Previews of pubications in the ECAP Journal

Expected at ECAP

Brief summaries of articles to be reviewed and published in future issues of the ECAP Journal.

  • CBT: long-term
    effect for
    selective mutism

    posted 14 january 2018
    by Beate Ørbeck

    Oslo University Hospital, Norway.

    The present study provides 5-year follow-up data after a home- and school based cognitive-behavioural intervention (CBT) developed for children with selective mutism (SM). Included were 30 children treated for mean 21 weeks at mean age six years.
    Children with selective mutismare characterized by a consistent lack of speech in specific social situations in which there is an expectation for speaking (e.g. school) despite speaking in other situations. Selective mutism is considered to be hard to treat, and data are still scarce on outcome, and predictors of outcome. Reports from the children themselves, and the use of more global quality of life measures, are also missing in the literature.
    The present study, found that treatment gains were largely maintained as rated by parent- and teacher questionnaires. 21 children were in full remission, five were in partial remission, and four still fulfilled diagnostic criteria for selective mutism. Older age- and severity of SM at baseline, and familial SM had a negative impact upon long-term outcome.
    The paper further discusses the diagnostic criteria of SM related to the status of participants at follow-up, prevalence of comorbid disorders and child reported quality of life and speaking behaviour.
    Take-home message: These results point to the long-term effectiveness of CBT for selective mutism, but also highlight the need to develop more effective interventions for the subset of children with persistent symptoms.
    Published online, 22 January 2018 (open access).
    Read the Beate Ørbeck interview. Contact the author.

  • Socio-economics and
    parenting influence 
    ADHD independently

    posted 3 January 2017
    by Eirini Flouri

    University College London, United Kingdom.

    Previous research shows that, compared to children without ADHD, children with ADHD experience more emotional and behavioural difficulties and more socio-economic disadvantage. In this study, we explored if the increased emotional and behavioural difficulties faced by children with ADHD may be accounted for by their more disadvantaged socio-economic circumstances. Our study, using data from 180 children (149 boys) with ADHD from the Millennium Cohort Study, had two aims. First, to examine the role of socio-economic disadvantage in the trajectories of emotional and conduct problems in children with ADHD at ages 3, 5, 7 and 11 years. Second, to explore the roles of the home environment (household chaos) and parenting (quality of emotional support, quality of the parent-child relationship and harsh parental discipline) in explaining any associations between socio-economic disadvantage and child emotional and conduct problems. We found that socio-economic disadvantage was associated with emotional and conduct problems but neither the home environment nor parenting attenuated this association. However, lower quality of the parent-child relationship and harsher discipline were associated with more conduct problems. It appears that socio-economic disadvantage and parenting contribute independently to the prediction of comorbid psychopathology in children with ADHD.
    Published online, 7 January 2017 (open access).
    Contact the author.

  • Perceived barriers
    for accessing child
    mental health treatment

    posted 3 January 2017
    by Tessa Reardon

    University of Reading,
    United Kingdom.

    Only a small number of children and adolescents with mental health problems access treatment, but we know relatively little about why this is the case. Unlike adults, young people typically rely on a parent or carer to seek help on their behalf, and therefore it is important to establish their views surrounding the difficulties involved in seeking and accessing professional help for their children. This paper syntheses findings from existing studies and highlights that parents perceive a range of barriers/facilitators relating to 1) the mental health system; 2) attitudes towards services; 3) understanding of mental health problems and the help seeking process; and
    4) family circumstances.
    The review highlights the need for improvements to child mental health services, and to raise public awareness of child mental health problems and how to access services.
    Published online, 4 January 2017.
    Contact the author.

  • ADHD: long-term 
    medication and treatment 

    posted 17 November 2016
    by Per Gustafsson

    University of Linköping, Sweden.

    Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder. Emilsson, Gustafsson, Öhnström, Marteinsdottir.
    Adherence to medication for ADHD is important because such treatment may ameliorate the possible serious consequences of ADHD on the entire life course; fewer friends, school difficulties and dismissals, arrests, unwanted pregnancy, sexually transmitted diseases and abuse of drugs or alcohol. Adolescents on long-term ADHD medication were administrated questionnaires concerning adherence to medication. In conclusion, adherence in general was high and more belief in the necessity of the medication, less concerns and less experience of side effects tended to improve adherence to medication prescription.
    Published online,
    15 November 2016
    Contact the author.

