Child & Adolescent Psychiatry/Psychology

This study examined whether distinct groups of young adolescents with mainly anxiety or mainly depression could be identified in a general population sample. Latent class analysis was used on self-report ratings of DSM-IV symptoms of anxiety and depressive disorders, because it was hypothesized that these ratings provide a bigger chance to identify distinct groups than parent ratings of symptoms that are poorly associated with DSM-IV. Results from exploratory and confirmatory latent class analysis showed that only very small numbers of young adolescents had mainly anxiety or mainly depressive symptoms. Instead, a five-group model fitted the data best. These five groups contained young adolescents who either had a high, intermediate, or low probability to have comorbid symptoms of anxiety and depression. It was concluded that symptoms of DSM-IV anxiety and depressive disorders co-occur in young adolescents, and that latent class analysis on items that capture also severe symptoms like suicidal thoughts are needed to derive groups with specific comorbidity patterns in a general population sample. r

Dermatoglyphics are the ridge constellations found on the hand palms and foot soles that are permanently formed by the 24th week of pregnancy. Associations have been found between adult schizophrenia and irregularities and asymmetries in dermatoglyphics. Children have not been studied before. The aim of this study was to assess the association between formal thought disorder (FTD), as a possible forerunner of schizophrenia, in children and asymmetry or discordance (DISC) of the finger prints. 222 children, aged 6-14, from an outpatient department of child psychiatry participated. Finger prints were rated with the three-pattern system (whorls, loops or arches). FTD criteria were illogical thinking (ILL), loose associations (LA), incoherence (INC), and poverty of content of speech (POC), as rated by the clinician. When boys with and without DISC were compared, no differences in FTD were found. In contrast, however, girls with DISC showed significantly more FTD than girls without DISC, t (72) = -2.39, p = 0.02. Further, for boys, only total FTD was positively correlated with DISC of the middle finger, r = 0.20, p = 0.02. For girls, total FTD was positively correlated with DISC of the index finger: r = 0.30, p = 0.02; DISC of the middle finger: r = 0.27, p = 0.03; and with total DISC dichotomous: r = 0.27, p = 0.02. In addition, total DISC correlated positively with ILL: r = 0.31, p = 0.01; LA: r = 0.23, p = 0.05; INC: r = 0.30, p = 0.01; and total FTD: r = 0.31, p = 0.01. Overall, the existence of finger print discordance, as a possible marker of prenatal instability, was associated with the occurrence of FTD in girls.

The objective of this study was to identify behavioral differences between children with multiple complex developmental disorder (MCDD) and those with pervasive developmental disorder-not otherwise specified (PDD-NOS). Twenty-five children (6-12 years) with MCDD and 86 children with PDD-NOS were compared with respect to psychiatric co-morbidity, psychotic thought problems and social contact problems using the child behavior checklist/4-18, the Dutch version of the diagnostic interview schedule for children-Version IV, the child and adolescent functional assessment scale, and the autism diagnostic observation schedulegeneric. MCDD was associated with anxiety disorders, disruptive behavior, and psychotic thought problems. PDD-NOS was associated with deficits in social contact. MCDD differs from autistic disorder, and can also be delineated from PDD-NOS.

individuals who primarily suffer from aggressive behaviors or rule-breaking behaviors, and not from attention problems or hyperactivity. Implications of these findings for future research and clinical practice are discussed. The value of the study was limited by the use of parent reports only.

This study investigated health-related QoL (HRQoL) and care-related quality of life (CarerQol) in clinically referred children with an autism spectrum disorder (ASD), and their primary and secondary caregivers. The EuroQol five-dimensional (EQ-5D) and the CarerQol questionnaires were used to respectively measure health-related QoL and care-related QoL. Primary caregivers reported pain/discomfort (42%) and anxiety/depression (40%). In caring, they mostly experienced problems in the relationship with the child (84%), and in combining care with daily activities (51%). Children with ASD had a relevantly lower QoL. Despite negative effects, almost all caregivers (96%) derived fulfillment from caring for their affected children. HRQoL and CarerQol reports of primary caregivers and children were correlated, both providing useful information to ASD measurement and treatment.

This study investigated health-related QoL (HRQoL) and care-related quality of life (CarerQol) in clinically referred children with an autism spectrum disorder (ASD), and their primary and secondary caregivers. The EuroQol five-dimensional (EQ-5D) and the CarerQol questionnaires were used to respectively measure health-related QoL and care-related QoL. Primary caregivers reported pain/discomfort (42%) and anxiety/depression (40%). In caring, they mostly experienced problems in the relationship with the child (84%), and in combining care with daily activities (51%). Children with ASD had a relevantly lower QoL. Despite negative effects, almost all caregivers (96%) derived fulfillment from caring for their affected children. HRQoL and CarerQol reports of primary caregivers and children were correlated, both providing useful information to ASD measurement and treatment.

