Family factors and children's disruptive behaviour: an investigation of links between demographic characteristics, negative life events and symptoms of ODD and ADHD

All in the Family? A Systematic Review and Meta-analysis of Parenting and Family Environment as Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD) in Children

Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health.

Behavior problems, social relationships, and adolescents' future orientation. Links from middle to late adolescence

INTRODUCTION

As adolescents leave high school, plans for the future are of great importance. Future orientation reflects positive thoughts regarding further education, employment, and family life. While future orientation has been found to affect behavior problems, the influence of behavior problems on future orientation is mainly unknown. Positive parent-child and peer relations may boost positive outlooks, but the interplay of behavior problems and social relations for future orientation remains to be studied.

METHODS

Participants were 485 adolescents, 54% girls, living in Mid-Sweden. At age 15, parents and adolescents rated ADHD- and internalizing symptoms, parents rated ODD-symptoms, and adolescents rated their relationship with parents and peers. At age 18, adolescents rated future orientation regarding education, employment, and family, and reported on delinquent acts.

RESULTS

Low levels of inattention symptoms and of delinquency were important for all higher future orientation aspects. In contrast, higher levels of hyperactive-impulsive symptoms were associated with more positive outlooks on work and family life. Relationships with parents and peers were stronger predictors of future outlooks, compared with behavior problems. There were few interaction effects of behavioral symptoms and social relationship quality.

CONCLUSIONS

Behavior problems in middle adolescence may negatively affect future outlooks. However, positive social relations, especially relations with peers, seem more important for optimistic views than behavior problems and thus may have a compensatory effect. The clinical implications should be to address the young person's social world, in the case of misgivings about the future, also in the presence of problematic behaviors.

Determination of the Mental Adjustment Status of Refugee Children in Primary School Age: The Case of Turkey

INTRODUCTION

This research was conducted as a descriptive study to determine the mental adjustment status of refugee children aged 6 to 14 in Duzce.

METHOD

The sample of the study consisted of 163 refugee children. Data were collected through face-to-face interviews with primary caregivers of children using the Hacettepe Mental Adjustment Scale. The collected data were analyzed in the SPSS 22.0 database using percentages, Mann Whitney U, Kruskal-Wallis H, and chi-square tests.

RESULTS

Adjustment problems were detected in 25.8% of the children participating and behavioral problems were detected in over half (52.4%).

DISCUSSION

In line with the findings obtained from the research, it has been suggested to form a team of mental health experts, including psychiatric nurses, who have adopted the principles of transcultural care to make early diagnosis and effective treatment of psychiatric diseases of refugee children.

Family Functioning in Children With ADHD and Subthreshold ADHD: A 3-Year Longitudinal Study

OBJECTIVE

To compare family functioning over time for elementary school children with Attention-Deficit/Hyperactivity Disorder (ADHD; N = 179) and subthreshold ADHD (ST-ADHD; N = 86), to children without ADHD (Control; N = 212).

METHOD

ADHD was assessed using the Conners 3 ADHD Index and Diagnostic Interview Schedule for Children IV. At baseline, 18-month follow-up and 36-month follow-up, parents completed measures assessing a range of family functioning domains.

RESULTS

At baseline, the ADHD group reported higher psychological distress, less parenting self-efficacy, less parenting consistency, and more stressful life events; and both groups reported poorer family quality of life (QoL) and greater parenting anger. Trajectories were largely similar to controls (i.e., stable over time), but unlike controls, ADHD and ST-ADHD groups showed lessening parent-partner support and parenting warmth, respectively; and both groups showed worsening aspects of family QoL.

CONCLUSION

Families of children with ADHD and ST-ADHD report persistently poor or worsening family functioning; highlighting a need for tailored psycho-social supports.

Shall we play together? Game-based learning for engagement and classroom climate in Spanish socially deprived communities

Purpose

The purpose of this study is to analyze the effects of a game-based learning (GBL) program on the classroom climate and engagement of high schools in socially deprived communities in Spain.

Methods

The study included 277 students from two secondary schools located in Southern Spain, situated in Zones in Need of Social Transformation. Sampling was non-probabilistic and accidental, based on the accessibility of the school and the willingness of the management and teaching staff to participate in the GBL program. The study employed a control group and two experimental groups (cooperative games group only and cooperative and competitive games group) to compare pre-test and post-test data in both groups. The Brief Class Climate Scale and Engagement Inventory, validated in academic literature, were used as assessment instruments.

Results

The study used a series of ANOVA tests to compare the experimental groups with the control group. The results indicated statistically significant changes in all study variables. In all cases, the experimental groups demonstrated greater benefits than the control group.

Discussion and conclusion

The study findings reveal that games can provide significant benefits to students, regardless of whether they are cooperative or competitive. The study provides evidence of the benefits of GBL in high schools located in socially deprived communities in Spain.

Longitudinal Associations Between COVID-19 Stress and the Mental Health of Children With ADHD

OBJECTIVE

To investigate the longitudinal associations between COVID-19 induced stress (related to COVID-19 restrictions/changes), attention-deficit/hyperactivity disorder (ADHD) symptoms, oppositional symptoms, and mental health outcomes (negative affect, anxiety, depression, and irritability) in children with ADHD during the COVID-19 pandemic.

METHOD

Parents of 140 Australian children with ADHD (aged 5-17 years) completed an online survey in May 2020 during stay-at-home restrictions and 12-months later.

RESULTS

Baseline COVID-19 stress was associated with increased total ADHD symptom severity (β = .21, p = .007) and hyperactivity/impulsivity symptoms (β = .23, p = .002) at 12-months, after accounting for covariates (i.e., child age, gender, ADHD medication, socio-economic status, and baseline symptoms). Despite some indication of associations between baseline COVID-19 stress and 12-month oppositional symptoms and negative affect, these were attenuated when adjusting for baseline symptoms.

CONCLUSIONS

The study provides initial evidence of the medium-term impacts of pandemic-related stress for children with ADHD.

Association between maternal polycystic ovary syndrome and attention-deficit/hyperactivity disorder in offspring aged 3-6 years: A Chinese population-based study

Background

Maternal polycystic ovary syndrome (PCOS) may increase the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring; however, their association remains unexplored in Asian populations. Hence, this study aimed to investigate the association between maternal PCOS and ADHD in offspring aged 3-6 years and whether it differed by offspring sex.

Methods

This was a district-wide population-based study of 87,081 preschoolers from 234 kindergartens in Longhua District, Shenzhen, China. The parents were invited to complete a self-administrated questionnaire covering information on socio-demographics, maternal disease history, and child behavior. ADHD symptoms were measured with the parent-rating 26-item Swanson, Nolan, and Pelham Rating Scale (SNAP-IV). Logistic regression was performed to examine the associations between maternal PCOS and ADHD symptoms in offspring.

Results

The response rate was 80% and 63,390 mother-child pairs were included. Of the mothers, 1,667 (2.6%) reported PCOS diagnoses. The mean age of children at ADHD assessment was 4.86 ± 0.84[SD] years, and 53.6% were boys. Children with maternal PCOS had a higher risk of developing ADHD symptoms than other children (12.0 vs. 9.4%, adjusted odds ratio [OR] = 1.32, 95% CI: 1.13-1.54). The risk estimate was significant in boys (adjusted OR = 1.38, 95% CI: 1.14-1.66) but not in girls (adjusted OR = 1.23, 95% CI: 0.94-1.57, P for interaction = 0.391). Treatment of PCOS tended to be associated with a lower risk of ADHD symptoms than untreated PCOS albeit risk confidence intervals were overlapped (treated: adjusted OR = 1.28, 95% CI: 1.06-1.54 vs. untreated: adjusted OR = 1.14, 95% CI: 1.08-1.83).