  • Childhood disorders: 
    increased risk of 

    posted 7 September 2016
    by Timo Hennig

    University of Hamburg, Germany.

    What are the odds for children with mental health disorders to have psychotic experiences and disorders when they are adolescents? Do ADHD and other childhood disorders indicate an imminent risk for psychosis? We investigated a sample of 5,528 children from the prospective Avon Longitudinal Study of Parents and Children. Children diagnosed with a DSM-IV disorder at age 7 had significantly increased risks of psychotic experiences and disorders at age 12 and 18. In our article, we provide detailed risk estimates for the complete range of childhood disorders and discuss the implications of our findings.
    Published online,
    13 September 2016.

    Contact the author.

  • Sleep hygiene education
    may prevent adolescent
    self-harm and suicide

    posted 25 June 2016
    by Xianchen Liu

    Shandong University School of Public Health, China.

    Non-suicidal self-injury (NSSI) is prevalent and is associated with increased risk of suicidal behavior in adolescents. NSSI and sleep problems begin to increase in adolescence. Little is known about the relationship between sleep and NSSI. Dr. Xianchen Liu and colleagues (Shandong University Center for Suicide Prevention Research) investigated sleep and NSSI in 2090 Chinese adolescents. The authors found that night sleeping < 6 hours, poor sleep quality, sleep dissatisfaction, daytime sleepiness, and frequent nightmares were all associated with increased risk of NSSI. However, poor sleep quality and frequent nightmares were independently associated with NSSI. Specifically, adolescents with poor sleep quality or frequent nightmares were 2-3 times more likely than those without sleep problems to engage in NSSI. Sleep hygiene education and intervention programs aiming to help improve sleep quality and cope with distress associated with frequent nightmares may be important to prevent adolescent self-harm and suicide.
    Published online,
    6 July 2016
    Contact the author.

  • Symptoms and
    cognitions in
    parents of children
    with PTSD 

    posted 8 March 2016
    by Dunja Tutus

    University of Ulm, Department of Child and Adolescent Psychiatry and Psychotherapy, Germany.

    This study investigated the frequency of traumatic experiences as well as symptoms of posttraumatic stress (PTSS) and depression in 113 parents of children and adolescents with posttraumatic stress disorder (PTSD). Furthermore, we explored the association of parental symptoms with their dysfunctional thoughts related to their child’s trauma.
    The majority of the parents reported own potentially traumatic experiences. About one in two caregivers showed at least moderate posttraumatic stress symptoms and one out of three parents reported clinically significant symptoms of depression. Parental symptoms were significantly correlated with their dysfunctional thoughts.
    Since research shows that parental stress symptoms increase the risk for the development and maintenance of PTSD in their children, our results emphasize the need to systematically assess and address parental symptoms when treating traumatized children and adolescents.
    Published online, 
    1 February 2016
    Contact the author.

  • Early development in children with attention and activity disorders

    posted 11 February 2016
    by Sanne Lemcke

    Aarhus University Hospital, Centre for Child and Adolescent PsychiatryDenmark.

    Early development in children later diagnosed with disorders of attention and activity: a longitudinal study in the Danish National Birth Cohort (DNBC).
    A study in a large birth cohort has shown that children later diagnosed with disorders of attention and activity can show signs of developmental deviations during the first years of their life.
    In the DNBC 76,286 mothers were interviewed about their child’s development and behaviour at ages 6 and 18 months. When the children were 8-14 years of age, 2,034 were identified via Danish health registers with ICD-10 diagnoses of disorders of attention and activity. In the 6 month interviews an association was found between the diagnosed group and shorter duration of breastfeeding and incessant crying. At 18 months almost all answers pointed at associations between the diagnosed group and developmental deviations especially in areas such as language, motor and attention. At both ages an association was also seen, if the mother found it difficult to handle the child. However, the probability of a later diagnosis was low even though the child had presented some symptoms.
    Published online,
    9 February 2016.

    Contact the author.

  • Sexual experience
    of adolescent boys
    with autism

    posted 4 January 2016
    by Jeroen Dewinter

    Tilburg University, Netherlands.

