The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T)

Teachers predict ADHD more accurately than parents: findings from a large epidemiological survey

OBJECTIVE

Observational reports of parents and teachers might conflict in the diagnostic process of pediatric Attention-Deficit/Hyperactivity Disorder (ADHD). This study investigates the diagnostic accuracy of parents and teachers in identifying ADHD in children, focusing on the influences of parental education level, child gender, and age.

METHODS

Data were derived from the Turkish Epidemiological Survey in Childhood Psychopathologies, encompassing 5,830 children aged 6-13 years. ADHD diagnoses were determined using a semi-structured interview and impairment ratings from both parents and teachers. Both groups completed the ADHD Rating Scale-IV to identify ADHD-related symptoms. Diagnostic accuracy was evaluated by comparing sensitivity, specificity, positive predictive value, and negative predictive value across informants. Parental education was categorized into lower (LEL) and higher education levels (HEL).

RESULTS

Teachers exhibited significantly higher diagnostic accuracy (93.7%) compared to parents (89.9%, p < 0.001), a trend consistent across gender and age groups. Teachers predicted ADHD in girls (95.2%) with greater accuracy than boys (92.1%), and similar patterns were observed for parents (girls: 92.0%, boys: 88.0%, p < 0.001). Parents with HEL demonstrated better diagnostic performance (91.3%) than those with LEL (89.4%, p < 0.05), though both were outperformed by teachers. Accuracy slightly declined in older children (10-13 years), but the differences were statistically insignificant.

CONCLUSION

The findings highlight teachers' superior ability to predict ADHD, likely due to their comparative observational advantages in structured settings. Parental education and child gender also influenced diagnostic performance. These results underscore the importance of incorporating teacher reports into diagnostic protocols while addressing socio-educational disparities to improve parent-reported accuracy.

Evaluation of Frontal QRS-T Angle in Children With ADHD and Healthy Controls

INTRODUCTION

Conflicting findings exist regarding the link between attention deficit hyperactivity disorder (ADHD) and cardiovascular diseases. This study aimed to evaluate the frontal QRS-T (fQRS-T) angle and its correlation with symptom severity in children diagnosed with ADHD.

METHODS

The study population consisted of 172 patients diagnosed with ADHD (120 drug naive and 52 drug positive) and 82 healthy controls. ADHD symptoms were assessed using the Atilla Turgay DSM-IV-Based Screening and Assessment Scale for Disruptive Conduct Disorders (T-DSM-IV-Scale). The fQRS-T angle and corrected QT (QTc) interval were obtained from the automated reports of 12-lead electrocardiography device for each patient.

RESULTS

QTc interval and fQRS-T angle were significantly different among the groups. Post hoc analyses showed that QTc interval and fQRS-T angle of ADHD drug naive and ADHD drug positive patients were significantly higher than the healthy control groups. However, there was no significant difference between drug naive and drug positive patients regarding QTc interval and fQRS-T angle. Both QTc interval and fQRS-T angle showed positive correlations with the severity of ADHD symptoms (r = 0.263, p = .001 and r = 0.175, p = .023 respectively).

CONCLUSION

We found that fQRS-T angle was significantly wider in children with ADHD. Therefore, we suggest that fQRS-T angle may help in cardiovascular risk assessment in children with ADHD.

The association between maternal diabetes and the risk of attention deficit hyperactivity disorder in offspring: an updated systematic review and meta-analysis

Mixed results have been reported regarding the link between different types of maternal diabetes and attention deficit hyperactivity disorder (ADHD) in offspring. Hence, we conducted a systematic review and meta-analysis to explore these associations. Relevant studies on the subject were retrieved from six major databases, including PubMed, Medline, Embase, Scopus, CINAHL, and PsychINFO. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale, and between-study heterogeneity was assessed using the I2 statistic. Subgroup, sensitivity, and meta-regression analyses were conducted to identify the sources of heterogeneity between studies. In total, seventeen observational studies (five case-control and twelve cohort studies) with 18,063,336 study participants were included in the final analysis. Our random-effects meta-analysis revealed that exposure to any form of maternal diabetes was associated with an increased risk of ADHD in children. Specifically, we observed a heightened risk of ADHD in children exposed to gestational diabetes mellitus, any pre-existing diabetes, pre-existing type 1 diabetes mellitus, and type 2 diabetes mellitus. Our study suggests that children exposed to diabetes during prenatal development are at a higher risk of developing ADHD. These findings underscore the critical importance of early screening and timely interventions for exposed offspring.

Universal depressive symptom screening in middle schools in Istanbul: An epidemiologic study

INTRODUCTION

Depression is a significant public health concern, with severe adolescent morbidity and mortality. Promoting adolescents' mental health is increasingly recognized, and schools are proposed as screening and preventive intervention sites. This cross-sectional study aimed to screen self-reported elevated depressive symptom prevalence among secondary school students in Istanbul, Turkey. The secondary objectives were determining behavioral problems, resilience, positive attitudes, and risk factors associated with depressive symptoms.

METHODS

Data collection was conducted between April-June 2022. Six thousand one hundred ten students from nine randomly selected schools from different city districts were approached. Depression was screened by the Centre for Epidemiological Studies Depression Scale for Children (CES-DC). The Strengths and Difficulties Questionnaire (SDQ) was used for screening behavioral problems and positive attitudes. Resilience was evaluated by the Child and Youth Resilience Measure (CYRM).

RESULTS

The final study sample comprised 2780 participants (response rate 47.7 %) with a mean age of 12.4 ± 1.1 years (females:52.7 %). Elevated depressive symptoms were detected in 31.2 % of the students. Female students exhibited higher scores in CES-DC and total difficulties but lower resilience scores in CYRM than male students. In a multiple regression analysis, female gender, higher total difficulties score, lower resilience score, and lower perceived academic performance significantly predicted CES-DC [F(6,2279) = 421, p < 0.01].

DISCUSSION

Our findings showed high rates of elevated self-reported depressive symptoms in a city sample among Turkish adolescents at middle schools, in addition to coexisting behavioral difficulties and decreased resilience indicating poor psychosocial functioning. Given the prevalent depressive symptoms, screening and intervention programs involving resilience promotion may involve school systems to prevent adolescent depression.

