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Hartley G, Sirois F, Purrington J, Rabey Y. Adverse Childhood Experiences and Autism: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:2297-2315. [PMID: 38041427 DOI: 10.1177/15248380231213314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Evidence suggests that autistic children have a higher probability of experiencing adverse childhood experiences (ACEs) compared to their non-autistic peers. This meta-analysis (PROSPERO: CRD42022262635) aimed to quantify the association of autism and ACEs. Eight databases and Google Scholar were searched for studies that reported dichotomous outcomes regarding the associations between ACEs and autistic individuals, compared to non-autistic individuals. A random-effects model was used to calculate the average Odds Ratio (OR) of the relationship between a diagnosis of autism and ACEs. A total of 40 studies with 5,619,584 participants were included, generating an overall average OR 2.11 (CI 1.61, 2.77). Significant differences in the magnitude of association were found across studies with regards to the type of ACEs studied, comparison groups, and population type. Overall, moderate certainty evidence (downgraded for bias) indicates that autistic individuals are at greater risk of experiencing ACEs, compared to non-autistic individuals. Appropriate support for autistic individuals and their families are required to prevent ACEs and treat the impact of ACEs.
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Alinaitwe R, Elyanu PJ, Kanywa JB, Akena D. Use of computer-assisted self-interview in detection of and referral for depression among adolescents living with HIV at an urban HIV treatment clinic in Uganda: a quasi-experimental study. BMJ Paediatr Open 2024; 8:e002383. [PMID: 38886110 PMCID: PMC11184185 DOI: 10.1136/bmjpo-2023-002383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/22/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Depression is common among adolescents living with HIV (ALHIV) and impacts their quality of life. However, it is not routinely detected and treated due to a lack of screening tools, coupled with large numbers of clients in the HIV clinics and limited staff. Enabling adolescents to do a self-assessment for depression on a tablet computer could possibly improve the detection of depression in this population. We set out to assess the detection and referral of depression among ALHIV in care in Uganda. METHODS This was a quasi-experimental study design with a historical control at Baylor College of Medicine of Children's Foundation. We conducted a retrospective chart review of 425 adolescents covering a 3-month period and documented the proportion screened for depression and referred to the clinic counsellors. From July to September 2022, eligible adolescents aged 10-19 years who had assented and consented self-assessed for depression using a Patient Health Questionnaire-Adolescent on a tablet computer-assisted self-interview (CASI). Adolescents who screened positive had a prompt on the tablet computers referring them to the counsellor for mental healthcare. We compared the proportions of participants screened for depression and referred to counsellors from clinic chart review and on the CASI using paired t-tests. RESULTS Out of 425 medical records reviewed, 54% (231/425) were females and the median age was 15 years. Of the participants who self-assessed on the CASI, 52% (222/425) were males and the median age of all participants was 16 years. Self-assessment on the CASI increased the rate of detection of depression from 0% to 23.3%. Of those referred on the CASI, 15% accessed care at the referral point. CONCLUSION The use of CASI improves the rate of detection of depression among ALHIV; however, there is a need to address the barriers to effective referral for mental health services.
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Affiliation(s)
| | | | | | - Dickens Akena
- Makerere University College of Health Sciences, Kampala, Uganda
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Zhang A, Luo X, Lin R, He C, Wang J, Huang G. Group arts therapies for patients with schizophrenia: a protocol of systematic review and meta-analysis. BMJ Open 2024; 14:e082076. [PMID: 38834330 PMCID: PMC11163625 DOI: 10.1136/bmjopen-2023-082076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/15/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Schizophrenia, a chronic mental problem, significantly impacts cognition, emotion and social functioning. Conventional pharmacotherapy faces challenges including numerous side effects, low adherence to medication and substantial costs. In this context, group arts therapies (GATs) emerge as a promising complementary approach for symptom alleviation in schizophrenia patients. Nonetheless, the effectiveness and safety of GATs are yet to be firmly established. This study aims to systematically assess the therapeutic impact of all group-based artistic interventions as complementary treatments for schizophrenia, focusing on their potential benefits. METHODS AND ANALYSIS This study will search four English-language databases (PubMed, Web of Science, Cochrane Library and Embase), two Chinese databases (Wanfang Data and China National Knowledge Infrastructure) and three Korean databases (RISS, Korean Citation Index and DBpia) from their inception until October 2023. It will include all randomised controlled trials that compare GATs for schizophrenia with standard rehabilitation methods. The primary outcome is the improvement in patients' positive and negative symptoms. Methodologies such as bias risk assessment, data synthesis, sensitivity analysis and subgroup analysis will be implemented using Review Manager V.5.4. Study results with high heterogeneity will be merged using a random-effects model (I 2>50% or p<0.1). In cases where meta-analysis is not viable due to significant clinical and methodological heterogeneity, a qualitative summary of the findings will be provided. ETHICS AND DISSEMINATION The data used in this systematic review are anonymised, devoid of any private information, eliminating the requirement for ethical approval. Dissemination of the research findings will be conducted via peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42023471583.
