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Biomedical subjects

M Rutter

Publications and source records attributed to M Rutter.

At least 217 records · Page 12Linked to original sources
PubMed1982

Prevention of children's psychosocial disorders: myth and substance.

A critical appraisal of primary prevention of children's psychosocial disorderrs indicates that our knowledge on this topic is limited and that there are few interventions of proven value. Nevertheless, there are possibilities for effective prevention. Myths associated with unwarranted claims for the value of prevention are reviewed in terms of unproven assumptions that: (1) prevention cuts costs; (2) prevention in childhood will improve adult health; (3) improved living standards will reduce mental illness; (4) sensible interventions can only be beneficial; (5) providing people with information leads to preventive action; (6) the main issue in prevention is implementing what we know; (7) the best approach is to tackle the basic cause; and (8) the crucial issue is to identify that one basic cause. Principles of causation are discussed and a model of causative influences is used to consider potentially effective primary prevention policies with respect to those directed at (a) individual predisposition; (b) ecologic factors; (c) influences on opportunity and situation; and (d) current stresses and strengths. It is concluded that a good deal is known about risk factors and the areas in which primary prevention might be effective, but that less is known concerning precisely how to intervene in orde to bring about the desired results. There is a potential for effective primary prevention but, so far, it remains largely unrealized.

Adolescent↗
PubMed1981

Autistic children's responses to structure and to interpersonal demands.

Ten autistic children were exposed to four different styles of approach by an adult, in which the common context was the child's involvement in the completion of a model-building task. These styles varied in the extent to which they made interpersonal demands of the child and in the amount of task-directed structure that was imposed. Measures based upon observation of the adult's and the children's behavior indicated that the styles applied were reliably discriminable, and that the children's responses, both social and task-directed, were positively related to the interpersonal and task-oriented demands that were made of them. Within the group of children tested, some individual differences in the responses to the styles were suggested that may be relevant to the diagnosis of autism.

Adolescent↗
PubMed1981

A prospective study of children with head injuries: II. Cognitive sequelae.

A 2 1/4-year prospective study of children suffering head injury is described. Three groups of children were studied: (a) 31 children with 'severe' head injuries resulting in a post-traumatic amnesia (PTA) of at least 7 days; (b) an individually matched control group of 28 children with hospital treated orthopaedic injuries; and (c) 29 children with 'mild' head injuries resulting in a PTA exceeding 1 hour but less than 1 week. Individual psychological testing was carried out as soon as the child recovered from PTA, and then again 4 months, 1 year, and 2 1/4 years after the injury. A shortened version of the Wechsler Intelligence Scale for Children (WISC), the Neale Analysis of Reading Ability and a battery of tests of specific cognitive functions were employed. The mild head injury group had a mean level of cognitive functioning below the control group, but the lack of any recovery; during the follow-up period indicated that the intellectual impairment was not a consequence of the injury. In the severe head injury group, the presence of cognitive recovery and a 'dose-response' relationship with the degree of brain injury showed that the intellectual deficits were caused by brain damage. Some degree of cognitive impairment was common following head injuries giving rise to a PTA of at least 2 weeks. Conversely no cognitive sequelae, transient or persistent, could be detected when the PTA was less than 24 hours. The results were less consistent in the 1-day to 2-week PTA range, but the evidence suggested that a broadly defined threshold for impairment operated at about that level of severity of injury. Timed measures of visuo-spatial and visuo-motor skills tended to show more impairment than verbal skills but otherwise there was no suggestion of a specific pattern of cognitive deficit. Recovery was most rapid in the early months after injury, but substantial recovery continued for 1 year with some improvement continuing n the second year in some children, especially those with the most severe injuries. Age, sex and social class showed no significant effects on the course of recovery.

Achievement↗
PubMed1981

A prospective study of children with head injuries: III. Psychiatric sequelae.

