Scandinavian Journal of Child and Adolescent Psychiatry and Psychology最新文献

Background: The Difficulties in Emotion Regulation Scale (DERS) is widely used in both clinical and non-clinical research to assess emotional regulation difficulties. To guide interpretation of scores, establishing thresholds for normative DERS scores is informative. However, despite its widespread use, to date no study has provided such threshold for youths. This literature review aimed to fill this gap by examining the 90% reference interval for the DERS in youths aged 11-19 years.

Methods: We conducted a systematic search on PubMed (MEDLINE) on 12 March 2024, to identify studies reporting DERS-36 total scores (DERS-T) in youths aged 11-19 years from either community-based populations or healthy volunteers.

Results: A total of 34 studies were included; 20 studies included community-based participants (n = 6,960), while the remaining 14 studies included healthy volunteers (n = 766), resulting in a total of 7,726 participants. The 90% reference interval for DERS-T from all included participants had a threshold of 121.8 normative emotion regulation in youths.

Conclusion and significance: This threshold is considerably higher than DERS-T scores reported in most clinical studies and a substantial variation in reference intervals across studies is observed. We identify five main methodological factors related to the DERS-36 and discuss their potential impact on the validity, reliability, and generalizability of findings. Given the DERS-T range of 36-180, we conclude that the 90% reference interval derived from our review is not sufficiently robust to guide clinical or scientific interpretations. Our work is not exhaustive, and further research is needed to validate and test the reliability of this reference interval.

Given shifts to dimensional models of personality pathology and a growing consensus that personality disorder (PD) often onsets during adolescence, there is a need for validated measures of PD in adolescents. Level of Personality Functioning (LPF) is particularly relevant for the identification of emerging personality dysfunction in adolescents given its ability to capture developmental discontinuity as metacognitive capacities in self- and interpersonal-functioning emerge. However, no studies as of yet have validated a measure of LPF in a sample of Spanish-speaking adolescents. In addition, no study has evaluated whether LPF associates with status as victim of parental neglect vs. community adolescents. A total of 570 Spanish-speaking adolescents between the ages of 11 and 18 (n = 168 with a history of parental neglect, n = 402 from a community sample) completed the briefest form of LPF, the LPFS-BF 2.0. Results from the confirmatory factor analysis revealed adequate fit of a unidimensional model, and invariance analyses suggested measurement invariance across gender and age (early versus late adolescents). Internal consistency was adequate, and convergent validity was supported through negative correlations of the LPFS-BF 2.0 with empathy and reflective function, and positive associations with alexithymia. Contrary to expectations, total scores on the LPFS-BF 2.0 did not distinguish adolescents with a history of parental neglect and adolescents from a community sample. Overall, results support the Spanish translation of the LPFS-BF 2.0 as a valid measure for use in adolescents.

Background: Adolescents with substance use problems (SUP) constitute a group expected to face increased mental health problems (MHP). SUP can exacerbate mental health issues while also serving as a coping mechanism. Understanding the interplay between psychological, substance-related, and social factors is crucial for shaping effective interventions for this demographic. This article presents a three-year follow-up study with adolescents who had outpatient treatment for SUP, focusing on MHP and psychiatric conditions.

Objective: This study aims to determine the prevalence of ongoing SUP and MHP in adolescents who received outpatient treatment at a specialized substance use clinic three years post-treatment initiation. Additionally, it seeks to explore psychosocial risk factors distinguishing adolescents with solely MHP from those with both MHP and persistent SUP (co-occurring problems) three years post-treatment initiation.

Method: The study utilizes a longitudinal design, combining structured interview data at intervention onset with national register data at one- and three-years post-treatment initiation. A total of 451 adolescents participated, with 29% females and a median age of 17 years. Descriptive statistics and gender distribution of outcome groups are presented, alongside logistic regressions to assess the predictive value of risk factors for psychiatric conditions, substance use, and co-occurring conditions.

Results: Nearly three-quarters of enrolled youth show no ongoing SUP, and one-third exhibit indications of MHP three years after treatment initiation. Risk factors diverge when distinguishing adolescents with MHP from those with co-occurring problems at the three-year mark post-treatment. School problems, depression, female gender, and low primary drug use increase the likelihood of solely exhibiting MHP.

Conclusions: Integrated outpatient clinics like Maria clinics could play a crucial role in early detection and management of both SUP and MHP. The findings offer hope, suggesting positive outcomes regarding substance use even for individuals with heavy risk loads or severe SUP.

Background: Although autistic individuals are interested in interacting with peers, they express a need for social skills programs that could support them in navigating their daily social world, which is governed by neurotypical social norms.

Aim: This study investigated the feasibility and adaptability of the manualised and evidence-based program KONTAKT™ Social Skills Toolbox Group Program in supporting autistic children aged 8 to 12 years in navigating their everyday social worlds.

Material and methods: KONTAKT™ was delivered to 15 autistic children (Mage=10.87, SDage=1.04; 67% male) over 16, 60-minute sessions. A pre-test and post-test design was employed evaluating changes in personally meaningful social goals, social skills, quality of friendship and autistic traits. Focus groups were also conducted and analysed using thematic analysis post completion of the program, exploring participants, their parents and the KONTAKT™ trainer's perceptions of the program.

Results: Findings suggest stakeholders' satisfaction with the program's content and structure, indicating the potential cross-age feasibility of KONTAKT™ in supporting autistic children to achieve their personally meaningful social goals and in improving their social performance navigating their daily social lives.

Conclusion and significance: This feasibility study supported the finalisation of KONTAKT™ children's manual and workbooks, preparing it for further evaluation of its efficacy in a randomised controlled trial. (Australian New Zealand Clinical Registry: 12619000994189; ClinicalTrials.gov: NCT04024111).