Conclusion

Maternal PCOS increases the risk of developing ADHD in offspring, especially boys. Further studies are warranted to confirm our findings, and early neurodevelopmental screening may be needed in children born to mothers with PCOS.

Substance-Related Problems in Adolescents with ADHD-Diagnoses: The Importance of Self-Reported Conduct Problems

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a known risk factor for substance-related problems (SRP) during adolescence, but the nature of this relationship and the importance of co-occurring conduct problems are not fully understood.

METHODS

Data stem from a linked dataset between a large population-based survey conducted in 2012 of Norwegian adolescents aged 16 to 19, and registry-based data from specialized child and adolescent mental health services (n = 9,411).

RESULTS

Adolescents with "ADHD + high conduct problems" had increased risk of SRP (odds ratios = 2.37-10.14). Adolescents with "ADHD only" had very similar risk of SRP as adolescents from the general population with low symptoms of conduct problems. Relative to boys, girls with "ADHD + high conduct problems" appeared to have somewhat higher risk for SRP.

CONCLUSION

The present study suggests that the risk for SRP among adolescent with ADHD is largely driven by co-existing conduct problems.

A Systematic Review of Multiple Family Factors Associated with Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD) is characterized by a recurrent pattern of angry/irritable emotional lability, argumentative/defiant behavior, and vindictiveness. Previous studies indicated that ODD typically might originate within a maladaptive family environment, or was at least maintained within such an environment. As such, the present review summarized pertinent research from the last 20 years that focused on the pathways connecting family risk factors to the development of child ODD symptoms. A systematic search of electronic databases was completed in August 2020, resulting in the inclusion of 62 studies in the review. The review established a multi-level framework to describe the mechanisms underlying the pathway from familial factors to ODD psychopathological symptoms: (a) the system level that is affected by the family's socioeconomic status and family dysfunction; (b) the dyadic level that is affected by conflict within the marital dyad and parent-child interactions; and (c) the individual level that is affected by parent and child factors. Additionally, from the perspective of family systems theory, we pay special attention to the interactions among and between the various levels of the pathway (moderation and mediation) that might be associated with the occurrence and severity of ODD symptoms. Considering future prevention and intervention efforts, this three-level model emphasizes the necessity of focusing on familial risk factors at multiple levels and the mechanisms underlying the proposed pathways.

Family, personal, parental correlates and behavior disturbances in school-aged boys with attention-deficit/hyperactivity disorder (ADHD): a cross-sectional study

BACKGROUND

To evaluate the relationship among family, personal, parental correlates, and behavioral disturbances in boys with attention-deficit/hyperactivity disorder (ADHD).

METHODS

We performed a hospital-based cross-sectional study. School-aged boys who first visited the hospital between 2000 and 2011 with ADHD were identified. Through medical records review, demographic information, family characteristics, personal characteristics, parental characteristics, and the Child Behavior Checklist (CBCL) collected during the first outpatient visit were retrieved. A T-score higher than 63 in the internalizing or externalizing subscale of the CBCL indicated severe behavioral disturbances in each domain. Multivariable logistic regression was used to evaluate the relationship between the correlates and behavioral disturbances. Eligible patients were further classified into groups without behavioral disturbance, with either only severe internalizing or only severe externalizing behaviors, or with both behaviors. Multivariable ordinal logistic regression was used to investigate the association between the correlates and the number of types of behavioral disturbances.

RESULTS

A total of 1855 boys with ADHD were included. In the multivariable logistic regression, family factors, including being first-born, living in a family not with both parents, and family history of mental disorder, were associated with severe internalizing and externalizing behaviors. Personal factors, including prenatal complications, perinatal complications, and medical and psychiatric comorbidities, were associated with severe internalizing behaviors, but only prenatal complications and medical comorbidities were associated with severe externalizing behaviors. Parental factors were only associated with severe externalizing behaviors. A higher paternal education level had a protective effect, but younger motherhood increased the risk. In ordinal logistic regression, these factors were also associated with more types of behavioral disturbances.

CONCLUSIONS

Multiple factors are related to behavioral disturbances in ADHD. Our study reported the association among family, personal, parental factors, severe internalizing behavior, severe externalizing behavior, and number of behavioral disturbances in boys with ADHD. However, the impacts differed as the behavior phenotypes varied. Further research is needed to better understand the heterogeneity of ADHD behavior.

Health Inequalities in Children and Adolescents: A Scoping Review of the Mediating and Moderating Effects of Family Characteristics

This scoping review systematically mapped evidence of the mediating and moderating effects of family characteristics on health inequalities in school-aged children and adolescents (6-18 years) in countries with developed economies in Europe and North America. We conducted a systematic scoping review following the PRISMA extension for Scoping Reviews recommendations. We searched the PubMed, PsycINFO and Scopus databases. Two reviewers independently screened titles, abstracts and full texts. Evidence was synthesized narratively. Of the 12,403 records initially identified, 50 articles were included in the synthesis. The included studies were conducted in the United States (n = 27), Europe (n = 18), Canada (n = 3), or in multiple countries combined (n = 2). We found that mental health was the most frequently assessed health outcome. The included studies reported that different family characteristics mediated or moderated health inequalities. Parental mental health, parenting practices, and parent-child-relationships were most frequently examined, and were found to be important mediating or moderating factors. In addition, family conflict and distress were relevant family characteristics. Future research should integrate additional health outcomes besides mental health, and attempt to integrate the complexity of families. The family characteristics identified in this review represent potential starting points for reducing health inequalities in childhood and adolescence.

Reading Comprehension Impairment in Children With Neurofibromatosis Type 1 (NF1): The Need of Multimodal Assessment of Attention

Attention span, which has been shown to have an impact on reading quality in many other conditions, is one of the main cognitive disorders of neurofibromatosis type 1 (NF1). The aim of this work is to observe the impact of attention on reading comprehension, in NF1 and non-NF1 children. A multicenter, cross-sectional study was conducted on 150 children (8-12 years old) with or without NF1 (75 NF1 vs 75 non-NF1; 72 female, 78 male), matched for age, sex, handedness, and reading level, thus forming a continuum from good to poor readers in both NF1 and non-NF1 groups. Children with intellectual deficiency or neurologic or psychiatric disorder were excluded. Attentional skills were assessed by combining a parent questionnaire (Child Behavior CheckList) and a performance-based assessment (Conner's Continuous Performance Test-Second Edition). Reading comprehension was assessed through a standardized reading comprehension test (ORLEC Lobrot). The performance-based attention scores were associated with text and sentence comprehension ability (P = .0235 and P = .0164, respectively), while indirect questionnaire attention scores were only associated with sentence comprehension (P = .0263). For both groups, the correlations between questionnaire and performance-based measures were low. We have shown that reading comprehension is greatly influenced by attention in NF1 and non-NF1, even if predictors of good reading comprehension also include IQ score and reading accuracy. Indirect observer-rated questionnaires and direct performance-based measures of attention do not assess the same variables, are linked to different components of reading skills, and are not interchangeable assessments of attention difficulties. Both assessments are complementary and must be used simultaneously, leading to recommendations that support multimodal assessment of attention.