Psychometric properties of the Turkish version of the universal mental health literacy scale for adolescents

PURPOSE

While enhancing mental health literacy is a critical component of preventive mental health, there is currently no mental health literacy instrument specific to adolescents in Turkey. This study aimed to adapt the universal mental health literacy scale for adolescents (UMHL-A) to Turkish and determine its validity and reliability.

METHODS

This methodological study utilized data collected from 268 adolescents aged 10 to 14 years, between April and June 2024. Data were obtained using a personal information form and the UMHL-A. The construct validity of the scale was evaluated using confirmatory factor analysis, and its reliability was assessed with internal consistency and test-retest reliability.

RESULTS

The scale consists of two parts: the Likert UMHL-A, a five-point scale to determine adolescents' attitudes, and the T/F UMHL-A, a true/false scale to measure their knowledge. In this study, it was shown that the Likert UMHL-A, which includes 8 items and two factors, namely help-seeking and stigma, and the T/F UMHL-A, which consists 9 items and two factors namely mental health knowledge and mental illness knowledge, had good fit indices. The Cronbach's alpha reliability coefficient was 0.934 for the Likert UMHL-A, and 0.862 for the T/F UMHL-A. The item-total score correlation coefficients of the Likert UMHL-A ranged between 0.582 and 0.856, whereas those of the T/F UMHL-A varied between 0.483 and 0.804.

CONCLUSION

The Turkish version of the UMHL-A is a valid and reliable tool for assessing adolescents' mental health literacy.

IMPLICATIONS FOR PRACTICE

Health professionals can use this brief and easy-to-apply instrument in clinical practices or educational programs to identify and improve adolescents' mental health literacy.

A New Objective Diagnostic Tool for Attention-Deficit Hyper-Activity Disorder (ADHD): Development of the Distractor-Embedded Auditory Continuous Performance Test

Background/Objectives: Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. Traditional diagnostic methods, which depend on subjective assessments, often lack precision. This study evaluates the validity and reliability of a newly developed diagnostic tool, the Distractor-Embedded Auditory Continuous Performance Test (da-CPT), which integrates auditory stimuli with distractors to enhance the clinical utility of ADHD diagnosis. Methods: The study included 160 children aged 6-12 years, comprising 80 with a confirmed ADHD diagnosis and 80 controls. All participants completed the da-CPT, a web-based tool designed to assess inattention, hyperactivity, impulsivity, and timing via an auditory-based task. To validate the da-CPT, participants also completed the Conners' Parent Rating Scale-Revised Short Form (CPRS-R) and either the MOXO or IVA-2 tests. Data were analyzed using ROC curves and statistical correlations to assess sensitivity, specificity, and overall diagnostic accuracy. Results: The da-CPT demonstrated high diagnostic accuracy, with a sensitivity of 91.25% and specificity of 83.75%. ROC analysis indicated that the inattention index had the highest discriminatory power (AUC = 0.881), followed by timing, impulsivity, and hyperactivity (all p < 0.01). Furthermore, the da-CPT scores were strongly correlated with ADHD severity (p < 0.01). Conclusions: This study confirms that the da-CPT is a valid and reliable tool for diagnosing ADHD in children aged 6-12. By incorporating auditory stimuli and distractors, the tool offers a more ecologically valid assessment of ADHD symptoms in clinical settings, improving diagnostic precision and utility.

VEGF, IGF-1 and FGF-2 Serum Levels in Children and Adolescents with Autism Spectrum Disorder with and without Bipolar Disorder

PURPOSE

To investigate serum levels of VEGF, IGF-1 and FGF-2, and relationships with several clinical characteristics in children and adolescents with autism spectrum disorder (ASD) with and without bipolar disorder (BD).

METHOD

40 subjects with ASD + BD as study group, and 40 subjects with ASD as control group were included. Serum levels of VEGF, IGF-1, and FGF-2 were measured using commercial enzyme-linked immunosorbent assay kits.

RESULTS

The study group was significantly higher than the control group in terms of ASD severity, self-harming behavior and sleep disturbance. Serum VEGF and FGF-2 levels were significantly higher in the ASD + BD group than in the control group. There was no significant difference in serum IGF-1 levels between the two groups. There was no correlation between VEGF, IGF-1 and FGF-2 serum levels and ASD severity in the study group. However there was a negative correlation between VEGF levels and age at first diagnosis of BD, and a positive correlation between IGF-1 levels and the number of bipolar episodes in the study group.

CONCLUSION

Growth factors like VEGF and FGF-2 may be potential biomarkers of bipolar disorder in young subjects with ASD. Given the difficulty of clinical management of BD in young subjects with ASD, potential biomarkers would help clinicians in the diagnosis and follow up of BD in this special population. Further research is needed whether VEGF and FGF-2 can be potential biomarkers in the clinical management of young subjects with ASD and BD.

The predictors of mental health literacy among adolescents students

AIM

This study aimed to examine levels of mental health literacy (MHL) and associated factors among adolescents.

METHODS

A descriptive, cross-sectional, analytical study was conducted with a total of 650 students aged 11-18 years in three middle and three high schools. Data were collected using the Child and Adolescent Mental Health Literacy Scale and evaluated using descriptive statistics and regression analysis to determine whether age, gender, and grade are predictive factors of MHL.

RESULTS

The mean age of the participants in the study was 16.8 ± 1.35 years, 55 % of the students were girls, and the mean MHL score was 3.96 ± 1.2, indicating moderate MHL. Multiple regression analysis indicated that the variables of age, gender, and grade explained 5.5 % of the variance in MHL score. When these variables were examined individually, gender and grade had no significant effect (p > 0.05), while older age was associated with higher MHL score (p < 0.05).

CONCLUSION

The results of this study showed that MHL improved with age. MHL promotion is important in mental health resilience. Collaboration between school nurses, school counselors, and psychiatric nurses to provide mental health educational interventions may help reduce stigma and increase help-seeking behaviors.

