We have a particular interest in the development of interpersonal communication in this issue, and in some of the problems that are seen when the system goes awry. Subtle deficits of communication are far more common among children referred to child psychiatric facilities than is generally appreciated. It is arguable that they are probably detected rather more easily by other children than by clinicians or even parents. Subtle disorders of language, particularly the higher-order features of language such as pragmatics, may contribute to the social difficulties faced by many children presenting to psychiatrists and psychologists. Unfortunately, until very recently we did not have any really good measures for detecting and measuring these subtle disorders, which may have profound consequences for children's behavioural and emotional adjustment, and may also contribute to educational failure.

A common clinical problem is the appropriate diagnosis to apply to a child who presents with a mixture of communicative and social impairments. Diagnostic difficulties are compounded by the lack of suitable assessment tools for evaluating how children use language in relation to a given social context. We refer to this issue as pragmatics. Bishop presents data on a new checklist for detecting pragmatic deficits, which is designed for completion by teachers or other professionals who are in daily contact with the child. Her instrument represents an important development. Careful evaluation of the checklist has shown that it can be rated reliably. Information obtained from it is intended to complement that from more formal language assessments, which are for the most part insensitive to children's pragmatic skill deficits. Bishop argues that diagnostic difficulties in the field of communication deficits are not uncommon, and her assertion will find echoes in the experience of many clinicians.

There has, over the last few years, been a keen and contentious debate surrounding the interpretation and implications of an inexorably upward trend in class sizes in Britain, focusing particularly on the primary sector. This has been played out against a backcloth of such diverse influences as the continued diminution in public sector spending, low teacher morale, changes in school management and budgeting incorporating a market approach to school enrolment, the enhanced role of parents in school governance, the publication of league tables, and disputes about differential funding of schools. Day, Tolley, Hadfield, Parkin, and Watling (1996) characterise the resultant polarisation of view as being between education pressure groups on the one hand and the government on the other, i.e. the “critical” versus the “official” view. However, this is probably too narrow a characterisation because all parties with a legitimate interest in education have been involved, from parents and teachers through to national pressure groups such as teacher unions and the National Commission on Education. Several independent surveys have been undertaken, which show both the wide consensus about the effect of increasing class sizes among these groups, and the strength with which they hold their views.

The last 40 years has seen a virtual revolution in both medical research and medical practice. Child psychiatry has been part of that revolution. The situation in the 1950s is briefly noted and seven examples are used to illustrate how causal research in the past has led to changes in clinical practice. The areas used as examples comprise: autism, hyperactivity/attention deficit syndromes, conduct disorders, depressive conditions, genetic research, organic brain dysfunction, and psychosocial risk processes. Prospects for the future with respect to the impact of research on clinical practice are discussed in relation to molecular genetics, environmental risks, cognitive and affective processing of experiences, links across the lifespan, and functional brain imaging. Attention is drawn to implications for training as well as for practice.

The developmental approach to childhood psychopathology identifies deviations from typical patterns of development and stability of individual characteristics over time, and precursors in early life of later functions. The application of this approach to the social, communicative, and cognitive development of children with autism is discussed. Results from a longitudinal study of children with autism and other developmental disorders are described, indicating that children with autism have stable deficits in joint attention, representational play, and responsiveness to the emotions of others, and that early variations in these abilities are important for concurrent and subsequent language development and for peer engagement many years later.

A meta-analysis was conducted to identify information processing factors that characterise children with Developmental Coordination Disorder (DCD). A total of 50 studies yielded 374 effect sizes based on 983 DCD and 987 control children. A mild generalised performance deficit was indicated, since motor-impaired children were inferior on almost all measures of information processing. There were, however, several areas where their deficiencies were more pronounced. The greatest deficiency was in visual-spatial processing. This was evident regardless of whether or not the tasks involved a motor component. Most other deficiencies were in the small-to-moderate range and included kinaesthetic and cross-modal processing. The findings support the notion that perceptual problems, particularly in the visual modality, are associated with difficulties in motor coordination.

Boys identified as hard-to-manage at age 4 and age-matched controls were assessed on laboratory measures of inattention, impulsivity, and hyperactivity at ages 4, 6, and 9. Hard-to-manage boys still exhibited some behavioral difficulties at age 9, but were not more inattentive or impulsive than controls. Boys with Attention Deficit Disorder (ADD) at age 9 showed performance deficits in each symptom-related domain relative to problem boys without ADD and controls. However, hard-to-manage problem boys with and without ADD did not differ on most earlier measures of inattention, impulsivity, and hyperactivity, suggesting that symptoms specific to ADD emerged more clearly between ages 6 and 9.

This study examined characteristics of social cognitive processing, psychiatric disorder, and behavioral ratings of 380 children aged 7 to 14 years who had been referred consecutively for child psychiatric services with identified and unsuspected language impairments and with normally developing language. The results indicated that children with language impairments generally exhibited greater deficits in social cognitive processing, and particularly emotion decoding and social problem solving, than children who have language that is developing normally. Differences in psychiatric diagnosis and behavior problems were observed only between children with previously identified language impairments and children with normally developing language; children with previously identified language impairments were more likely to be diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD) and to be rated by both parents and teachers as having more severe attentional problems. In addition, teachers rated them as more socially withdrawn. The results suggest that it is important to incorporate measures of both social cognition and language functioning routinely into clinical assessment, something that currently is rarely done.