    This study compared follow-up data related to lifetime sexual experience in a group of high-functioning adolescent boys with ASD (n=30), aged 16-20, with a matched group of boys in the general population (n=60). Almost all boys had experience with masturbation and having an orgasm. The majority of boys, however fewer boys with ASD, compared with controls, had experience with kissing and petting. The results suggest that some boys with ASD did not gain experience (yet) with the first steps in partnered sexual experiences. No significant differences emerged relating to more intimate partnered sexual experiences. The boys with partnered experience had a variety of types of partners, mostly of comparable age. Several boys with ASD had not anticipated their sexual debut. Although they felt ready for it, some boys reported regret afterward. There were no differences relating to sexual abuse or coercion. The sexual experience in this sample and the assumed developmental differences indicate the need for early, attuned and comprehensive sexuality-related education and communication.
    Published online,
    20 January 2016
    Contact the author.

  • Clinical use of the
    diagnostic tool
    in autism

    posted 2 November 2015
    by Eric Zander 

    Karolinska Institutet, Center of Neurodevelopmental Disorders – KIND, Stockholm, Sweden.

    The Autism Diagnostic Observation Schedule (ADOS) is a first choice diagnostic tool in autism spectrum disorder (ASD). Excellent interpersonal objectivity (interrater reliability) has been demonstrated within groups of highly trained "research reliable" examiners in research setting but is unknown for clinically trained users. We investigated the spontaneous interrater reliability for the ADOS modules 1-4 among clinically trained ADOS users in clinical routine across multiple sites. Interrater reliabilities of the ADOS items and domain totals among clinical users were in the same range as previously reported for research reliable users, while the one for diagnostic classification was lower. Objectivity was lower for Pervasive Developmental Disorder Not Otherwise Specified and non-spectrum diagnoses as compared to autism. Findings endorse the objectivity of the ADOS in naturalistic clinical settings, but also pinpoint its limitations and the need and value of adequate and continuous rater training.
    Published online,
    19 November 2015
    Contact the author.

  • The use of medication
    in selective mutism:
    a systematic review

    posted 30 October 2015
    by Katharina Manassis 

    University of Toronto, Canada.

    Selective mutism (SM) is a debilitating disorder in which children fail to speak in certain settings, often affecting their ability to function at school and in social situations. Medication is often combined with psychological treatment in SM, but the evidence for using medication in these children is limited. This review of the literature found ten papers that described medication treatment of >2 children with SM, and many case reports. Medications that target serotonin and another medication called phenelzine seemed to improve symptoms, but only three studies had comparison groups of SM children who were not given medication, measures were inconsistent, and side effects were not consistently described. Clinicians must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychological treatment is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychological treatment are also needed.
    Published online,
    9 November 2015
    Contact the author.

  • Low vitamin D level:
    possible risk for autism

    posted 15 October 2015
    by Feiyong Jia

    Jilin University, Changchun, China.

    Several studies have shown a possible relationship between the risk for ASD and vitamin D levels in patients, maternal vitamin D levels during pregnancy, and the amount of exposure to solar UVB. Also, indications exist that autism symptoms and global functioning may significantly improve after vitamin D supplementation.
    To determine whether decreased levels of vitamin D are truly a risk factor for autism, we performed a meta-analysis of all currently known studies on serum vitamin D levels and ASD. Our results show that serum vitamin D levels of ASD patients are significantly lower than those of healthy controls, suggesting that lower vitamin D level is a risk factor for ASD.
    Published online,
    29 October 2015
    Contact the author

  • Influence of parents'
    moods on developing
    chronic tics

    Posted 6 July 2015
    by Yoav Ben-Shlomo

    University of Bristol, UK.

    Little is known as to whether environmental factors influence the risk of a child developing Tourette's syndrome (TS) or chronic tics (CT). We have examined whether maternal or paternal mood during pregnancy is associated with the risk of the subsequent child having TS or CTs in the Avon Longitudinal study of Parents and Children (ALSPAC). We found that chronic maternal anxiety but not paternal anxiety was associated with a doubling of risk whilst pre-natal depression had almost a 80% increased relative odds of TS and CTs. This was weakened after adjusting for past maternal depression. These findings may reflect either shared genetic susceptibility or a pre-natal exposure influencing brain development in foetal life. Further work needs to see if these findings can be replicated in other datasets.
    Published in ECAP,
    15 July 2015 (open access)
    Contact the author