M edical procedures often evoke pain, distress, and anxiety. 1 Especially in children, these feelings not only severely affect comfort levels during medical procedures but are also associated with adverse consequences, such as attempts to escape, 2 poor recovery, 3 eating and sleeping disturbances, 3 and posttraumatic stress symptoms. 4 Furthermore, as pain and anxiety can lead to avoidance of health care, 5,6 interventions are needed to address pain and anxiety in pediatric patients. Distraction is a commonly applied intervention during medical procedures. For example, the use of music 7,8 and movies 9,10 has been proven efficacious in reducing pain and anxiety. Virtual reality (VR) is a relatively new technique to provide distraction and might be more effective than traditional methods. VR consists of a computer-generated environment, in which orientation and 3-dimensional interaction are possible. This environment is projected right in front of the user's eyes via advanced head-mounted displays (HMDs), including a wide field of view and motion tracking systems. 11 VR can create full immersion, which is a feeling of presence in the virtual environment. 11,12 Importantly, more immersion is related to more pain reduction, because BACKGROUND: Medical procedures often evoke pain and anxiety in pediatric patients. Virtual reality (VR) is a relatively new intervention that can be used to provide distraction during, or to prepare patients for, medical procedures. This meta-analysis is the first to collate evidence on the effectiveness of VR on reducing pain and anxiety in pediatric patients undergoing medical procedures. METHODS: On April 25, 2018, we searched EMBASE, MEDLINE, CENTRAL, PubMed, Web of Science, and PsycINFO with the keywords "VR," "children," and "adolescents." Studies that applied VR in a somatic setting with participants ≤21 years of age were included. VR was defined as a fully immersive 3-dimensional environment displayed in surround stereoscopic vision on a head-mounted display (HMD). We evaluated pain and anxiety outcomes during medical procedures in VR and standard care conditions. RESULTS: We identified 2889 citations, of which 17 met our inclusion criteria. VR was applied as distraction (n = 16) during venous access, dental, burn, or oncological care or as exposure (n = 1) before elective surgery under general anesthesia. The effect of VR was mostly studied in patients receiving burn care (n = 6). The overall weighted standardized mean difference (SMD) for VR was 1.30 (95% CI, 0.68-1.91) on patient-reported pain (based on 14 studies) and 1.32 (95% CI, 0.21-2.44) on patient-reported anxiety (based on 7 studies). The effect of VR on pediatric pain was also significant when observed by caregivers (SMD = 2.08; 95% CI, 0.55-3.61) or professionals (SMD = 3.02; 95% CI, 0.79-2.25). For anxiety, limited observer data were available. CONCLUSIONS: VR research in pediatrics has mainly focused on distraction. Large effect sizes indicate that VR is an effective distraction intervention to reduce pain and anxiety in pediatric patients undergoing a wide variety of medical procedures. However, further research on the effect of VR exposure as a preparation tool for medical procedures is needed because of the paucity of research into this field.

Background: Dilated cardiomyopathy (DCM) in children is an important cause of severe heart failure and carries a poor prognosis. Adults with heart failure are at increased risk of anxiety and depression and such symptoms predict adverse clinical outcomes such as mortality. In children with DCM, studies examining these associations are scarce. Aims: We studied whether in children with DCM: (1) the level of emotional and behavioral problems was increased as compared to normative data, and (2) depressive and anxiety problems were associated with the combined risk of death or cardiac transplantation. Methods: To assess emotional and behavioral problems in children with DCM, parents of 68 children, aged 1.5–18 years (6.9±5.7 years), completed the Child Behavior Checklist. Results: Compared to normative data, more young children (1.5–5 years) with DCM had somatic complaints (24.3% vs. 8.0%; p < .001), but fewer had externalizing problems (5.4% vs. 17.0%; p = .049). Overall internalizin...

This study investigated health-related QoL (HRQoL) and care-related quality of life (CarerQol) in clinically referred children with an autism spectrum disorder (ASD), and their primary and secondary caregivers. The EuroQol five-dimensional (EQ-5D) and the CarerQol questionnaires were used to respectively measure health-related QoL and care-related QoL. Primary caregivers reported pain/discomfort (42%) and anxiety/depression (40%). In caring, they mostly experienced problems in the relationship with the child (84%), and in combining care with daily activities (51%). Children with ASD had a relevantly lower QoL. Despite negative effects, almost all caregivers (96%) derived fulfillment from caring for their affected children. HRQoL and CarerQol reports of primary caregivers and children were correlated, both providing useful information to ASD measurement and treatment.

