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Shen Y, Jin H, Guo F, Zhang W, Fu H, Jin M, Chen G. Association of Magnesium, Iron, Copper, and Zinc Levels with the Prevalence of Behavior Problems in Children and Adolescents. Biol Trace Elem Res 2024:10.1007/s12011-024-04098-4. [PMID: 38388752 DOI: 10.1007/s12011-024-04098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
Magnesium (Mg), iron (Fe), copper (Cu), and zinc (Zn) are indispensable elements in children's growth and development. However, epidemiological evidence regarding essential elements and their mixed exposure to behavior problems remains in its infancy. The objective of the present study was to evaluate the association between essential elements and the manifestation of behavior problems, with an additional focus on the implications of their mixture. An electronic medical records review was performed among 4122 subjects aged 6-18 years who underwent examinations at Children's Hospital, Zhejiang University School of Medicine, between January 2019 and July 2022. The concentrations of essential elements were measured by atomic absorption spectrometry, and behavior problems were assessed by using the Conners' Parent Rating Scale (CPRS). A total of 895 (21.7%) children and adolescents were identified as having behavior problems. For single exposure, inversely linear dose-response relationships were identified between continuous Mg and Zn levels and the prevalence of behavior problems, and the prevalence ratios (PRs) in the categorical lowest tertile were 1.28 (95% confidence interval, CI: 1.07-1.54) for Mg and 1.31 (95% CI: 1.05-1.63) for Zn compared to the highest tertile. For mixture exposure, an inverse association between essential elements and behavior problems was also found, mainly contributed by Mg (posterior inclusion probability, PIP = 0.854). Whole blood levels of Mg and Zn were significantly inversely associated with behavior problems. The findings highlight the pivotal role of essential elements in behavior problems and emphasize the importance of maintaining adequate levels of essential elements during children's maturation.
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Affiliation(s)
- Ying Shen
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310005, China
| | - Huyi Jin
- Department of Public Health, and Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Fanjia Guo
- Department of Public Health, and Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Wanting Zhang
- Department of Public Health, and Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
- Jiaxing Center for Disease Control and Prevention, Jiaxing, 314000, China
| | - Hao Fu
- Department of Public Health, and Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Mingjuan Jin
- Department of Public Health, and Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Guangdi Chen
- Department of Public Health, and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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Chaulagain A, Lyhmann I, Halmøy A, Widding-Havneraas T, Nyttingnes O, Bjelland I, Mykletun A. A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder. Eur Psychiatry 2023; 66:e90. [PMID: 37974470 PMCID: PMC10755583 DOI: 10.1192/j.eurpsy.2023.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. METHODS We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. RESULTS The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. CONCLUSIONS Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.
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Affiliation(s)
- Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
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de Vargas LDS, Jantsch J, Fontoura JR, Dorneles GP, Peres A, Guedes RP. Effects of Zinc Supplementation on Inflammatory and Cognitive Parameters in Middle-Aged Women with Overweight or Obesity. Nutrients 2023; 15:4396. [PMID: 37892471 PMCID: PMC10609714 DOI: 10.3390/nu15204396] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Obesity has been linked to cognitive decline and adverse effects on brain health. Zinc (Zn) is a mineral with important metabolic functions that can modulate obesity-related neurological impairment. Thus, the present study aimed to evaluate the effects of 12 weeks of Zn supplementation on the inflammatory profile, cognitive function, and mood of overweight or obese women through a double-blind, placebo-controlled study. The study included 42 women aged between 40 and 60, randomly divided into two groups: Zn supplementation (30 mg/day) or placebo for 12 weeks. Data regarding sociodemographic, anthropometric, dietary, and physical activity were collected. Mini-mental state examination (MMSE), verbal fluency test, clock drawing test, and Stroop test were performed. Anxiety and depression symptoms were assessed using the Beck anxiety inventory and the BDI-II, respectively. Saliva samples were collected to evaluate IL-1β, IL-6, TNF-α, insulin, nitrite, and Zn levels. Of the 42 participants (mean age 49.58 ± 6.46 years), 32 were included in the study analyses. Changes in body weight and macronutrient consumption were not different between placebo and Zn supplementation groups. Cognitive scores on the MMSE and Stroop tests were higher in the Zn supplementation group than in the placebo group. Salivary levels of IL-1b and Zn increased in the Zn group compared to placebo. There was no significant change in the adjusted means of the BDI-II and BECK scores between the zinc vs. placebo groups. Twelve weeks of Zn supplementation was able to partially improve the cognitive scores assessed in overweight or obese women, regardless of weight loss. These findings suggest that Zn supplementation can be considered an adjunct strategy to enhance cognitive health in overweight or obese women.