  • Off-label use of 
    psychotropic drugs

    Posted 18 March 2015
    by Eva Skovslund Nielsen

    Institute of Biomedicine, Aarhus University,

    This study describes the rate of non-approved, so-called off-label use of psychotropic drugs, at a child and adolescents psychiatric outpatient clinic in Denmark.
    In a cross-sectional study we assessed information from patient-records of children treated with medicines for psychiatric disorders. The information was regarding age and weight of the child, indication for treatment, daily dose of the drug and duration of treatment. Using this information the prescriptions were classified as either on-or off-label.
    Six-hundred-and-fifteen prescriptions, from nine different drug-types, were prescribed for 503 children. Overall results showed that 170 of these (27.6%) were off-label. ADHD-drugs comprised 450 prescriptions (73.2%), 11 of these prescriptions were classified as off-label (2.4%). Other psychotropic drugs comprised the rest, 165 prescriptions (26.8%), 159 of these prescriptions were off-label (96.4%).
    The sleep-inducing drug melatonin was dominant with 106 prescriptions, all off-label. The most common causes for off-label prescribing was age and indication for the treatment.
    Off-label use of drugs may be evidence-based; however clinical trials in children are needed in order to provide data on efficacy and safety of drug use in children.
    Published online,
    25 February 2015
    Contact the author.

  • Brain studies: rather
    rigorous than
    hurriedly inserted

    Posted 13 January 2015
    by Frank Verhulst

    Erasmus Medical Center, Netherlands

    Epidemiological studies have been successful in describing the frequency and course of child psychiatric problems. The high expectations that biological factors can be used to better explain, diagnose or predict child psychiatric problems have not been met. More ambitious large-scale child psychiatric cohort studies are needed, carefully applying genetics, neuroscience, or other molecular research to better understand how the brain produces maladaptive behaviour. Progress will only be booked if the basic sciences are systematically integrated in cohorts with rigorous epidemiological designs rather than hurriedly inserted in child psychiatric studies.
    Published in ECAP,
    22 February 2015 (open access).

    Contact the author.

  • Bully victimization

    Posted 7 January 2015
    by Linda Halldner Henriksson

    Karolinska Institutet, Sweden

    Bully victimization is associated with great individual, familial, and societal costs. Improved understanding of risk factors for bullying could guide risk assessment and prevention strategies. Previous research has identified various neurodevelopmental problems as risk factors for bully victimization. In our prospective Swedish, population-based twin study, neurodevelopmental problems in general and social interaction and motor control problems in particular at age 9, moderately increased bully victimization risk at age 15. Further, the results suggested that the overall burden of neurodevelopmental problems, rather than their specific nature, were more important for this risk increase. Nevertheless, our findings also indicated that social interaction problems among girls were central to risk bully victimization. Bullying happens in a social context and is also influenced by other factors. However, optimal reduction of bully victimization may benefit from information addressing also individual factors.
    Published in ECAP, September 2015.
    Contact the author.

  • Emotional child abuse
    strongest predictor of 
    adult psychological symptoms

    Posted 23 September 2014
    by Aida Dias

    Utrecht University, Netherlands

    Child maltreatment is broadly accepted as a cause for poor long-term health. Moderate or severe exposure to child maltreatment has been self-reported by 14.7% of Portuguese adults in the community. This percentage largely exceeds the number of cases targeted by the agencies for protection of children at risk. Emotional abuse overlapped all other forms of child maltreatment and it was found the strongest predictor of adult psychological symptoms. Actions to prevent and reduce the impact of child maltreatment, particularly the emotional abuse are in need of improvement.
    Published in ECAP,
    October 2014.

    Contact the author.

  • Importance of early
    intervention in 
    selective mutism (SM)

    Posted 22 September 2014
    by Beate Ørbeck

    Oslo University Hospital, Norway

    The present study provides follow-up data one year after the end of a 6-months home- and school based cognitive-behavioural intervention developed for children with selective mutism (SM).
    Children with SM are characterized by a consistent lack of speech in specific social situations in which there is an expectation for speaking (e.g. school) despite speaking in other situations. SM is considered to be hard to treat, and data are scarce both on the short-and long term outcome, as well as predictors of outcome. The few retrospective adult follow-up studies show persisting communication- and/or anxiety problems in a substantial proportion of cases. Suggested predictors of treatment outcome have been severity of SM, age at diagnosis, and familial SM/other anxiety disorders, while comorbidity has not been examined, in spite of the reported psychiatric comorbidity in children with SM.
    The present study found a moderate and continuous increase of speaking behaviour from the time of inclusion through the treatment period up until follow up. Older age at diagnosis and severity of SM had a negative impact upon outcome, while familial SM and comorbidity did not.
    The paper further discusses the diagnostic criteria of SM related to the status of participants at follow-up.
    Take-home message: Greater improvement in younger children highlights the importance of an early intervention in SM.
    Published in ECAP, September 2014 (pdf, open access). Contact the author.
    Beate Ørbeck interview on our clinical pages.

