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Waking the Dead by Kylie Brant

There was a time in my life when that title phrase would have reflected the task of getting my five kids out of bed in the morning in time for school .  But now it refers to the third of my Mindhunters trilogy, which released on November 3.

I will confess to being something of a research geek at heart.  I love research. I can get lost in it. If reality hadn’t had a nasty way of interfering, I probably could have been a lifelong student. Alas, the    children required feeding. My husband expected a wife that dropped in occasionally. That lifelong college career was not to be.

Maybe that’s why I choose subject matter in my dark romantic thrillers that I have absolutely no expertise in. I find the research endlessly fascinating. I’m chock full of  random bits of knowledge that serve as little more than inappropriate dinner conversation (defleshing bones) or make for eye-widening introductions (Meeting husband’s new boss for the the first time, dh jerks his thumb at me and says, “She knows a half dozen ways to kill someone silently.”) You just never know when this stuff is going to come in handy.

My books tend to have a forensics / police procedural slant. I tell myself that the characters have different forensic specialties to prevent me from becoming bored. But I suspect that sub-consciously I’m planning subjects that I’d like to learn more about.

I don’t often have the opportunity to travel to the location of my story’s setting, but I did for Waking the Dead. My sister had once lived in a picturesque little Oregon mountain town called McKenzie Bridge. I always thought it sounded like a wonderful place to set a book. So I flew out to stay with my her for a few days, and we hiked the Willamette Forest and crawled through caves. I met someone who described the perfect cave to dump seven sets of skeletal remains. He didn’t need to know that during the course of our conversation I’d already mentally cast him as my villain complete with the character’s personality.  That was magic.

A magic that didn’t extend to the more technical aspects of the story. Turns out I know very little about the care and feeding of dermestid beetles, defleshing skeletal remains, testing bones for latent fingerprints or extracting DNA from bones. But I was able to find molecular scientists and forensic anthropologists to help along the way.  Research books only go so far.  It takes experts in the field to answer those questions specific to my plots.  I find their information and careers endlessly fascinating.

And always, after speaking with them, I’m left wondering, where *I* was on career day.

What careers / occupations do you find fascinating?  If you could do it all over again, what would you be ‘when you grew up’?  I’m giving away an autographed copy of Waking the Dead to one commenter today!  For more information about The Mindhunters check out my site at www.kyliebrant.com.

Does his “I Love You” mean The End?

There was chatter on Twitter a few weeks ago that I found intriguing. I don’t recall who initiated the conversation or who the participants were, but the topic was how most romances end once the hero says I Love You.

Remember the song by The Carpenters, We’ve Only Just Begun? I remember it fondly because it was one of the songs I chose for the soloist to sing at my wedding, some 30 years ago. Just like the song, I think that once a couple has made a commitment to each other, not necessarily in marriage, their story has just begun.

The most memorable book I’ve read where the characters are already in an established relationship is Marie Force’s LINE OF SCRIMMAGE. Before saying what I liked about the book, I’ll point out that I’m not giving away more detail than can be found on the back cover of the book. The book begins with the characters in the midst of divorce and as the days before their final hearing dwindle, the hero wants to work things out. The heroine has seemingly moved on and is engaged to be married to someone else once the divorce is final. Back story is put into place through thoughts and conversations, and the pain and heartache they each experienced is very real; almost tangible at times. I thought the book was a wonderful example of the trials and misunderstandings that accompany a decade-old relationship, and the near-desperation felt when that relationship appears to be nearing an end.

Given how much I enjoyed Ms. Force’s book, I wish I could find more romances where the initial steps of the romance have already taken place and the parties are working to make their marriage/relationship work. Does anyone else want for more stories where the hero’s declaration of love comes earlier, concentrating more on the struggles that go along with holding onto a relationship than starting one?

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Gender and age differences in the symptomatology of child depression

I should preface this ‘review’ by disclosing that I’m the corresponding author of this study. I don’t usually review my own work at Child-Psych but I think this particular study will be of especial interest to parents, educators, and clinicians.

