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

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a commonly occurring neurodevelopmental disorder associated with impairments in numerous aspects of functioning and quality of life. There is a growing recognition that brief and effective psychosocial interventions are needed for youth with ADHD.

Objective: The aim of this study was to assess the feasibility and preliminary effectiveness of a dialectical behavioral therapy-based skills training group for adolescents with ADHD in a routine clinical care setting.

Methods: Ten adolescents with ADHD/ADD (Attention Deficite Disorder) commenced a 10-week training group including psychoeduction, mindfulness and other self-regulatory skills training. Primary outcomes were pre- to post-treatment changes in guardian-rated ADHD-symptoms and participant-rated quality of life. Secondary outcomes were pre- to post-treatment changes in participant-rated executive functioning, depression, anxiety, and treatment satisfaction, as well as parent/guardian-rated executive functioning. All symptom/functioning scales were administered at pre-treatment, post-treatment, and a 12-week follow-up.

Results: Eight of the ten participants completed treatment, with > 80% attendance for treatment completers and high ratings for treatment satisfaction. Based on the intention-to-treat analyses, there were improvements from pre-treatment to follow-up in primary and secondary outcomes except quality of life. Based on the completer's analyses, there were improvements from pre-treatment to follow-up for guardian rated ADHD symptoms and executive functioning, depression, anxiety, and quality of life. Uncontrolled effect sizes for pre-treatment to 12-week follow-up for treatment completers were medium for inattention, executive functioning, and quality of life, and large for depression and anxiety.

Conclusions: The present study suggests that the DBT-based skills group training was feasible and, for treatment completers, yielded significant improvements across a range of symptom domains and quality of life assessed at the 12-week follow-up. However, this is only an exploratory finding and could be attributed to natural improvement or regression toward the mean. Therefore, further studies are warranted.

Background: Based on Achenbach's school-age questionnaires, research groups have investigated supplementary scales for stress problems, obsessive-compulsive problems, sluggish cognitive tempo, positive qualities, dysregulation, autism spectrum disorders, and mania in 6-18-year-olds partly only in some of the three perspectives the Achenbach System of Empirically Based Assessment (ASEBA) provides.

Objective: We aimed to evaluate these dimensions for the German-language forms and, if possible, to extend their use to further rating perspectives.

Methods: The internal consistencies of the supplementary scales were examined for three types of informants (parents, adolescents, and teachers) and different samples (community sample, clinical sample, and disorder-specific subsamples). Age-and gender-specific effects are displayed as well as cross-informant correlations. Additionally, different aspects of validity were analyzed: (a) convergent/divergent validity via correlations with traditional ASEBA scales (problem scales as well as the scales oriented to the Diagnostic and Statistical Manual of Mental Disorders 5th edition); (b) discriminative validity via differences between clinical vs. community-based sample as well as disorder-specific subgroup vs. clinical sample.

Results: Most of the supplementary scales showed at least acceptable internal consistency. For some scales, we found significant but rather small and informant-dependent gender and age differences. Convergent validity of the supplementary scales differed across informants. Mean differences between the supplementary scales in the clinical and the community sample as well as the diagnosis-specific subsamples were mostly significant, with predominantly large effect sizes.

Conclusions: Overall, the validity and reliability of the supplementary scales differed depending on informants and subgroups. While further research is necessary before the supplementary scales are implemented in clinical practice, initial recommendations for their use are derived.

Trial registration: This project was carried out as a reanalysis of the datasets upon which the German norms for the school-age versions are based (1). Therefore, the trial was not registered.

Background: The Beck Depression Inventory (BDI) is a widely acknowledged self-report screening tool for evaluating the presence and intensity of depressive symptoms. The BDI-IA, although an older version, is highly correlated with the updated BDI-II, remains clinically valuable, and is widely used due to its free availability.

Aim: This study aimed to examine the psychometric properties of the BDI-IA and compare its diagnostic accuracy with the abbreviated BDI-SF, BDI-PC, and BDI-6 versions against gold-standard research diagnoses in a representative Finnish adolescent clinical population.

Methods: The participants were referred outpatient adolescents aged 13-20 years (N = 752, 73% female). We investigated structural validity with item factor analysis and evaluated the criterion validity of mean scores and factor scores with various diagnostic measures. Sample-optimal cut-offs (criterion unweighted Cohen's kappa) were estimated with a bootstrap procedure.

Results: The sample-optimal cut-off for the full BDI was 19, slightly higher than that suggested by the previous literature. The abbreviations of the BDI-IA were demonstrated to be as good as the full scale in detecting depressive symptoms in all three diagnostic categorizations.

Conclusion: The use of brief and user-friendly questionnaires such as the BDI-PC or BDI-6 is recommended to ensure optimal depression screening and minimize the administrative burden, especially in primary care settings where clinical decision-making and referrals often need to occur within a limited time frame.

Introduction: Previous research has demonstrated a strong relationship between personality and psychopathology. However, the relationship between the traits listed in the Alternative Model for Personality Disorders (AMPD) and Disruptive Behavior Disorders (DBD) in adolescents has not been examined in detail. This study aimed to examine the relationship between the Personality Inventory for DSM-5 (PID-5) domains and DBD symptoms in an adolescent inpatient sample.

Methods: A total of 127 adolescents (71% female) aged 12-17 years (M = 15.24, SD = 1.33) were recruited from an inpatient psychiatric hospital. These participants exhibited a wide range of psychiatric disorders unresponsive to prior interventions. They completed the PID-5-Short Form, the Child Behavior Checklist (CBCL), and the Diagnostic Interview Schedule for Children - Computerized Version (DISC-IV).

Results: The antagonism, disinhibition, and psychoticism domains showed significant correlations with DBD scores. Hierarchical regression models predicting total DISC-IV and CBCL scores indicated that the addition of the PID-5 Antagonism and Disinhibition scales did not provide incremental predictive validity over total DBD symptoms.

Conclusion: DBD symptoms are related to psychoticism, antagonism, and disinhibition. However, total Antagonism and Disinhibition scores did not contribute additional predictive power for overall psychopathology beyond DBD scores. These findings highlight questions about the discriminant validity of the PID-5 and suggest further research into the construct validity of these domains.

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.