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Affiliation(s)
- Liziane da Silva de Vargas
- Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre 90050-170, Brazil; (L.d.S.d.V.); (J.J.); (A.P.)
| | - Jeferson Jantsch
- Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre 90050-170, Brazil; (L.d.S.d.V.); (J.J.); (A.P.)
| | - Juliana Ribeiro Fontoura
- Graduação em Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre 90050-170, Brazil
| | - Gilson Pires Dorneles
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910, Porto Alegre 90035-000, Brazil;
| | - Alessandra Peres
- Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre 90050-170, Brazil; (L.d.S.d.V.); (J.J.); (A.P.)
- Graduação em Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre 90050-170, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre 90050-170, Brazil
| | - Renata Padilha Guedes
- Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre 90050-170, Brazil; (L.d.S.d.V.); (J.J.); (A.P.)
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre 90050-170, Brazil
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Lange KW, Lange KM, Nakamura Y, Reissmann A. Nutrition in the Management of ADHD: A Review of Recent Research. Curr Nutr Rep 2023; 12:383-394. [PMID: 37505402 PMCID: PMC10444659 DOI: 10.1007/s13668-023-00487-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE OF REVIEW Various nutrients and diet quality have been suggested to be involved in the pathophysiology of ADHD. The purpose of this review was to examine data from recent cohort studies and dietary interventions to determine whether nutrition may play a role in the management of ADHD. RECENT FINDINGS Preliminary evidence suggests that minerals might have beneficial effects on ADHD symptomatology. Probiotics might offer novel strategies to prevent or treat ADHD. Inverse associations between adherence to "healthy" diets and ADHD symptoms have been observed. Children with ADHD responding to the few-foods diet (or oligoantigenic diet) with an elimination of individually identified food items show substantially improved behavior and cognitive functioning. Evidence from recent research does not allow any recommendations regarding the use of micronutrients or probiotics in the management of ADHD. The few-foods diet may become an additional therapeutic option for children with ADHD.
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Affiliation(s)
- Klaus W. Lange
- Faculty of Human Sciences, University of Regensburg, 93040 Regensburg, Bavaria, Germany
| | | | - Yukiko Nakamura
- Faculty of Human Sciences, University of Regensburg, 93040 Regensburg, Bavaria, Germany
| | - Andreas Reissmann
- Faculty of Human Sciences, University of Regensburg, 93040 Regensburg, Bavaria, Germany
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Tabata K, Miyashita M, Yamasaki S, Toriumi K, Ando S, Suzuki K, Endo K, Morimoto Y, Tomita Y, Yamaguchi S, Usami S, Itokawa M, Hiraiwa-Hasegawa M, Takahashi H, Kasai K, Nishida A, Arai M. Hair zinc levels and psychosis risk among adolescents. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:107. [PMID: 36433958 PMCID: PMC9700858 DOI: 10.1038/s41537-022-00307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/24/2022] [Indexed: 11/27/2022]
Abstract
Recent meta-analyses have shown lower zinc and higher copper levels in the serum of people with schizophrenia than in healthy controls. However, the relationship between trace elements (TEs) and the pathophysiology of psychosis, including schizophrenia, remains unclear due to the antipsychotic effects on mineral levels. In this study, we aimed to determine the relationship between zinc and copper levels in hair and psychosis risk among drug-naïve adolescents. This study was conducted as a part of a population-based biomarker subsample study of the Tokyo Teen Cohort Study, including 252 community-dwelling 14-year-old drug-naïve adolescents. Zinc and copper levels in hair were measured using inductively coupled plasma mass spectrometry. The thought problems (TP) scale from the Child Behavior Checklist was used to evaluate psychosis risk. Regression analysis showed that hair zinc levels were negatively correlated with the TP scale (T-score) (β = -0.176, P = 0.005). This result remained significant after adjusting for age and sex (β = -0.175, P = 0.005). In contrast, hair copper levels were not associated with the TP scale (T-score) (β = 0.026, P = 0.687). These findings suggest that lower zinc levels could be involved in the pathophysiology of psychosis, independent of antipsychotics. Further longitudinal studies are required to investigate whether hair zinc level is a useful new biomarker for assessing psychosis risk.
