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People with developmental disabilities are at considerable risk for the development of comorbid psychiatric conditions. Psychopharmacological treatments may have a crucial role in a multidisciplinary and multimodal approach to the management of psychopathology in this population. Psychiatric illnesses that are particularly amenable include mood disorders, anxiety disorders, schizophrenia, and attention deficit hyperactivity disorders (ADHDs) and antidepressants, mood stabilisers, anxiolytics, antipsychotics, and stimulants should be considered, respectively. ADHD may also respond to alpha(2)-agonists. Psychotropic agents such as beta-antagonists can target aggressive, self injurious, and stereotypical behaviours and opioid antagonists may be helpful in treating self injurious behaviour and stereotypy. Selective serotonin reuptake inhibitors, newer anticonvulsants, and atypical neuroleptics are preferred when treating psychiatric disorders among people with developmental disabilities. This paper will review the major studies of pharmacological treatment of mental illness in individuals with developmental disabilities.

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It has been proposed that teenage girls often smoke cigarettes to protect themselves from the impulse to binge eat, with its feared weight-gain consequences, particularly when other measures such as greater dietary restraint have failed. The present study looked at the relationship between body mass index and standardised questionnaire responses concerning smoking, alcohol consumption, moods, weight changes, attitudes to body weight and shape, dietary patterns and menstruation in 1936 British (London) and 832 Canadian (Ottawa) schoolgirls. Data analysis revealed links between cigarette smoking and body weight/shape concerns, and awareness by subjects of these links; there was also a tendency for smokers in these two populations to be overweight but not grossly obese. Smoking was also related at all ages to being postmenarchal. The London population in particular revealed an association between smoking and a weight loss of 7 kg or more at some stage since puberty. Smoking was also linked, in a minority, with regular vomiting undertaken as a further defence against weight gain when overeating had occurred. These associations existed alongside the major and predictable association found between alcohol consumption and smoking. Similarities between the British and Canadian schoolgirls were striking in respect of rank order of reasons given for smoking and consequences of giving it up. Since smoking amongst older women is reportedly associated with below-average body weight it may indeed be effective in helping to curb weight gain. Our study provided little evidence of association between smoking and generalised anxiety or social anxiety (in either population), or depression (in the British cohort). We suggest that any preventive psychological approach to teenage female smoking should include attention to weight gain anxiety and consequent pursuit of thinness.

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Thirty adolescents who received a psychiatric diagnosis based on the DSM-III clinical criteria were compared to 28 adolescents who were free of a diagnosis using the same criteria, on a parent-completed questionnaire (Revised Behavior Problem Checklist) and self-report measures (Revised Children's Manifest Anxiety Scale, Children's Depression Inventory, SCL-90-R). The two groups of adolescents were significantly distinguished by scores from the parent questionnaire but not by self-report measures. Possible explanations for the discrepant results are discussed. It is concluded that the parent measure may be used to reliably distinguish adolescents with psychiatric disorders from those free of similar disorders.

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This is a five year follow-up study of adopted children and adolescents. Thirty-five adoptees and 23 control subjects were assessed. Five years earlier, the initial sample consisted of 57 pairs of adoptees and controls. The study showed that both adopted and control subjects were improved at the follow-up assessment and that there were no significant differences in clinical diagnoses and social adaptation between the groups. Compared with the controls, the adoptees were scored higher on a behaviour scale (Revised Behavior Problem Checklist) by parents. Adoption by the sixth month of age was associated with better overall psychosocial functioning. Significantly more adoptees were not living with their adoptive families. Factors associated with outcome are discussed.

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Early detection of anxiety and depression is important because of the relationship between these disorders, suicide and other problems (i.e. social, phobias, learning problems). This study screened prepubertal students in a school setting for symptoms of anxiety and depression using self-report measures (Revised Children's Manifest Anxiety Scale and the Children's Depression Inventory). Controls and children who scored high on measures of anxiety or depression or both were interviewed with their parents and were tested using the Diagnostic Interview for Children and Adolescents (computer version) and the Peabody Individual Achievement Test. Initial results indicated that anxiety is more prevalent in prepubertal children than depression. The correlation between different diagnostic measurements used in this project was calculated. A correlation was found between low scores of self-esteem and high scores of anxiety and depression on self-reports. It is concluded that self-report measures are good screening tools.

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This case study describes a 9-year-old-girl presenting with symptoms of anxiety and depression who was found to have mitral valve prolapse syndrome. The relationship of mitral valve prolapse and anxiety and depression has been studied and a review of the literature is presented. The family history of heart and psychiatric problems is explored. The importance of the bio-psycho-social approach is stressed as well as the suggestion that mitral valve prolapse be included as part of the differential diagnosis for anxiety.

