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European Child & Adolescent Psychiatry    [6 followers]  Follow    
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 1435-165X - ISSN (Online) 1018-8827
     Published by Springer-Verlag Homepage  [2187 journals]   [SJR: 1.269]   [H-I: 51]
  • The Pressure–Activation–Stress scale in relation to ADHD and
    • Abstract: Abstract The Pressure–Activation–Stress (PAS) scale is a self-report questionnaire for children concerning perceived stress. To explore behavioral and physiological correlates, we investigated if scores discriminate between a group prone to perceive high levels of stress [children with attention-deficit/hyperactivity disorder (ADHD)] and a healthy school sample, and if they are associated with diurnal cortisol levels. The PAS scale was filled in at home by children (11–17 years) with clinically confirmed ADHD (n = 102) and non-affected comparisons (n = 146). Saliva samples were collected four times during a regular school day for radioimmunoassay analysis of cortisol. Subtypes and severity of ADHD symptoms were determined using parental rating scales. Children with ADHD scored higher on the PAS scale than a school sample. The PAS scores were similar over ages in the ADHD group while they increased with age in the healthy group. Female sex was associated with higher stress in both groups but no gender interaction was found. No association was found between PAS scores and cortisol levels in neither group. Children in the ADHD group had a lower ratio of cortisol levels/perceived stress on all sampling occasions, built up both by the higher PAS scores and the lower cortisol levels in children with ADHD. The higher PAS scores in children with ADHD support the validity of the scale. The lack of association between PAS scores and diurnal cortisol levels is intriguing and illustrates the complexity of the stress concept. Stress-related fragility seems to accompany ADHD during childhood.
      PubDate: 2014-04-16
  • Predicting ADHD in school age when using the Strengths and Difficulties
           Questionnaire in preschool age: a longitudinal general population study,
    • Abstract: Abstract Indicated prevention of ADHD may reduce impairment and need of treatment in youth. The Strengths and Difficulties Questionnaire (SDQ) is a brief questionnaire assessing child mental health, reported to be a valid screening instrument for concurrent ADHD. This study aimed to examine the validity of using the SDQ in preschool age to predict ADHD in school age in a longitudinal design. The study population included 2,315 children from the Copenhagen child cohort 2000 with no prior history of clinically diagnosed ADHD, who were assessed at age 5–7 years by the SDQ completed by parents and preschool teachers. Danish National Registers were used to measure the outcome of any first time ICD-10 diagnosis for hyperkinetic disorder or attention-deficit disorder and/or prescription of central stimulants during years 2005–2012. Screening potentials of the SDQ’s predictive algorithms were described, and Cox regression analyses estimated the risk of later ADHD diagnosis for screen-positive children. A total of 2.94 % of the study population were clinically diagnosed and/or were treated with central stimulants for ADHD before age 11–12. Children with possible/probable disorder according to the SDQ hyperactivity/inattention algorithm showed markedly increased risk of a subsequent ADHD diagnosis, hazard ratio 20.65 (CI 95 % 12.71–33.57) and sensitivity 45.6 %. Other domains of psychopathology according to the SDQ were also associated with an increased risk of receiving a subsequent ADHD diagnosis. In summary, we show that the SDQ can identify a group of children with highly increased risk of later being diagnosed and/or treated for ADHD in school age.
