This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.capmh.com The latest articles from Child and Adolescent Psychiatry and Mental Health (ISSN 1753-2000) published by BioMed Central Objective342 Caucasian subjects with attention deficit/hyperactivity disorder (ADHD) were recruited from pediatric and behavioral health clinics for a genetic study. Concurrent comorbidity was assessed to characterize the clinical profile of this cohort. Methods: Subjects 6 to 18 years were diagnosed with the Schedule for Affective Disorders & Schizophrenia for School aged Children (K-SADS-P IVR). Results: The most prevalent diagnoses co-occurring with ADHD were Oppositional Defiant Disorder (ODD) (40.6%), Minor Depression/Dysthymia (MDDD) (21.6%), and Generalized Anxiety Disorder (GAD) (15.2%). In Inattentive ADHD (n=106), 20.8% had MDDD, 20.8% ODD, and 18.6% GAD; in Hyperactive ADHD (n=31) 41.9% had ODD, 22.2% GAD, and 19.4% MDDD. In Combined ADHD, (n=203), 50.7% had ODD, 22.7% MDDD and 12.4% GAD. MDDD and GAD were equally prevalent in the ADHD subtypes but, ODD was significantly more common among Combined and Hyperactive ADHD compared to Inattentive ADHD. The data suggested a subsample of Irritable prepubertal children exhibiting a diagnostic triad of ODD, Combined ADHD, and MDDD may account for the over diagnosing of Bipolar Disorder. Conclusions: Almost 2/3rd of ADHD children have impairing comorbid diagnoses; Hyperactive ADHD represents less than 10% of an ADHD sample; ODD is primarily associated with Hyperactive and Combined ADHD; and, MDDD may be a significant morbidity for ADHD youths from clinical samples. http://www.capmh.com/content/2/1/15 Josephine Elia, Paul Ambrosini and Wade Berrettini Child and Adolescent Psychiatry and Mental Health 2008, 2:15 2008-07-03 doi:10.1186/1753-2000-2-15 Child and Adolescent Psychiatry and Mental Health 1753-2000 2 15 2008-07-03 Background: Research is needed to establish the utility of diagnostic interviews in clinical settings. Studies comparing clinical diagnoses with diagnoses generated with structured instruments show generally low or moderate agreement and clinical diagnostic assignment (e.g. admission or chart diagnoses) are often considered to underdiagnose disorders. The objective of this study was to evaluate the impact of implementing the Schedule for Affective Disorders and Schizophrenia for School-Age Children -Present and Lifetime Version (Kiddie-SADS-PL) into an in-patient adolescent clinical setting. Methods: Participants were all adolescents admitted through the years 2001-2004 (N = 333 admissions, age 12-17 years). The authors reviewed the charts of the previous three years of consecutive admissions, patients being evaluated using routine psychiatric evaluation, before the Kiddie-SADS-PL was introduced. They then reviewed the charts of all consecutive admissions during the next twelve months, patients being evaluated by adding the instrument to routine practice. Results: The rates of several main diagnostic categories (depressive, anxiety, bipolar and disruptive disorders) increased considerably, suggesting that those disorders were likely underreported when using non-structured routine assessment procedures. The rate of co-morbidity increased markedly as the number of diagnoses assigned to each patient increased. Conclusions: The major differences in diagnostic assignment rates provide arguments for the utility of diagnostic interviews in inpatient clinical settings but need further research, especially on factors that affect clinical diagnostic assignment in "real world" settings. http://www.capmh.com/content/2/1/14 Bertrand Lauth, Sigurdur Rafn A Levy, Gudlaug Juliusdottir, Pierre Ferrari and Hannes Petursson Child and Adolescent Psychiatry and Mental Health 2008, 2:14 2008-07-03 doi:10.1186/1753-2000-2-14 Child and Adolescent Psychiatry and Mental Health 1753-2000 2 14 2008-07-03 Background: Nail biting (NB) is a very common unwanted behavior. The majority of children are motivated to stop NB and have already tried to stop it, but are generally unsuccessful in doing so. It is a difficult behavior to modify or treat. The objective of this study was to investigate the prevalence of co-morbid psychiatric disorders in a clinical sample of children with NB who present at a child and adolescent mental healthcare outpatient clinic and the prevalence of psychiatric disorders in their parents.MethodA consecutive sample of 450 referred children was examined for NB and 63 (14%) were found to have NB. The children and adolescents with nail biting and their parents were interviewed according to DSM-IV diagnostic criteria. They were also asked about lip biting, head banging, skin biting, and hair pulling behaviors. Results: Nail biting is common amongst children and adolescents referred to a child and adolescent mental health clinic. The most common co-morbid psychiatric disorders in these children were attention deficit hyperactivity disorder (74.6%), oppositional defiant disorder (36%), separation anxiety disorder (20.6%), enuresis (15.6%), tic disorder (12.7%) and obsessive compulsive disorder (11.1%). The rates of major depressive disorder, mental retardation, and pervasive developmental disorder were 6.7%, 9.5%, 3.2%, respectively. There was no association between the