Genetic sensitivity analysis: Adjusting for genetic confounding in epidemiological associations

Associations between exposures and outcomes reported in epidemiological studies are typically unadjusted for genetic confounding. We propose a two-stage approach for estimating the degree to which such observed associations can be explained by genetic confounding. First, we assess attenuation of exposure effects in regressions controlling for increasingly powerful polygenic scores. Second, we use structural equation models to estimate genetic confounding using heritability estimates derived from both SNP-based and twin-based studies. We examine associations between maternal education and three developmental outcomes - child educational achievement, Body Mass Index, and Attention Deficit Hyperactivity Disorder. Polygenic scores explain between 14.3% and 23.0% of the original associations, while analyses under SNP- and twin-based heritability scenarios indicate that observed associations could be almost entirely explained by genetic confounding. Thus, caution is needed when interpreting associations from non-genetically informed epidemiology studies. Our approach, akin to a genetically informed sensitivity analysis can be applied widely.

Attention deficit hyperactivity disorder in first- and second-generation immigrant children and adolescents: A nationwide cohort study in Sweden

BACKGROUND

Studies on the incidence of Attention Deficit Hyperactivity Disorder (ADHD) among immigrant children and adolescents is limited and results are mixed. The aim of this study was to compare the ADHD risk between first- and second-generation immigrants aged 4-16 years and their native peers in Sweden.

METHODS

This was an open nationwide retrospective cohort study. We included 1,902,526 native and 805,450 children and adolescents with an immigrant background, born 1987-2010, and aged 4-16 years at baseline. We identified participants using national population data and participants were observed until they received an ADHD diagnosis in the National Patient Register, turned 18 years, migrated, died, or until the end of the study, whichever came first. ADHD risks were adjusted for birth year and age and maternal income at baseline.

RESULTS

For both males and females, the ADHD risk was lower among most immigrant groups. However, the combination of a Swedish-born mother and foreign-born father was associated with an increased risk of ADHD. The ADHD risk varied substantially between immigrants from different regions of the world. For example, immigrants from other Scandinavian countries, North America, and Latin America and the Caribbean had higher rates of ADHD compared with natives.

CONCLUSIONS

Future research should examine the underlying factors behind the differences in ADHD risks between certain immigrant subgroups and natives, such as family structure, cultural and language barriers and potential differences in health care utilization among immigrant families.

Autism Spectrum and Other Neurodevelopmental Disorders in Children of Immigrants: A Brief Review of Current Evidence and Implications for Clinical Practice

Children of immigrants may have higher neurodevelopmental risks than those of non-immigrant populations. Yet, some evidence suggests that this group may receive late diagnosis, and therefore miss beneficial early interventions. Clinicians may misattribute symptoms of disorders to other social, behavioral or language problems. Likewise, there might be cultural differences in parents' likelihood of perceiving or reporting first developmental concerns to clinicians. Population-based standardized screening may play an important role in addressing ethnic inequalities in the age at diagnosis, although further research focusing on cross-cultural use is necessary. Once children are diagnosed, clinicians may rely on culturally sensitive procedures (translation services, cultural mediators) to increase the accessibility of interventions and improve adherence among immigrant families. In this brief review, we provide an overview about what is currently known about the epidemiology and risk factors of neurodevelopmental disorders, paying special attention to autism spectrum disorder (ASD), in children of immigrants and suggest the necessity of population-based screening and culturally sensitive care.

Cognitive and Emotional Profiles of CU Traits and Disruptive Behavior in Adolescence: a Prospective Study

In this study we followed 82-90 adolescents, 50% boys, from 15 to 16 years, investigating CU traits and disruptive behaviors as predictors of cognitive skills and arousal to emotional pictures. At age 15, CU traits were rated by adolescents and disruptive (aggregated ADHD-ODD-delinquent) behaviors were rated by parents and adolescents. At age 16, executive function, reaction time variability (RTV), IQ and arousal to negative pictures were assessed. The results showed that, with control for disruptive behaviors, CU traits predicted lower RTV, higher IQ and lower arousal to negative pictures. With control for CU traits, disruptive behaviors predicted lower spatial working memory, lower interference control and higher RTV. Our findings are of theoretical and clinical relevance as they point to highly diverging cognitive and emotional profiles of CU traits and disruptive behaviors.

Sleep problems and associations with psychopathology and cognition in young people with 22q11.2 deletion syndrome (22q11.2DS)

BACKGROUND

Young people with 22q11.2 deletion syndrome (22q11.2DS) are at high risk for neurodevelopmental disorders. Sleep problems may play a role in this risk but their prevalence, nature and links to psychopathology and cognitive function remain undescribed in this population.

METHOD

Sleep problems, psychopathology, developmental coordination and cognitive function were assessed in 140 young people with 22q11.2DS (mean age = 10.1, s.d. = 2.46) and 65 unaffected sibling controls (mean age = 10.8, s.d.SD = 2.26). Primary carers completed questionnaires screening for the children's developmental coordination and autism spectrum disorder.

RESULTS

Sleep problems were identified in 60% of young people with 22q11.2DS compared to 23% of sibling controls (OR 5.00, p < 0.001). Two patterns best-described sleep problems in 22q11.2DS: restless sleep and insomnia. Restless sleep was linked to increased ADHD symptoms (OR 1.16, p < 0.001) and impaired executive function (OR 0.975, p = 0.013). Both patterns were associated with elevated symptoms of anxiety disorder (restless sleep: OR 1.10, p = 0.006 and insomnia: OR 1.07, p = 0.045) and developmental coordination disorder (OR 0.968, p = 0.0023, and OR 0.955, p = 0.009). The insomnia pattern was also linked to elevated conduct disorder symptoms (OR 1.53, p = 0.020).

CONCLUSIONS

Clinicians and carers should be aware that sleep problems are common in 22q11.2DS and index psychiatric risk, cognitive deficits and motor coordination problems. Future studies should explore the physiology of sleep and the links with the neurodevelopment in these young people.

Family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD)

PURPOSE

To evaluate the associations between family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD).

METHODS

We conducted a matched case-control study. Data were retrieved from medical records at a psychiatry center in northern Taiwan. School-aged boys with ADHD who first visited the outpatient department at the psychiatric center between 2000 and 2011 were identified. The Child Behavior Checklist was used for aggressive behavior assessment. Boys with ADHD with T scores higher than 70 on the aggressive subscale were classified as cases and others with T scores lower than 70 were classified as controls at a 1:4 ratio. After controlling for other familial, personal, and parental factors, a multivariate conditional logistic regression was performed to evaluate the effects of family structure and birth order on aggressive behaviors of boys with ADHD.

RESULTS

277 cases and 1108 controls were included in the final analysis. Compared with living in a traditional family with both parents, living in a non-traditional family in which one or both parents were absent increased the risk of aggressive behaviors by 1.47-fold, with the highest risk for those in single parent families. Being the firstborn increased risk by 1.45-fold and the risk was higher when the firstborn had siblings.

CONCLUSIONS

Living in non-traditional families in which one or both parents were absent, and being the firstborn increased risk of aggression in school-aged boys with ADHD. Identification of this high-risk population and development of adequate preventive strategies are warranted.