The detect consensus report on Attention Deficit/Hyperactivity Disorder and its management among Turkish children and adolescents (Detect: consensus report on ADHD among Turkish youth)

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common and heritable neurodevelopmental disorders which may last through the life-span. A consensus report on diagnosis and management of ADHD among Turkish youth was prepared previously. However, the participants as well as the management options were rather limited and developments in the past decade necessitated a revision and update of the consensus. Therefore, this review aims to summarize the consensus among Child and Adolescent Psychiatrists from Türkiye on the nature and management of pediatric ADHD. For those aims, the etiology of ADHD, diagnostic and evaluation process, epidemiology, developmental presentations, differential diagnoses and comorbidities, course/outcome and pharmacological as well as non-pharmacological management options were reviewed and suggestions for clinical practice are presented. Since ADHD is a chronic disorder with wide-ranging effects on functionality that is frequently accompanied by other mental disorders, a multidimensional therapeutic approach is recommended. However, since the disorder has neurobiological basis, pharmacotherapy represents the mainstay of treatment. Additional therapies may include psychosocial therapy, behavioral therapy, school-based therapeutic approaches, and family education. This review provides recommendations for ADHD at the national and global levels. It contains information about ADHD that will contribute to and facilitate clinicians' decision-making processes. It is advisable to consider this guideline in clinical practice.

Mental Health Problems Among Adolescents With Mild Intellectual Disability and Relation to Sleep Quality and Perceived Social Support: A Comparative Study

The current cross-sectional study sought to determine the mental health problems of adolescents with mild intellectual disability (ID) and influencing factors. This study, which used a comparison group, was performed with 188 adolescents (91 with mild ID and 97 without ID) between January 2019 and June 2019 in Turkey. Data were collected using a Personal Information Form, the Strengths and Difficulties Questionnaire, Pittsburgh Sleep Quality Index, and Perceived Social Support Scale. Adolescents with mild ID were at higher risk for mental health problems compared to those without ID. According to linear regression analysis, sex, age, birth order, maternal age, parents' educational level, sleep quality, and perceived social support were statistically significant predictive factors of mental health problems in adolescents with mild ID. Results of this study indicate that adolescents with mild ID are at greater risk for mental health problems and that effective prevention/intervention strategies are needed. [Journal of Psychosocial Nursing and Mental Health Services, 62(3), 39-50.].

The Burden of Attention-Deficit Hyperactivity Disorder (ADHD) in the Middle East and North Africa Region, 1990 to 2019

OBJECTIVE

To report the burden of ADHD in the Middle East and North Africa (MENA) region from 1990 to 2019.

METHODS

Publicly available data on the burden of ADHD were retrieved from the Global Burden of Disease study 2019. The counts and age-standardized rates (per 100,000) were presented.

RESULTS

In 2019, ADHD had an age-standardized point prevalence of 1245.1 and a years lived with disability (YLD) rate of 15.1 per 100,000 in MENA, which were 7.2% (-11 to -3.3) and 7.2% (-11.2 to -2.7) lower, respectively, than in 1990. The highest YLD rate of ADHD was found in the 10 to 14 age group and there were no remarkable differences between males and females. No clear association was found between the YLD rate and the socio-demographic index.

CONCLUSION

The burden of ADHD in the MENA region decreased over the period 1990 to 2019, and regularly updating the epidemiological information is suggested.

Quality of Life and Psychological Well-Being in Children and Adolescents After Renal Transplantation

BACKGROUND

Kidney transplantation is the predominant treatment option in patients with end-stage renal disease. The aim of this study was to evaluate the effect of the presence of a psychiatric disorder on the quality of life in children and adolescents after kidney transplantation.

METHODS

A total of 43 patients aged 6 to 18 years were included in the study. All participants and their parents were asked to complete the Pediatric Quality of Life Inventory (PedsQL), and families only, the Strengths and Challenges Questionnaire. Psychiatric symptoms and disorders of the patients were evaluated according to the Schedule for Mood Disorders and Schizophrenia for School-Age Children/Now and Lifetime Turkish Version. Patients were divided into 2 groups according to psychiatric symptoms and disorders.

RESULTS

The most common psychiatric disorder was attention deficit and hyperactivity disorder (26%). The questionnaires filled out by the patients revealed a lower Total PedsQL Score (P = .003), PedsQL Physical Functionality Score (P = .019), and PedsQL Social Functioning Score (P = .016) in patients with psychiatric disorders. When the parents filled out the questionnaires, the Total PedsQL Score was similar in both groups. The PedsQL Emotional Functionality Score (P = .001) and PedsQL School Functionality Score (P = .004) were significantly lower in patients with psychiatric disorders. The Strengths and Difficulties Questionnaire revealed significantly higher total (P = .014) and hyperactivity/inattention subscale scores (P = .001) in those with a psychiatric disorder.

CONCLUSIONS

Psychiatric disorders in kidney transplant patients adversely affect the quality of life.

Accelerated epigenetic aging at birth interacts with parenting hostility to predict child temperament and subsequent psychological symptoms

In an effort to elucidate new factors that may contribute to developmental psychopathology, the current study examined whether accelerated epigenetic aging at birth related to children's differential susceptibility to the effects of aversive parenting on early emerging mental health risk. Using data from a multiethnic birth cohort, the interaction between Horvath's methylation age in umbilical cord blood and hostile parenting behaviors was examined in relation to perceptions of infant's temperament at 6 months and to children's psychological symptoms at 3 years in 154 families. Results broadly revealed that children with higher levels of accelerated methylation aging evinced more unpredictable temperaments and more psychological symptoms if their mothers reported more hostile parenting, but showed fewer difficulties if mothers engaged in less hostile parenting; children with lower levels of accelerated methylation age did not show associations between hostility and temperament or psychological symptoms. Effects were not accounted for by gestational age at birth, demographic factors, or the distribution of cell subtypes. These findings suggest that accelerated epigenetic age may function as a form of differential susceptibility, signaling increased risk for psychopathology in more aversive contexts but decreased risk in less aversive early environments. Taken together, they point to a novel biological process to consider within risk for psychopathology.