Last week the Journal of Clinical Psychiatry published one of our studies that examined age and gender differences in the presentation of clinical depression among children and adolescents. The study was part of a large NIMH-funded Program Project on child depression led by my collaborator and recent mentor Maria Kovacs. For those who may not be familiar with Dr. Kovacs’ work, she is one of the world leaders in child depression research. She has been studying childhood onset depression for several decades and is the creator of the Child Depression Inventory – one of the most used child assessment instruments in the world.

During the last decade her team has been following an unusually large sample of children and adolescents diagnosed with clinical depression in Hungary. As part of that study, we recently analyzed and published data that allowed us to closely examine how depression is manifested among these children and adolescents. We were particularly interested in examining whether there were specific differences in the presentation of depression between boys and girls, as well as between younger children (as young as 7 years of age) and adolescents.

The study consisted of 559 children with a DSM-based diagnosis of major depression disorder, including 247 depressed girls and 312 depressed boys ranging in age from 7 to 15 (mean age 11). Depression diagnosis was obtained via a semi-structured clinical interview (the Interview Schedule for Children and Adolescents-Diagnostic Version). The results of this interview was then analyzed by two independent psychiatrists and diagnosis was determined using a consensus procedure. This helped us make sure that all children included in the study had a confirmed diagnosis of depression based on standard DSM-IV criteria. We then examined the individual symptoms endorsed during these interviews and attempted to identify different patterns of symptoms across different age groups as well as between boys and girls.

The results:

Below you can see the unadjusted rates of each symptom (% present) for boys and girls across all ages.

There are a few things worth mentioning. First, depressed mood and irritability were the two most common symptoms among these kids, and anhedonia was relatively less frequent (only between 40 and 50% of the sample showed this symptom). This is not consistent with the DSM-IV criteria that indicates that irritability should replace depressed mood in the diagnostic criteria of depression in children. Our analysis suggests that contrary to the DSM-IV assumption, depressed mood is extremely common among depressed children. In contrast, it is anhedonia that is less common in this population. We were also surprised at how common were thoughts of death in this group, which highlights the need for clinicians and educators to assess for suicidal ideation among depressed kids.

Below you can see the results of the changes in odds ratio for age and sex while adjusting for the intercorrelation between symptoms.

The column of the left tells you how the odds for each symptom changed per year (the odds of being present). The asterisks indicate which symptom significantly changed per year. In sum, depressed mood, hypersomnia, psychomotor retardation, fatigue, and thoughts of death, and suicidal ideation significantly increased from middle childhood to adolescence, while psychomotor agitation significantly decreased per year.

The column on the right tells us how the odds for each symptoms changed by the sex of the child. Specifically,  anhedonia, insomnia, hypersomnia, and somatic complaints were more likely to be seen in females, while psychomotor agitation was more likely to be seen in males.

In sum, this study provides an overview of the symptom presentation of depression among depressed children and adolescents. The study is compelling in that it presents an examination of symptoms among a very large sample of depressed kids. In fact, this is the largest research sample of children with a diagnosis of major depression ever examined for this purpose. The study suggests that, contrary to previous reports, depressed mood is extremely common in this population. The analysis also suggested that the presentation of depression becomes more neurovegetative with age and among females. Neurovegetative symptoms include those that reflect whole-body processes, such as sleep and motor functioning, so clinicians should be particularly attentive to these symptoms. Finally, thoughts of death and suicidal ideation were very common, also highlighting the need for more careful screening of suicidality among depressed children.]

The reference:

Ildikó Baji, Nestor L. Lopez-Duran, Maria Kovacs, Charles J. George, László Mayer, Krisztina Kapornai, Enikő Kiss, Julia Gádoros, & Ágnes Vetró (2009). Age and Sex Analyses of Somatic Complaints and Symptom Presentation of Childhood Depression in a Hungarian Clinical Sample J Clin Psychiatry

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Depression in preschool – Not a transient developmental phase.

In the current issue of Archives of General Psychiatry, Joan Luby and her team at Washington University in St. Louis presented the findings of a powerful longitudinal study of depression in early childhood. In this new article, Dr. Luby examined the continuity and stability of early childhood depression. Specifically, her team wanted to explore whether preschool depression was a transient developmental phase or a more chronic condition. Surprisingly, this question has not been fully answered mostly because of the limited knowledge we have about early childhood depression.