      PubDate: 2014-04-16
  • From positive emotionality to internalizing problems: the role of
           executive functioning in preschoolers
    • Abstract: Abstract Temperament and psychopathology are intimately related; however, research on the prospective associations between positive emotionality, defined as a child’s positive mood states and high engagement with the environment, and psychopathology is inconclusive. We examined the longitudinal relation between positive emotionality and internalizing problems in young children from the general population. Furthermore, we explored whether executive functioning mediates any observed association. Within a population-based Dutch birth cohort, we observed positive emotionality in 802 children using the laboratory temperament assessment battery at age 3 years. Child behavior checklist (CBCL) internalizing problems (consisting of Emotionally Reactive, Anxious/Depressed, and Withdrawn scales) were assessed at age 6 years. Parents rated their children’s executive functioning at ages 4 years. Children with a lower positive emotionality at age 3 had a higher risk of withdrawn problems at age 6 years (OR = 1.20 per SD decrease in positive emotionality score, 95 % CI: 1.01, 1.42). This effect was not explained by preexisting internalizing problems. This association was partly mediated by more problems in the shifting domain of executive functioning (p < 0.001). We did not find any relation between positive emotionality and the CBCL emotionally reactive or anxious/depressed scales. Although the effect sizes were moderate, our results suggest that low levels of positive emotionality at preschool age can result in children’s inflexibility and rigidity later in life. The inflexibility and rigidity are likely to affect the child’s drive to engage with the environment, and thereby lead to withdrawn problems. Further research is needed to replicate these findings.
      PubDate: 2014-04-13
  • A longitudinal perspective on childhood adversities and onset risk of
           various psychiatric disorders
    • Abstract: Abstract It is well-known that childhood adversities can have long-term effects on mental health, but a lot remains to be learned about the risk they bring about for a first onset of various psychiatric disorders, and how this risk develops over time. In the present study, which was based on a Dutch longitudinal population survey of adolescents TRAILS (N = 1,584), we investigated whether and how childhood adversities, as assessed with three different measures, affected the risk of developing an incident depressive, anxiety, or disruptive behavior in childhood and adolescence. In addition, we tested gender differences in any of the effects under study. The results indicated that depressive, anxiety and disruptive behavior disorders each had their own, characteristic, pattern of associations with childhood adversities across childhood and adolescence, which was maintained after adjustment for comorbid disorders. For depressive disorders, the overall pattern suggested a high excess risk of incidence during childhood, which decreased during adolescence. Anxiety disorders were characterized by a moderately increased incident risk during childhood, which remained approximately stable over time. Disruptive behavior disorders took an intermediate position. Of the three childhood adversities tested, an overall rating of the stressfulness of the childhood appeared to predict onset of psychiatric disorders best. To conclude, the risk of developing a psychiatric disorder after exposure to adversities early in life depends on the nature of the adversities, the nature of the outcome, and the time that has passed since the adversities without disorder onset.
      PubDate: 2014-04-11
  • Risk factors for incident major depressive disorder in children and
           adolescents with attention-deficit/hyperactivity disorder
    • Abstract: Abstract The greater burden of illness in youth with co-occurring attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) deserves further investigation, specifically regarding the influence of other psychiatric or medical conditions and the pharmacotherapies prescribed. A retrospective cohort design was employed, using South Carolina’s (USA) Medicaid claims’ dataset covering outpatient and inpatient medical services, and medication prescriptions between January, 1996 and December, 2006 for patients ≤17 years of age. The cohort included 22,452 cases diagnosed with ADHD at a mean age 7.8 years; 1,259 (5.6 %) cases were diagnosed with MDD at a mean age of 12.1 years. The probability of a child with ADHD developing MDD was significantly associated with a comorbid anxiety disorder (aOR = 3.53), CD/ODD (aOR = 3.45), or a substance use disorder (aOR = 2.31); being female (aOR = 1.77); being treated with pemoline (aOR = 1.69), atomoxetine (aOR = 1.31), or mixed amphetamine salts (aOR = 1.28); a comorbid obesity diagnosis (aOR = 1.29); not being African American (aOR = 1.23), and being older at ADHD diagnosis (aOR = 1.09). Those developing MDD also developed several comorbid disorders later than the ADHD-only cohort, i.e., conduct disorder/oppositional-defiant disorder (CD/ODD), at mean age of 10.8 years, obesity at 11.6 years, generalized anxiety disorder at 12.2 years, and a substance use disorder at 15.7 years of age. Incident MDD was more likely in individuals clustering several demographic, clinical, and treatment factors. The phenotypic progression suggested herein underscores the need for coordinated early detection and intervention to prevent or delay syndromal MDD, or to minimize its severity and associated impairment over time.
