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

Background: Assessment of disability is part of the psychiatric diagnostic process, and validated scales are needed for the assessment of functioning. The Swedish translations of the Child Sheehan Disability Scale (CSDS) for adolescents and parents (CSDS-P) have been adapted for use in psychiatric settings. Objective: The purpose of the study was to explore the psychometric properties of the Swedish CSDS and the CSDS-P among adolescent psychiatric patients. Method: Patients (n = 107) were assessed with the CSDS, the Strengths and Difficulties Questionnaire (SDQ adolescent), and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) diagnostic interview. Their parents participated in the interview and completed the CSDS-P and SDQ parent. Results: Internal consistency was α =.813 for the CSDS (three items) and α =.842 for the CSDS-P (five items). For both scales, principal component analyses showed one component. The correlations between the total scores of the CSDS and CSDS-P in relation to a general K-SADS-PL symptom summation index were r_s = .332, p < .001 and r_s = .237, p = .014, respectively. Correlations with the total K-SADS function summation index were r_s < .300 for both. The correlation between the CSDS and the total difficulties score on the SDQ was r_s = .433, p < .001. Conclusions: The Swedish translations of the CSDS and CSDS-P had similar psychometric properties to Whiteside's CSDS and the Adult Sheehan Disability Scale. Concurrent validity and correlation between the CSDS and CSDS-P were weak.

Background: Early identification of young children exposed to trauma who are at risk of developing post-trauma symptomatology such as posttraumatic stress disorder (PTSD) or other emotional or behavioral problems is important for allocating appropriate treatment and preventing long-term consequences. However, assessment of young children exposed to trauma is challenging because children may not be able to talk about their trauma or trauma reactions. Story stem tools combine storytelling and play to access the internal world of young children and can be used in the assessment of children exposed to trauma.

Objective: To examine reliability and validity of a new story stem tool, the Odense Child Trauma Screening (OCTS). OCTS was developed to screen for play-based behavior and narrative representations indicative of traumatization in preschool and young schoolchildren.

Method: Forty-nine Danish children aged 4.5-8.9 years (M = 6.6, SD = 1.2) participated in the OCTS. Participants included a risk sample of 31 children exposed to traumas and a community sample of 18 children. Caregivers were interviewed about child symptoms of PTSD, major depressive disorder (MDD), and reactive attachment disorder (RAD) and answered the Strengths and Difficulties Questionnaire (SDQ). The community sample completed OCTS test-retests.

Results: Interrater reliability proved excellent (ICC = .96-1.00). Test-retest reliability was acceptable (ICC = .66). Significant moderate correlations were found between the OCTS total score and scales of PTSD, MDD and RAD and the SDQ Total Difficulties Scale. The ability of the OCTS to discriminate between children from the risk and community sample was good.

Conclusions: The study provided preliminary evidence of reliability and validity of the OCTS as a screening tool for young children exposed to trauma. OCTS shows promise as a standardized, age-appropriate informant-based screening measure applicable for clinical assessment.

Presented here is the unique case of diagnostic investigation for a 16 year old male presenting in an acute state of apparent psychosis. The patient had a long history of previous specialist work-ups, tentative diagnoses, multiple emergency department admissions, and medication trials, all of which failed to produce significant lasting relief. While initial encounters diagnostically centered on autoimmune encephalitis, comprehensive work-ups always drove the differential towards a likely psychiatric disorder. Despite this consistent professional opinion, tentative diagnosis of schizophrenia with underlying Autism Spectrum Disorder was delayed for many years, due to a variety of complicating factors. Overall, this case highlights many different considerations that might assist in avoiding a protracted road to diagnosis, including navigating the obstacles that parental interaction with a complex healthcare system can pose during diagnostic evaluation and recommended treatment as well as, the role of re-interpreting past test results within the context of new literature, and the complexities of diagnosing comorbid psychiatric conditions.

Background: Mental health problems are common in adolescence and seeking help for them is becoming more common. Referrals to adolescent mental healthcare have recently increased in Finland.

Objective: To examine time trends in internalizing and externalizing mental health symptoms among Finnish adolescents.