The study included 306 preschool children (age 3 to 5) recruited from community sources in the St. Louis area. However, this is not a normative community sample, as the recruitment strategy was designed to recruit children at risk for depression and other psychiatric disorders (for example due to a family history of depression). This is a common and appropriate recruitment technique when the objective of the study is to examine the disease process rather than to provide normative or epidemiological information about the condition.  The participating children and their parents underwent a series assessments upon entry to the study (baseline) and then 12 (wave 1) and 24 (wave 2) months later.

The results

1. At baseline 25% (N=75) children met diagnostic criteria for major depression disorder, 26% (N=79) met criteria for other psychiatric disorder, and 47% ( N= 146) did not meet criteria for any psychiatric disorder.
2. At baseline, there was a significant difference in age among the groups, with depressed kids being more likely to be older than the kids in the other psychiatric diagnostic group. There were no gender differences between the depressed kids and the other groups.
3. At baseline, the depressed kids were more likely to have experienced more traumatic events than the non-depressed kids.
4. Below you can see the analysis of the longitudinal progression of MDD compared to other disorders.  Looking only at the top section of the draw, compared to kids without any psychiatric disorder at base line, kids with MDD were 11 times more likely to have MDD vs No disorder at follow up. Similarly, kids with MDD were 7 times more likely than kids with no disorder to have MDD vs. Psychiatric disorder at follow up. Finally kids with MDD were not more likely than the no disorder group to have another psychiatric disorder vs. no disorder. A Similar interpretation can be applied to the other two draws.



5. The researchers also examined the predictors of depression at follow up. Four factors were significant predictors of MDD at follow up:  having MDD at baseline (increased odds of 264%), having a family history of an affective disorder, having disruptive disorder at baseline, and having family income levels below $20,000.
6. Below you can also see the trajectory of MDD based on different severity at baseline. Severe MDD appears to follow a chronic trajectory. Those with less severe MDD follow two trajectories: a recovery, and a recovery-relapse trajectory. The authors could not identify any factors that would help us predict the  trajectories (e.g., chronic vs. recover) among kids with MDD.

There are two critical findings presented in this study. One is that MDD in preschool is highly stable and predictive of future MDD, specially when baseline MDD is severe (more than 50% of the kids with initial MDD continued to have MDD at follow up). Thus, it does not appear that MDD in preschool is a developmental transitional phase. Second, MDD appears to be a risk factor uniquely for MDD. That is, unlike more general ‘internalizing symptoms,’ which are predictive of a number of different disorders, the presence of MDD in preschool does not seem to be an indicator of future ‘general’ psychopathology, but instead it is mostly an indicator of future MDD. This suggests that the MDD diagnosis obtained at this age truly reflects a somewhat homogeneous disease process that is in place and is not simply a reflection of a non-specific dysregulation of emotion that could precede a number of conditions.

Luby, J., Si, X., Belden, A., Tandon, M., & Spitznagel, E. (2009). Preschool Depression: Homotypic Continuity and Course Over 24 Months Archives of General Psychiatry, 66 (8), 897-905 DOI: 10.1001/archgenpsychiatry.2009.97

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Sleep problems in preschool children with and without developmental disorders: when parents and the actigraphs don’t agree.

I was just reading a study that examined the proposed pathways from sleep problems in preschool children to behavioral disruption during the day. Specifically, a team from the MINDS institute at UC Davis was interested in exploring some possible reasons that could explain why sleep problems often lead to behavioral dysregulation during the day. The most obvious candidate, and the target for their study, is daytime sleepiness. It is commonly reported by parents and educators, that children that experience sleep problems at night are usually sleepy during the day, and this sleepiness may be the trigger for behavioral problems.

The authors examined 194 preschool children, including 68 kids with Autism, 57 with non-autism developmental delays, and 69 typically developing. Sleep problems were measured via parents reports but also through the use of actigraphs. These are very sensitive motion sensors that are attached to the child’s leg and are able to reliably identify when the child falls asleep or wakes up during the night. This allows the researcher to determine a number of specific sleep indicators, such as total sleep hours during the day, sleep efficiency (total hours of actual sleep while in bed), sleep latency (how long does it take the child to fall asleep), and wake after sleep duration (total minutes awake after initially falling asleep).