  • Effects of aspects
    of disadvantage and 
    the contribution of
    good parenting
    to a child's resilience

    Posted 19 September 2014
    by Eirini Flouri

    Institute of Education, University of London, UK

    Children tend to be at greater risk of behavioral and emotional difficulties in more socially and economically disadvantaged families.This paper demonstrates the separate effects of various aspects of disadvantage: neighborhood deprivation, family poverty and adverse life events (such as the departure or death of a parent) on child outcomes. Difficulties were measured as externalizing (eg aggressive) and internalizing (eg emotional) components of the Strength and Difficulties Questionnaire. Nearly 17,000 children in the UK Millennium Cohort Study were followed through ages 3, 5, and 7. As not all children living with these disadvantages have as many difficulties as would be expected, we asked whether good parenting may be protecting some children from the risks of poor circumstances. We found evidence, in some sorts of risk for certain difficulties, that parenting contributes to a child's resilience in the face of disadvantage.
    Published in ECAP,
    October 2014.

    Contact the author.

  • Inappropriate use of pediatric emergency rooms (USA)

    Posted 17 September 2014
    by Eugene Grudnikoff

    Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead NY, USA

    Pediatric emergency room (ER) services are frequently used for non-urgent psychiatric care in the US. We reviewed records of 243 youth referred over 1 year from surrounding schools for an ER evaluation after a behavioral incident or a psychiatric concern.
    Following the ER evaluation by psychiatrists and trainees, 7.8% students were psychiatrically hospitalized, and 44.4% were released with psychiatric referral. The remaining 116 students (47.7%) were released without follow-up; these students likely did not have the level of severity or urgency appropriate for emergency room level of care. They were categorized as “inappropriate referrals” in our study.
    Only 18.5% of referred students were evaluated by a school nurse, social worker, or counselor before being sent to ER. There were fewer inappropriate referrals among students who were first screened at the school. In-school screening following an incident occurred infrequently, but reduced unnecessary and costly evaluations by 52%.
    Read the interview with Dr Eugene Grudnikoff.
    Published in ECAP, September 2014.
    Contact the author.

  • ADHD, anxiety and
    depression: genetic
    and parenting roles

    Posted 26 August 2014
    by Daniel Segenreich

    Federal University of Rio de Janeiro, Brazil

    How may genetics and parenting roles influence the incidence of ADHD, anxiety and depression symptoms? In what ways may anxiety and ADHD symptoms be related? And how could the influence of ADHD on anxiety be measured, and vice versa?
    A family-based research was conducted in Federal University of Rio de Janeiro aiming to investigate some of the above questions. Our first findings about the aggregation of inattention, hyperactivity, anxiety and depression symptoms in families of children with ADHD have been reported on ‘Multilevel analysis of ADHD, anxiety and depression symptoms aggregation in families’.
    Results indicated that: (1) maternal clinical variables (ADHD, anxiety and depression) were more correlated with offspring variables than paternal ones; (2) maternal inattention (but not hyperactivity) was correlated with both inattention and hyperactivity in the offspring; (3) maternal anxiety was correlated with offspring inattention; on the other hand, maternal inattention was correlated with anxiety in the offspring.
    Although we expect many discussions from these results, there is a specific and relevant finding that we must focus on. Almost all the significant results were related to the symptoms aggregation rates between mothers and children.
    Published in ECAP,
    August 2014
    Contact the author.