Psychiatric Disorders and Peer-Victimization in Children and Adolescents With Growth Hormone Deficiency

In this study, we aimed to investigate psychiatric disorders, bullying/victimization, and quality of life in children and adolescents with idiopathic growth hormone deficiency (GHD). Sixty-one children and adolescents who were diagnosed as having idiopathic GHD were evaluated using a semistructured interview by a child and adolescent psychiatrist. Some 45.9% of the subjects with GHD were diagnosed with at least 1 psychiatric disorder. The most common psychiatric diagnosis was social anxiety disorder (18.3%). Twenty-eight percent of the subjects reported being bullied by their peers. Victimization rates were less frequent in those treated for more than 1 year. Children aged between 6 and 12 years had poorer quality of life and higher anxiety levels than adolescents aged between 13 and 18 years. Due to the higher rates of existing psychiatric disorders, the clinical management of patients with GHD should be conducted with a multidisciplinary approach, in which pediatric endocrinologists and mental health professionals work in coordination.

Dikkat eksikliği hiperaktivite bozukluğu olan bir ergende modifiye salımlı metilfenidat kaynaklı Raynaud fenomeni

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder commencing before the age of 12 years and characterized by developmentally inappropriate inattention, hyperactivity, and/or impulsivity symptoms. Stimulants such as methylphenidate (MPH) are used as first-line therapy for children with ADHD. Psychostimulants may be associated with vascular problems. Raynaud’s phenomenon (RP) is a peripheral vasculopathy potentially associated with connective tissue diseases characterized by recurring reversible vasospasm attacks triggered by cold and emotional stress. Several cases have been published involving RP observed with MPH. The present report discusses a 14-year-old girl with ADHD who experienced RP with the addition of 10 mg modified-release MPH during 27 mg osmotic release (OROS)-MPH therapy, but not during 36 mg OROS-MPH therapy.

Which factors affect internalized stigmatization in adolescents with mental disorders?

PURPOSE

The aim of this descriptive study was to determine the factors affecting internalized stigmatization of adolescents with mental disorders.

METHOD

The study data were collected in a university hospital between August 1, 2020 and July 30, 2021 (n = 123), using a Personal information form and the Internalized Stigmatization of Mental Illness-Adolescent Form (ISMI-AF).

RESULTS

Gender and the number of hospitalizations were determined to be independent variables with explanatory power in the ISMI-AF, and in the model created with these variables, it was determined that these variables explained 18% of the change in the total points of the ISMI-AF.

CONCLUSIONS

It could be recommended that psychosocial programs are developed with the aim of decreasing internalized stigmatization and increasing the psychological resilience of adolescents.

Metacognitive awareness and emotional resilience in children with Attention Deficit Hyperactivity Disorder

Background

This study explored the metacognitive awareness and emotional resilience levels of children suffering from attention deficit hyperactivity disorder (ADHD) (n=60) with typically developing children (n=30).

Methods

Measures included Metacognitive Awareness Inventory and Resiliency Scales for Children and Adolescents filled out by participants, the List of Adverse Life Events, Turgay DSM-IV-Based Disruptive Behavior Disorders Scale, and Revised Child Anxiety and Depression Scale—Parent Form filled out by parents.

Results

Metacognitive awareness and emotional resilience were found to be low in the children with ADHD. Emotional resilience increases as metacognitive awareness increases. Metacognitive awareness decreased in the presence of heightened ADHD, anxiety, and/or depression symptoms expressed by the parents' questionnaires (p < 0.001, r = −0.438; p < 0.001, r = −0.403; and p < 0.001, r = −0.421).

Conclusions

Findings identified that metacognitive skills and emotional resilience are affected in ADHD.

Emergency mental health care for chi̇ldren and adolescents outside of regular working hours: 7 years outcomes from a tertiary hospital

OBJECTIVE

This study aims to define the clinical characteristics and management strategies of children and adolescents presenting with psychiatric crises to the emergency department (ED) of a tertiary health care facility outside of working hours, and to identify predictors of multiple ED visits among them.

METHODS

From January 2012 to December 2018, retrospective records of patients presenting with psychiatric symptoms to the ED and examined by a child psychiatrist after 5 p.m. on weekdays and for 24 h on weekends and public holidays were analyzed.

RESULTS

Our sample consisted of 1576 visits and 1364 patient (Female:Male=1.8:1, mean age=14.86 ± 2.72). The most common reason for visits was self-injurious thought or behaviors (SITB), and the most common diagnosis was depression. While depression was statistically more common in girls, attention deficit hyperactivity disorder, autism and/or intellectual disability (ASD/ID), psychotic disorders, and bipolar disorder were more common in boys. The forensic evaluation was the most common reason for visits among children younger than 6 years old. Of visits, 23% transferred to hospitalization. A history of mental health contact was the lowest in depression (37.5%), psychosis (34.1%), and substance use disorders (33%). Of patients, 10.8% had multiple visits. A history of mental health contacts, conduct disorder, ASD/ID, bipolar disorder, psychotic disorder, and dissociative disorder were predictors of multiple visits to ED with psychiatric reasons.

CONCLUSION

Emergency mental health care outside of regular working hours can be a critical step in the diagnosis and treatment of serious psychiatric disorders in children and adolescents.

The Effects of Methylphenidate Treatment on Bullying Perpetration and Victimization in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

Objective: Although it is known that attention-deficit/hyperactivity disorder (ADHD) increases the risk of bullying perpetration and victimization, the data on the effect of methylphenidate (MPH) treatment, which is frequently used in the treatment of ADHD, on bullying perpetration and victimization, are very limited. The aim of this study was to investigate the effect of MPH treatment on bullying perpetration and victimization in children and adolescents with ADHD. Methods: Children and adolescents with ADHD, aged 8-16 years, who had not been treated for ADHD for at least 1 year and prescribed only MPH treatment were invited to participate in this open-label naturalistic study. After 3 months of MPH treatment, peer bullying involvement status was analyzed in comparison with the pretreatment data. Results: There was a significant decrease in all subscales of the Conners' Parent Rating Scale (CPRS) and Conners' Teacher Rating Scale after MPH treatment. Being a bully decreased from 50% to 18% and being a victim decreased from 80% to 46%. It was determined that for every 1 point decrease in the CPRS Conduct Problems subscale, the risk of being a bully was reduced ∼2-fold, and every 1 point decrease in the CPRS Anxiety subscale reduced the risk of being a victim 2.44-fold. Conclusions: This is the first longitudinal study examining the effect of MPH treatment on bullying perpetration and victimization in children and adolescents with ADHD. It appears that MPH treatment may be effective in improving the situations of bullying perpetration and victimization in ADHD patients. In addition, the fact that the decrease in behavioral problems reduces the risk of being a bully and the decrease in anxiety symptoms reduces the risk of being a victim, suggests that prevention and intervention programs for bullying perpetration and victimization should target these problem areas.