      PubDate: 2014-04-05
  • Influence of assessment instrument on ADHD diagnosis
    • Abstract: Abstract We compared four instruments commonly used to screen for and diagnose Attention-Deficit/Hyperactivity Disorder (ADHD) in children. The Bergen Child Study included a DSM-IV ADHD symptom list and the Strengths and Difficulties Questionnaire (SDQ) as screen in Phase one. Phase two included the parent Development and Well-Being Assessment (DAWBA), whereas Phase three comprised in-depth clinical assessment, including the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS). We compared ADHD as diagnosed by the four instruments in the children with normal intellectual functioning participating in all three phases (N = 234). The DSM-IV ADHD symptom list showed moderate agreement with all other instruments (κ = 0.53–0.57), whereas there was fair agreement between the K-SADS-DAWBA (κ = 0.31) and between SDQ–DAWBA (κ = 0.33). The DAWBA diagnosed fewer children with ADHD than did the other instruments. Implications for use of the instruments are discussed.
      PubDate: 2014-04-01
  • Transcription Factor Activating
    (       class="a-plus-plus">TFAP-2β) genotype and
           symptoms of attention deficit hyperactivity disorder in relation to
           symptoms of depression in two independent samples
    • Abstract: Abstract The Transcription Factor Activating Protein-2β (TFAP-2β) gene has been shown to influence monoaminergic neurotransmission, and several genes important for monoaminergic function have binding sites for TFAP-2β. Familial studies of attention deficit hyperactivity disorder (ADHD) suggest a hereditary-determined subtype of ADHD with comorbid depression. We examined a functional variation of the TFAP-2β gene in the context of co-occurring symptoms of ADHD and depression in two independent population-based samples of adolescents (Group A, n = 175 and Group B, n = 1,506) from Sweden. Results indicated 6.1 to 7.8 % of adolescents screened positively for ADHD and depression symptoms. Symptoms of depression were more common among girls who screened positively for ADHD and did not carry the nine-repeat allele of the TFAP-2β intron 1 Variable Number Tandem Repeat (VNTR) polymorphism. The presence of the nine-repeat variant of the TFAP-2β intron 1 VNTR appears to protect girls with ADHD symptoms from the co-expression of symptoms of depression.
      PubDate: 2014-04-01
  • Subthreshold traits of the broad autistic spectrum are distributed across
    • Abstract: Abstract Autism is a categorical developmental disorder characterized by impairment in socialization, communication, and by restricted and circumscribed interests. Several authors have described the presence of subthreshold autistic traits in the general population, pervasive developmental disorders representing the extreme end of their distribution. In this study, we explored the presence of autistic traits in siblings and parents of a proband with autism, and in siblings and parents of a normally developing child, using the previously validated self-report French Autism Quotient, an adaptation of the AQ developed by S. Baron-Cohen. Scores were distributed between two main factors, F1 corresponding to socialization and communication, F2 to imagination and rigidity. Here, we show that both parents and siblings of a child with autism have more symptomatic scores in the domains of communication and socialization. In addition, we show that in these families the parents, but not the siblings, are distributed across different subcategories, according to their scores for the F1 and F2 domains. We hypothesize that these different subgroups may correspond to different underlying genetic mechanisms.
      PubDate: 2014-04-01
  • Behavioral problems in school-aged hearing-impaired children: the
           influence of sociodemographic, linguistic, and medical factors
    • Abstract: Abstract The purpose of this study was to examine several behavioral problems in school-aged hearing-impaired children with hearing aids or cochlear implants, compared to normally hearing children. Additionally, we wanted to investigate which sociodemographic, linguistic, and medical factors contributed to the level of behavioral problems, to pinpoint where targeted interventions can take place. This large, retrospective study included a sample of 261 school-aged children (mean age = 11.8 years, SD = 1.6), that consisted of three age- and gender-matched subgroups: 75 with hearing aids, 57 with cochlear implants, and 129 normally hearing controls. Self- and parent-reports concerning reactive and proactive aggression, delinquency, and symptoms of psychopathy, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder were used. In addition, several language and intelligence tests were administered. Hearing-impaired children showed significantly more proactive aggression, symptoms of psychopathy, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder than their normally hearing peers. More behavioral problems were associated with special schools for the deaf, sign (-supported) language, hearing aids (in contrast to cochlear implants), higher age, male gender, lower socioeconomic status, lower intelligence, and delayed language development. Hearing-impaired children face multiple problems regarding their behavior. The outcomes implicate that professionals should be aware of the higher risk of developing behavioral problems, in order to screen, detect, and treat in time. Furthermore, the associated risk and protective factors emphasize that clinicians must always consider the heterogeneity of the group of hearing-impaired children, in order to help and support the individual patient.