A 2 1/4-year prospective study of children suffering head injury is described. Three groups of children were studied: (a) 31 children with 'severe' head injuries resulting in a post-traumatic amnesia (PTA) of at least 7 days; (b) an individually matched control group of 28 children with hospital-treated orthopaedic injuries; and (c) 29 children with 'mild' head injuries resulting in a PTA exceeding 1 hour but less than 1 week. A retrospective assessment of the children's pre-accident behaviour was obtained by parental interview and teacher questionnaire immediately after the accident and before the behavioural sequelae of the injury could be known. Further psychiatric assessments were undertaken 4 months, 1 year and 2 1/4 years after the initial injury. The mild head injury group showed a raised level of behavioural disturbance before the accident but no increase thereafter. It was concluded that head injuries resulting in a PTA of less than 1 week did not appreciably increase the psychiatric risk. By contrast, there was a marked increase in psychiatric disorders following severe head injury. The high rate of new disorders in children with severe head injuries who were without disorder before the accident, together with the finding of a dose-response relationship with the severity of brain injury, indicated a causal relationship. However, the development of psychiatric disorders in children with severe head injuries was also influenced by the children's pre-accident behaviour, their intellectual level, and their psychosocial circumstances. With the exception of social disinhibition and a slight tendency for the disorders to show greater persistence over time, the disorders attributable to head injury showed no specific features.

Amnesia↗
PubMed1981

A prospective study of children with head injuries: IV. Specific cognitive deficits.

Twenty-five children with a head injury resulting in a posttraumatic amnesia of at least one week were compared with an individually matched group of 25 children with orthopedic injuries. Both groups were studied a few weeks after the accident and the again at 4 months, 1 year and 21/4 years after the injury. The head injury group showed a persistent deficit on the WISC Performance IQ scale; the deficit on the Verbal IQ scale was more transient. An extensive battery of neuropsychological tests was employed to identify specific deficits not shown on the WISC. On the whole, these tests showed a pattern of results similar to that found with the WISC, and in most cases children without deficits on the Performance IQ scale of the WISC also did not show deficits on the battery of specific tests. However, in a few cases, tests of speed of visuo-motor or visuo-spatial functioning picked up deficits attributable to the head injury which occurred in children with normal scores on the WISC.

Adolescent↗
PubMed1981

Psychological sequelae of brain damage in children.

The author reviews the empirical evidence on the psychological sequelae of brain damage in childhood, concluding that brain injury causes a markedly increased risk in both intellectual impairment and psychiatric disorder. The risk is related to the severity of the brain damage, but there is little indication of locus effects. Psychiatric disorder is probably most likely to occur when there is abnormal neurophysiological activity; to some extent it may be influenced by the nature of the basic medical condition. Psychiatric consequences of brain injury are also substantially affected by the child's pre-injury behavior, psychosocial circumstances, and cognitive level. However, there are few psychological sequelae that are specific to brain damage.

Amnesia↗
PubMed1981

Psychiatric interviewing techniques: I. Methods and measures.

An account is given of the overall strategy and measures used in a three-phase study of styles and techniques employed in the initial diagnostic interviews with the parents of children referred to a child psychiatric clinic. The measures of interview style included interviewer activity and talkativeness, directiveness, types of questions and statements, interventions designed to elicit or to respond to feelings, and non-verbal qualities. The informant's response and the interview 'outcome' were assessed through measures of the quantity and quality of factual information obtained, and of the extent of expression of emotional feelings by the informant. Good inter-rater reliability was achieved with most measures. Some difficulties were experienced in achieving comparable thresholds for the recognition of expressed emotions.

Adolescent↗
PubMed1981

Psychiatric interviewing techniques II. Naturalistic study: eliciting factual information.

A naturalistic study was undertaken of 36 video and audio taped interviews made by 7 different psychiatric trainees. The interviews studied were those conducted in the ordinary course of clinic work for diagnostic and therapeutic planning purposes by trainees when first seeing the parent or parents of a child newly referred to a psychiatric clinic. It was found that a directive style with specific probes and requests for detailed descriptions was associated with the obtaining of better-quality factual information than that associated with a more free-style approach. Interviewers who talked less and who made use of open questions and checks tended to have more talkative informants. Double questions were liable to result in ambiguous answers, but multiple-choice questions did not appear to cause distortion and in some circumstances might be helpful.

Adolescent↗
PubMed1981

Psychiatric interviewing techniques. III. Naturalistic study: eliciting feelings.