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Affiliation(s)
- Aijia Zhang
- Faculty of Humanities and Arts, Macau University of Science and Technology, Taipa, Macau, China
| | - Xuexing Luo
- Faculty of Humanities and Arts, Macau University of Science and Technology, Taipa, Macau, China
| | - Runqing Lin
- Faculty of Humanities and Arts, Macau University of Science and Technology, Taipa, Macau, China
| | - Caihong He
- Operation Centre, Guangzhou Wanqu Cooperative Institute of Design, Guangzhou, Guangdong, China
| | - Jue Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, China
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangdong University of Technology, Guangzhou, Guangdong, China
| | - Guanghui Huang
- Faculty of Humanities and Arts, Macau University of Science and Technology, Taipa, Macau, China
- Zhuhai MUST Science and Technology Research Institute, Zhuhai, Guangdong, China
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Moran K, Dyas R, Kelly C, Young D, Minnis H. Reactive attachment disorder, disinhibited social engagement disorder, adverse childhood experiences, and mental health in an imprisoned young offender population. Psychiatry Res 2024; 332:115597. [PMID: 38194802 DOI: 10.1016/j.psychres.2023.115597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/10/2023] [Accepted: 11/06/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND A high proportion of young people in prison have a history of abuse and neglect, and/or of neurodevelopmental or psychiatric conditions. Despite this, the only two conditions specifically associated with abuse and neglect, Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED), have never been included as part of a comprehensive prevalence study. METHODS A cross sectional study, in 110 male inmates aged 16 to 23, examined the prevalence of, and associations between, adverse childhood experiences (ACEs), neurodevelopmental and mental health conditions, including RAD and DSED. OUTCOMES Virtually all of the young men (96 %) had one or more lifetime neurodevelopmental or mental health conditions, 85.5 % had a current condition, yet less than 3 % reported having received a mental health assessment in prison. High rates of RAD and/or DSED symptoms were found (53.6 %) and 74.5 % had experienced some form of abuse or neglect. INTERPRETATION There is a high prevalence of ACEs, RAD/DSED, neurodevelopmental and other mental health conditions within this population. Comprehensive clinical assessments are required to ensure appropriate support and staff training is needed to ensure that the full implications of the high prevalence of neurodevelopmental and mental health conditions are understood as part of trauma informed care.
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Affiliation(s)
- Kate Moran
- School of Psychology, Trinity College Dublin, Ireland.
| | - Rebecca Dyas
- University of Glasgow School of Health and Wellbeing, Glasgow, Scotland
| | | | - David Young
- Mathematics and Statistics, University of Strathclyde, Scotland.
| | - Helen Minnis
- University of Glasgow School of Health and Wellbeing, Glasgow, Scotland.
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Smith LH, Warren E, Hendrickson N, Joshua K. An Empty Scoping Review of Emergency Department to School Transition for Youth with Mental Health Concerns. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.23.24301673. [PMID: 38343854 PMCID: PMC10854341 DOI: 10.1101/2024.01.23.24301673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The number of youth Emergency Department (ED) visits due to mental health concerns has been steadily increasing with a large number of youth being referred from school. Despite the increase in ED visits, there has not been an increase in the number of students who are actually admitted to the hospital. Further, youth referred from school are more likely to be discharged from the ED. Given the unique relationship between school and ED referrals and the large number of youth who do not require hospitalization, this study sought to understand how schools are supporting students who return to school after an ED visit. We conducted a scoping review to identify programs and practices to support ED to school transition. Two reviewers screened 907 manuscripts, but none of the manuscripts met the inclusion criteria. We discuss the importance of supporting students returning to school from the ED and draw from the literature on hospital to school transition to make recommendations for educators.