Method: A time-trend school survey was conducted among 9^th graders (15-year-olds) in Tampere, Finland, in three time periods: 2002-03, 2012-13 and 2018-19 (N = 4,162).

Results: Compared to the period 2002-03, prevalence of externalizing symptoms decreased in the period 2012-13 and further in 2018-19. The prevalence of internalizing symptoms did not change significantly between 2002-03 and 2012-13; however, in 2018-19, depression, social anxiety, general anxiety, poor subjective health, stress symptoms among boys, and poor self-esteem increased compared to earlier time periods. The increases were more marked among girls. However, suicidal ideation did not increase in 2018-19 compared to earlier time periods.

Conclusion: Whereas the prevalence of externalizing symptoms decreased among Finnish adolescents between 2002-03 and 2018-19, the prevalence of internalizing symptoms increased between 2012-13 and 2018-19. To help to understand the causes of these increases and to prevent internalizing problems, further research on the underlying causes is needed.

Background: Comorbid anxiety disorders are prevalent in children with autism spectrum disorders (ASD), but only a minority receives adequate treatment for anxiety. Cognitive behavioral therapy (CBT) has been shown to be effective in treating anxiety disorders. The objectives of the present pilot study were to test the feasibility of the CBT program "Less stress" for comorbid anxiety disorders in children with ASD and explore whether an improvement in diagnostic outcomes for anxiety disorders and symptoms of anxiety was found after treatment.

Methods: Participants were ten children diagnosed with ASD and anxiety disorders (eight boys, mean age = 9.5 years, range 8 - 12 years). The "Less Stress" program includes three months of weekly treatment sessions followed by three monthly booster sessions. Five therapists participated. A standardized semi-structured diagnostic interview with the mothers was used to assess comorbid disorders. Child anxiety symptoms were measured with the Revised Child Anxiety and Depression Scale (RCADS).

Results: The therapists found the manual easy to use but adaptations were necessary, particularly shorter sessions due to frequent (n = 7) comorbid Attention-Deficit/Hyperactivity Disorder. The participants found the program useful and the parents noted that they had learned methods they could continue using after the end of the program.Eight of ten children completed the treatment. Seven of the eight completers benefited from the program. Five of those seven children were free from all anxiety disorders, while two had fewer anxiety disorders. On a group level, a significant mean reduction of anxiety symptoms (RCADS) was found after treatment.

Conclusion: The therapists found the "Less stress" program to be a feasible intervention in a sample of children with ASD and comorbid anxiety. The significant reduction of anxiety after treatment is promising, but a replication in a larger and more rigorous study is needed to investigate the effectiveness of the intervention.

Background: Randomized controlled trials have shown that dexamphetamine sulfate (DEX) is efficacious in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents; however, data on the effectiveness and safety of DEX in routine practice are scarce.

Objective: This study investigated the long-term effectiveness and safety of Attentin^® (immediate-release DEX) in children and adolescents with ADHD in routine practice.

Methods: ATTENTION was a multicenter, prospective, observational, non-interventional study that enrolled pediatric patients with ADHD (aged 6-17 years) with a clinically inadequate response to previous methylphenidate (MPH) treatment. Patients were assessed at baseline and two follow-up visits after approx. 6 and 12 months of DEX treatment. The primary endpoint was the investigator-rated ADHD rating scale IV (ADHD-RS-IV) total score change from baseline to the first follow-up visit.

Results: The study enrolled 140 patients (mean age: 11.2 years). Significant reductions in ADHD-RS-IV total scores were observed in the titration phase and were maintained up to the second follow-up visit. The mean ADHD-RS-IV total score change from baseline to the first follow-up visit was -11.9 (27.1 vs. 13.4, p < .001). Beneficial effects of DEX were observed on both ADHD-RS-IV subscales ('hyperactivity/impulsivity' and 'inattention') and in both children and adolescents. Clinical response, defined as a reduction in the ADHD-RS-IV total score of at least 30% at the first follow-up visit, was observed in 78.1% of patients. Patients reported an average onset of action of 36.2 minutes and an average duration of action of 6.5 hours after intake of the first dose of DEX in the morning. DEX was well tolerated. Small significant increases in mean systolic and diastolic blood pressure compared to baseline were observed.