A naturalistic study was undertaken of 36 video and audio-taped interviews undertaken by 7 different psychiatric trainees. The interviews studied were those conducted in the ordinary course of clinic work for diagnostic and therapeutic planning purposes by trainees when first seeing the parent or parents of a child newly referred to a psychiatric clinic. It was found that a variety of rather different interview techniques seemed to facilitate emotional expression. These included a low level of interview talk with few interruptions, a high rate of open rather than closed questions, direct requests for feelings, interpretations and expressions of sympathy. The issue of how far these associations reflected causal influences is discussed.

Child↗
PubMed1981

Psychiatric interviewing techniques. IV. Experimental study: Four contrasting styles.

The development and definition of four contrasting interview styles is described. The four styles were designed using different permutations of techniques which, on the basis of an earlier naturalistic study, appeared to be most effective in eliciting either factual information or feelings. A 'sounding board' style utilized a minimal activity approach; an 'active psychotherapy' style actively sought to explore feelings and to bring out emotional links and meanings; a 'structured' style adopted an active cross-questioning approach, and a 'systematic exploratory' style aimed to combine a high use of both fact-oriented and feeling-oriented techniques. Quantitative measures based on video-tape and audio-tape analysis showed that two experienced interviewers could be trained to adopt these four very different styles and yet remain feeling and appearing natural. An experimental design to compare the four styles is described.

Attitude↗
PubMed1981

Psychiatric interviewing techniques V. Experimental study: eliciting factual information.

Four experimental interview styles, each recommended by experts in the field, were compared for their efficiency in eliciting factual information during the initial diagnostic interviews with the mothers of children referred to a psychiatric out-patient clinic. If encouraged to talk freely, mothers tended to mention most (but not all) key issues without the need for standardized questioning on a pre-determined range of topics. However, systematic questioning was essential in order to obtain good quality factual data. Better data were obtained when interviewers were sensitive and alert to factual cues and chose their probes with care. Clinically significant factual information, idiosyncratic to the family and outside the range of standard enquiry was common, but was obtained satisfactorily with all four styles. No one style was generally preferred by informants. The advantages of systematic questioning for obtaining factual information were not associated with any disadvantages with respect to the eliciting of emotions and feelings.

Attitude to Health↗
PubMed1981

Psychiatric interviewing techniques. VI. Experimental study: eliciting feelings.

Four experimental interview styles, designed to differ in the extent of their use of active fact-oriented and active feeling-oriented techniques, were compared in relation to their use in the initial diagnostic interviews with the mothers of children referred to a psychiatric clinic. All four styles proved to be effective in eliciting emotions and feelings, but the findings suggested that each was effective for different reasons. It appeared that emotional expression could be encouraged by the interviewer's response to emotional cues, by a reflective style with little factual cross-questioning, by the use of direct requests for self-disclosures, by the optimal (but not necessarily maximal) use of interpretations. and expressions of sympathy, and by direct requests for feelings.

Emotions↗
PubMed1980

A prospective study of children with head injuries: I. Design and methods.

The main unresolved issues with respect to the psychological sequelae of brain damage in childhood are noted, and the previous studies of children suffering head injury are critically reviewed. A new prospective study is described. Three groups of children were studied: (a) 31 children with "severe" head injuries resulting in a post-traumatic amnesia of at least 7 days; (b) an individually matched control group of 28 children with hospital-treated orthopaedic injuries; and (c) 29 children with "mild" head injuries resulting in a post-traumatic amnesia exceeding 1 hour but less than 1 week. The children were studied as soon as possible after the accident and then again 4 months, 1 year, and 2 1/4 years after the injury. The parents were interviewed, using systematic and standardized interview techniques; both parents and teachers completed behavioural questionnaires; and the children were seen for individual psychological testing the WISC, the Neale Analysis of Reading Ability and a battery of tests of more specific cognitive functions. At the final follow-up, the severe head injury group (but not the other 2 groups) received a systematic neurological examination and the school teacher who knew the child best was personally interviewed. The findings are given on physical handicap, neurological abnormality, school placement and psychiatric referrals. All types of disabilities were both more frequent and more persistent in the children with severe head injuries.

Amnesia↗