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Affiliation(s)
| | - Emily Warren
- University of Virginia, School of Education & Human Development
| | | | - Kate Joshua
- University of Virginia, Claude Moore Health Sciences Library
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Williams AJ, Cleare S, Borschmann R, Tench CR, Gross J, Hollis C, Chapman-Nisar A, Naeche N, Townsend E, Slovak P. Enhancing emotion regulation with an in situ socially assistive robot among LGBTQ+ youth with self-harm ideation: protocol for a randomised controlled trial. BMJ Open 2024; 14:e079801. [PMID: 38195171 PMCID: PMC10806609 DOI: 10.1136/bmjopen-2023-079801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Purrble, a socially assistive robot, was codesigned with children to support in situ emotion regulation. Preliminary evidence has found that LGBTQ+ youth are receptive to Purrble and find it to be an acceptable intervention to assist with emotion dysregulation and their experiences of self-harm. The present study is designed to evaluate the impact of access to Purrble among LGBTQ+ youth who have self-harmful thoughts, when compared with waitlist controls. METHODS AND ANALYSIS The study is a single-blind, randomised control trial comparing access to the Purrble robot with waitlist control. A total of 168 LGBTQ+ youth aged 16-25 years with current self-harmful ideation will be recruited, all based within the UK. The primary outcome is emotion dysregulation (Difficulties with Emotion Regulation Scale-8) measured weekly across a 13-week period, including three pre-deployment timepoints. Secondary outcomes include self-harm (Self-Harm Questionnaire), anxiety (Generalised Anxiety Disorder-7) and depression (Patient Health Questionnaire-9). We will conduct analyses using linear mixed models to assess primary and secondary hypotheses. Intervention participants will have unlimited access to Purrble over the deployment period, which can be used as much or as little as they like. After all assessments, control participants will receive their Purrble, with all participants keeping the robot after the end of the study. After the study has ended, a subset of participants will be invited to participate in semistructured interviews to explore engagement and appropriation of Purrble, considering the young people's own views of Purrble as an intervention device. ETHICS AND DISSEMINATION Ethical approval was received from King's College London (RESCM-22/23-34570). Findings will be disseminated in peer review open access journals and at academic conferences. TRIAL REGISTRATION NUMBER NCT06025942.
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Affiliation(s)
- A Jess Williams
- Department of Informatics, King's College London, London, UK
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Seonaid Cleare
- Department of Informatics, King's College London, London, UK
- University of Glasgow, Glasgow, UK
| | - Rohan Borschmann
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Oxford, Oxford, UK
| | | | - James Gross
- Stanford University, Stanford, California, USA
| | - Chris Hollis
- Division of Psychiatry, University of Nottingham, Nottingham, UK
| | | | | | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Petr Slovak
- Department of Informatics, King's College London, London, UK
- University of Oxford, Oxford, UK
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Thiyagarajan S, Saldanha PRM, Govindan R, Leena KC, Prathyusha PV. Development of Agile Scrum Perception Tool to Evaluate Students' Opinions on Agile Methodology in Nursing Education. Int J Appl Basic Med Res 2024; 14:35-41. [PMID: 38504840 PMCID: PMC10947761 DOI: 10.4103/ijabmr.ijabmr_423_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/15/2023] [Accepted: 12/15/2023] [Indexed: 03/21/2024] Open
Abstract
Background and Aim Agile methodology (AM) is an innovative, active, team-based learning method that enhances higher-order thinking (metacognitive ability), collaboration, hands-on training, and student engagement in the classroom and clinical environment. Exploring the student's opinions of AM in teaching helps understand how agile can be utilized in higher education to positively improve learning ability, leadership, and teamwork. Hence, the study aimed to develop the agile scrum perception tool (ASPT) to evaluate the opinions on AM among nursing students. Materials and Methods A cross-sectional design was carried out to develop ASPT in different phases. The tool was initially derived from focus group discussion and literature review. The preliminary draft was revised and modified based on expert review and suggestions by content and construct validity. Reliability was calculated in terms of internal consistency. The developed tool was evaluated using data from 200 4th-year nursing students. Results A total of 23 items of ASPT have adequate psychometric properties in terms of reliability and validity. Internal consistency was checked by coefficient alpha, which was 0.87. Construct validity was analyzed by factor analysis; all items were loaded in 6 factors, accounting for 54% of the variance in the total ASPT score. Conclusion ASPT has good validity, reliability, and broader scope in medical and allied education related to project management, clinical teaching, and classroom teaching.