age of onset of nail biting and the co-morbid psychiatric disorder. Severity and frequency of NB were not associated with any co-morbid psychiatric disorder. About 56.8% of the mothers and 45.9% of the fathers were suffering from at least one psychiatric disorder. The most common psychiatric disorder found in these parents was major depression. Conclusion: Nail biting presents in a significant proportion of referrals to a mental healthcare clinic setting. Nail biting should be routinely looked for and asked for in the child and adolescent mental healthcare setting because it is common in a clinical population, easily visible in consultation and relatively unintrusive to ask about. If present, its detection can then be followed by looking for other more subtle stereotypic or self-mutilating behaviors. http://www.capmh.com/content/2/1/13 Ahmad Ghanizadeh Child and Adolescent Psychiatry and Mental Health 2008, 2:13 2008-06-02 doi:10.1186/1753-2000-2-13 Child and Adolescent Psychiatry and Mental Health 1753-2000 2 13 2008-06-02 ObjectivesFollowing the end of the Gulf War that resulted in the liberation of Kuwait, there are no reports on the impact of veterans' traumatic exposure and posttraumatic stress disorder (PTSD) on their children. We compared the severity of anxiety, depression, deviant behavior and poor family adjustment among the children of a stratified random sample of four groups of Kuwaiti military men, viz: the retired; an active -in-the-army group (AIA) (involved in duties at the rear); an in-battle group (IB) (involved in combat); and a prisoners -of- war (POWs) group. Also, we assessed the association of father's PTSD/combat status and mother's characteristics with child psychosocial outcomes.MethodSubjects were interviewed at home, 6 years after the war, using: the Child Behavior Index to assess anxiety, depression, and adaptive behavior; Rutter Scale A2 for deviant behavior; and Family Adjustment Device for adjustment at home. Both parents were assessed for PTSD. Results: The 489 offspring (250 m, 239 f; mean age 13.8 yrs) belonged to 166 father-mother pairs. Children of POWs tended to have higher anxiety, depression, and abnormal behavior scores. Those whose fathers had PTSD had significantly higher depression scores. However, children of fathers with both PTSD and POW status (N = 43) did not have significantly different outcome scores than the other father PTSD/combat status groups. Mother's PTSD, anxiety, depression and social status were significantly associated with all the child outcome variables. Parental age, child's age and child's level of education were significant covariates. Although children with both parents having PTSD had significantly higher anxiety/depression scores, the mother's anxiety was the most frequent and important predictor of child outcome variables. The frequency of abnormal test scores was: 14% for anxiety/depression, and 17% for deviant behavior. Conclusion: Our findings support the impression that child emotional experiences in vulnerable family situations transcend culture and are associated with the particular behavior of significant adults in the child's life. The primacy of the mother's influence has implications for interventions to improve the psychological functioning of children in such families. Mental health education for these families has the potential to help those in difficulty. http://www.capmh.com/content/2/1/12 Fawziyah A Al-Turkait and Jude U Ohaeri Child and Adolescent Psychiatry and Mental Health 2008, 2:12 2008-05-29 doi:10.1186/1753-2000-2-12 Child and Adolescent Psychiatry and Mental Health 1753-2000 2 12 2008-05-29 Background: The objective of this analysis was to measure changes in items on the Pediatric Adverse Event Rating Scale (PAERS) that relate to emotional well-being of children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) during treatment with atomoxetine for up to 24 weeks from the perspective of the patient, the parent, and the physician. Methods: Patients aged 6–17 years with ADHD were treated with atomoxetine (target dose 1.2 mg/kg/day). In the two studies on which this secondary analysis is based the PAERS was used to assess the tolerability of atomoxetine in children and adolescents. This scale has a total of 48 items. The ten items that reflect emotional well-being were selected to measure changes over time from a patient, parent, and physician perspective. Results: 421 patients were treated with atomoxetine. 355 patients completed the 8-week treatment period, and 260 patients completed the 24-week treatment period. The ten items that reflect emotional well-being were grouped in five dimensions: depressed mood, self-harm, irritability/agitation, drowsiness, and euphoria. The scores of these dimensions decreased over time, both from a patient as well as from a parent and physician perspective. Only the dimension self-harm was extremely low at baseline and stayed low over time. The mean scores for the ten items depended on the rater perspective. Conclusion: The emotional well-being of children and adolescents with ADHD improved in terms of depressed mood, irritability/agitation, drowsiness, and euphoria during treatment with atomoxetine for up to 24 weeks. http://www.capmh.com/content/2/1/11 Peter M Wehmeier, Alexander