The association between pragmatic language impairment, social cognition and emotion regulation skills in adolescents with ADHD

OBJECTIVE

Attention Deficit and Hyperactivity Disorder (ADHD) is associated with significant pragmatic language impairment and theory of mind deficits, but there are only a handful of studies have investigated the relationship between them in these conditions. This study aimed that investigate two different aspects of Theory of Mind (ToM) (ToM decoding and reasoning), pragmatic language impairment, and emotion regulation in patients with ADHD.

METHOD

Seventy adolescents with ADHD were compared to matched 64 healthy controls. We administered Social Responsiveness Scale-2 (SRS-2), Difficulties in Emotion Regulation Scale (DERS), Kiddie-SADS, Conners Parent Rating Scale, Children's Communication Checklist-2 (CCC-2), Faux Pas, Comprehension Test, and Reading Mind in the Eyes Test (RMET) to all study participants.

RESULTS

The CCC-2 scores were found to be statistically significantly higher in the ADHD group than in healthy controls. ADHD group had lower performance in the Faces Test and RMET compared to healthy controls, which did not survive from false discovery rate correction. We also found that CCC-2 performance and Conners scores were significant predictors of social responsiveness.

CONCLUSION

Our results point to widespread impairment in pragmatic language use and communication from many perspectives. These results might be important to understand the difficulties in social functioning and interpersonal relationship in adolescents with ADHD.Key pointsADHD is associated with significant impairment in pragmatic language use and social cognitive functions.ToM-Decoding (RMET) is impaired much more than ToM-Reasoning (Faux Pas) in ADHD.Pragmatic language skills and severity of ADHD may be significant predictors of social responsiveness.Emotion regulation problems may affect communication and pragmatic language use.

A Retrospective Evaluation on Demographic, Phenomenological, and Comorbidity Features of Pediatric Obsessive-Compulsive Disorder

ABSTRACT

The impacts of sex, age of onset, phenotype, and comorbidity on clinical features were explored in a large clinical sample with pediatric obsessive-compulsive disorder (p-OCD) (n = 457), along with concomitant specific features in the framework of different symptom dimensions/phenotypes, by a retrospective cross-sectional evaluation design. The most prevalent phenotype was obsession/checking (almost half), and the clinical features belonging to different phenotypes varied among sexes, age of onset, severity, and comorbidities. The contamination and aggressive obsessions, along with the compulsions such as cleaning and repeating routine activities, were the most prevalent symptoms, which were prevalently accompanied by generalized anxiety disorder, attention deficit hyperactivity disorder, and depression. Females with OCD were likely prone to exhibit comorbid internalizing disorders, whereas males were prone to externalizing. This recent study on a large Turkish clinical sample of p-OCD followed up within 5 years, highlighting separate evidence on subtyping of p-OCD in phenotype and comorbidity frame.

Investigation of quality of life in obese adolescents: the effect of psychiatric symptoms of obese adolescent and/or mother on quality of life

OBJECTIVES

The present study assessed the obese adolescents' health-related quality of life (HRQoL) based on both adolescent-reported and maternal-reported questionnaires to clarify adolescent-related psychiatric factors, maternal psychiatric factors, and body mass index (BMI) percentile variables that independently affect the quality of life (QoL).

METHODS

A total of 190 adolescents (120 females and 70 males) were included in the study. The impact of clinical and psychiatric factors on the Pediatric Quality of Life Inventory-Child Version (PedsQL-C) scores was analyzed using hierarchical linear regression methods.

RESULTS

The final models showed that only the Revised Child Anxiety and Depression Scale-Child Version major depressive disorder scores negatively predicted the physical, psychosocial, and total health scores of the PedsQL-C. The psychosocial scores of the PedsQL-P were negatively predicted by the Strengths and Difficulties Questionnaire emotional, and Conners' Parent Rating Scale-Revised-Short Form (CPRS-R-S) attention-deficit/hyperactivity disorder (ADHD) index scores. The PedsQL-P total scores were negatively predicted by the CPRS-R-S ADHD index scores.

CONCLUSIONS

The findings of this study indicate that the adolescents' psychiatric symptoms and BMI percentile played a significant role in the PedsQL subscale functioning of obese adolescents compared to maternal psychiatric symptoms.

Anxiety, depression and post-traumatic stress disorder symptoms in adolescents during the COVID-19 outbreak and associated factors

INTRODUCTION

Outbreaks of infectious diseases have negative effects on mental health. Currently, there is very little information about the psychological effects of the COVID-19 pandemic on adolescents and associated factors affecting their mental health. The aim of the present study is to determine the severity of anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in adolescents during the COVID-19 outbreak, and to investigate the associated factors with these symptoms.

METHODS

The present study was conducted with a total of 447 adolescents. Psychiatric symptoms were evaluated by the use of DSM-5 Level 2 Anxiety Scale, DSM-5 Level 2 Depression Scale and National Stressful Events Survey PTSD Short Scale. The association between age, gender, residential area, presence of COVID-19 in the participant, presence of COVID-19 in the family or environment and psychiatric symptoms were evaluated with linear regression analysis.

RESULTS

The mean age of participants was 15.06, and 38.3% of the participants were men and 61.7% were women. The rate of participants with moderate or high levels of anxiety, depression and PTSD symptoms was 28%, 37.6% and 28.5%, respectively. High age and living in an urban area were associated with increased anxiety, depression and PTSD symptoms. In addition, female gender was associated with increased depression symptoms, and the presence of COVID-19 in the family or environment was associated with increased anxiety symptoms.