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Affiliation(s)
- Koichi Tabata
- grid.272456.00000 0000 9343 3630Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan ,grid.265073.50000 0001 1014 9130Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuhiro Miyashita
- grid.272456.00000 0000 9343 3630Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan ,grid.417102.1Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Syudo Yamasaki
- grid.272456.00000 0000 9343 3630Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kazuya Toriumi
- grid.272456.00000 0000 9343 3630Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shuntaro Ando
- grid.26999.3d0000 0001 2151 536XDepartment of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiro Suzuki
- grid.272456.00000 0000 9343 3630Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan ,grid.263518.b0000 0001 1507 4692Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kaori Endo
- grid.272456.00000 0000 9343 3630Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yuko Morimoto
- grid.443136.70000 0004 0642 8892Department of Psychology, Ube Frontier University, Ube, Japan
| | - Yasufumi Tomita
- grid.272456.00000 0000 9343 3630Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Satoshi Yamaguchi
- grid.272456.00000 0000 9343 3630Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Satoshi Usami
- grid.26999.3d0000 0001 2151 536XCenter for Research and Development on Transition from Secondary to Higher Education, The University of Tokyo, Tokyo, Japan
| | - Masanari Itokawa
- grid.272456.00000 0000 9343 3630Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan ,grid.417102.1Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Mariko Hiraiwa-Hasegawa
- grid.275033.00000 0004 1763 208XDepartment of Evolutionary Studies of Biosystems, The Graduate University for Advanced Studies, SOKENDAI, Hayama, Japan
| | - Hidehiko Takahashi
- grid.265073.50000 0001 1014 9130Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan ,grid.265073.50000 0001 1014 9130Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyoto Kasai
- grid.26999.3d0000 0001 2151 536XDepartment of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XThe International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), Tokyo, Japan
| | - Atsushi Nishida
- grid.272456.00000 0000 9343 3630Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Makoto Arai
- grid.272456.00000 0000 9343 3630Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Rosenau PT, van den Hoofdakker BJ, Matthijssen AFM, van de Loo-Neus GHH, Buitelaar JK, Hoekstra PJ, Dietrich A. Withdrawing methylphenidate in relation to serum levels of ferritin and zinc in children and adolescents with attention-deficit/hyperactivity disorder. J Psychiatr Res 2022; 152:31-37. [PMID: 35714551 DOI: 10.1016/j.jpsychires.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/26/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
Iron and zinc have been associated with attention-deficit/hyperactivity disorder (ADHD), executive functioning, and response to methylphenidate, given their link with the dopaminergic system. This study aimed to investigate the effect of withdrawing methylphenidate after long-term treatment on serum levels of ferritin and zinc; and if baseline (pre-discontinuation) serum levels of these nutritional markers moderated the effects of withdrawing methylphenidate on ADHD and oppositional defiant disorder (ODD) symptoms, and working memory. Blood samples were collected from 63 children and adolescents who participated in a randomized, placebo-controlled methylphenidate discontinuation study. They were assigned to either seven weeks of continued treatment with methylphenidate or to gradual withdrawal to placebo. With mixed models for repeated measures we (i) compared changes in ferritin and zinc serum levels between both groups, and (ii) investigated moderating effects of ferritin and zinc on the effects of discontinuation on ADHD and ODD symptoms, and working memory. We additionally explored correlations of baseline and change serum levels with respective symptom scores. Withdrawing methylphenidate led to a decrease in ferritin levels. Higher baseline ferritin was associated with a larger increase (i.e., worsening) of teacher-rated hyperactivity-impulsivity and ODD symptoms after withdrawal; and higher baseline zinc with a larger increase in number of errors on the working memory task after withdrawal. Serum levels did not correlate with ADHD and ODD symptoms. Our preliminary results suggest that ferritin and zinc may be potential biomarkers for the effectiveness of long-term treatment with methylphenidate.
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Affiliation(s)
- Paul T Rosenau
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands.
| | - Barbara J van den Hoofdakker
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands
| | - Anne-Flore M Matthijssen
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
| | | | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry Center Nijmegen, Nijmegen, the Netherlands; Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Nijmegen, the Netherlands
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands
| | - Andrea Dietrich
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands
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