Schacht, Martin Lehmann, Ralf W Dittmann, Susan G Silva and John S March Child and Adolescent Psychiatry and Mental Health 2008, 2:11 2008-05-28 doi:10.1186/1753-2000-2-11 Child and Adolescent Psychiatry and Mental Health 1753-2000 2 11 2008-05-28 Background: The objective of this analysis was to evaluate the psychometric properties of a brief scale developed to assess the degree of difficulties in children with Attention-Deficit/Hyperactivity Disorder (ADHD). The Global Impression of Perceived Difficulties (GIPD) scale reflects overall impairment, psychosocial functioning and Quality of Life (QoL) as rated by patient, parents and physician at various times of the day. Methods: In two open-label studies, ADHD-patients aged 6–17 years were treated with atomoxetine (target-dose 0.5–1.2 mg/kg/day). ADHD-related difficulties were assessed up to week 24 using the GIPD. Data from both studies were combined to validate the scale. Results: Overall, 421 patients received atomoxetine. GIPD scores improved over time. All three GIPD-versions (patient, parent, physician) were internally consistent; all items showed at least moderate item-total correlation. The scale showed good test-retest reliability over a two-week period from all three perspectives. Good convergent and discriminant validity was shown. Conclusion: GIPD is an internally consistent, reliable and valid measure to assess difficulties in children with ADHD at various times of the day and can be used as indicator for psychosocial impairment and QoL. The scale is sensitive to treatment-related change. http://www.capmh.com/content/2/1/10 Peter M Wehmeier, Alexander Schacht, Ralf W Dittmann and Manfred Döpfner Child and Adolescent Psychiatry and Mental Health 2008, 2:10 2008-05-28 doi:10.1186/1753-2000-2-10 Child and Adolescent Psychiatry and Mental Health 1753-2000 2 10 2008-05-28 Background: The goals were to determine the presence of posttraumatic stress disorder (PTSD) in children after paediatric intensive care treatment, to identify risk factors for PTSD, and to compare this data with data from a major fire disaster in the Netherlands. Methods: Children completed the Dutch Children's Responses to Trauma Inventory at three and nine months after discharge from the paediatric intensive care unit (PICU). Comparison data were available from 355 children survivors who completed the same questionnaire 10 months after a major fire disaster. Results: Thirty-six children aged eight to 17 years completed questionnaires at three month follow-up, nine month follow-up, or both. More than one third (34.5%) of the children had subclinical PTSD, while 13.8% were likely to meet criteria for PTSD. Maternal PTSD was the strongest predictor for child PTSD. There were no significant differences in (subclinical) PTSD symptoms either over time or compared to symptoms of survivors from the fire disaster. Conclusion: This study shows that a considerable number of children have persistent PTSD after PICU treatment. Prevention of PTSD is important to minimize the profound adverse effects that PTSD can have on children's well-being and future development. http://www.capmh.com/content/2/1/9 Madelon B Bronner, Hendrika Knoester, Albert P Bos, Bob F Last and Martha A Grootenhuis Child and Adolescent Psychiatry and Mental Health 2008, 2:9 2008-05-20 doi:10.1186/1753-2000-2-9 Child and Adolescent Psychiatry and Mental Health 1753-2000 2 9 2008-05-20 Background: The Strengths and Difficulties Questionnaire (SDQ) has become one of the most widely used measurement tools in child and adolescent mental health work across the globe. The SDQ was originally developed and validated within the UK and whilst its reliability and validity have been replicated in several countries important cross cultural issues have been raised. We describe normative data, reliability and validity of the Chinese translation of the SDQ (parent, teacher and self report versions) in a large group of children from Shanghai. Methods: The SDQ was administered to the parents and teachers of students from 12 of Shanghai's 19 districts, aged between 3 and 17 years old, and to those young people aged between 11 and 17 years. Retest data was collected from parents and teachers for 45 students six weeks later. Data was analysed to describe normative scores, bandings and cut-offs for normal, borderline and abnormal scores. Reliability was assessed from analyses of internal consistency, inter-rater agreement, and temporal stability. Structural validity, convergent and discriminant validity were assessed. Results: Full parent and teacher data was available for 1965 subjects and self report data for 690 subjects. Normative data for this Chinese urban population with bandings and cut-offs for borderline and abnormal scores are described. Principle components analysis indicates partial agreement with the original five factored subscale structure however this appears to hold more strongly for the Prosocial Behaviour, Hyperactivity – Inattention and Emotional Symptoms subscales than for Conduct Problems and Peer Problems. Internal consistency as measured by Cronbach's α coefficient were generally low ranging between 0.30 and 0.83 with only parent and teacher Hyperactivity – Inattention and teacher Prosocial Behaviour subscales having α > 