CONCLUSION

The present study shows that adolescents have serious levels of anxiety, depression and PTSD symptoms during the COVID-19 pandemic. These results emphasise the need for mental health interventions that are appropriate for the characteristics of this age group.

Associated factors of legal child marriage in Turkey: pregnancy and below-average intelligence

Turkish civil code permits child marriages at 16-17 years of age, but if a child is 16 years old judicial consent is needed. Before making a final decision on marriage consent, the judges refer these children to the doctor, and ask whether they are psychologically and physically ready for marriage. While the literature on child marriage in Turkey is rich, little is known about the underlying factors leading 16-year-old girls to request legal child marriage. This study examined the socio-demographic and clinical characteristics of girls applying to the courts for judicial marriage consent. Hospital records of girls admitted to a hospital in the Istanbul province of Turkey between January 2015 and December 2018 for the assessment of their physical and mental readiness for marriage were scanned. Of the 122 girls admitted to hospital for this purpose, eight were excluded as they had incomplete data, leaving 114 participating girls. All girls were Turkish citizens and had been referred from the law courts. Being pregnant/having a child (54.4%), having had a religious (non-legal) marriage (49.1%) and having an intelligence score of less than 90 (91.2%) were common among the participants. Among those who had a religious marriage, 78.6% were pregnant/had a child at the time of evaluation and 32.1% reported that they were pregnant before their religious marriage took place. None of the participants reported being forced to marry, but many had run away from home to marry (33.3%). Among those running away to marry, the major reason for deciding to do this was being pregnant (63.2%). Running away from home to marry was found to be related to lower parental educational levels (p<0.05). Contrary to the literature, the findings indicate that girls who request judicial consent for legal child marriage in Turkey are not being forced to marry. However, lower educational level seems to be an important factor. Below-average intelligence of the girl and her parents, running away from home to marry and early unsafe sexual intercourse, leading to child pregnancy, were found to be closely associated with legal child marriage in Turkey.

Lifetime depressive and current social anxiety are associated with problematic internet use in adolescents with ADHD: a cross-sectional study

AIM

To evaluate the relationships between problematic internet use (PIU) and psychiatric comorbid disorders and internet use habits in a clinical sample of adolescents with attention-deficit/hyperactivity disorder (ADHD).

METHOD

This cross-sectional study included 95 adolescents with ADHD. Problematic behaviors and symptoms related to internet use were evaluated via Young's Internet Addiction Scale (YIAS), and subjects with a YIAS score of ≥50 were categorized as PIU while those with a score of <50 were defined as normal internet use (NIU). The two groups were compared with respect to demographics and psychometric tests. While psychiatric disorders were examined by a semistructured instrument, self-report and parent-report scales were used to assess other individual and clinical characteristics of participants.

RESULTS

33.7% (n = 32) of the participants were determined to have PIU. There was no gender (p = .058) or age (p = .426) difference between the PIU and NIU groups. Current presence of social phobia (p = .035) and history of major depressive disorder (p = .006) were more frequent in the PIU group than the NIU group. Multivariable regression analysis revealed that PIU was independently associated with online gaming (OR: 2.375, 95% CI: 1.532-3.681), e-mail use (OR: 1.864, 95% CI: 1.170-2.971), social networking (OR: 1.834, 95% CI: 1.156-2.910), and Social Phobia Scale for Children and Adolescents (SPSCA) score (OR: 1.058, 95% CI: 1.020-1.098).

CONCLUSION

PIU may be common among adolescents with ADHD. The severity of social phobia and particular online activities (playing online games, e-mailing, social networking) may be associated with a higher risk of PIU in adolescents with ADHD.

Serum zonulin and claudin-5 levels in children with attention-deficit/hyperactivity disorder

OBJECTIVE

This study aimed to investigate serum zonulin and claudin-5 levels of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and healthy controls by controlling the parameters such as age, sex and body mass index (BMI) percentile which are known to affect these parameters.

METHOD

A total of 80 treatment-naive children and adolescents with ADHD and 40 healthy volunteer controls aged 8-12 years were enrolled in this study. The severities of ADHD symptoms were assessed via parent- and teacher-rated questionnaires. The severity of anxiety and depression symptoms of the children were assessed by the self-report inventories. Serum levels of zonulin and claudin-5 were measured using commercial enzyme-linked immunosorbent assay kits.

RESULTS

The multivariate analysis of covariance (MANCOVA) revealed a significant main effect of groups in the serum zonulin and claudin-5 levels, an effect that was independent of age, sex and BMI percentile. Significant differences were found between the study groups in terms of serum log-claudin-5 levels. However, there was no significant difference between the study groups in terms of serum zonulin levels.

CONCLUSION

These findings provide additional evidence for dysregulation of the blood-brain barrier, especially abnormalities in claudin-5 function, which may be involved in the aetiology of ADHD.Key pointsADHD is one of the most common neurodevelopmental disorders of childhood. Although ADHD is quite common, its aetiology has yet to be fully explained.In recent years, studies on the relationship between intestinal and blood-brain brain barrier permeability and psychiatric disorders have increased.In our study, serum claudin-5 levels were higher in the ADHD group compared to the control group, while serum zonulin levels did not differ between the groups.

Quality of Life and Psychological Well-being in Children and Adolescents with Disorders of Sex Development

Objective

The aim of this study was to assess the quality of life (QoL) and psychological well-being in child and adolescent with disorders of sex development (DSD).

Methods

Sixty-two cases, aged 2-18 years, who were followed by a multidisciplinary DSD team were included. All participants and their parents were requested the complete the Pediatric Quality Of Life Inventory (PedsQL) and the Strengths and Difficulties Questionnaire. The psychiatric diagnoses of the patients were evaluated according to Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Turkish Version.