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The relationship of anxiety to depression in children and adolescents has perplexed and preoccupied researchers and professionals in the field of child and adolescent psychiatry over the last two decades. This article illustrates this as it is demonstrated through epidemiologic, genetic, and biologic issues as well as environmental and developmental considerations and investigated procedures. The relevant literature is reviewed in depth, and the discussion on the inter-relatedness of the various factors, as they influence anxiety and depression, is brought forth.

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Epidemiologic studies in psychiatry in general, and child psychiatry in particular, represent a new focus. Certain disease entities in children and adolescents are better studied than others. Depression and anxiety of childhood seem to exemplify this statement. Depressive illness in childhood, although recently accepted in its full clinical implications, is a relatively well researched area with regard to epidemiology and prevalence. A number of factors have been identified as being influential such as age, race, socioeconomic status, sex, IQ, and source of information. Anxiety, however, still remains an area that is unexplored and not well researched. Very few studies have epidemiologically looked at the various types of anxiety and their prevalence in childhood and adolescence. Factors that further complicate this have been the relationships between anxiety and the normal developmental stages as well as the association between anxiety and depression. The various symptoms or subtypes of anxiety seem to be normal phenomena at different developmental stages. As a result, the identification of anxiety disorders, as they specifically influence children and adolescents, has been very much undervalued. Further research is needed to differentiate anxiety from depressive disorders and more specifically to distinguish among the different subtypes of anxiety disorders and to study their prevalence. It is only then that greater attention can be given to the course, prognosis, and treatment outcome of the anxiety disorders.

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The number of adopted children referred to a Canadian psychiatric service was found to be greater than warranted by their ratio in the community. They presented more with conduct disorders and less with anxiety disorders and were significantly more impaired than the controls.

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Sexual victimization of children is a relatively new area of enquiry and initial studies have been directed towards identification and etiology. It is only recently that treatment issues are beginning to be addressed. This paper first reviews the literature on the direct and indirect effects of sexual abuse on the child victim, and outlines five key issues in treatment. The major foci in treatment to date are described and a number of existing models, which have been devised to address these treatment issues, are briefly summarized.

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The present study examined the relationship between anxiety and depression in children in the context of proposed adult models. The results support the qualitative distinction between anxious and depressed patient groups on subsets of rating scale measures and clinical variables. In contrast to anxious children who were younger, (day patients) had been ill for longer than one year, presented with behavioral problems, and were low on observer ratings of depressive symptoms; depressed children were older, (inpatients) had been ill for less than one year, presented with emotional problems and were high on observer ratings of both anxious and depressive symptoms. The finding that the older depressed children were concurrently anxious while the younger anxious children were not concurrently depressed is discussed from the viewpoint of a hypothesized temporal sequence between anxiety and depression. The implication of this and other related findings are discussed in regard to their importance for differential diagnosis and prognosis.

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The need for psychotherapy with the mentally retarded is evident from the high prevalence of emotional disturbance in this group. Psychotherapy can be done following the same general principles as with nonretarded persons, with modifications for the level of cognitive and language skills. Psychotherapy is effective for a broad range of problems, especially in the area of social skills. In an era of increased community placement, this area becomes an important focus for the prevention of further emotional disturbance. The paucity of research to date indicates that the various forms of psychotherapy with the mentally retarded produce favorable results. The overall outcome maximizes the contribution of the retarded to society and minimizes family pathology. Further evaluation and more systematic studies are greatly needed in order to sensitize professionals and society at large to the undeveloped potential of the retarded and their response to this form of intervention.

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Recent research in the field of mental retardation has pointed to a better-defined population with exacting prevalence of the basic pathology and related disabilities. Advances in the areas of prevention and treatment have further reduced the prevalence and incidence of mental retardation. Current legislation and legislative procedures have led to a more equitable and fairer application of human rights to all citizens. However, discrepancies and ambiguities still remain with respect to interpretation of the spirit of the law as related to the retarded. Financial restraints and serious economic hardship have impacted on social and political attitudes and created two-tier systems of the rich and poor with the retarded referred to as "surplus population." This situation has, in turn, influenced the availability of resources, manpower, training, and research in this field. The future could be brighter if sociologic and philosophic changes parallel technologic advances. It is our duty and commitment to continue and further the developments in all spheres relevant to the retarded in order to maximize human potential whenever possible.

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The author outlines the recent advances in the field of developmental disabilities and discusses how these advances have expanded the role and scope of various professional groups. Genetic conditions and chromosomal aberrations, prenatal diagnosis, the infant at risk, and trends in assessing intelligence are detailed within the context of prevention. Treatment modalities are covered in detail.

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