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Robust evidence that anorexia nervosa is preceded rather than accompanied by high-concern (overprotective) parenting is limited. To look for evidence of parental high concern occurring before any onset of disorder. Forty consecutive referrals of adolescent girls with DSM-III-R anorexia nervosa were compared with matched controls using obstetric records and maternal interviews. Index mothers reported higher rates of: near-exclusive child care (P = 0.02), infant sleep difficulties (P = 0.018), severe distress at first regular separation (P = 0.048), high maternal trait anxiety levels (P = 0.008) and later age for first sleeping away from home (P = 0.009). More index families had experienced a severe obstetric loss prior to their daughter's birth (P = 0.066). This study lends evidence to the clinical contention that high-concern parenting in infancy is associated with the later development of anorexia nervosa. This may derive, in part, from aspects of unresolved grief.

BackgroundThis paper reviews research on the psychological treatment of depression in children.MethodManual and computer literature searches were performed.ResultsThe most promising psychological interventions for depression in children are individual rather than family therapies. Cognitive – behavioural therapy seems to be an effective treatment for depressive symptoms and mild depressive disorders. It may also be a useful preventive intervention, though this remains to be conclusively demonstrated. There have been no systematic studies comparing psychological treatments with medication.ConclusionsStudies comparing psychological treatments and medication are now required.

Abstract Objective: To determine whether cognitive behaviour therapy is an effective treatment for childhood and adolescent depressive disorder. Design: Systematic review of six randomised trials comparing the efficacy of cognitive behaviour therapy with inactive interventions in subjects aged 8 to 19 years with depressive disorder. Main outcome measure: Remission from depressive disorder. Results: The rate of remission from depressive disorder was higher in the therapy group (129/208; 62%) than in the comparison group (61/168; 36%). The pooled odds ratio was 3.2 (95% confidence interval 1.9 to 5.2), suggesting a significant benefit of active treatment. Most studies, however, were based on relatively mild cases of depression and were of only moderate quality. Conclusions: Cognitive behaviour therapy may be of benefit for depressive disorder of moderate severity in children and adolescents. It cannot, however, yet be recommended for severe depression. Definitive large trials will be required to determine whether the results of this systematic review are reliable. Key messages Depressive disorders are a common problem in child psychiatric clinics, but a recent systematic review found that tricyclic medication was of unproved benefit This systematic review identified six randomised trials of a psychological treatment—cognitive behaviour therapy—in subjects aged 8 to 19 years with depressive disorder The results seemed to show that cognitive behaviour therapy is an effective treatment for depressive disorder of moderate severity Because of the small number of trials available for this quantitative analysis definitive large trials will be required to determine whether the present results are reliable