Results

There was no significant difference between the 46,XX DSD and 46,XY DSD groups for both child and parent in Total PedsQL score. In the subscale scores, the PedsQL Physical Functionality Score reported by children was significantly lower for the 46,XX DSD group than for the 46,XY DSD group (p=0.01). There was a psychiatric diagnosis in 25.8% of cases. The PedsQL School Functionality Score reported by children in the group with psychiatric diagnosis was significantly lower than the group without psychiatric diagnosis (p=0.018). In the group with psychiatric diagnosis, the PedsQL Total Score and the subscale scores (Emotional Functionality Score, Social Functionality Score, School Functionality) reported by parents were significantly lower than in parents of the group without psychiatric diagnosis.

Conclusion

This study emphasized that psychiatric disorders in DSD patients negatively affect the QoL. Psychiatric support and counseling from a multidisciplinary team are very important for families affected by DSD.

Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis

Attention-deficit / hyperactivity disorder (ADHD) and Bipolar Disorder (BD) are common mental disorders with a high degree of comorbidity. However, no systematic review with meta-analysis has aimed to quantify the degree of comorbidity between both disorders. To this end we performed a systematic search of the literature in October 2020. In a meta-analysis of 71 studies with 646,766 participants from 18 countries, it was found that about one in thirteen adults with ADHD was also diagnosed with BD (7.95 %; 95 % CI: 5.31-11.06), and nearly one in six adults with BD had ADHD (17.11 %; 95 % CI: 13.05-21.59 %). Substantial heterogeneity of comorbidity rates was present, highlighting the importance of contextual factors: Heterogeneity could partially be explained by diagnostic system, sample size and geographical location. Age of BD onset occurred earlier in patients with comorbid ADHD (3.96 years; 95 % CI: 2.65-5.26, p < 0.001). Cultural and methodological differences deserve attention for evaluating diagnostic criteria and clinicians should be aware of the high comorbidity rates to prevent misdiagnosis and provide optimal care for both disorders.

Validity and reliability of the internalized stigma of Mental Illness Scale-Adolescent Form

PURPOSE

The goal of this study was to assess the validity and reliability of the Turkish version of the Internalized Stigma of Mental Illness Scale-Adolescent Form (ISMI-AF).

METHODS

A total of 145 adolescents (12-18 years of age) who were diagnosed with at least one mental disorder according to DSM-5-TR participated in the study. Data were collected at a mental health hospital between October 2017 and 2019 using a sociodemographic information form, the ISMI-AF, and Beliefs towards Mental Illness (BMI) Scale. Reliability (Cronbach's alpha, Split-Half, Spearman-Brown, Hotelling T² test) and validity analyses of the ISMI-AF were performed. SPSS 26.0 and LISREL 8.80 software were used for statistical analyses.

RESULTS

The Cronbach's alpha coefficient for total score was .88, Split-Half score was .84, and the Spearman-Brown factor score was .85. Confirmatory factor analysis showed that the scale confirmed to the five-factor structure in adolescents, but factor loadings and reliability coefficients were low in the "stigma resistance" subscale. There was a positive and weak correlation between ISMI-AF and BMI (r = .37, p = .00).

CONCLUSION

The ISMI-AF is a valid and reliable measurement tool that can be used in adolescents. This scale can help psychiatric nurses who work in this field identify and address internalized stigma, which is one of the key factors affecting adherence to treatment, especially in adolescents.

The prevalence and comorbidity rates of specific learning disorder among primary school children in Turkey

Purpose: The aim of the present study was to investigate the prevalence of specific learning disorder (SLD), comorbid disorders, and risk factors in primary school children for the first time in two-stage design in Turkey.Materials and methods: Participants were 1041 pupils in 28 primary schools and aged from 7 to 11. The Mathematics, Reading, Writing Assessment Scale (MOYA) teacher and parent forms were used in the screening stage and parents and teachers of each child completed MOYA. Ninety-five children were screen positive and eighty-three of these children participated in the interview. SLD diagnoses were based on DSM V criteria. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) was used for the comorbid psychiatric disorders.Results and conclusions: The prevalence rate of the SLD was 6.6%, impairment in reading was 4%, in mathematics was 3.6%, and in written expression was 1.8%. About 62.75% of children with SLD had one or more comorbid diagnoses. ADHD was the most common comorbid mental disorder in SLD (54.9%). SLD prevalence was higher among males. The prevalence of SLD in primary school children in Turkey is consistent with previous studies.

Effect of Psychoeducation on Stress in Parents of Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Study

The current experimental pre-/posttest study sought to determine the effect of psychoeducation on the stress levels of parents of children with attention-deficit/hyperactivity disorder (ADHD). A total of 172 parents participated and were randomly assigned to experimental (n = 86) and control (n = 86) groups. There was no significant difference between mean pretest scores of parents in the experimental and control groups on the Caregiver Stress Scale (p > 0.005); however, significant differences were found between pre- and posttest scores in the experimental group after psychoeducation and at 6-month follow up (p < 0.001). There were also significant differences between pre- and posttest scores and pretest scores and 6-month follow-up scores in the experimental group (p < 0.05). In the light of the findings, psychiatric nurses can use psychoeducation programs to support families of children with ADHD to reduce their stress levels. [Journal of Psychosocial Nursing and Mental Health Services, 58(7), 34-41.].

The Relationship between Second-to-Fourth Digit Ratios, Attention-Deficit/Hyperactivity Disorder Symptoms, Aggression, and Intelligence Levels in Boys with Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

Observations of sex differences have led some scientists to doubt whether the neuroendocrine system is involved in attentiondeficit/hyperactivity disorder (ADHD) etiology. One of the interesting study subjects in this context is prenatal steroid hormone exposure. The aim of the present study was to replicate and extend previous work by addressing two research questions: 1) Are second-tofourth digit (2D:4D) ratios lower in ADHD than in controls? 2) Is there a correlation between 2D:4D ratios and symptoms of ADHD, aggression and intelligence scores in boys with ADHD?

METHODS

The study included 100 treatment-naive male children diagnosed with ADHD and 55 healthy male children. We measured the ratios of 2D:4D and administered a Wechsler Intelligence Scale for Children-Revised to assess IQ scores, as well as behavioral rating scales, in children with ADHD and comparison individuals.

