A study material of teenage boys from the general population was used to test the hypothesis on early alcohol abuse suggested by the results of previous prospective studies on selected materials. The results of interviews of 1,004 18-year-old boys from the general population in the Stockholm area support the hypothesis that there is a group (about 4% during autumn 1980) of boys with a high consumption of alcohol, simultaneous use of drugs and criminal behaviour. As a group these boys had been brought up in emotionally disturbed homes, with alcoholic parents, and they also showed personality features indicating psychopathy. The study provides evidence that results of investigations on selected materials are also relevant to the general population.
In Swedish child and adolescent psychiatry there is a more than 60-year long tradition of using longitudinal methods in research on juvenile delinquency. Since the 1940's, results have been presented using either prospective or retrospective longitudinal designs for this purpose. Starting from genetics as scientific paradigm, new approaches including neuropsychiatry and social psychiatry showed the need for a multidisciplinary view at the border between medicine and behavioral sciences. Both Swedish and international research in the area has clearly demonstrated that factors relating to gender, maturation, resilience vs. vulnerability, the mental health of the parents, the social network and the organization of the school are of importance when trying to understand, prevent and treat juvenile delinquents. The challenge presented to today's and future researchers is to understand how the complexity of the modern western society will impact already established knowledge.
Of 640 women who paid their first visit to the two maternal welfare centres in a new Stockholm suburb during one prospective year, 532 (85%) were interviewed with regard to 41 stress factors forming a "life stress score" (LSS). The interviews were supplemented with data from hospital, social welfare and police records concerning the expectant mother and the father. The 532 mothers were divided into three groups according to the degree of psychosocial stress (group 1 (n = 194) without psychosocial stress; group 2 (n = 171) with severe psychosocial stress; and group 3 (n = 167) in an intermediate group). In group 2, there were 23 mothers and 51 fathers in 64 families known to suffer from alcoholism/heavy drinking at the time of the first interview and these comprised our study group. The pregnancies and deliveries in the families were investigated with prospective methods. There were 497 liveborn children of whom 54 were born into families known for alcoholism/heavy drinking. The physical health and development of the children was followed by prospective data from the child welfare centers. Data concerning psychological development and psychiatric health of the child were obtained by interviewing the mother and evaluating the child during visits at home at one and four years of age. At one year of age, 452 of the children (226 boys, 226 girls) and at four to five years of age, 412 of the children (202 boys, 210 girls), were evaluated using the Griffiths' Development Scales. Findings from these evaluations form the basis for comparison of development of children from alcoholic/heavy drinking parents with all other children. For 388 children, data were available from all examinations up to the end of the fourth year, including 38 children (12 boys, 26 girls) in the study group and 350 other children (183 boys, 167 girls). The present findings indicate that children of alcoholic parents in the general population who were followed from pregnancy up to the end of their fourth year have a higher risk of pre- and postnatal death, and have poorer mental development and more symptoms of a psychopathological child psychiatric nature (DSM-III) than other children. Differences related to physical development during infant years disappeared during the observation time. With regard to mental development over a longer period, it appears that factors related to the parent's addictions and the child's sex (i.e. male child) are more important than pediatric risk factors in the form of a score of reduced optimality.
Hyperkinetic disorders, MBD (minimal brain dysfunction), DAMP [deficits in attention, motor function (or muscular control) and perception], ADD (attention deficit disorder), and ADHD (attention deficit hyperactivity disorder), are currently the focus of interest among parents, clinicians and researchers in Sweden; and guidelines for the assessment and treatment of such disorders were published in the USA in 1997, and in Europe in 1998. However, despite the accumulated knowledge, and new hypotheses which have been proposed, e.g., that ADHD is "a disorder of adaptation," there is no consensus as to the understanding, treatment and prevention of these disorders. In a consensus statement published by an NIH (National Institutes of Health) panel in the USA it was concluded that, after years of clinical research and experience, our knowledge of the aetiology of ADHD remains speculative, and no documented strategies for its prevention are available. A review of Swedish views and concepts of these disorders since 1950 showed discussion to have been characterised by more similarities than differences, and that nothing really new had emerged. However, differences have existed in the sphere of general education. Since WWI, changes in the organisation of the statutory school system have been designed to improve both education and health among schoolchildren. Such changes seem to have had both beneficial and adverse effects on the overall health of the children. The prevalence of ADHD-like problems declined during the period, 1949-70, when all Swedish six-year-olds were screened for school-readiness with a standardised national test, and the class in which a child started school was dependent on intellectual capacity, overall mental age, and the presence or absence of reading, spelling and learning difficulties, and of behavioural problems. Since this was discontinued after reorganisation of the school system in 1970, the prevalence of problematic behaviour has once again increased. Thus, in the search for new approaches to the support of children with hyperactivity and attention deficit problems, analysis of the organisation of the school system should not be forgotten.
Of 1,206 patients treated during the period 1970-1980 in a department of child psychiatry in a large city in Sweden 24 (2%) (14 boys and 10 girls) had died by the end of 1981. Twenty-one of these (88%) died of "injuries following external violence and poisoning", of whom 15 (63%) were suicides. Twenty subjects (83%) had grown up in surroundings characterised by one or more psychosocial stress factors. The study indicates a possible link between psychosocial background factors and deaths from "injuries following external violence and poisoning".
In order to detect possible relationships between antisocial behaviour and the incidence of "sudden violent death" in young people, information relating to mortality in antisocial Swedish adolescents has been traced and compiled. A register was drawn up covering those young persons (1,056; 832 boys and 224 girls; mean age 16 years) who were admitted to Swedish probationary schools during the period 1 January - 31 December 1967. Using the registers of immigration and emigration, and causes of death kept by SCB (Statistiska Centralbyrån), mortality occurring between 1 January 1967 - 31 December 1985 was tabulated. One hundred and ten boys (13%) and 22 girls (10%) had died. The deaths had occurred at a rate of approximately seven new deaths per observation year, the youngest being still in their teens when they died. For comparison, the criteria set up by insurance companies for life insurance premiums are based on a death expectancy for healthy Swedish boys and girls in the age groups corresponding to the subjects under observation of 1.2-3.1% for boys and 1.1-2.6% for girls. Eighty-eight percent of the dead boys and 77% of the dead girls had died "sudden violent deaths" - accidents, suicides, death from uncertain causes, murder/manslaughter, or alcohol/drug abuse. For both sexes, death from uncertain causes and suicides were the most frequent single causes of death. Death as a direct result of alcohol/drug abuse occurred only in boys. The results give support to the assumption that a link exists between childhood environment, the development of antisocial behaviour/mental insufficiency and a "sudden violent death" at an early age.(ABSTRACT TRUNCATED AT 250 WORDS)