Linking Stressful Experiences and Psychological Problems: The Role of Self-Esteem

Stressful experiences have repeatedly been related to psychological problems. The current study extends previous work on stress and psychological problems by examining the link between stressful experiences and both internalizing (INT) and externalizing (EXT) problems. Additionally, individual differences are investigated by testing the moderating role of self-esteem. Questionnaire data of 750 adolescents aged 12–18 were collected and analyzed using multiple regression analyses. Analyses were controlled for sex and socioeconomic status. Results indicated that adolescents who report more stressful experiences are more likely to experience both INT and EXT problems, and these relationships were stronger for adolescents with low self-esteem. Post hoc analyses (e.g., different thresholds for determining stressful experiences) support the robustness of our findings. The findings on self-esteem emphasize the importance of taking individual differences into account in the relation between stressful experiences and psychological problems. The results can be seen as a next step in cross-sectional research.

Multilevel analysis of personality, family, and classroom influences on emotional and behavioral problems among Chinese adolescent students

Background

The classroom environment plays a potentially important role in shaping the emotions and behavior of adolescents. However, few studies have focused on this factor. The aim of this study was to explore the association between the classroom environment and emotional and behavioral problems among Chinese adolescents while also considering personality-and family-related factors.

Methods

This cross-sectional study was conducted in November and December, 2009. A set of questionnaires, including the Strengths and Difficulties Questionnaire (SDQ), the Eysenck Personality Questionnaire (EPQ), the Family Environment Scale (FES), the Questionnaire on Teacher Interaction (QTI), and the Center for Epidemiological Studies- Depression Scale (CES-D), were distributed to participants. A total of 5,433 Chinese adolescent students (aged 9–18) and 244 classroom teachers in Liaoning Province were ultimately included in the study. Hierarchical linear modeling was used to explore the factors associated with emotional and behavioral problems.

Results

Multilevel analyses revealed that adolescent emotional and behavioral problems significantly varied among classrooms. Although personality and family characteristics exerted the greatest influence on adolescents’ emotions and behavior at the individual-level, interactions between classroom teachers and students increasingly affected adolescents with respect to age at the class-level. A mild positive association was found between adolescents’ mental health problems and the mental health of teachers.

Conclusion

This study focused on the classroom environment in order to understand Chinese adolescent mental health problems, the findings of which highlight important implications for policymakers and educators. The results underscore the importance of establishing a comfortable classroom climate by improving teacher-student interactions and meeting specific needs at different school stages, thus promoting a climate of positive mental health among Chinese adolescents.

Ethnic inequalities in child and adolescent health in the Scandinavian welfare states: The role of parental socioeconomic status - a systematic review

Aims: Adult non-Western immigrants in Scandinavia tend to be worse off in terms of health than native-born populations, which cannot be fully ascribed to their often lower socioeconomic status (SES). This review examines if differences in health status are also present between non-Western immigrant and majority children in Denmark, Norway and Sweden, and if SES explains the differences. Methods: Following PRISMA guidelines, relevant Scandinavian peer-reviewed quantitative publications since 1990 were identified through a systematic search of PubMed, EMBASE, Scopus, Web of Science and SveMed. Of 1197 identified publications, 27 remained relevant after applying inclusion criteria: 3 Danish, 6 Norwegian and 18 Swedish studies. Results: Non-western immigrant children had overall poorer outcomes compared with ethnic majority children in Denmark, Norway and Sweden in health issues covered by the included studies: diabetes, obesity, oral and mental health, and well-being. However, in diabetes, obesity and mental health, non-Western immigrant children from certain countries and regions, and descendants of non-Western immigrants had similar/more favourable outcomes than majority children. In mental health and well-being, ethnic inequalities were strongly associated with SES, while for diabetes, obesity and oral health, differences remained significant after adjusting for SES. Conclusions: Overall poorer health outcomes in non-Western immigrant compared with majority children in Scandinavia cannot be fully explained by SES. Evidence points to additional mechanisms at individual, household, societal or policy levels, including reasons for migration, culture and societal discrimination. Finally, methodological issues may influence study outcomes, e.g. heterogeneity of populations studied and socioeconomic variables included.

Characteristics of undiagnosed children with parent-reported ADHD behaviour

There is an ongoing public debate on the diagnosis of attention deficit hyperactivity disorder (ADHD) in which critics have claimed that the disorder is over-diagnosed, while the potential under-diagnosis of children with ADHD has received little attention. In this study we estimate the number of children with parent-reported ADHD behaviour at age 7 and absence of recorded ADHD diagnosis through adolescence, and investigate whether socio-demographic characteristics of this group differed from the children diagnosed with ADHD during follow-up. Our study was based on data from the Danish National Birth Cohort, where parents of 51,527 children completed questionnaires, including the Strength and Difficulties Questionnaire (SDQ). ADHD diagnosis was identified through Danish registers and parent-reported ADHD behaviour by the specific SDQ subscale. Socio-demographic predictors of positive parent-reported SDQ ADHD behaviour and absence of recorded ADHD diagnosis in their children were examined using logistic regression analyses. Children with parent-reported ADHD behaviour and no diagnosis (1.3%) were more likely to be girls (OR 1.83; 95% CI 1.45; 2.29), more likely to have mothers with a low socioeconomic status (OR high vs. low 1.49; 95% CI 1.10; 2.02), and to live in certain regions of the country (OR: Capital vs. Southern: 2.04; 95% CI 1.51; 2.73) than children with an ADHD diagnosis. The children showed markedly impairments on all the SDQ subscales. The results demonstrate a considerable number of children with ADHD symptoms who potentially go undetected and underline the influence of socio-demographic factors in the pathway to a diagnosis of ADHD.

Mediators and Moderators of the Relation between Parental ADHD Symptomatology and the Early Development of Child ADHD and ODD Symptoms

The present study examined mediators and moderators of the relation between parental ADHD symptomatology and the development of child attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms across the preschool years. Participants included 258 (138 boys) 3-year-old children (M = 44.13 months, SD = 3.39) with and without behavior problems and their parents who took part in a 3-year longitudinal study. Maternal ADHD symptoms predicted later ADHD symptoms in children, controlling for early child symptomatology. Both family history of ADHD and paternal comorbid psychopathology predicted later child ADHD and ODD symptoms, but they did not account for the association between maternal and child ADHD symptoms. Although paternal ADHD symptoms were associated with age 3 child ADHD symptoms, they did not significantly predict later child ADHD symptoms controlling for early symptomatology. Family adversity moderated the relation between maternal ADHD and child ADHD symptoms, such that the relation between maternal and child ADHD symptoms was stronger for families with less adversity. Maternal overreactive parenting mediated the relation between maternal ADHD symptoms and later child ADHD and ODD symptoms. Our findings suggest that targeting paternal comorbid psychopathology and maternal parenting holds promise for attenuating the effects of parental ADHD on children's ADHD.

An epidemiological study of ADHD and conduct disorder: does family conflict moderate the association?

PURPOSE

To examine the role of family conflict in the relationship between attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD).

METHODS

A cross-sectional national population survey was carried out among 10,838 14-16 year old students in all secondary schools in Iceland. Three latent measures, financial status, ADHD and CD, and one observed measure, family structure, were included in the study. A structural equation model was used to evaluate direct effects between ADHD and CD for four different groups; females and males, experiencing family conflict and those not experiencing family conflict.