      PubDate: 2014-04-01
  • Prevalence of depressive symptoms and associated developmental disorders
           in preschool children: a population-based study
    • Abstract: Abstract Depression is an incapacitating disorder, which is often overlooked in preschool children. The aim of this study was to analyse the prevalence of depressive symptoms and co-occurring risk factors in a large, population-based sample of preschool children. All 653 children (of a total of 731) in a defined geographical area were assessed during the school-entry exam by community care paediatricians. In addition to clinical appraisal, parents filled out the Preschool Feelings Checklist, a 16-item screening instrument with good psychometric properties. The mean age was 6.2 years (range 5.0–7.6 years) and the sample included 344 boys and 305 girls. The prevalence of depressive symptoms of clinical relevance (total score ≥3) was 5.7 % (37). There were no differences between boys and girls, and between younger (<6 years) and older (>6 years) children. Depressive symptoms were associated with parental separation and comorbid behavioural problems, but especially with developmental motor and speech problems and disorders. Migration to Germany had no influence. Depressive symptoms are common in preschool children and associated with developmental problems. Depression should be considered in children with speech and motor problems who are at special risk. Early detection and treatment are recommended.
      PubDate: 2014-04-01
  • Implementation of routine outcome measurement in child and adolescent
           mental health services in the United Kingdom: a critical perspective
    • PubDate: 2014-04-01
  • A forgotten lethal psychosis: a case report
    • Abstract: Abstract Homocystinuria due to cystathionine β-synthase deficiency is an inborn error of metabolism first described almost 50 years ago, which involves the accumulation of plasma homocysteine and other metabolites. Without early detection and appropriate treatment, common and sometimes lethal consequences include ocular abnormalities, osteoporosis, developmental delays, marfanoid phenotype, vascular disease, and mental retardation. Almost 50 % of subjects develop a psychiatric disorder during their life, but only 2.8 % present a psychiatric symptom as the initial manifestation. Among this group, psychotic disorders are infrequent. We describe the case of a 17-year-old boy presenting with a first episode psychosis and an unknown homocystinuria due to cystathionine β-synthase deficiency, which led to a lethal outcome.
      PubDate: 2014-04-01
  • Continuity in features of anxiety and attention deficit/hyperactivity
           disorder in young preschool children
    • Abstract: Abstract Anxiety disorders and attention deficit/hyperactivity disorder (ADHD) develop before school age, but little is known about early developmental pathways. Here we test two hypotheses: first, that early signs of anxiety and ADHD at 18 months predict symptoms of anxiety and ADHD at age 3½ years; second, that emotional dysregulation at 18 months predicts the outcome of co-occurring anxiety and ADHD at age 3½ years. The study was part of the prospective Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. The 628 participants were clinically assessed at 3½ years. Questionnaire data collected at 18 months were categorized into early behavioural scales of anxiety, ADHD, and emotional dysregulation. We investigated continuity in features of anxiety and ADHD from 18 months to 3½ years of age through logistic regression analyses. Anxiety symptoms at 3½ years were predicted by early signs of anxiety (Odds ratio (OR) = 1.41, CI = 1.15–1.73) and emotional dysregulation (OR = 1.33, CI = 1.15–1.54). ADHD symptoms at 3½ years were predicted by early signs of ADHD (OR = 1.51, CI = 1.30–1.76) and emotional dysregulation (OR = 1.31, CI = 1.13–1.51). Co-occurring anxiety and ADHD symptoms at 3½ years were predicted by early signs of anxiety (OR = 1.43, CI = 1.13–1.84), ADHD (OR = 1.30, CI = 1.11–1.54), and emotional dysregulation (OR = 1.34, CI = 1.13–1.58). We conclude that there were modest continuities in features of anxiety and ADHD through early preschool years, while emotional dysregulation at age 18 months was associated with symptoms of anxiety, ADHD, and co-occurring anxiety and ADHD at age 3½ years.