  • Predictors of
    and barriers to
    service use for ADHD

    Posted 22 August 2014
    by Kapil Sayal

    University of Nottingham, UK

    For children at risk of ADHD, we explored barriers to and predictors of receiving specialist health services. This study involves a five year follow-up of children whose schools, across England, had taken part in a randomised controlled trial of school-level interventions. 162 children with high levels of ADHD behaviours at age 5 were followed up at age 10 years. The most frequent barrier that parents reported was a lack of information about who could help. Amongst children using specialist health services who fulfilled criteria for ADHD at follow-up, 36% had been prescribed stimulant medication. Higher levels of teacher-rated symptoms of inattention and hyperactivity/impulsivity at age 5 were associated with specialist health service use by age 10. A novel finding is that parental mental health problems (at follow-up) were also independently associated with service use. These findings highlight that severity of teacher-rated ADHD symptoms in early school years is a determinant of subsequent health service use. In particular, clinicians and teachers should be aware that parental mental health problems are associated with service use for children at risk of ADHD.
    Published in ECAP, September 2014.
    Contact the author.

  • CBT moderators to
    reduce aggressiveness
    in young children

    Posted 18 August 2014
    by Kirsten Smeets

    Karakter child and adolescent psychiatry, Radboud University Medical Centre of Nijmegen, Netherlands

    Aggressive behavior in adolescents is an increasing public health concern since it often leads to a variety of problems, like being expelled from school or contact with police or justice. Cognitive Behavior Therapy (CBT) is one of the most common and promising treatments of aggression. In this treatment, adolescents learn how to deal with aggression by using techniques to control their anger and improve their social skills. However, there are many different forms of CBT and it is unclear why some adolescents respond yet others do not. Therefore, we reviewed the literature for studies examining the effect of CBT on aggression in children and adolescents (up to 23 years old). A total of 25 studies (2302 participants) were combined and resulted in medium treatment effect of CBT to reduce aggression. Subtype of aggression, age, gender and type of treatment did not influence the success of the treatment. Furthermore, treatment setting and duration did not seem to influence treatment effect, which shows the need for development of more cost-effective and less-invasive interventions. Future research should include more variables regarding predictors of treatment outcome in larger meta-analyses. This requires better standardization of design, variables, and outcome measures across studies.
    Published in ECAP,
    August 2014.

    Contact the author.

  • Aggressive  
    behaviour in 
    young children

    Posted 14 July 2014
    by Anne Lise Kvalevaag

    Helse Fonna HF, University of Bergen, Norway

    This population based study, with 20,155 participating fathers’ and children from the Norwegian Mother and Child Cohort Study, adds to the field of early onset behavioural difficulties in childhood, with the finding that approximately 16 % of preschool-aged children still performed physically aggressive behaviour (hitting) in their interaction with others and that psychological distress in expectant fathers is a risk factor for physically aggressive behaviour in their daughters. Boys hit others significantly more often than girls at 18 months and at age 3 but not at age 5.
    Published in ECAP, July 2014.
    Contact the author.

  • Behavioural problems: 
    conjoint role of
    DCDC2 gene

    Posted 25 June 2014
    by Valentina Riva

    Scientific Institute Eugenio Medea Bosisio Parini,
    Lecco, Italy

    Both genetic and socio-demographic factors influence the risk for behavioural problems in developmental age. Genetic studies indicate that shared genetic factors partially contribute to behavioural and learning problems, in particular reading disabilities (RD). For the first time, we explored the conjoint role of two markers of DCDC2 gene (i.e., READ1 and rs793862), an identified RD candidate gene, and socioeconomic status (SES) upon behavioral phenotypes in a general population of Italian children. With this study we found that READ1 genetic variant predicts children with the worst outcome in attention functioning among children exposed to low SES.

    Published in ECAP, March 2015 (first published online, July 2014).
    Read Valentina's BLOG.
    Contact the author.

  • Peer relations underlying
    mental health problems in
    overweight children

    Posted 22 June 2014
    by Ingebjørg Hestetun

    Department of Child and Adolescent Psychiatry,
    Telemark Hospital, Skien, Norway

    Our research supports the hypothesis that peer problems may be an important underlying factor for mental health problems in overweight children. The purpose of the study was to investigate the associations between overweight, peer problems and mental health problems in a sample of 12 – 13 year old Norwegian schoolchildren. Parents of 744 children gave information about mental health and peer relations by completing the extended version of the Strength and Difficulties Questionnaire (SDQ). Height and weight were objectively measured. Overweight children were more likely to have peer problems than normal weight children. They also were more likely to have indications of psychiatric disorders, but this association was no longer present when adjusted for peer problems. The results highlight the importance of focusing on peer relations and reducing stigmatization of this vulnerable group.
    Published in ECAP, July 2014.
    Contact the author.

  • Ethnicity or
    social disadvantage?