This study investigated the association of child, caregiver, and caregiving measurements with the quality of life (QoL) in 81 caregivers (mostly parents) of clinically referred children with autism spectrum disorder (ASD). We used the EuroQol five-dimensional (EQ-5D) questionnaire and the care-related QoL questionnaire (CarerQol) to respectively assess health-related QoL and care-related QoL. Health-related QoL was associated with the caregiver’s internalizing problems and adaptive coping, explaining 38% of the variance. Parenting stress and adaptive coping were associated with the care-related QoL and explained 60% of the variance. Child variables were not associated with the caregiver’s health- and care-related QoL if caregiver and caregiving variables were taken into account. Findings indicate the importance of the caregiver’s mental health, coping, and parenting stress in caring for children with ASD.

Children with the neurogenetic disorder neurofibromatosis type 1 (NF1) often have problems with learning and behaviour. In both parent reports and neuropsychological assessment, motor problems are reported in approximately one third to one half of the children with NF1. Studies using broad motor performance test batteries with relatively large groups of children with NF1 are limited. The aim of this cross-sectional observational study was to describe the severity of motor problems in children with NF1 and to explore the predictive value of demographics, intelligence, and behavioural problems. From 2002 to 2014, 69 children with NF1, aged 4 to 16 years (age = 9.5 ± 2.8 years; 29 girls) had a motor, psychological, and neurological evaluation in an NF1 expertise centre. Data were collected about (1) motor performance (M-ABC: Movement Assessment Battery for Children), (2) intelligence, and (3) emotional and behavioural problems as rated by parents. Sixty-one percent of these children sc...

Purpose Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder associated with cognitive deficits. The NF1 cognitive phenotype is generally considered to be highly variable, possibly due to the observed T2-weighted hyperintensities, loss of heterozygosity, NF1-specific genetic modifiers, or allelic imbalance. Methods We investigated cognitive variability and assessed the contribution of genetic factors by performing a retrospective cohort study and a monozygotic twin case series. We included data of 497 children with genetically confirmed NF1 and an IQ assessment, including 12 monozygotic twin and 17 sibling sets. Results Individuals carrying an NF1 chromosomal microdeletion showed significant lower full-scale IQ (FSIQ) scores than individuals carrying intragenic pathogenic NF1 variants. For the intragenic subgroup, the variability in cognitive ability and the correlation of IQ between monozygotic NF1 twin pairs or between NF1 siblings is similar to the general population....

The current 7-year follow-up study investigated: (1) the stability of ASD severity, and (2) associations of ASD severity in adolescence with (a) childhood and concurrent psychiatric comorbidity, and (b) concurrent societal functioning. The Autism Diagnostic Observation Schedule (ADOS) and the Diagnostic Interview Schedule for Children were administered in childhood (ages 6-12) and in adolescence (ages 12-20) to 72 individuals with a pervasive developmental disorder-not otherwise specified (PDD-NOS). ADOS calibrated severity scores showed a large stability (r = .51). Psychiatric comorbidity in childhood and adolescence were not associated with ASD severity in adolescence. Mental health care use (87 %) and special education needs were high (71 %). Reevaluation of ASD severity and psychiatric comorbidity later in life seem useful when PDD-NOS is diagnosed in childhood.

In a non-selected sample of children with Neurofibromatosis type 1 (NF1) the prevalence rate of autism spectrum disorder (ASD) and predictive value of an observational (ADOS)-and questionnaire-based screening instrument were assessed. Complete data was available for 128 children. The prevalence rate for clinical ASD was 10.9%, which is clearly higher than in the general population. This prevalence rate is presumably more accurate than in previous studies that examined children with NF1 with an ASD presumption or solely based on screening instruments. The combined observational-and screening based classifications demonstrated the highest positive predictive value for DSM-IV diagnosis, highlighting the importance of using both instruments in children with NF1.

BACKGROUND Trichotillomania (TTM) is a psychiatric condition that first manifests itself in infancy and adolescence. If untreated, the condition can become chronic. TTM places a considerable burden on the individual patient. The condition is often linked to social isolation and the emergence of somatic and psychiatric comorbidity. Nevertheless, investment in research, particularly in the pharmacotherapeutical area, has been rather limited. AIM To provide an overview of the phenomenology of TTM, the associated comorbidity and the therapies available for treating this underexposed child psychiatric disorder. METHOD We searched PubMed using the the MeSH term 'trichotillomania/therapy' and located 49 relevant articles. RESULTS We found 49 usable articles. Selective serotonine reuptake inhibitors (SSRIs) are the most frequently prescribed drugs for the treatment of pediatric TTM, although their efficacy is not yet proven. The results of a meta-analysis of several SSRIs did not di...