      PubDate: 2014-04-01
  • Registration of aggressive incidents in an adolescent forensic psychiatric
           unit and implications for further practice
    • Abstract: Abstract Although aggression is part of daily life in psychiatric units for adolescents, empirical data on its prevalence are sparse. Only few studies have described prevalence of aggressive incidents in adolescent psychiatric wards, and data in forensic psychiatric care are even more limited. Available studies reported high prevalence rates of aggression, ranging from 0.4 to 2.4 incidents of aggression per day across (forensic) child and adolescent psychiatric units. Between 27 and 78 % of all admitted youth committed an aggressive act. In this study, we collected systematically registered data of all aggressive incidents from the first 2 years (2010–2012) on a newly established forensic adolescent psychiatric unit, which used a formal aggression management program embedded in the social competence model, which is based on early intervention in the ‘chain of behavior’ to prevent any further escalation. The inclusion of also minor aggressive incidents is unique in the literature and the clinical relevance is highlighted. A mean of one incident a day took place, with each adolescent involved in at least one incident. Notably, 1.7 aggressive incidents per month made seclusion of restraint use necessary. Based on the social competence theory, the aggression management model suggests intervening early in the cascade of aggression, in order to prevent further escalation and reduce the need for intrusive interventions. Evidence supported that aggression is a contextual event, as external factors clearly influence the incidence of aggression. Aggression management should be built on both relational and structural security.
      PubDate: 2014-03-31
  • Neurobiology and treatment of adolescent female conduct disorder:
           FemNAT-CD consortium: a new European cooperation
    • PubDate: 2014-03-30
  • Dimensionality of childhood psychopathology and the challenge of
           integration into clinical practice
    • PubDate: 2014-03-29
  • Weak association of glyoxalase 1 (       class="a-plus-plus">GLO1) variants with autism
           spectrum disorder
    • Abstract: Abstract The prevalence of the autism spectrum disorder (ASD) was recently estimated to 1 in 88 children by the CDC MMWR. In up to 25 % of the cases, the genetic cause can be identified. Past studies identified increased level of advanced glycation end products (AGE) in the brain samples of ASD patients. The methylglyoxal (MG) is one of the main precursors for AGE formation. Humans developed effective mechanism of the MG metabolism involving two enzymes glyoxalase 1 (GLO1) and hydroxyacylglutathione hydrolase (HAGH). Our aim was to analyse genetic variants of GLO1 and HAGH in population of 143 paediatric participants with ASD. We detected 7 genetic variants in GLO1 and 16 variants in HAGH using high-resolution melting (HRM) analysis. A novel association between variant rs1049346 and ASD [OR (allele C)] = 1.5; 95 % CI = 1.1–2.2 and p < 0.05) was identified, and weak association between ASD and variant rs2736654 [OR (allele A)] = 2.2; 95 % CI = 0.99–4.9; p = 0.045) was confirmed. Additionally, a novel genetic variant (GLO1 c.484G > A, p.Ala161Thr) with predicted potentially damaging effect on the activity of the glyoxalase 1 that may contribute to the aetiology of ASD was identified in one participant with ASD. No association between genetic variants of the HAGH gene and ASD was found. Increased level of MG and, consequently, AGEs can induce oxidative stress, mitochondrial dysfunction and inflammation all of which have been implicated to act in the aetiology of the ASD. Our results indicate potential importance of MG metabolism in ASD. However, these results must be interpreted with caution until a causative relation is demonstrated.