RESULTS

ADHD was significantly and positively associated with CD for all groups. When controlling for financial status and family structure it was found that ADHD was positively and significantly associated with CD for adolescent females and males not experiencing family conflict as well as for those experiencing family conflict. The link between ADHD and CD was significantly stronger for those adolescents who had experienced family conflict compared to those who had not experienced family conflict. These results suggest that family conflict moderates the association between ADHD and CD for both girls and boys.

CONCLUSIONS

The results of this study indicate that family environment and ADHD symptoms are important when predicting CD among adolescent youth. Most notably, family conflict exacerbates the effects of ADHD symptoms on CD among both females and males.

Family structure and childhood mental disorders: new findings from Australia

PURPOSE

Many children now live in non-traditional families-including one-parent, blended, and step families. While a substantial body of international evidence indicates that these children display poorer cognitive and socio-emotional outcomes than children living in traditional families, research on childhood mental disorders is scarce. This report provides new evidence of the relationships between family structure and childhood mental disorders in an under-researched context, Australia.

METHODS

We use recent, nationally representative data on children aged 4-17 from Young Minds Matter, the second Australian Child and Adolescent Survey of Mental Health and Well-being (N = 6310). Mental disorders were assessed using the Diagnostic Interview Schedule for Children-Version IV and included social phobia, separation anxiety disorder, generalised anxiety disorder, obsessive-compulsive disorder, major depressive disorder, attention-deficit/hyperactivity disorder, and conduct disorder.

RESULTS

Compared to children living in original families, children in one-parent, blended, and step families experienced a higher prevalence of mental disorders. Amongst children whose parents separated, the time since separation was not statistically significantly related to the prevalence of mental disorders.

CONCLUSIONS

Although we are unable to assess causality, our findings highlight the strength of the association between family structure and child and adolescent mental health. They also stress the need for programs to support children, parents, and families in non-traditional family types to reduce mental health inequalities in childhood and later life.

Violent media exposure, aggression and CU traits in adolescence: Testing the selection and socialization hypotheses

We investigated the role of exposure to violent action for later aggression and for later callous-unemotional traits in a sample of Swedish adolescents (N = 77-85), testing the selection and socialization hypotheses. Adolescents reported on violent delinquency and on callous-unemotional (CU) traits at age 15, on their media habits at age 16 and on reactive and proactive aggression and CU traits at age 18. The socialization hypothesis was supported with regard to aggression, that is, violent delinquency did not affect consumption of violent action, but controlling for violent delinquency, consumption of violent action added to proactive aggression and, marginally, to reactive aggression. The selection hypothesis was supported with regard to CU traits, that is, high levels of CU traits predicted frequent consumption of violent action, but consumption of violent action did not affect later levels of CU traits. Frequent violent media use was associated with later aggression. The associations between CU traits and violent media need further study.

Association between immigrant background and ADHD: a nationwide population-based case-control study

BACKGROUND

Information about psychiatric disorders among those with immigrant parents is important for early detection and service development. The aim of this study is to examine the association between parental immigration and the diagnosis of attention-deficit hyperactivity disorder (ADHD) in offspring in Finland.

METHODS

This matched case-control study was based on a national birth cohort. The sample included all singletons who were born in Finland in 1991-2005 and diagnosed with ADHD by the year 2011 (n = 10,409) and their matched controls (n = 39,124). Nationwide registers were used to identify participants and to gather information on the parents' country of birth and native language. Conditional logistic regression analyses were conducted using maternal and paternal migration status and region of birth as well as time since maternal migration as exposure factors.

RESULTS

The likelihood of being diagnosed with ADHD was significantly increased among children of two immigrant parents [adjusted odds ratio (aOR) 4.7, 95% CI 3.4-6.6] and children of an immigrant father (aOR 1.9, 95% CI 1.6-2.2). The likelihood of receiving an ADHD diagnosis was equal among children whose mother was a recent immigrant when she gave birth and those whose mother had stayed in Finland at least for a year before birth. The association between parental migration and ADHD diagnosis was strongest among fathers born in sub-Saharan Africa or Latin America and among mothers born in sub-Saharan Africa or North Africa and Middle East. Children, whose parents were born in countries with low Human Development Index (HDI), were more often diagnosed with ADHD.

CONCLUSIONS

The increased likelihood of ADHD diagnosis among children of immigrants indicates increased exposure to environmental risk factors, differences in the use of health services, or challenges in diagnosing immigrants' children.

A discursive analysis concerning information on "ADHD" presented to parents by the National Institute of Mental Health (USA)

A discourse analysis was performed based on an online document under the headline: "What is Attention Deficit Hyperactivity Disorder (ADHD, ADD)?" published by the National Institute of Mental Health (NIMH), USA. Three parts of the document were analysed: (1) The introductory part, as this sets the tone of the whole text. (2) Parts of the text that were specifically addressed to parents. (3) Etiology and pathology of "ADHD" with reference to a number of different symptoms and behaviors. Inattention and hyperactivity are presented in the document as a floating spectrum of symptoms caused by "ADHD." Other factors of importance for children's development, that is, early attachment, close relationships, previous experiences, culture, and contexts are ignored. Children who are perceived as inattentive and hyperactive are portrayed as having inherent difficulties with no reference to their emotions or efforts to communicate. The child is viewed as suffering from a lifelong disorder that might not be cured but controlled by a diagnosis and subsequent medication. Parents are advised to control their child's behavior and to strive for early diagnosis in order to receive treatment provided by experts. Those who are presented as experts rely on a biomedical model, and in the document, detailed descriptions of medication to correct the undesired behaviors are provided. The value of judgment in the assessment of different symptoms and behaviors that signifies "ADHD" is absent, rather taken-for-granted beliefs were identified throughout the document. A heterogeneous set of behaviors is solely described as a disorder and hereafter it is stressed that the same behaviors are caused by the disorder. In this manner, cause and effects of "ADHD" are intertwined through circular argumentation.

Impact of a Father Figure's Presence in the Household on Children's Psychiatric Diagnoses and Functioning in Families at High Risk for Depression

The consequences of living in single-parent households on children's wellbeing are well documented, but less is known about the impact of living in single-mother households among children with high familial risk for depression. Utilizing data from an ongoing three-generation study of high-risk families, this preliminary study examined a sample of 161 grandchildren of probands diagnosed with major depressive disorder, comparing those in single-parent households to those in dual-parent households with household status defined as the full-time presence of a resident male in the home. High-risk children were compared across households in terms of psychiatric diagnoses (measured by Schedule for Affective Disorders and Schizophrenia for School-Age Children; K-SADS-PL) and global functioning (assessed by Global Assessment Scale, child version; C-GAS). Results indicated that high-risk children in single-parent households had 4.7 times greater odds for developing a mood disorder and had significantly lower mean C-GAS scores (p = 0.01) compared to those in dual-parent households. Differences remained significant when controlling for household income, child's age, and either parent's depression status. There were no significant differences between high-risk children across households when household status was instead defined as legal marital status. This study has several limitations: sample size was small, pro-bands were recruited from a clinical population, and participants had not passed completely through the period of risk for adult psychiatric disorders. These findings point towards the importance of identifying and closely monitoring children at risk for depression, particularly if they reside in households without a resident father figure.

Psychiatric disorders in Danish children aged 5-7 years: A general population study of prevalence and risk factors from the Copenhagen Child Cohort (CCC 2000)

BACKGROUND

Knowledge about the presentation of psychopathology in preschool age and associated risk factors is fundamental to preventive intervention before schooling.