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Affiliation(s)
- Suseela Thiyagarajan
- Clinical Instructor, College of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prakash R M Saldanha
- Professor of Pediatrics/Vice Principal, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India
| | - Radhakrishnan Govindan
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - K C Leena
- Dean/Principal, Yenepoya Nursing College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India
| | - P. V Prathyusha
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Taylor MJ, van Leeuwen TM, Kuja-Halkola R, Lundström S, Larsson H, Lichtenstein P, Bölte S, Neufeld J. Genetic and environmental architecture of synaesthesia and its association with the autism spectrum-a twin study. Proc Biol Sci 2023; 290:20231888. [PMID: 37876199 PMCID: PMC10598415 DOI: 10.1098/rspb.2023.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023] Open
Abstract
Synaesthesia is a sensory phenomenon where external stimuli, such as sounds or letters, trigger additional sensations (e.g. colours). Synaesthesia aggregates in families but its heritability is unknown. The phenomenon is more common in people on the autism spectrum compared with the general population and associated with higher autistic traits. Using classical twin design, we assessed the heritability of individual differences in self-reported synaesthesia and the genetic and environmental contributions to their association with autistic traits within a population twin cohort (n = 4262, age = 18 years). We estimated individual differences in synaesthesia to be heritable and influenced by environmental factors not shared between twins. The association between individual differences in synaesthesia and autistic traits was estimated to be predominantly under genetic influence and seemed to be mainly driven by non-social autistic traits (repetitive behaviours, restricted interests and attention to detail). Our study suggests that the link between synaesthesia and autism might reside in shared genetic causes, related to non-social autistic traits such as alterations in perception. Future studies building on these findings may attempt to identify specific groups of genes that influence both autism, synaesthesia and perception.
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Affiliation(s)
- Mark J. Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17165 Stockholm, Sweden
| | - Tessa M. van Leeuwen
- Tilburg School of Humanities and Digital Sciences, Department of Communication and Cognition, Tilburg University, 5037 AB Tilburg, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 XZ Nijmegen, The Netherlands
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17165 Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Centre for Ethics, Law and Mental Health, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17165 Stockholm, Sweden
- School of Medical Sciences, Örebro University, 70281 Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17165 Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, 11364 Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, WA 66102 Perth, Western Australia
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, 11364 Stockholm, Sweden
| | - Janina Neufeld
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, 11364 Stockholm, Sweden
- Swedish Collegium for Advanced Study (SCAS), 75238 Uppsala, Sweden
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Yahyavi ST, Faraji S. Absconding from a Psychiatric Hospital in a Developing Country, Related Factors, and the Consequences. Med J Islam Repub Iran 2023; 37:110. [PMID: 38145184 PMCID: PMC10744138 DOI: 10.47176/mjiri.37.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Indexed: 12/26/2023] Open
Abstract