Conclusions: Attentin^® is an effective and well-tolerated long-term treatment for pediatric ADHD patients with a clinically inadequate response to previous MPH treatment.

Introduction: This paper investigates levels of depressive symptoms among older children and young adolescents, 11-14 years of age. The population-based sample was assessed twice during a 12-month period. Point-prevalence, 12-month prevalence, and 12-month incidence were measured by a validated self-reported scale (SFMQ) and are presented in this paper.

Methods: A total of 2148 pupils were invited to participate in this study, and 1748 pupils and at least one parent/guardian provided informed consent. The population was assessed twice within one 12-month period resulting in 1439 participants at both data collection points. Depressive symptoms were measured by a validated self-reported scale, The Short Mood and Feelings Questionnaire (SMFQ).

Results: The results indicate that the point-prevalence was just under 10% in 6^th to 10^th grade with a 12-month prevalence at almost 3%. The results also indicate an incidence rate of 4.5% over 12-months. This study confirms that girls report a higher range of point prevalence, 12- month-prevalence, and 12-month incidence compared to boys.

Conclusions: The results indicate that depressive symptoms among children and young adolescents is a serious health challenge. The results demonstrate substantial gender differences even at an early age (11-14 years), where girls report significantly higher point prevalence, 12-month-prevalence, and 12-month incidence compared to boys. Results from this study suggest that depressive symptoms are an important problem that young adolescents face, and the study underlines the need for more intervention tailored to gender at the middle-school level, especially with respect to those children and adolescents who experience persistent depressive symptoms.

Background: Children with ADHD tend to present with poorer cognitive functioning leaving them more vulnerable to a range of negative outcomes. To date, only a handful of longitudinal studies have examined the stability of Wechsler composite scores in children and adolescents with ADHD, and none of them used a more recent version of the Wechsler Intelligence Scales for Children (WISC), than the WISC-III.

Objective: The present study investigates the cognitive stability and its longitudinal relationship with the severity of the child's ADHD symptoms and school grades.

Method: Cognitive functioning was measured with the fourth editions of the WISC-IV or the Wechsler Adult Intelligence Scales (WAIS-IV) at baseline and at a 3-4-year follow-up in children with ADHD (n = 125, mean age = 11.40 years, SD = 3.27) and a Control group of schoolchildren (n = 59, mean age = 11.97 years, SD = 2.15). The stability of cognitive functioning and the relationship between cognitive functioning, ADHD and grades were evaluated using linear mixed models and logistic regression.

Results: Standardized composite scores of Full scale IQ, Verbal Comprehension, and Processing Speed declined between baseline and follow-up in the ADHD group. ADHD symptom scores were associated with Working Memory scores. Together, the severity of concurrent ADHD symptoms and lower scores for verbal comprehension at baseline and follow-up were associated with an increased risk of not achieving grades at follow-up in youth with ADHD.

Conclusions: Youth with ADHD often present with cognitive impairments, not improved over time. Together these increase the risk of poorer academic outcomes. Concurrent evaluation of symptom severity and cognitive functions can add potentially useful information in terms of treatment planning, and school supports to prevent school failure.

Objective: Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression.

Methods: Fifty clinically depressed adolescents (13-17 years, 84% girls) completed self-reported measures of suicidal ideation, depressive symptoms, and attachment style to parents.

Results: There was a statistically significant bivariate association between higher levels of attachment anxiety in relation to mothers and fathers and higher levels of suicidal ideation. When attachments to both parents were included in the same multivariate model, only attachment anxiety to the mother was significantly associated with the level of suicidal ideation. Self-reported depressive symptoms remained significantly associated with the level of suicidal ideation in all analyses. Younger adolescents with attachment anxiety reported higher levels of suicidal ideation than older adolescents.

Conclusion: Conclusions about directionality and causality of associations between insecure attachment and suicidal ideation are limited due to the cross-sectional design. Our findings suggest that attachment anxiety in relation to the mother and father is associated with increased levels of suicidal ideation. Implication of these findings for treatment selection is discussed.

[This corrects the article on p. 110 in vol. 8, PMID: 33564627.].