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Biomedical subjects

M Rutter

Publications and source records attributed to M Rutter.

At least 19 recordsLinked to original sources
PubMed1992

Classification of pervasive developmental disorders: some concepts and practical considerations.

Classifications have to meet a variety of purposes. Clinical and research needs are different and there is much to be said for separate clinical and research schemes. Care is needed to ensure that classifications provide an appropriate medium for teaching about diagnosis and do not cause difficulties when used as a "passport" to resources. Principles of classification are considered in relation to the need to take course, as well as symptomatology, into account, and with respect to the neuropsychiatric interface. The value of a multiaxial approach is noted. The pros and cons of autism and pervasive developmental disorders (PDD) as an overall descriptive term, of lumping or splitting, and of different choices with respect to PDD subcategories are discussed.

Autistic Disorder↗
PubMed1992

The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder.

The effect of conduct disorder on adult social functioning in the areas of work, sexual/love relationships, social relationships and criminality was studied in a sample of young adults who spent much of their childhoods in group-cottage children's homes and an inner-city comparison group. Most subjects with conduct disorder had pervasive (but not necessarily severe) social difficulties compared to peers without conduct disorder. Less than half of this group met DSM-III adult criteria for antisocial personality disorder and just over half were given a diagnosis of personality disorder on interviewer clinical ratings. A latent class model that used both the retrospective and contemporaneous indicators of conduct disorder confirmed the very high continuity with adult social difficulties. Current diagnoses did not adequately describe this group and conduct disorder appeared to be an almost necessary condition for multiple social disability in adults in these samples.

Adolescent↗
PubMed1992

Season of birth: issues, approaches and findings for autism.

Rates of birth in the general population show seasonal fluctuations for reasons that are ill understood. Variations from these general population patterns have been reported for several psychiatric conditions and used as the basis for aetiological hypotheses. In this paper, the evidence for alterations in the expected seasonal fluctuation in birth dates of autistic people is evaluated. A national sample of 1435 autistic individuals and a clinic sample of 196 subjects are compared to general population figures and to 121 sibling controls. Compared with the general population, the national sample showed significant deviations from the expected rate of birth by month. In the clinic sample, differences from the anticipated monthly pattern were only evident when this sample was compared to the sibling controls. A variety of models for seasonal trends, including year quarters, temperature and sine wave forms, were fitted to these variations but no consistent picture emerged.

Adolescent↗
PubMed1991

Childhood experiences and adult psychosocial functioning.

Various studies have shown statistically significant associations between adverse experiences in childhood and abnormal psychosocial functioning in early adult life. It should not be assumed that this finding necessarily means an enduring effect of early experience. Part of the explanation is that adverse environments tend to be persistent and, hence, that what is being reflected is simply continuity in risk factors. But even when such continuity is taken into account, substantial associations over time remain. Using data from two long-term longitudinal studies a variety of possible mediating mechanisms are considered and shown to be operative. These include: an immediate effect leading to emotional/behavioural disturbance in childhood that then persists into adult life (this mechanism may be more important than appreciated hitherto, because heterotypic continuity has concealed the strength of the persistence of disturbance); one risk environment increasing the likelihood of occurrence of a second, different risk environment; the establishment of patterns of behaviour that bring about later risk environments; and the development of an increased vulnerability to later risk environments.

Adult↗
PubMed1991

Reliability and validity of a psychosocial axis in patients with child psychiatric disorder.

The interrater reliability of a classification scheme of psychosocial stressors was assessed among 52 child psychiatrists in rating exercises with 28 case histories. Validity was evaluated in a field study of 377 cases rated by 39 of the same child psychiatrists. The impact of glossary descriptions on reliability and validity was also determined. Reliability was low with most Kappa values being in the range of 0.20 to 0.40. The glossary did not affect interrater reliability, but it significantly decreased the use of abnormal codes. The discriminant validity of the codes was supported in that the most commonly used codes were used with differential frequency in a pattern that conforms with the known psychosocial correlates of the different psychiatric conditions of childhood.

Child↗
PubMed1991

Adult outcomes of childhood and adolescent depression: II. Links with antisocial disorders.

Sixty-three child and adolescent patients meeting operational criteria for depression and 68 non-depressed child psychiatric controls were followed into adulthood. Twenty-one percent of the depressed group had had conduct disorder (CD) in conjunction with their index depression. Depressed children with comorbid CD did not differ from depressed children without conduct problems with respect to depressive symptom presentation or demographic characteristics. However, depressives with CD had a worse short-term outcome and a higher risk of adult criminality than depressed children without conduct problems. There was a strong trend for depressives with CD to have a lower risk of depression in adulthood than depressed children without conduct problems. The outcomes of depressives with CD were very similar to those of nondepressed children with CD. The findings are discussed in the context of current classification schemes.

Adolescent↗
PubMed1991

Comorbidity in child psychopathology: concepts, issues and research strategies.

Epidemiological data show that the co-occurrence of two or more supposedly separate child (and adult) psychiatric conditions far exceeds that expected by chance (clinic data cannot be used for this determination). The importance of comorbidity is shown and it is noted that it is not dealt with optimally in either DSM-III-R or ICD-9. Artifacts in the detection of comorbidity are considered in terms of referral and screening/surveillance biases. Apparent comorbidity may also arise from various nosological considerations; these include the use of categories where dimensions might be more appropriate, overlapping diagnostic criteria, artificial subdivision of syndromes, one disorder representing an early manifestation of the other, and one disorder being part of the other. Possible explanations of true comorbidity are discussed with respect to shared and overlapping risk factors, the comorbid pattern constituting a distinct meaningful syndrome, and one disorder creating an increased risk for the other. Some possible means of investigating each of these possibilities are noted.

Adult↗
PubMed1990

Adult outcomes of childhood and adolescent depression. I. Psychiatric status.

The present study was based on the clinical data summaries ("item sheets") of children who attended the Maudsley Hospital, London, England, during the late 1960s and early 1970s. These summaries were used to identify a group of 80 child and adolescent psychiatric patients with an operationally defined depressive syndrome. The depressed children were individually matched with 80 nondepressed psychiatric controls on demographic variables and nondepressive childhood symptoms by a computer algorithm. At follow-up, on average 18 years after the initial contact, information was obtained on the adult psychiatric status of 82% of the total sample. Adult assessments were made "blind" to case/control status. The depressed group was at an increased risk for affective disorder in adult life and had elevated risks of psychiatric hospitalization and psychiatric treatment. They were no more likely than the control group to have nondepressive adult psychiatric disorders. These findings suggested that there is substantial specificity in the continuity of affective disturbances between childhood and adult life.

Adolescent↗
PubMed1989

Infantile autism and developmental receptive dysphasia: a comparative follow-up into middle childhood.

An interim follow-up study of a group of "higher functioning" boys with infantile autism and control group of boys with severe (receptive) developmental language disorder (or dysphasia) is reported. The boys were compared both initially and at follow-up for overall functioning in the areas of language, peer relationships, stereotyped behaviors, and disruptive public behaviors, as well as for the presence of a number of specific symptoms. In some respects, the behaviors that differentiated the groups initially did so also at follow-up, although there were important differences. Very few of the autistic boys had good language skills at follow-up, whereas nearly half of the dysphasic group were communicating well, a difference that is striking in view of the initial general similarity between the groups in terms of poor language functioning. However, some of the dysphasic children had developed greater difficulties in peer relationships. The implications for concepts of the nature of the deficit in severe receptive developmental language disorders are considered.

Autistic Disorder↗