Background This study aimed to investigate the factors related to absconding and consequences of absconding in a psychiatric hospital in a developing country within 3 years. Methods This was a retrograde descriptive cross-sectional study from a psychiatry hospital in a developing country, Iran. The registered data of absconding between March 2018 and February 2021 were extracted. Furthermore, a retrograde follow-up by telephone on what happened after the absconding and the remembered motives was done. The obtained data were analyzed using SPSS statistical software for Windows Version 23 by descriptive statistics. The chi-square test, Fisher exact test, Student t test, or Mann-Whitney U tests were used for data analysis. P ˂ .05 was considered statistically significant. Results Out of 7069 admitted patients during a 36-month period, 51 (39 men and 12 women) had absconded. The total absconding rate was 0.72%. The mean ± (SD) age of the patients was 29.7 ± (10.46) years, with a range of 10 to 54 years. No statistical difference between men and women emerged in terms of age (P = 0.89). Most of the absconders were men (76%), young (mean age, 29.7 years), single (70.6%), and involuntarily hospitalized (78.4%) in an urban area (90.2%), and absconded in the evening shift (58.8%) via the route of the main gate (58.8%) in the early days of admission (5 days). In terms of psychiatric diagnosis, the highest rank belonged to bipolar disorder (33.33%) and substance-related disorders (33.33%). About one-third of absconders had a current substance-related problem and most of them had experienced withdrawal symptoms or cravings days before absconding (75%). Absconders mentioned that "no need for admission" (45.1%), "economic problems" (23.5%), and "substance craving" (13.7%) were the most common reasons for leaving the hospital. Most of the absconders were hospitalized later (70.5%). The risk for self-harm (21%) or harm to others (2%) after absconding was low. Conclusion The general profile of absconders was concordant with previous studies. It was highlighted that economic problems in recent years had an evident impact on patients and it could be postulated that consideration of substance withdrawal may decrease absconding. It is advised to adhere to the policies that support community-based psychiatry and place an emphasis on early discharge and continuity of outpatient care.
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Affiliation(s)
- Seyyed Taha Yahyavi
- Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Faraji
- Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Forsström D, Oscarsson M, Buhrman M, Rozental A. A study protocol of a randomized controlled study of internet-based cognitive behavioral therapy for adult attention deficit hyperactivity disorder. Internet Interv 2023; 33:100652. [PMID: 37529408 PMCID: PMC10388197 DOI: 10.1016/j.invent.2023.100652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactivity, impulsivity and lack of attention. It can have a major impact on everyday life and result in negative consequences for one's personal, academic, and work situation. For individuals with symptoms of ADHD, increased levels of anxiety and depression are common, and an overall reduction of quality of life is often present. This study protocol describes a clinical trial of internet-based cognitive behavioral therapy (iCBT), using a randomized controlled study design, with the primary aim to increase quality of life, as well as to reduce symptoms of ADHD, anxiety, depression, and stress. A second aim is to investigate, by qualitative means, what aspects of treatment were perceived as helpful and hindering when it comes to completing iCBT. Two hundred participants with symptoms of ADHD will be included and randomized to two conditions (treatment and wait-list control). The treatment period is comprised of a maximum of ten weeks, with two mandatory modules and ten modules from which the participants can choose freely. Self-report measures will be completed by the participants at baseline and end of treatment, as well as at a six-month follow-up. The treatment is guided by therapists and consists of weekly correspondence with the participants. The study will utilize an intention to treat design, with ANOVAs and Reliable Change Index to evaluate treatment effects. The qualitative part of the project will be interview-based and employ thematic analysis. Lastly, a psychometric evaluation of a common instrument for determining ADHD-symptoms will also be made. The results will hopefully contribute to the evidence base for iCBT for individuals with symptoms of ADHD and help disseminate potentially effective interventions.