This study examined the language, achievement, and cognitive characteristics of 380 children, aged 7 to 14 years, consecutively referred to child psychiatric services. Among those children referred solely for psychiatric problems, 40% had a language impairment that had never been suspected. Children with previously identified and unsuspected language impairments were similar with respect to receptive and expressive language and on measures of cognitive processing. Although both groups of children with language impairments exhibited poorer academic achievement than children with normal language, children with previously identified language impairments had the lowest achievement. The milder achievement problems of children with unsuspected language impairment may explain why their problems had not been suspected. Both the clinical and theoretical implications of the findings are discussed. Heightened awareness concerning the high frequency of language impairment and other cognitive processing problems in children referred for psychiatric assessment and treatment should lead to more systematic examination of language functioning and evaluation of the impact of language and communication functioning on therapeutic outcomes.

The Children's Communication Checklist (CCC) was developed to assess aspects of communicative impairment that are not adequately evaluated by contemporary standardised language tests. These are predominantly pragmatic abnormalities seen in social communication, although other qualitative aspects of speech and language were also included. Some items covering social relationships and restricted interests were incorporated, so that the relationship between pragmatic difficulties and other characteristics of pervasive developmental disorders could be explored. Checklist ratings were obtained for 76 children aged 7 to 9 years, all of whom had received special education for language impairment. In 71 cases, 2 raters (usually a teacher and speech-language therapist) independently completed the checklist, making it possible to establish inter-rater reliability. From an initial pool of 93 items, 70 items, grouped into 9 scales, were retained. Five of the subscales were concerned with pragmatic aspects of communication. A composite pragmatic impairment scale formed from these subscales had inter-rater reliability and internal consistency of around .80. This composite discriminated between children with a school diagnosis of semantic-pragmatic disorder and those with other types of specific language impairment (SLI). The majority of children with pragmatic language impairments did not have any evidence of restricted interests or significant difficulties in the domains of social relationships.

Comprehensive data on the developmental history and current behaviours of a large sample of high-functioning individuals with diagnoses of autism, Asperger's syndrome, or other related disorder were collected via parent interviews. This provided the basis for a taxonomic analysis to search for subgroups. Most participants also completed theory of mind tasks. Three clusters or subgroups were obtained; these differed on theory of mind performance and on verbal abilities. Although subgroups were identified which bore some relationship to clinical differentiation of autistic, Asperger syndrome, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) cases, the nature of the differences between them appeared strongly related to ability variables. Examination of the kinds of behaviours that differentiated the groups suggested that a spectrum of autistic disorders on which children differ primarily in term of degrees of social and cognitive impairments could explain the findings.

Deaf children aged 4 to 16 years were given a false-belief test of theory of mind. Although the children experienced difficulty with the test, relative to hearing children, confirming a report by Peterson and Siegal (1995), performance was age-related, with a significantly higher proportion of 13- to 16-year-olds passing the test. It was concluded that deaf children raised in a spoken language environment show a developmental delay in theory of mind acquisition. This delay is consistent with the assumption that their early opportunities for learning about mental states are relatively restricted and that the normal development of theory of mind is dependent upon such opportunities.

This study was designed to examine the classification performance of diagnostic rules for pervasive developmental disorder not otherwise specified (PDD-NOS) and multiple complex developmental disorder (McDD), with clinical diagnosis as the gold standard. McDD is an heuristic concept of a developmental disorder characterised by social impairments, affective dysregulation, and thought disturbance. Detailed information on the symptoms, reliably extracted from the charts of 103 children with PDD-NOS and McDD, 32 with autistic disorder, and 96 with non-PDD disorders, was used to determine the presence of the DSM-IV criteria of autistic disorder and the criteria of McDD. A scoring rule for PDD-NOS based on a short set of seven DSM-IV criteria with a cut-off point of three items and one social interaction item set as mandatory had the best balance between high sensitivity and high specificity. The most effective and simple rule based on McDD criteria had a cut-off of three items, out of six items of anxieties and thought disturbance.

The categorical consequences and psychometric properties of different sociometric classification methods were evaluated. Children aged 9 to 12 years (N=254) completed three sociometric questionnaires and a peer assessment measure on two occasions 5 weeks apart. The sociometric data were analysed using 13 different methods. Analysis of kappa values indicated relatively poor agreement across methods on subject classification. Temporal stability of the classifications was also poor. Assessment of construct validity involved analysis of the peer assessment items, using MANOVA to test hypotheses based on ideas from social exchange theory. Cross-sex rating biases and difficulties with the neglected and controversial classifications are discussed as indicating a need for the application of theoretically based approaches which consider features of the peer group social system and a need for caution in selecting methods for clinical use.