivation were compared with 52 within-UK adoptees who did not suffer deprivation. The children were rated by teachers and parents on levels of I/O, conduct difficulties, and emotional difficulties using the Revised Rutter Scales. Data were collected at age 6 for the entire sample and at age 4 for the UK adoptees and for the subsample of Romanian children who entered the UK before the age of 2 years. Mean level analyses suggested a significant effect of duration of deprivation on I/O, but not on conduct or emotional difficulties. The effects of duration of deprivation were specific to I/O and were not accounted for by low birth weight, malnutrition, or cognitive impairment. Levels of I/O correlated with attachment disturbances. Furthermore, the effects of duration of deprivation on I/O did not attenuate over time. We conclude that I/O may well constitute an institutional deprivation syndrome, but that the type of attention deficit and overactivity exhibited by these children may present a different clinical picture from that of "ordinary" varieties of attention deficit disorder or hyperkinetic syndrome.

Adoption↗
PubMed2001

Testing hypotheses on specific environmental causal effects on behavior.

There have been strong critiques of the notion that environmental influences can have an important effect on psychological functioning. The substance of these criticisms is considered in order to infer the methodological challenges that have to be met. Concepts of cause and of the testing of causal effects are discussed with a particular focus on the need to consider sample selection and the value (and limitations) of longitudinal data. The designs that may be used to test hypotheses on specific environmental risk mechanisms for psychopathology are discussed in relation to a range of adoption strategies, twin designs, various types of "natural experiments," migration designs, the study of secular change, and intervention designs. In each case, consideration is given to the need for samples that "pull-apart" variables that ordinarily go together, specific hypotheses on possible causal processes, and the specification and testing of key assumptions. It is concluded that environmental risk hypotheses can be (and have been) put to the test but that it is usually necessary to use a combination of research strategies.

Adult↗
PubMed2001

Genetic moderation of environmental risk for depression and anxiety in adolescent girls.

BACKGROUND: There is huge individual variation in people's response to negative life events. AIMS: To test the hypothesis that genetic factors moderate susceptibility to the environmentally mediated risks associated with negative life events. METHOD: The Virginia Twin Study of Adolescent Behavioral Development (VTSABD) was used to study the effects of independent life events (assessed from maternal interview) on depression/anxiety (assessed from child interview) in 184 same-gender female twin pairs, aged 14--7 years, measured on two occasions. RESULTS: There was no genetic effect on the independent negative life events studied. A significant gene-environment interaction was found using structural equation modelling. There was no effect of independent life events on adolescents' depression in the absence of parental emotional disorder, but a significant effect in its presence. CONCLUSIONS: There is an environmentally mediated effect of life events on depression/anxiety. Genetic factors play a significant role in individual differences in susceptibility to these environmentally mediated risks.

Adolescent↗
PubMed2001

The Maudsley long-term follow-up of child and adolescent depression. 1. Psychiatric outcomes in adulthood.

BACKGROUND: Strong links exist between juvenile and adult depression but comorbid conduct disorder in childhood may mitigate this continuity. AIMS: To test the impact of comorbid conduct disorder on psychiatric adult outcomes. METHOD: A group of 149 subjects assessed at the Maudsley Hospital in the period 1970-1983 and meeting DSM-IV criteria for major depressive disorder with (n=53) or without (n=96) conduct disorder were interviewed 20 years later. Data were collected on the lifetime history of psychiatric disorders. RESULTS: Adult depressive recurrence was high for major depression (62.4%) and any depression (75.2%), and survival analyses showed no difference between the two groups. The group with conduct disorders had higher rates of drug misuse and dependence, alcoholism and antisocial personality disorders. CONCLUSIONS: Adolescent depression carries an elevated risk of adult depression irrespective of comorbidity. Comorbid conduct disorder in childhood is associated with raised rates of other psychiatric outcomes.

Adolescent↗
PubMed2001

The Maudsley long-term follow-up of child and adolescent depression. 2. Suicidality, criminality and social dysfunction in adulthood.

BACKGROUND: Strong links exist between juvenile and adult depression, but comorbid conduct disorder may be associated with worse adult social difficulties. AIMS: To test the impact of comorbid conduct disorder on social adjustment and dysfunction, suicidality and criminality of adults who had had depression as youths. METHOD: Subjects (n=149) assessed at the Maudsley Hospital in 1970-1983 and meeting DSM-IV criteria for major depressive disorder with (CD-MDD; n=53) or without (MDD; n=96) conduct disorder were interviewed 20 years later. Data were collected on lifetime psychiatric disorders and adult social/personality functioning. Death certificates and criminal records were obtained. RESULTS: The suicide risk was 2.45%, and 44.3% of the sample had attempted suicide once in their lives. Compared with the MDD group, the CD-MDD group had higher rates of suicidal behaviours and criminal offences, and exhibited more pervasive social dysfunction. CONCLUSIONS: Adolescent depression is associated with raised risks of adult suicidality and with persistent interpersonal difficulties. Youths with CD-MDD show more severe and pervasive social dysfunction.

Adolescent↗
PubMed2001

Child psychiatric symptoms and psychosocial impairment: relationship and prognostic significance.

BACKGROUND: Relatively little is known about the relationships between psychiatric symptoms, diagnosis and psychosocial impairment. AIMS: To examine these contemporaneous relationships and prognostic significance in a large general population sample. METHOD: Symptoms of major depression, conduct and oppositional defiant disorders were assessed by interview in two waves of the Virginia Twin Study of Adolescent behavioural Development (2800 children aged 8-16 years). RESULTS: Many children below the DSM-III-R diagnostic threshold, especially for depression, had symptom-related impairment, whereas many children reaching the symptom threshold for conduct and oppositional defiant disorders were little impaired. Impairment score was linearly related to symptom count, with no evidence of any additional impairment at the diagnostic threshold. For depression, only symptoms predicted later symptoms and diagnosis. For conduct and oppositional defiant disorders, impairment was additionally predictive of later symptoms and diagnosis. CONCLUSIONS: Impairment, in addition to symptoms, is important for both nosology and prognosis.

Activities of Daily Living↗
PubMed2001

The development of a brief screening measure of emotional distress in children.

We report several studies developing a parent-rated measure of emotional distress for children in Singapore, with the key objectives being to derive a very brief valid measure of global distress. The refined item set comprised behaviourally expressed broad manifestations of emotional distress. Three developmental studies were undertaken, with the first two involving parental ratings on the measure for validation against clinician-rated distress levels, while also testing two rating options for the measure. We established clear comparative advantages to the rating anchors used in the Revised Rutter Scales. High inter-rater agreement was established across parental ratings, with the latter finding supporting objectives for the measure. Paternal scores correlated more strongly than maternal scores with clinician-generated distress scores. Additional properties of the measure were tested in a large community sample of nearly 2,000 Singapore schoolchildren in their last 2 years of primary school, allowing prevalence estimates and mean scores to be derived for each item. Here, girls and boys received identical total scores, scores were also independent of the number of children in the family and of ordinal position, and mothers returned higher scores than fathers.

Adolescent↗