In sum, the authors failed to find support the proposed hypothesis (that sleep problems lead to sleepiness and this is leads to behavioral disruptions) but there were a number very interesting findings regarding discrepancies between parental reports and the actigraphs.

Parental perception of whether his/her child had a sleep problem was not associated with total sleep hours throughout the day/night, efficiency of sleep, or latency of sleep onset as recorded by the motion sensors. Parental report was only associated with ‘wake after sleep’ duration. These findings suggest that parents perception of sleep problem may be reflecting only one aspect of sleep dysregulation, in that parents may be more sensitive (or reactive) to the kids’ waking throughout the night than to other potential problems like reduced total sleep or difficulties falling asleep.

The actigraphs did not fully support the common finding that children with special needs, and specifically kids with autism, have significantly more sleep problems than typically developing kids. That is, the 3 groups of kids (autism, non-autism developmental delays, and typical) did not differ in sleep efficiency, sleep latency, and wake after sleep. Instead, total sleep hours was the only significant difference between these kids.

These findings made me think about the reliability of methods that assess child sleep difficulties based solely on parental report, and the validity of long held beliefs regarding sleep problems when such beliefs respond mostly to parental perceptions of the kids sleep difficulties. The concern is not necessarily that parental reports may be unreliable, but that they may be limited in that they can reflect only one aspect of the potential problems with the sleep cycle. These findings also suggest that clinicians should take a comprehensive approach when interviewing parents about their kids sleep problems.

Goodlin-Jones, B., Tang, K., Liu, J., & Anders, T. (2009). Sleep problems, sleepiness and daytime behavior in preschool-age children Journal of Child Psychology and Psychiatry DOI: 10.1111/j.1469-7610.2009.02110.x

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Fathers’ depression during pregnancy related to excessive infant crying

Thank you everyone for your patience during the two-week break in child-Psych.  As some of you know, I just relocated from Pittsburgh to Michigan where I started my new research program while working as an Assistant Professor at the Department of Psychology of The University of Michigan. The transition is time consuming but I’m finally all settled in the new town and I’m almost fully operational. I hope that I’ll be able to write several weekly updates to child-psych starting this week.

Last night I had a chance to start reading again and an article published in Pediatrics caught my attention. The article reported the findings of a study examining the link between father’s depression and infant excess crying or colic.  The study appears to continue a line of research that explores the often neglected role of father’s mental health on the child’s development. For example, recently I commented on the effects of father-daughter bond on the quality of the daughters romantic relationships, and on a study examining the impact of fathers (not mothers) postpartum depression on the child’s language development.

In this new study, the researchers were interested in examining factors that may be associated with excess infant crying. Specifically, although mother depression (pre and postpartum) has been associated with colic, little is known about the effects of father depression. This is of major importance since recent studies suggest that fathers get depressed during and after pregnancy at rates that are comparable to mothers. The study was part of the Generation R Study, a large population-based longitudinal of child development. The study included 7,654 children born between 2002 and 2006. The researchers evaluated maternal and paternal depression at 20 weeks of pregnancy. Crying behaviors were assessed via parental questionnaire at 2 months after delivery.

The results:

1. Excessive infant crying, defined as more than 3 hours per day on more than 3 days per week, was observed in 110 kids, or 2.5% of the sample
2. Maternal depression was not associated with infant crying; however
3. Parental depression was significant associated with infant crying. Specifically, infants who showed excess crying were significantly more likely to have depressed fathers when compared to their peers.
4. The effect of paternal depression was still noticeable even when controlling for maternal depression and other explanatory variables.

Previous research have been criticized because of  the practice of obtaining all information from the same source. For example, fathers are asked to report on their child’s behavior and also on their own behavior. This often results in “report bias” so that the father’s reports on the child’s behavior may not be accurate and instead may be affected by their own behavior. However, this particular study has some strengths that help reduced the potential for report bias. Specifically, the study was prospective. Thus, parents reported on their depression  during pregnancy and then reported on the child’s crying months later. This helps reduce the chance that the parents reports on the child’s crying was affected by their own emotional state at that time. In addition, the prospective nature of the study helps control for the effect of the child on the parent. That is, babies with significant colic are more likely to elicit stress on their parents possibly leading to depression. However, since this study showed that parental depression prior to the birth of the baby was associated with excessive crying, the child’s distress could not be the cause of the parental depression (at least the depression experienced before birth). All in all, this study provides further evidence that fathers mental health during birth and early childhood have a significant impact on the baby’s development.