0.7. Inter-rater correlations were similar to those reported previously (range 0.23 – 0.49) whilst test retest reliability was generally lower than would be expected (range 0.40 – 0.79). Convergent and discriminant validity are supported. Conclusion: We report mixed findings with respect the psychometric properties of the Chinese translation of the SDQ. Reliability is a particular concern particularly for Peer Problems and self ratings by adolescents. There is good support for convergent validity but only partial support for structural validity. It may be possible to resolve some of these issues by carefully examining the wording and meaning of some of the current questions. http://www.capmh.com/content/2/1/8 Yasong Du, Jianhua Kou and David Coghill Child and Adolescent Psychiatry and Mental Health 2008, 2:8 2008-04-29 doi:10.1186/1753-2000-2-8 Child and Adolescent Psychiatry and Mental Health 1753-2000 2 8 2008-04-29 Background: The aim of the study was to explore resilience among refugee children whose parents had been traumatized and were suffering from Post-Traumatic Stress Disorder (PTSD). Methods: The study comprised 80 refugee children (40 boys and 40 girls, age range 6–17 yrs), divided into two groups. The test group consisted of 40 refugee children whose parents had been tortured in Iraq before coming to Sweden. In accordance with DSM-IV criteria, these children were further divided in two sub-groups, those who were assessed as having PTSD-related symptoms (n = 31) and those who did not have PTSD-related symptoms (n = 9). The comparison group consisted of 40 children from Egypt, Syria and Morocco whose parents had not been tortured. Wechsler Intelligence Scale for Children, 3rd edn. (WISC-III), Diagnostic Interview for Children and Adolescents- Revised (DICA-R), Post-Traumatic Stress Symptoms checklist (PTSS), "I Think I am" (ITIA) and Strengths and Difficulties Questionnaire (SDQ) were used to assess IQ; PTSD-related symptoms; self-esteem; possible resilience and vulnerability. Results: Children without PTSD/PTSS in the traumatized parents group had more favorable values (ITIA and SDQ) with respect to total scores, emotionality, relation to family, peer relations and prosocial behavior than the children in the same group with PTSD/PTSS and these values were similar to those the children in the comparison group (the non-traumatized parents group). The children in the non-traumatized parents group scored significantly higher on the IQ test than the children with traumatized parents, both the children with PTSD-related symptoms and those without PTSD-related symptoms. Conclusion: Adequate emotional expression, supportive family relations, good peer relations, and prosociality constituted the main indicators of resilience. Further investigation is needed to explore the possible effects of these factors and the effects of IQ. The findings of this study are useful for treatment design in a holistic perspective, especially in planning the treatment for refugee children, adolescents and their families. http://www.capmh.com/content/2/1/7 Atia Daud, Britt af Klinteberg and Per-Anders Rydelius Child and Adolescent Psychiatry and Mental Health 2008, 2:7 2008-03-28 doi:10.1186/1753-2000-2-7 Child and Adolescent Psychiatry and Mental Health 1753-2000 2 7 2008-03-28 Background: Relatively little is known about the long-term psychopathological and psychosocial outcome of early-onset schizophrenia. The existing literature describes more severe courses of illness in these patients compared with adult-onset schizophrenia. This article reports preliminary data of a study exploring the outcome of early-onset schizophrenia 13.4 years (mean) after first admission. Predictors for interindividual outcomes were investigated. Methods: We retrospectively assessed 27 former patients (mean age at first admission 15.5 years, SD = 2.0) that were consecutively admitted to the Department of Child and Adolescent Psychiatry at the University of Wuerzburg between 1990 and 2000. A multidimensional approach was chosen to assess the outcome consisting of a mail survey including different questions about psychopathological symptoms, psychosocial parameters, and standardized self-reports (ESI and ADS). Results: Concerning the psychopathological outcome, 22.2% reported having acute schizophrenic symptoms. Almost one third (30.8%) described symptoms of depression and 37.0% reported having tried to commit suicide or seriously thought about it. 77.8% of the former patients were still in outpatient treatment. Compared to the general population, the number of patients without a school graduation was relatively high (18.5%). Almost half of participants still live with their parents (48.1%) or in assisted or semi-assisted living conditions (33.3%). Only 18.5% were working in the open market. Conclusion: Schizophrenia with an early onset has an unfavourable prognosis. Our retrospective study of the psychopathological and psychosocial outcome concludes with a generally poor rating. http://www.capmh.com/content/2/1/6 Andreas Reichert, Susanne Kreiker, Claudia Mehler-Wex and Andreas Warnke Child and Adolescent Psychiatry and Mental Health 2008, 2:6 2008-02-27 doi:10.1186/1753-2000-2-6 Child and Adolescent Psychiatry and Mental Health 1753-2000 2 6 2008-02-27