Background: Experimental research has shown the benefits of auditory white noise on cognitive performance in children with attention problems. However, little is currently known about individual differences in noise response amongst children with a clinical diagnosis of attention deficit hyperactivity disorder (ADHD). In addition, no research has so far tested the effects of visual white noise on children with ADHD.

Objectives: The present work aimed at testing the effect of visual and auditory white noise on cognitive performance in children diagnosed with ADHD.

Method: Forty-three children with ADHD diagnosis performed a visuo-spatial working memory test with experimentally controlled auditory and visual white noise. Symptomatic and demographic data were collected.

Results: Surprisingly, results did not show significant effects of noise across the full sample of ADHD children. However, responses to noise appeared to affect subgroups of ADHD children differently: Those with relatively more inattentive traits responded positively on noise exposure whereas those with relatively more hyperactive/impulsive traits performed worse during noise exposure. Individual differences in noise response in the auditory and visual modalities were strongly correlated.

Conclusions: It is important to consider individual differences in response to noise exposure, and to take into account the specific ADHD symptom profile (inattentive vs. hyperactive/impulsive) in applying noise to support cognitive performance in children with ADHD.

Background: Medikinet^® MR and Concerta^® are long-acting methylphenidate formulations used for the treatment of pediatric and adult attention-deficit/hyperactivity disorder (ADHD). The two formulations have shown comparable safety profiles in two head-to-head randomized controlled trials. However, real-world studies comparing the safety profiles of these products are not available.

Objective: This study aimed to compare the real-world safety of Medikinet^® MR and Concerta^® using register data.

Method: This population-based cohort study was conducted based on data from Danish registries. The study included patients with continuous long-term (i.e., ≥12 months) exposure to either Medikinet^® MR or Concerta^® between 1995 and 2018. Outcomes included several selected adverse events of interest. A sensitivity analysis was performed, excluding patients exposed to Concerta^® generics. For each outcome, Fisher's exact test was performed to compare the number of cases between the two groups. Odds ratios (ORs) and 95% confidence intervals were estimated using logistic regression models with patients exposed to Concerta^® as the reference group.

Results: The study population included 1249 patients exposed to Medikinet^® MR and 2455 patients exposed to Concerta®. No cases of cerebral arteritis or priapism were identified in either cohort. ORs for sudden death and anorexia could not be calculated due to the absence of cases in the Medikinet^® MR cohort. For the remaining outcomes, no statistically significant difference in risk was found between Medikinet^® MR-exposed and Concerta^®-exposed patients. The sensitivity analysis produced results consistent with those obtained in the main analysis.

Conclusions: The results of this population-based cohort study indicate that Medikinet^® MR and Concerta^® have comparable real-world safety profiles.

Background: Depression is common and increasing in young people, who seem especially vulnerable, both in the probability of developing depression, and in the resulting negative consequences across the lifespan. Unfortunately, available treatments rarely lead to full remission and even in cases of remission relapse rates are high. Different explanatory models have been proposed, and research indicates a multifaceted etiology. The descriptive DSM-5 has low diagnostic validity in this age-group, especially for depressive disorders, and limited attention has been given to young people's own experiences of becoming depressed. Hence, there is a risk of missing clinical information that is important for the therapeutic alliance and treatment.

Objective: This study aimed to explore young people's experiences of becoming depressed.

Method: A qualitative study was performed. Six participants with clinical depression, currently in treatment at child and adolescent psychiatric outpatient clinics in northern Sweden were recruited. Interviews followed a semi-structured manual, and data was analyzed with inductive qualitative content analysis.

Results: Participants described different reasons for their depression, and from their stories four categories were identified: "Being subjected to violence", "Suffering separation and loss", "Feeling abandoned", and "Feeling burdened and vulnerable". These categories were interpreted in the theme: "Dealing with an overwhelming life situation".

Conclusions: The participants presented mainly stressful external and relational events preceding their depression. A combination of overwhelming stressors, lack of support and lack of time for recovery was described. This points to the importance of validating the narratives of young patients with depression and to offer trauma-informed treatment approaches in mental health care.

Background: Digital solutions have been reported to provide positive psychological and social outcomes to childhood critical illness survivors, a group with an increased risk for long-term adverse psychosocial effects.

Objective: To explore health professionals' perspectives on the potential of digital psychosocial follow-up for childhood critical illness survivors.

Methods: Using a qualitative approach, expert interviews with six health professionals working at a Norwegian hospital were conducted. Transcribed interviews were analyzed using Braun and Clarke's six-phase thematic analysis framework. Concurrent data collection and analysis using inductive coding was also employed, and a model of codes was constructed.

Results: The interview yielded thirteen unique codes regarding the health professionals' perspectives on the potential for digital psychosocial follow-up for childhood critical illness survivors, organized in a model comprising the two main themes: Affecting Factors and Digital Usage. Demographic factors (the child's medical condition, age, gender, and residence) and environmental factors (the child's family and health professionals) tended to affect the current psychosocial follow-up. Hospital limitations concerning a lack of digital solutions, worse relationship building with video communication, and children's already high screen time reflected the current state of digital usage. However, ongoing digitalization, existing successful digital solutions, children's good digital skills, and an ongoing process of creating an artifact are also seen as opportunities for digital usage in future psychosocial follow-up for childhood critical illness survivors.

Conclusions: Researchers can build further on these findings to investigate the potential of digital psychosocial follow-up for childhood critical illness survivors, and clinicians can use it as a starting point for improving psychosocial follow-up.