The reference: van den Berg, M., van der Ende, J., Crijnen, A., Jaddoe, V., Moll, H., Mackenbach, J., Hofman, A., Hengeveld, M., Tiemeier, H., & Verhulst, F. (2009). Paternal Depressive Symptoms During Pregnancy Are Related to Excessive Infant Crying PEDIATRICS, 124 (1) DOI: 10.1542/peds.2008-3100

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The Shameful Secret

The scenario: You’re at a gathering of book lovers. Maybe it’s a conference, a dinner party of friends, a Tweet-Up someone arranged. The conversation, naturally, turns to books. Being a book lover yourself, you happily throw yourself passionately into the conversation until it happens. The moment you dread. Your conversational companions start talking about that book everyone has read. The one that falls on every “100 books you must read” list. The one you’ve never read.

There could be any number of reasons you haven’t read it. The book didn’t interest you, you’ve been meaning to read it but it keeps getting buried under all the other books you’ve moved to the bottom of your TBR pile. Or maybe you’re a little contrary and all of the hype has made you so tired of hearing about it, you never want to read it, watch it (when it’s eventually made into a movie) or hear about it.

I’ve had conversations with romance readers where I’ve gasped when they’ve told me they haven’t read a book or an author (usually it’s Nora Roberts, because I tend to think of her as a romance staple) but there haven’t been many conversations where I’ve had cause to make someone else gasp. After all, I’ve got twenty-five years of reading romance under my belt, since I started in the fourth grade, when I’d sneak my mom’s Harlequin categories out of the brown grocery bag she carried them home from the used bookstore in.

Until a few months ago, that is, when, during a conversation about a recently published book, I mentioned my shameful secret : I have never read Jane Austen’s Pride and Prejudice*. I’ve never watched the movie either. Oh sure, I know the main characters of Pride and Prejudice. I know Colin Firth is supposedly the perfect Mr. Darcy and some women nearly swoon when his role in the movie is mentioned. I know the book is probably romantic, and wonderful and…one of those “must reads” for any romance reader. But I haven’t read it. I don’t know how that happened, it’s one of those things I try not to talk about or think about too often, keeping my secret shame buried deep (heh, I’m kidding).

There are other books I haven’t read that “everyone” else seems to have: Twilight by Stephanie Meyers, The DaVinci Code by Dan Brown, The Harry Potter series by JK Rowling to name a few non-romances (there are other romances/romance authors I could list, but I don’t want to cause too much shock in one day). Some I may read eventually, some I have no interest in delving past the cover. To be honest, I don’t worry too much about it because I think I’m fairly well read and, well, no matter how much I read there are always going to be books I haven’t read and that I won’t ever read. I can live with that. There’s a whole reading world out there to explore and it would be boring if we all read the same books, even the bestsellers. I know I’m not the only one out there who’s made someone gasp by admitting I haven’t read a particular book. I’ll bet most of you have as well. So what’s your “secret shame”? What book or author haven’t you read that might make me, or someone reading, gasp?

*I did download Pride and Prejudice to my iPhone some time back and actually started reading it last week.

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“If I vaccinate her, my teen will have sex”: Factors affecting mothers’ rejection of HPV vaccines.

On Monday I discussed a study examining the link between parental vaccination refusal and childhood pertussis. I was most interested in discussing the process by which parents reach the decision to reject vaccine recommendations. In theory, I assume most parents reach such a decision after weighting the risk of vaccines against the risk of refusing the vaccines, and I questioned whether parents have the necessary information to properly weight these risks.

While reading the same issue of the journal Pediatrics, I came across a related study that examined the factors that predict whether a mother intended to vaccinate her daughter against HPV. I was very interested in this study because it could shed light into the decision processes behind parental refusal to vaccinate. That is, is the decision to refuse vaccination only a function of weighting risks vs. benefits? Or is such a decision also associated with other factors that may not be related to the issue of vaccine safety at all?