RESULTS

We observed lower 2D:4D ratios in the right hand in ADHD in comparison to the control group. The left-hand ratios of 2D:4D, however, did not differ between ADHD and control groups. There were negative correlations between the left-hand 2D:4D ratios and the hyperactivity scores. However, no significant correlation was detected between right-hand 2D:4D ratios and the psychological questionnaire scores.

CONCLUSION

These results provide further evidence that fetal androgen exposure may contribute to the pathophysiology of ADHD, at least in boys.

Attention-Deficit Hyperactivity Disorder Symptoms in A Group of Children Receiving Orthodontic Treatment in Turkey

Objective

Children with attention-deficit hyperactivity disorder (ADHD) are known to have several oral health problems, particularly traumatic dental injuries, decayed or filled teeth, and poor oral hygiene. The objective of the present study was to determine the ADHD symptoms in a group of patients with malocclusion and receiving orthodontic treatment.

Methods

A total of 88 subjects with a diagnosis of malocclusion between aged 8 and 17 years were included in the study. Socio-demographic characteristics, breastfeeding history, oral habits, and dental trauma history of the subjects were acquired by a detailed questionnaire. Subjects and their parents completed questionnaires addressing ADHD, other psychiatric problems, and dental health impact on the quality of life. During the orthodontic examination, the Index of Complexity, Outcome, and Need was applied to confirm the diagnosis of malocclusion.

Results

Parent-reported psychiatric complaint occurred in almost half of the patients (n=38, 43.2%); the most frequent psychiatric complaints were inattention (n=22, 25%), opposition (n=13, 14.8%), and hyperactivity (n=11, 12.5%). The estimated ADHD prevalence according to parent measure was 15.9% (n=14). Self-report measures revealed that 18.4% (n=16) had behavioral symptoms. The most affected quality of life domain was psychological discomfort.

Conclusion

The findings indicate that ADHD prevalence in children with malocclusion is high. The orthodontists should have a keen eye on behavioral problems.

Attention Deficit Hyperactivity Disorder and Psychiatric Comorbidities

Aim: This study aims to obtain current information on the clinical features of attention deficit hyperactivity disorder cases, comorbid psychiatric disorders and psychiatric drug use. Methods: All patients between the ages of 6 and 18 years who were admitted to our outpatient clinic and diagnosed with attention deficit hyperactivity disorder were included in the study. The files of the patients were examined and their demographic characteristics, symptoms, psychiatric diagnoses and drug profiles were recorded. The pattern of the psychiatric disorders accompanied by attention deficit hyperactivity disorder cases and the differences according to age and gender were analyzed. The differences were determined in patients with psychiatric comorbidity compared to those without. Result: The mean age of the 777 patients included in the study was 11.1±2.94 and 76.6% were boys. 60.9% of attention deficit hyperactivity disorder patients had comorbid psychiatric disorders. The most common psychiatric comorbidities were specific learning disability (23.6%), oppositional defiant disorder (12.9%) and conduct disorder (12.1%). There was no difference between the genders in terms of the incidence of psychiatric comorbidities. The rate of psychiatric comorbidity was significantly higher in adolescents than in children. A psychotropic medication was used in 86.4% of the cases and psychotropic polypharmacy was present in 31.5%. The rate of polypharmacy was significantly higher in the group with psychiatric comorbidity. Conclusion: Attention deficit hyperactivity disorder is frequently accompanied by other psychiatric disorders and the psychiatric comorbidity leads to a more complicated clinical profile. Approximately one-third of attention deficit hyperactivity disorder patients have psychiatric polypharmacy and these patients should be carefully monitored. Primary care physicians who are frequently confronted with attention deficit hyperactivity disorder cases should be careful about psychiatric comorbidities. Keywords: Child psychiatry, attention deficit hyperactivity disorder, mental disorders, Family practice

Serum Galectin-3 Levels in Children with Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with underlying pathogenesis and etiological factors not fully understood. We assumed that galectin-3, which is also linked with inflammatory responses, may play an important role in the ethiopathogenesis of ADHD. In this study, we aimed to investigate whether serum galectin-3 levels are related to ADHD in childhood.

METHODS

The current study consisted of 35 treatment-naive children with ADHD and 35 control subjects. The severities of ADHD and conduct disorder symptoms were assessed via parent- and teacher-rated questionnaires. The severity of anxiety and depression symptoms of the children were determined by the self-report scale. Venous blood samples were collected and serum galectin-3 levels were measured.

RESULTS

The ADHD group had significantly higher serum Galectin-3 levels than the control group. To control confounding factors, including age, sex, and BMI percentile, one-way analysis of covariance (ANCOVA) test was also performed. Analyses revealed a significantly higher serum log- Galectin-3 levels in children with ADHD compared to controls. No association was found between the mean serum galectin-3 levels and sociodemographic characteristics and clinical test scores, except the oppositional defiant behavior scores.

CONCLUSION

Our research supports the hypothesis that serum levels of galectin-3 might be related to ADHD.

Assessment of intraocular pressure, macular thickness, retinal nerve fiber layer, and ganglion cell layer thicknesses: ocular parameters and optical coherence tomography findings in attention-deficit/hyperactivity disorder

Objective:

To compare intraocular pressure (IOP) and macular, retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL) thicknesses in treatment-naive children with attention-deficit/hyperactivity disorder (ADHD), children with ADHD on regular methylphenidate (MPH) treatment for at least 3 months, and healthy controls.

Methods:

A total of 58 treatment-naive children with ADHD, 45 children with ADHD on regular MPH treatment, and 44 healthy controls were enrolled in this study. All participants underwent a comprehensive eye examination. Optical coherence tomography (OCT) was used to assess global RNFL thickness, central macular thickness, and GCL thickness in both eyes.

Results:

Separate univariate analysis of covariance (ANCOVA) on the outcome variables revealed a significant difference among the research groups with respect to IOP in the left eye. Post-hoc univariate analyses indicated that left IOP was significantly higher in children with ADHD under MPH treatment than among healthy controls. However, global RNFL thickness, central macular thickness, and GCL thickness of both eyes, as well as IOP in the right eye, were not significantly different across groups.

Conclusion:

Further longitudinal follow-up studies are needed to determine whether MPH treatment has any effect on IOP or OCT findings.