      PubDate: 2014-03-27
  • A descriptive study of symptom change as a function of attachment and
           emotion regulation in a naturalistic adolescent inpatient setting
    • Abstract: Abstract This is the first study to describe the relation between attachment security, emotion regulation, and symptom change in a sample of adolescents completing inpatient treatment in a naturalistic setting. We examined whether attachment security predicted symptom change, and whether emotion regulation capacities mediated this relation. A sample of n = 194 inpatient adolescents was assessed (65.5 % female, M age = 15.45 years, SD = 1.44) at admission and discharge and analyses were conducted in accordance with the aforementioned objectives including testing of moderation and mediation models. We found that securely attached adolescents experienced greater reduction in internalizing symptoms from admission to discharge, even when controlling for length of stay. Nonacceptance of emotional responses mediated the relation between maternal attachment security and internalizing symptom change. These findings did not hold for externalizing symptoms, nor when paternal attachment was explored. Attachment plays an important role in symptom change for internalizing problems, with nonacceptance of emotional responses partially mediating this link. Possible explanations for the absence of moderation for paternal attachment and externalizing problems are discussed, as are explanations for the mediating effect of emotion regulation.
      PubDate: 2014-03-22
  • Empathy and prosocial behavior in response to sadness and distress in 6-
           to 7-year olds diagnosed with disruptive behavior disorder and
           attention-deficit hyperactivity disorder
    • Abstract: Abstract Empathy has been associated with decreased antisocial and increased prosocial behavior. This study examined empathy and prosocial behavior in response to sadness and distress in disruptive behavior disorder (DBD) and attention-deficit hyperactivity disorder (ADHD). Six- and 7-year-old children with DBD (with and without ADHD) (n = 67) and with ADHD only (n = 27) were compared to typically developing children (TD) (n = 37). Parents and teachers rated affective empathy in response to sadness and distress on the Griffith Empathy Measure. Children reported affective empathic ability in response to sad story vignettes. Empathy-induced prosocial behavior in response to sadness and distress was assessed with a computer task, the Interpersonal Response Task (IRT). Compared to TD, children with DBD (with and without ADHD) and those with ADHD only were rated as less empathic by their teachers, but not by their parents. No differences between groups were observed in children who reported affect correspondence. Children with DBD (with and without ADHD) showed less prosocial behavior in response to sadness and distress compared to TD. Children with ADHD only did not differ from TD. An additional analysis comparing all children with a diagnosis to the TD group revealed that the difference in prosocial behavior remained after controlling for ADHD symptoms, but not after controlling for DBD symptoms. These findings of impaired empathy-induced prosocial behavior in response to sadness and distress in young children with DBD suggest that interventions to ameliorate peer relationships may benefit from targeting on increasing prosocial behavior in these children.
      PubDate: 2014-03-19
  • Serum matrix metalloproteinase-9 levels and severity of symptoms in boys
           with attention deficit hyperactivity disorder ADHD/hyperkinetic disorder
    • Abstract: Abstract The serum levels of matrix metalloproteinase-9 (MMP-9) in neuropsychiatric disorders of adults have been widely investigated. So far, no studies have been conducted on the relationship of MMP-9 and cognitive domains in children with two phenotype models, attention deficit/hyperactivity disorder and hyperkinetic disorder (ADHD/HKD). The aim of this research was to evaluate and test the hypothesis that serum MMP-9 levels are associated with the severity of symptoms in children with ADHD/HKD and to compare the results in two models of this disorder. The study group comprised 37 Caucasian boys aged 7–12 years with HKD, being a subset of the combined ADHD subtype. Intellectual functions were measured using Wechsler Intelligence Scale for Children-Revised. The analysis of serum concentrations of MMP-9 was based on a quantitative sandwich ELISA. The statistical regression analysis revealed a correlation between increased serum MMP-9 levels and severity of symptoms in the ADHD (β = 0.33; p = 0.043) and HKD (β = 0.34, p = 0.037) model. According to the results, elevated levels of serum MMP-9 in boys with HKD may be associated with clinical impulsivity domain (β = 0.38; p = 0.019).
      PubDate: 2014-03-17
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