As background, HVP is a sexually transmitted infection that is associated with a number of serious conditions including cervical cancer. A vaccine for HPV was approved by the FDA in 2006, which has the potential to significantly decrease the prevalence of HPV-related conditions. In this new study, the authors examined 7,207 nurses who had at least 1 daughter participating in a large longitudinal study of adolescence. The authors were interested in examining what demographic and attitudinal variables were associated with intention to vaccinate their daughters against HVP.

The results:

1. Intention to vaccinate was associated with the age of the daughter. 48% of mothers of girls between 9 to 12 intended to vaccinate, compared to 86% of mothers of teens between 16 to 18 years of age.
2. Income was highly associated with intention to vaccinate with those making over $40,000 being 2 times more likely to report an intention to vaccinate their daughters than those making less than 40K
3. Having a history of HPV or HPV related disease doubled the changes of intention to vaccinate.

A number of beliefs about vaccines also predicted whether the mothers intended to vaccinate the daughters. A few interesting findings:

4. Mothers who believed that vaccinated girls would practice riskier sex were 38 times less likely to report an intention to vaccinate their daughters than mothers who did not have this belief.
5. Mothers who believed their daughters were at risk of HPV were 77 times more likely to intend to vaccinate than other mothers
6. Mothers who believed that the vaccine was the best protection against cervical cancer were 234 times more likely to intend to vaccinate their daughters than mothers who did not have this belief.

Initially these results were not that surprising. It seems clear that intention to vaccinate was highly associated with specific beliefs mothers have about the effects, nature, and potential consequences of the vaccine. What I found most interesting is that these results were based on a very unique and not highly representative sample. That is, these mothers were all nurses, and theoretically, they would be better educated than the general population about vaccines. Thus, it was very surprising that even among these highly educated mothers, the decision to vaccinate their daughters was affected by factors not necessarily directly associated with “vaccine safety” but with other ‘values’ or “beliefs” factors, such as the belief that if they vaccinated their daughters, the teens would be more likely to have risky sexual relations.

Kahn, J., Ding, L., Huang, B., Zimet, G., Rosenthal, S., & Frazier, A. (2009). Mothers’ Intention for Their Daughters and Themselves to Receive the Human Papillomavirus Vaccine: A National Study of Nurses PEDIATRICS, 123 (6), 1439-1445 DOI: 10.1542/peds.2008-1536

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Vaccination refusal increases risk of pertussis by 2,000%: Balancing the risks of vaccines and preventable diseases

Pertussis is a highly contagious and potentially deadly respiratory infection that affects mostly children in the developing world. The low prevalence of pertussis in industrialized nations is partly due to the effectiveness of the pertussis vaccine. However, several studies have indicated that the rates of pertussis in the US have significantly increased during the last decade, likely due to a parallel decrease in vaccinations, as parents have become increasingly worried about vaccine safety. But is this true? Are children of parents who decline the pertussis vaccine at higher risk for acquiring this disease?

The journal of the American Academy of Pediatrics recently published a study that examined the association between vaccination refusal and pertussis infections in Colorado. In this study, the authors conducted a case-control examination of children between 2 months and 18 years who were members of a large health plan (Kaiser Permanente Colorado). The study included 156 cases of pertussis and 595 control non-pertussis children.

The results:

1. The authors found time trend in the cases of pertussis, with a large increase in cases of pertussis after the year 2000.
2. Of the 156 children who acquired pertussis, 12% were children of parents who refused vaccination.
3. In contrast, only 0.5% of the children who did not get pertussis were children of parents who refused vaccination.
4. Among children of all ages, refusing vaccination increased the risk of pertussis infection by 2,280%!!!

And these numbers may actually be an underestimate of the real risk of vaccine refusal, since the authors found a possible bias in diagnostic practices. Specifically, parents who agreed to vaccinate their children were 2 times more likely than vaccine-refusing parents to visit the doctor for upper respiratory infections. One interpretation of this finding is that parents who accepted the vaccination are more likely to seek medical services when their kids are sick than parents who refused vaccination. If this is the case, it is likely that cases of pertussis in the unvaccinated kids may have been missed (as these kids were less likely to visit the doctor) so that the rate of pertussis among unvaccinated kids is actually higher than what was observed in this study.