AIMS

To investigate the full spectrum of psychiatric diagnoses in general population children at the period of transition from preschool to school.

METHODS

A sample of 1585 children from the Copenhagen Child Cohort, CCC2000 aged 5-7 years was assessed using the Development and Well-Being Assessment (DAWBA) with diagnostic classification by experienced clinicians. Perinatal, sociodemographic and socio-economic data was obtained from Danish national registries.

RESULTS

The prevalence of any ICD-10 psychiatric disorder was 5.7% (95%CI: 4.4-7.1). Pervasive developmental disorders (PDD) were found in 1.3% (95%CI: 0.8-1.8) and behavioural and hyperkinetic disorders were found in 1.5% (95%CI: 0.9-2.1) and 1.0% (95%CI: 0.4-1.6), respectively. Emotional disorders were found in 2.9% (95%CI: 1.9-40). More boys were diagnosed with PDD, behavioural disorders and tics. No gender differences were found in hyperactivity disorders (HD) and emotional disorders. Co-morbidity was frequent, in particular between HD and PDD, but also between HD and emotional disorder and behavioural disorder. Teenage mothers, single parents and low household income the first two years after the child's birth were associated with a three-to fourfold increased risk of psychiatric disorder in the child at age 5-7 years.

CONCLUSION

The study results point to two "windows of opportunity" for prevention. In the earliest postnatal years, prevention should target families at socio-economic risk; and in the years before schooling, intervention should focus on children with symptoms of PDD, HD, and behavioural disorders.

A Developmental Psychopathology Perspective on ADHD and Comorbid Conditions: The Role of Emotion Regulation

Research investigating attention-deficit/hyperactivity disorder (ADHD) and co-occurring disorders such as oppositional defiant disorder, conduct disorder, anxiety, and depression has surged in popularity; however, the developmental relations between ADHD and these comorbid conditions remain poorly understood. The current paper uses a developmental psychopathology perspective to examine conditions commonly comorbid with ADHD during late childhood through adolescence. First, we present evidence for ADHD and comorbid disorders. Next, we discuss emotion regulation and its associations with ADHD. The role of parenting behaviors in the development and maintenance of emotion regulation difficulties and comorbid disorders among children with ADHD is explored. An illustrative example of emotion regulation and parenting over the course of development is provided to demonstrate bidirectional relations among these constructs. We then present an integrated conceptual model of emotion regulation as a shared risk process that may lead to different comorbid conditions among children with ADHD. Implications and directions for future research are presented.

Extracurricular activity participation moderates impact of family and school factors on adolescents' disruptive behavioural problems

BACKGROUND

The prevalence of problem behaviours among British adolescents has increased in the past decades. Following Erikson's psychosocial developmental theory and Bronfenbrenner's developmental ecological model, it was hypothesized that youth problem behaviour is shaped in part by social environment. The aim of this project was to explore potential protective factors within the social environment of British youth's for the presentation of disruptive behavioural problems.

METHOD

This study used secondary data from the Longitudinal Study of Young People in England, a cohort study of secondary school students. These data were analysed with generalized estimation equations to take the correlation between the longitudinal observations into account. Three models were built. The first model determined the effect of family, school, and extracurricular setting on presentation of disruptive behavioural problems. The second model expanded the first model by assuming extracurricular activities as protective factors that moderated the interaction between family and school factors with disruptive behavioural problems. The third model described the effect of prior disruptive behaviour on current disruptive behaviour.

RESULTS

Associations were found between school factors, family factors, involvement in extracurricular activities and presence of disruptive behavioural problems. Results from the second generalized estimating equation (GEE) logistic regression models indicated that extracurricular activities buffered the impact of school and family factors on the presence of disruptive behavioural problems. For instance, participation in sports activities decreased the effect of bullying on psychological distress. Results from the third model indicated that prior acts of disruptive behaviour reinforced current disruptive behaviour.

CONCLUSION

This study supports Erikson's psychosocial developmental theory and Bronfenbrenner's developmental ecological model; social environment did influence the presence of disruptive behavioural problems for British adolescents. The potential of extracurricular activities to intervention strategies addressing disruptive behavioural problems of adolescents is discussed.

Factors Influencing Time Lag Between Initial Parental Concern and First Visit to Child Psychiatric Services Among ADHD Children in Japan

The aim of this study was to examine the factors associated with a time lag between initial parental concern about ADHD symptoms and the first visit to a hospital in Japan that offers child psychiatric services. We investigated the demographic characteristic, symptoms, diagnosis, and healthcare system factors including duration between initial parental concern about symptoms and the first visit to a hospital (N = 387). The mean time lag between initial parental concern and the first visit to a hospital was 2.6 years. Risk factors for a longer time lag include the young age of a child, behavioral problems of the child, lower maternal education, difficulty in determining appropriate medical institution, referral route, and the distance from home to the hospital. A more established connection between a hospital with child psychiatric services and other health institutions is recommended for earlier referral to an appropriate hospital.

Recent research on the mental health of immigrants to Sweden: a literature review

The arrival of large numbers of economic migrants and refugees has seen the Swedish immigrant population increase rapidly. Research has shown that immigrants may be more susceptible to mental disorders because of traumatic events prior to immigration and adverse circumstances in their new country. The aim of this literature review is to summarize and interpret recent research on the mental health of immigrants to Sweden.

METHODS

A systematic search for relevant literature in PubMed was performed on 13 February 2014. Relevant literature was limited to original research articles published between 1 January 1994 and 13 February 2014. Content relating to mental disorders and suicide was reviewed and summarized.

RESULTS

Nationwide studies showed increased risks of common mental disorders such as depression, as well as psychotic disorders, in immigrants to Sweden compared to native Swedes. However, the results are complex, with notable differences between different immigrant groups and between males and females. Risk of suicide was increased in some immigrant groups, but decreased in others. There has been little qualitative research on the mental health of immigrants and few intervention studies have targeted immigrants.

CONCLUSION

Immigrants to Sweden are a mixed group with differing, but often increased, risks of mental disorders. Targeted qualitative and intervention studies may facilitate efforts to develop and implement preventive methods for immigrants at high risk of mental ill health, and to tailor treatment to the specific needs of different immigrant groups.

Infancy predictors of hyperkinetic and pervasive developmental disorders at ages 5-7 years: results from the Copenhagen Child Cohort CCC2000

BACKGROUND

Epidemiological studies infancy predictors of mental disorders are scarce.

METHODS

The study is part of a longitudinal birth-cohort study, The Copenhagen Child Cohort CCC2000. Infant mental health and development and mother-infant relations were assessed by community health nurses from birth to age 10 months. Data on the perinatal period were obtained from Danish National Registers. Mental health outcome at age 5-7 years was investigated in 1,585 children who were assessed by the Developmental and Well-Being Assessment (DAWBA) and diagnosed according to the ICD-10.

