HOMEResourcesArchive of Brown Newsletter
| Child sexual abuse and subsequent psychopathology |
| A recent study out of Australia linked data from a cohort of sexually abused children to registered cases of patients that sought mental health services, concluding that both male and female victims of abuse sought psychiatric treatment at almost four times the rate of the general population. In this study, male victims were more than twice as likely to have had treatment compared to female victims. A sample of 1612 children (1327 female) age 16 years or younger who had been sexually abused was extracted from the records of the Victorian Institute of Forensic Medicine. This cohort was linked with cases from the Victorian Psychiatric Case Register, which records all contacts with public in-patient and community mental healthy services (does not include admissions in the private health sector or outpatient contacts with private providers). The control population used for comparison represented the general population and was restricted to the same age range as the sexual abuse cases. To ensure that cases were counted only once, a diagnostic hierarchy was employed to specify a single diagnosis when comorbid conditions were present. Categories, in order of precedence, were: schizophrenic disorders, major affective disorders, organic disorders, other affective and somatoform disorders, anxiety disorders and acute stress reactions, childhood mental disorders, personality disorders, conduct disorders, and alcohol and drug-related disorders. The mean age of the children when they were examined for sexual abuse was 9.4  4.1 years; the majority of the sample (78.3%) was determined to have experienced penetrative abuse. At the time of data-linking to the Psychiatric Case Register, the mean age was 27.1 13.3 years.During a 10-year period ending in June 2000, 12.4% of this cohort of sexually abused children contacted a public mental health service provider. Significantly fewer of the comparison (general) population recorded a contact (3.6%). Male cases of child sexual abuse were significantly more likely than female cases to have contacted a public mental health service (22.8% vs. 10.2%; p < 0.001). The most frequently recorded diagnostic category among victims of child sexual abuse were anxiety disorders and acute stress reactions (equally prominent in males and females); this cohort was three times more likely to receive this diagnosis compared to the general population comparison group. In this study, sexual abuse victims had five-times the rate of a primary diagnosis of personality disorder (no gender difference). Also, victims of child sexual abuse had twice the rate of major affective disorders - this increased risk was largely confined to female victims. Interestingly, in this study, the rates of schizophrenic disorders, alcohol- and drug-related disorders and other affective and somatoform disorders did not differ significantly between the cohort of sexually abused children and the general population. This study had several limitations. First, only a subset of sexual abuse victims (possibly the more severely abused) was studied. Second, the outcomes measure examined contact with public mental health services, which may be an extreme indicator of psychopathology. The authors note that these systematic biases would likely lead to an underestimation of the association between child sexual abuse and mental disorders. "In a sense, this study documents not the breadth but the depth of the psychiatric problems associated with child sexual abuse," the authors said. This study also contributed data on the effects of sexual abuse on male victims, demonstrating that although there are subtle gender differences in response, male victims have adverse mental health outcomes similar to female victims. Spataro J, Mullen PE, Burgess PM: Impact of child sexual abuse on mental health: prospective study in males and females. Br J Psychiatry 2004; 184:416- 21. E-mail: paul.mullen@forensicare.vic.gov.au |
| Exposure to phenylalanine linked with ADHD symptoms |
| Exposure to elevated levels of phenylalanine appears to be associated with attention-deficit/hyperactivity disorder (ADHD) symptoms, according to a recently published study. Children in the research study had been exposed to elevated levels of phenylalanine, either postnatally, as in Phenylketonuria (PKU), or prenatally, as in Maternal PKU (MPKU). Seventy-nine children participated in three groups: 46 children with PKU; 15 children born to mothers with PKU; and, 18 control participants (nonhyperphenylalaninemic siblings of children with PKU). Participants were children ages 7 to 16 years who had an IQ greater than 80 on the Wechsler Intelligence Scale for Children-3rd edition, and who had no evidence of a thought disorder, pervasive developmental disorder or sensory impairment. Participants with PKU (20 males, 26 females) ranged from 8 to 14 years of age. None were taking any psychopharmacological medications. All were on a phenylalanine-restricted dietary treatment protocol. The phenylalanine levels were obtained within 20 minutes after completion of psychological assessment; the levels ranged from 0.9 mg/dl to 22.8 mg/dl. The recommended treatment level is 2 to 6 mg/dl. The MPKU offspring (7 males, 8 females) ranged in age from 7 to 16 years. Maternal metabolic control was measured by the number of weeks gestation that elapsed until all subsequent blood phenylalanine levels were below 10 mg/dl. Mothers took from 2 to 24 weeks gestational age to achieve metabolic control. Participants in the control group (9 males, 9 females) ranged in age from 8 to 13 years, and were recruited from families of children with PKU. No significant differences were found among the three groups on participant gender, age or IQ. Information was gathered from the participants, their parents and teachers. The researchers report finding higher levels of hyperactivity/impulsivity in the MPKU offspring group. Compared to control participants, higher levels of inattention were reported in both phenylalanine-exposed groups. In the PKU sample, the highest association was observed between phenylalanine level and ADHD symptom total. In the MPKU offspring, the highest correlation was between weeks to maternal metabolic control and ADHD symptom total. Also, both maternal IQ and child age were associated with ADHD symptoms. Exposure to elevated levels of phenylalanine and ADHD symptoms appear to be associated. The toxicity is dose-dependent, with higher levels of phenylalanine associated with more severe symptoms. In addition, when the exposure occurs also seems to be important: hyperactivity/impulsivity and inattention are associated with prenatal exposure while postnatal exposure is associated with more inattentive symptoms. Antshel KM, Waisbren SE: Developmental Timing of Exposure to Elevated Levels of Phenylalanine is Associated With ADHD Symptom Expression. Journal of Abnormal Child Psychology 2003; 31(6):565-574. Email: antshelk@upstate.edu. |