In sum, this study indicated that children of parents who refused vaccination were over-represented among cases of pertussis in Colorado during the past decade and that vaccination refusal increased the risk of pertussis by more than 2000%

These findings made me think about the underlying reasons that drive some parents to refuse vaccination: the fear that by vaccinating their kids they are increasing their kids’ risk of having a severe side effect. But I’m wondering if these parents are properly weighting the risks. Specifically, I wonder how many of these parents have reliable information about both sides of the equation; so that the real and known risks of vaccination are properly weighted against the real and known risks of non-vaccination (such as a 2,000% increase in the risk of acquiring pertussis)?

Glanz, J., McClure, D., Magid, D., Daley, M., France, E., Salmon, D., & Hambidge, S. (2009). Parental Refusal of Pertussis Vaccination Is Associated With an Increased Risk of Pertussis Infection in Children PEDIATRICS, 123 (6), 1446-1451 DOI: 10.1542/peds.2008-2150

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Firesetting in childhood and adolescence: early sign of psychopathology?

This past week, police officers in Florida arrested an 18-year-old kid as prime suspect in a wave of cat killings and mutilations. The killing and torturing of animals for pleasure (excluding traditional hunting) is one of the strongest signs of serious psychopathology. Firesetting is likely a close second, with most adults and adolescents who engage in arson also have a history of childhood firesetting. But until now, most studies have not been able to accurately examine what type of firesetting is predictive of later problems? For example, some children who engage in firesetting do not engage in arson or have serious psychopathology. So what are the characteristics (severity, duration, etc) that are associated with such ‘transitional’ or ‘phase’ firesetting versus a firesetting behavior that is more chronic and potentially pathological?

In an upcoming issue of the Journal of Child Psychology and Psychiatry a team of researchers from the University of Toronto in Canada conducted a large epidemiological examination of firesetting among 3,965 Canadian children and adolescents in grades 7 to 12. The authors examined the correlates of 4 types of firesetters:

1. No history of fire setting
2. Desisters: History of firesetting but none during the past year
3. Low frequency (1-2 during past year)
4. High frequency (3+ times during the past year)

The authors then examined the following variables:

• sex
• age
• school level
• grades
• is family intact?
• welfare involvement?
• difficulty with peers
• daily smoking
• binge drinking
• cannabis use
• other illicit drug use
• delinquent behaviors
• Ritalin use
• high sensation seeking personality
• psychological distress
• suicidal ideation

The Results:

1. 72% of the sample had either never engaged in fire setting (32%) or had engaged sometime during their lives but not during the past year (40.5%)
2. 27% reported engaging in firesetting during the past 12 months.

While controlling for other variables:

3. When compared to those with no history of firesetting, the “desisters” were were more likely to be male, older, smokers, cannabis  users, high sensation seekers, and have high levels of psychological distress.
4. When compared to those with no history of firesetting, the high frequency fire setters were more likely to be male, have low parental monitoring, be binge drinkers, cannabis users, illicit drug users, have a history of delinquent behaviors, be sensation seeking, have high levels of psychological distress, and have suicidal ideation.  This profile was almost identical to the profile of low frequency firesetters.

One way to conceptualize these findings is to examine the factors that predicted high/low frequency firesetters but die no predict ‘desisters’. For example, low parental monitoring was associated with low/high frequency firesetters but not with desisters. This suggests that low parental monitor is a risk factor in more chronic firesetting behaviors and that parental monitoring may not have an impact on isolated events of firesetting that do not become chronic. Cannabis was associated with all groups, so it’s not that informative. This is not surprising given that cannabis use is very frequent among teens. However, other illicit drug use was associated with frequent fire setting only, likely reflecting the severity of behavior problems among these teens. This is supported by the finding that only the low and high frequency fire setters, and not the desisters, were more likely to have a history of delinquent behaviors.

The Reference: MacKay, S., Paglia-Boak, A., Henderson, J., Marton, P., & Adlaf, E. (2009). Epidemiology of firesetting in adolescents: mental health and substance use correlates Journal of Child Psychology and Psychiatry DOI: 10.1111/j.1469-7610.2009.02103.x

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