    Posted 29 May 2014
    by Marcia Adriaanse

    Department of Child and Adolescent Psychiatry,
    VU Medical Centre, Amsterdam, Netherlands

    Worldwide studies have examined the prevalence of mental health problems among ethnic minority and majority youth. Some studies found higher rates of mental health problems in ethnic minorities; others reported lower or similar rates, depending on the types of problems, ethnic groups and host countries studied and the informants used. Underlying social factors seem to be most important in the explanation of observed ethnic differences in mental health problems. A complicating factor is that ethnic minority and majority youth generally do not grow up in comparable social contexts, making it a challenge to disentangle ethnicity from social factors. We searched for ways to address this issue and have succeeded by examining associations between social disadvantage and mental health problems while adjusting for ethnicity and testing for interactions. This study shows that (cumulative) social disadvantage is associated with mental health problems independent of ethnicity, partly explaining the higher prevalence of externalizing problems among ethnic minority youth compared to majority youth in the Netherlands. The findings suggest that ethnicity should not be studied as a factor as such, but as a proxy for social factors that are associated with ethnicity.
    Published in ECAP, 
    June 2014
    Contact the author.

  • Justice sensitivity
    and ADHD

    Posted 19 May 2014
    by Rebecca Bondü

    University of Potsdam, Germany

    Justice sensitivity is a personality disposition that describes differences in the frequency with which individuals perceive injustice and in the intensity of their emotional, cognitive, and behavioral reactions to it. Persons with ADHD have been reported to be highly justice sensitive. We measured ADHD symptoms, justice sensitivity as a victim, observer, and perpetrator, anxious and angry rejection sensitivity, depressive symptoms, conduct problems, and self-esteem in 1235 German 10- to 19-year-olds. Participants with ADHD symptoms reported to feel treated unjustly more frequently and to show more intense negative reactions to it, to angrily and anxiously fear and react to rejection more strongly, but to cause injustice less frequently and to react to their own injustice less negatively than controls. Both justice and rejection sensitivity mediated the link between ADHD symptoms and related problems such as conduct problems and depression. Thus, justice and rejection sensitivity may help to explain the emergence and maintenance of problems often associated with ADHD and should therefore be considered in ADHD therapy.
    Published in ECAP,
    May 2014.

    Contact the author.

  • Early markers
    for ADHD

    Posted 30 April 2014
    by Desiree Silva

    University of Western Australia – UWA and Telethon Kids Institute, West Perth, Australia

    Information on early postnatal factors associated with Attention Deficit Hyperactive Disorder is lacking. We conducted a population based, record linkage study of 11,902 children under 18 years who met the DSMIV/ICD10 criteria for ADHD compared with a reference population of 27,304 linked to their hospital admissions under 4 years of age. Our results show significant early hospital morbidity for children diagnosed with ADHD where children with ADHD are 73% more likely to be admitted with an injury or poisons, twice more likely to be admitted with ear disease and neurological conditions. Multiple aetiologies and causal pathways need to be considered where some of these may include early infections and inflammatory conditions, epilepsy and injuries are associated with ADHD. Future studies should look at which of these conditions may be on the causal pathway or likely early markers for ADHD.
    Published in ECAP,
    April 2014.

    Contact the author.

  • Cannabis use
    during pregnancy

    Posted 17 April 2014
    by Erik Keimpema

    Medical University of Vienna, Austria

    Cannabis is one of the most frequently used substance of abuse during pregnancy. In addition, potent herbal “legal” highs, containing synthetic cannabinoids that mimic the effects of cannabis with unknown toxicity, have gained rapid popularity amongst young adults. Despite the surge in cannabis use during pregnancy, little is known about the biological and psychological consequences in the exposed offspring. In this paper, we compare clinical and preclinical experimental studies on the effects of fetal cannabis exposure until early adulthood, to stress the importance of animal models in understanding the effects of cannabis on the developing central nervous system. We conclude that preclinical experimental models confirm clinical studies and that cannabis exposure evokes significant modifications to fetal brain development leading to physiological and behavioural abnormalities.
    Published in ECAP,
    May 2014.

    Contact the author.