RESULTS

Predictors of autism spectrum disorders were problems of oral-motor development OR 5.02 (95% CI: 1.63-15.42) and overall development OR 4.24 (95% CI: 1.35-13.33). A deviant pattern of activity and interests were predictive of autism spectrum disorder, OR 5.34 (95% CI 1.45-19.70) and hyperkinetic disorder, OR 4.71 (95% CI: 1.28-17.39). Hyperkinetic disorder was furthermore predicted by mother-infant relationship problems, OR 8.07 (95% CI: 2.90-22.47). The significant associations between infant developmental problems and autism spectrum disorders persisted in multiple logistic regression analyses controlled for maternal psychological problems and mother-infant relationship problems, OR 3.21 (95% CI: 1.09-9.45). Mother-infant relationship problems remained strongly associated to hyperkinetic disorders in the multivariate analyses controlled for child development problems and maternal psychological problems, OR 5.20 (95% CI: 1.55-17.47). No significant infancy predictors were found regarding emotional and behavioural disorders at age 5-7 years.

CONCLUSION

Predictors of autism spectrum/pervasive developmental disorders and hyperkinetic disorders at child age 5-7 years were identified between birth and child age 10 months in community health settings. The study results suggest potential areas of early preventive intervention, which have to be further explored regarding the psychometric qualities of the identification of infants at risk, and concerning methods to handle and intervene towards these children in the general child health surveillance.

The influence of Chinese one-child family status on developmental coordination disorder status

We conducted a population-based study on Developmental Coordination Disorder (DCD) in mainland China to explore the influence of one-child status in Chinese families on DCD. A total of 4001 children selected from 160 classes in 15 public nursery schools. The Movement Assessment Battery for Children assessed motor function. The prevalence of DCD in Chinese one-child families (8.7%) was higher than that in multi-child families (5.9%). Chinese one-child family status (compared with younger children in multi-child families) were negatively related with total score (-1.793), Manual dexterity (-0.228), Aiming and catching (-1.145), Balance (-0.433) of MABC-2 and DCD (OR=2.294) when adjusted for the children's and family's characteristics, and perinatal factors (each p<0.05). As one of the studies in this Chinese context, it provides a platform for future intervention programs in one-child families in preventing children's developmental disorders.

Emotional and behavioral problems in migrant children and adolescents in Europe: a systematic review

Based on findings of Stevens and Vollebergh [69], who analyzed cross-cultural topics, this review considers the current prevalence of emotional and behavioral problems of native children and adolescents in comparison with children with a migration background in European countries. 36 studies published from 2007 up to 2013 chosen from a systematic literature research were included and analyzed in their perspective design in detail. Previous studies showed great differences in their results: Especially in Germany, many studies compare the heterogeneous group of immigrant children with native children to analyze an ethnic minority or migration process effect. Only a British and Turkish study demonstrates the selection effect in migration. Most Dutch or British studies examined different ethnic groups, e.g. Turkish, Moroccan, Surinamese, Pakistani, Indian or Black migrant children and adolescents. Migrant childhood in Europe could be declared a risk in increasing internalizing problem behavior while the prevalent rate in externalizing problem behavior was comparable between native and migrant children. A migration status itself can often be postulated as a risk factor for children's mental condition, in particular migration in first generation. Furthermore, several major influence factors in migrant children's mental health could be pointed out, such as a low socio-economic status, a Non-European origin, an uncertain cultural identity of the parents, maternal harsh parenting or inadequate parental occupation, a minority status, the younger age, gender effects or a specific culture declaration in diseases.

Interethnische Analysen der Verteilungen psychischer Störungen bei Kindern und Jugendlichen in einer Inanspruchnahmepopulation

Interethnic Analyses of Distributions in Children and Adolescents Mental Disorders in a Health Care Utilization The study examines ethnic differences in mental disorders in a child and adolescent psychiatry population in a major German city from 2007 to 2011 (N = 5,680). Risks of developing specific mental disorders were calculated. African migrant children and adolescents showed higher risk in traumatic stress and adjustment disorders (F 43 in ICD-10), the Asiatic group in dissociative disorders (F 44-45). Compared to other European migrants the German children and adolescents without migration background had a higher risk of affective disorders (F 3). Adolescents (N = 3,556) with Russian and Polish background had a higher risk of disorders induced by psychotropic substances (F 1). Turkish and Arabic adolescents had a 4- to 5-times increasing risk in schizophrenia as well as schizotypal or delusional disorders (F 2). In addition, mental disorders were influenced by gender and nationality. These study results suggest that a different vulnerability to specific mental disorders is associated to ethnicity.

Association between childhood specific learning difficulties and school performance in adolescents with and without ADHD symptoms: a 16-year follow-up

OBJECTIVE

The authors investigated whether childhood specific learning difficulties (SLDs) predict later school performance in adolescents with ADHD symptoms (ADHDs) and how SLDs associate with educational aspirations.

METHOD

In the Northern Finland Birth Cohort 1986 (n = 9,432), data about children were collected using questionnaires for parents and teachers at ages 7 and 8 and for parents and adolescents at ages 15/16. Information on school performance was obtained from a national register.

RESULTS

The occurrence of SLDs at 8 years was 19.9% (n = 1,198), ADHDs at 15/16 years was 8.0% (n = 530), and comorbid ADHDs and SLDs was 3.0% (n = 179). Having ADHDs but not SLDs or having both was associated with a significantly lower mean value in school grades for theoretical subjects. Adolescents with comorbid ADHDs and SLDs repeated a grade more often, and their educational aspirations were less ambitious than those in other groups.

CONCLUSION

ADHDs and SLDs have a negative influence on academic achievements.

Another way of thinking about ADHD: the predictive role of early attachment deprivation in adolescents' level of symptoms

PURPOSE

Attention deficit and hyperactivity disorder (ADHD) is one of the most frequent disorders in childhood and adolescence. Both neurocognitive and environmental factors have been related to ADHD. The current study contributes to the documentation of the predictive relation between early attachment deprivation and ADHD.

METHOD

Data were collected from 641 adopted adolescents (53.2% girls) aged 11-16 years in five countries, using the DSM oriented scale for ADHD of the Child Behavior Checklist (CBCL) (Achenbach and Rescorla, Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth and Families, Burlington, 2001). The influence of attachment deprivation on ADHD symptoms was initially tested taking into consideration several key variables that have been reported as influencing ADHD at the adoptee level (age, gender, length of time in the adoptive family, parents' educational level and marital status), and at the level of the country of origin and country of adoption (poverty, quality of health services and values). The analyses were computed using the multilevel modeling technique.

RESULTS

The results showed that an increase in the level of ADHD symptoms was predicted by the duration of exposure to early attachment deprivation, estimated from the age of adoption, after controlling for the influence of adoptee and country variables. The effect of the age of adoption was also demonstrated to be specific to the level of ADHD symptoms in comparison to both the externalizing and internalizing behavior scales of the CBCL.

CONCLUSION

Deprivation of stable and sensitive care in infancy may have long-lasting consequences for children's development.

Association of ADHD symptoms and social competence with cognitive status in preschoolers

We aimed to investigate the association of attention-deficit hyperactivity disorder (ADHD) symptoms and social competence outcomes with cognitive status in preschool children. The study population was drawn from three birth cohorts belonging to the Spanish INMA (Infancia y Medio Ambiente) project: Menorca (n = 289), Ribera d'Ebre (n = 60), and Granada (n = 108). Children were assessed at the age of 4 years for cognitive functions (McCarthy Scales of Children's Abilities, MSCA) by psychologists and for inattention and hyperactivity symptoms (ADHD Criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ADHD-DSM-IV) and social competence (California Preschool Social Competence Scale) by their teachers. Multiple regression analyses were conducted to examine potential associations between behavioral outcomes (ADHD symptoms and social competence) and MSCA cognitive outcomes, adjusting for confounders. The presence of general ADHD symptoms (inattention, hyperactivity, or both) and poorer social competence both showed negative associations with cognitive outcomes. When we compared children according to ADHD subtypes, those with inattention symptoms alone and those with both inattention and hyperactivity symptoms showed significantly lower cognitive function scores in comparison to children with no ADHD symptoms. Behavioral dysfunctions in preschoolers may be associated with impairment of cognitive functions.

Prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder in Taiwan, 1996-2005: a national population-based study

PURPOSE

We used National Health Insurance (NHI) database to examine the prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder (ADHD) diagnosis in Taiwan.

METHODS

The National Health Research Institute provided a database of 10,00,000 random subjects for study. A population-based random sample of 372,642 patients aged younger than 18 was obtained as a dynamic cohort. Those study subjects who had at least one service claim from 1996 to 2005, with a principal diagnosis of ADHD, were identified.

RESULTS

The cumulative prevalence of ADHD diagnosis increased from 0.06 to 1.64 % from 1996 to 2005. The annual incidence of ADHD diagnosis increased from 0.02 to 0.34 % from 1997 to 2005. The highest incidence rates of ADHD diagnosis for both males and females were in the 6- to 11-year age group. Higher incidence was detected in males (HR 3.76, 95 % CI 3.48-4.07), those who lived in northern region (HR 1.35, 95 % CI 1.07-1.71) and urban area (HR 1.53, 95 % CI 1.40-1.66). The percentage of stimulant use in children with ADHD diagnosis increased from 39.6 to 54.0 % from 1997 to 2005.

CONCLUSIONS

Our findings suggest increases in the prevalence and incidence rates of ADHD diagnosis in Taiwan, which was in line with those studies of Western countries. However, the prevalence of ADHD diagnosis in the NHI program was still much lower than in the community studies. The percentage of stimulant use in children with ADHD diagnosis also has an increasing trend, which warrants further study.

Family-environmental factors associated with attention deficit hyperactivity disorder in Chinese children: a case-control study

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders, affecting an estimated 5 to 12% of school-aged children worldwide. From 15 to 19 million Chinese children suffer from ADHD. The aim of this study was to investigate the association between family-environmental factors and ADHD in a sample of Chinese children.

METHODS

A pair-matched, case-control study was conducted with 161 ADHD children and 161 non-ADHD children of matching age and sex, all from 5-18 years of age. The ADHD subjects and the normal controls were all evaluated via structured diagnostic interviews. We examined the association between family-environmental factors and ADHD using the conditional multiple logistic regression with backward stepwise selection to predict the associated factors of ADHD.

RESULTS

Having experienced emotional abuse and being a single child were both significant factors associated with children diagnosed with ADHD. ADHD subjects were more likely to have suffered from emotional abuse (OR = 11.09, 95% CI = 2.15-57.29, P = 0.004) and have been a single child in the family (OR = 6.32, 95% CI = 2.09-19.14, P = 0.001) when compared to normal controls. The results were not modified by other confounding factors.

CONCLUSION

Our findings provide evidence that family-environmental factors are associated with ADHD among children in China. These findings, if confirmed by future research, may help to decrease ADHD by increasing the awareness of the effects of childhood emotional abuse.

Evaluation of "the incredible years" in Sweden: the transferability of an American parent-training program to Sweden

Structured parent training has been proven to be effective in reducing disruptive behavior problems (DBP) in children. Most of the programs that are used in Sweden have their origin in North America, and there is an ongoing debate over the transferability to Sweden of manual-based programs developed in other contexts. The goal of the present study was to study effectiveness of the Incredible Years parent-training program (IY), developed in the US, in regular clinical work in Sweden, using a randomized controlled design. Parents of 62 four to eight-year-old children diagnosed with Oppositional Defiant Disorder participated in the study. Parents of 38 children were assigned to parent training (PT) and 24 to a waiting list (WL). The results indicate that the IYS retains the positive effects on children's disruptive behavior problems when translated and transferred to Swedish. There was a statistically significant difference in reduction of DBP in children between the groups in favor of the PT. The improvement in the PT group was sustained at the one-year follow-up. The improvement also, at least to some extent, generalized over time to the school context. There was also a statistically significant difference in mothers' report of pre to post change in parenting alliance between the PT and WL groups. The IYS program was appreciated and well received by the participating mothers.

The French version of the Family Assessment Device

OBJECTIVE

To validate a French version of the Family Assessment Device (FAD), a well-known self-report questionnaire assessing family functioning in clinical and research settings.

METHODS

A French adaptation of the FAD was administered to 3 groups of subjects: a nonclinical group (n = 115), relatives of psychiatric patients (n = 102), and medical patients and their relatives (n = 106). Temporal stability was assessed by test-retest intraclass correlations. Internal consistency was measured by Cronbach alpha reliability coefficients. Discriminant validity was explored, comparing the scores of the 3 groups, using a covariance analysis (ANCOVA). The dimensional structure of the instrument was explored using a principal component analysis, with promax oblique rotation, on the entire sample.

RESULTS

The French FAD showed good temporal stability and good discriminant validity across groups. Internal consistency was satisfactory only for the General Functioning (GF) subscale. Factor analysis yielded a 3-factor model. The GF subscale was highly correlated with all of the other subscales.

CONCLUSIONS

The French version of the FAD provides a valuable tool for assessing family functioning. However, our study failed to identify the theoretical structure of the FAD and suggests that the GF subscale could be used as a better overall indicator of family functioning.

Does the 'hikikomori' syndrome of social withdrawal exist outside Japan? A preliminary international investigation

PURPOSE

To explore whether the 'hikikomori' syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated.

METHODS

Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome's prevalence in their country, etiology, diagnosis, suicide risk, and treatment.

RESULTS

Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents' felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization.

CONCLUSIONS

Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings.

Adolescent emotional and behavioural outcomes of nonparental preschool childcare

PURPOSE

This study aimed to identify whether nonparental preschool childcare was associated with adolescent mental health outcomes as measured by the strengths and difficulties questionnaire (SDQ).

METHOD

This study was a secondary analysis of data from the Croydon Assessment of Learning Study. From a general population sample of 2,726 adolescents tested for cognitive ability, additional data were collected from a stratified sub-sample of 197 subjects. A semi-structured interview asked parents about preschool childcare and early development concerns. Parent and teacher SDQ and IQ data were collected. Complete data were available from 167 subjects. Using nonparental preschool childcare as the 'treatment' effect and parental childcare as the 'control', propensity score matching analyses were used to analyse the effect of nonparental childcare on adolescent SDQ outcomes.

RESULTS

Nonparental childcare was reported by 49% of the sample and was not significantly associated with conduct, emotional, peer or prosocial SDQ subscales, but was found to have a significant average treatment effect on symptoms of attention/hyperactivity, on average raising the symptom subscale score by 1.8 (95% confidence interval 0.12-3.65). The propensity score analysis ensures the results could not be explained by the available measures that influenced receiving nonparental care. Increased time spent in nonparental childcare was associated with greater attention/hyperactivity symptoms.

CONCLUSIONS

Nonparental preschool care showed little association with generalized psychopathology but may be associated with hyperactivity and inattention problems. Replication of these findings in prospective studies is required.