  • Stress and ADHD

    Posted 9 April 2014
    by Johan Isaksson

    Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Sweden

    Children with ADHD perceive higher levels of stress than non-affected comparisons. Similar to previous studies, girls reported higher rates on perceived stress than boys. Interestingly, the higher stress scores contrast the markedly lower levels of the stress hormone cortisol, indicating a down-regulated HPA-axis in children with ADHD. Possibly, the low cortisol levels in ADHD may reflect an exhaustion of the HPA-axis or an impaired ability (that may be inherited) to respond to stressors thereby contributing to the higher degree of perceived stress.
    Published in ECAP,
    April 2014.

    Contact the author.

  • Pre-school ADHD

    Posted 1 April 2014
    by Martin K. Rimvall

    Child and Adolescent Psychiatric Centre, Mental Health Services, Capital Region of Denmark, Department Glostrup, Denmark


    The majority of children with Attention Deficit Hyperactivity Disorder (ADHD) are diagnosed in school age in spite of evidence pointing to onset in preschool age. 
    In this study, we investigated whether a short questionnaire, the Strengths and Difficulties Questionnaire (SDQ), applied at preschool age can be used to identify children at increased risk of being diagnosed with ADHD during school age. The study is part of the Copenhagen Child Cohort Study, CCC2000, which has followed 6,090 children from birth in year 2000 using register data and follow-up assessments. 
    A total of 2,315 children were investigated at age 5-7 years by the SDQ completed by parents and kindergarten/preschool teachers. The SDQ was examined regarding its prediction of later diagnosis and treatment for ADHD when followed until age 11-12 years. 
    The results show a 20-fold increased risk of ADHD in school age among children identified by the SDQ in preschool. The findings indicate that the SDQ can be a useful method for screening children for ADHD. Conditioned appropriate intervention, ADHD screening at this particular age can potentially reduce symptoms and impairment in school age for the child.
    Published in ECAP,
    April 2014.
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    and MMP-9

    posted 3 March 2014
    by Halina Kadziela-Olech

    "Serum matrix metalloproteinase-9 levels and severity of symptoms in boys with attention de?cit hyperactivity disorder ADHD/hyperkinetic disorder HKD"

    Child and Adolescent Psychiatry Unit of the University Children’s Hospital, Department of Pediatrics and Developmental Disorder, Medical University of Bialystok, Poland

    Attention Deficit / Hyperactivity Disorder / Hyperkinetic Disorder (ADHD/HKD) is a multifactorial neurodevelopmental condition. Despite intense research, brain mechanisms that underlie the behaviours in ADHD are still unclear. It can be assumed that the remodelling of the brain involving proteinases may be responsible for behavioural and cognitive symptoms observed in patients with ADHD/HKD. Changes in the activity of Matrix metalloproteinase – 9 (MMP-9) may be the result of such reorganization in this disorder. Many studies point out that the cognitive dysfunctions in neuropsychiatric disorders of adults may be associated with changes of MMP-9 activity. So far, no studies have been conducted on the relationship of MMP-9 and symptoms in children with ADHD/HDK. We hypothesized that the activity of MMP-9 may be related to intensity of symptoms and cognitive dysfunction in children with ADHD/HDK. An interesting observation was found in 37 boys with HKD, suggesting a significant association between increased serum MMP-9 levels and the severity of symptoms. Our data indicate that elevated levels of serum MMP-9 in boys with HKD may be associated with clinical impulsivity.
    Published in ECAP, 
    17 March 2014
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  • ADHD-C
    and SMD

    posted 21 February 2014
    by Pinar Uran and Birim Günay Kiliç

    "Comparison of neuropsychological performances and behavioral patterns of children with attention deficit hyperactivity disorder and severe mood dysregulation" 

    Ankara University School of Medicine Child and Adolescent Psychiatry Department, Turkey

    We aimed to investigate the similarities and differences in neuropsychological test performance, demographic features and behavioral patterns of children and adolescents with the Attention Deficit Hyperactivity Disorder combined type (ADHD-C), and the Severe Mood Dysregulation (SMD).
    ADHD-C group (but not SMD) could be differentiated from healthy controls with the neuropsychological tests used. ADHD-C group’s neuropsychological test performances were significantly poorer than the control group’s performances. SMD group could be differentiated from the ADHD-C and healthy control groups with Conners’ Parent Rating Scale; the average scores of the SMD group were significantly higher than the ADHD-C and control groups’ average scores.
    The main question of whether SMD represents a neuropsychological profile distinct from typically developing children and patients with ADHD-C remains to be answered.
    Published in ECAP,
    March 2014.
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