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Affiliation(s)
- David Forsström
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Department of Psychology, Stockholm University, Sweden
| | | | | | - Alexander Rozental
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Leung BK, Merlin S, Walker AK, Lawther AJ, Paxinos G, Eapen V, Clarke R, Balleine BW, Furlong TM. Immp2l knockdown in male mice increases stimulus-driven instrumental behaviour but does not alter goal-directed learning or neuron density in cortico-striatal circuits in a model of Tourette syndrome and autism spectrum disorder. Behav Brain Res 2023; 452:114610. [PMID: 37541448 DOI: 10.1016/j.bbr.2023.114610] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/22/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Abstract
Cortico-striatal neurocircuits mediate goal-directed and habitual actions which are necessary for adaptive behaviour. It has recently been proposed that some of the core symptoms of autism spectrum disorder (ASD) and Gilles de la Tourette syndrome (GTS), such as tics and other repetitive behaviours, may emerge because of imbalances in these neurocircuits. We have recently developed a model of ASD and GTS by knocking down Immp2l, a mitochondrial gene frequently associated with these disorders. The current study sought to determine whether Immp2l knockdown (KD) in male mice alters flexible, goal- or cue- driven behaviour using procedures specifically designed to examine response-outcome and stimulus-response associations, which underlie goal-directed and habitual behaviour, respectively. Whether Immp2l KD alters neuron density in cortico-striatal neurocircuits known to regulate these behaviours was also examined. Immp2l KD mice and wild type-like mice (WT) were trained on Pavlovian and instrumental learning procedures where auditory cues predicted food delivery and lever-press responses earned a food outcome. It was demonstrated that goal-directed learning was not changed for Immp2l KD mice compared to WT mice, as lever-press responses were sensitive to changes in the value of the food outcome, and to contingency reversal and degradation. There was also no difference in the capacity of KD mice to form habitual behaviours compared to WT mice following extending training of the instrumental action. However, Immp2l KD mice were more responsive to auditory stimuli paired with food as indicated by a non-specific increase in lever response rates during Pavlovian-to-instrumental transfer. Finally, there were no alterations to neuron density in striatum or any prefrontal cortex or limbic brain structures examined. Thus, the current study suggests that Immp2l is not necessary for learned maladaptive goal or stimulus driven behaviours in ASD or GTS, but that it may contribute to increased capacity for external stimuli to drive behaviour. Alterations to stimulus-driven behaviour could potentially influence the expression of tics and repetitive behaviours, suggesting that genetic alterations to Immp2l may contribute to these core symptoms in ASD and GTS. Given that this is the first application of this battery of instrumental learning procedures to a mouse model of ASD or GTS, it is an important initial step in determining the contribution of known risk-genes to goal-directed versus habitual behaviours, which should be more broadly applied to other rodent models of ASD and GTS in the future.
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Affiliation(s)
- Beatrice K Leung
- Decision Neuroscience Laboratory, School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Sam Merlin
- School of Science, Western Sydney University, Campbelltown, Sydney, NSW, Australia
| | - Adam K Walker
- Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Randwick, NSW, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, NSW, Australia
| | - Adam J Lawther
- Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Randwick, NSW, Australia
| | - George Paxinos
- Neuroscience Research Australia, Randwick, NSW, Australia; School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, University of New South Wales, NSW, Australia; Mental Health Research Unit, South Western Sydney Local Health District, Liverpool, Australia
| | - Raymond Clarke
- Ingham Institute, Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Bernard W Balleine
- Decision Neuroscience Laboratory, School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Teri M Furlong
- Neuroscience Research Australia, Randwick, NSW, Australia; School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia.
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van der Lubbe LM, Gerritsen C, Klein MCA, Rodgers RF, Hindriks KV. Experiences of Users with an Online Self-Guided Mental Health Training Program Using Gamification. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:141-168. [PMID: 37359192 PMCID: PMC10010230 DOI: 10.1007/s41666-022-00124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 11/01/2022] [Accepted: 12/22/2022] [Indexed: 03/14/2023]
Abstract
Young adulthood is a period of high risk for the development of mental health concerns. Increasing well-being among young adults is important to prevent mental health concerns and their consequences. Self-compassion has been identified as a modifiable trait with the potential to protect against mental health concerns. An online self-guided mental health training program using gamification was developed and the user experience was evaluated in a 6-week experimental design. During this period, 294 participants were allocated to use the online training program via a website. User experience was assessed via self-report questionnaires, and interaction data for the training program were also collected. Results showed that those who completed the intervention (n= 47) visited the website on average 3.2 days a week, with a mean of 45.8 interactions during the 6 weeks. Participants report positive user experiences of the online training, on average a System Usability Scale Brooke (1) score of 79.1 (out of 100) at the end-point. Participants showed positive engagement with story elements of the training, based on an average score of 4.1 (out of 5) in the evaluation of the story at the end-point. This study found the online self-compassion intervention for youth to be acceptable, although some features seem preferred by users as compared to others. Gamification in the form of a guiding story and a reward structure seemed to be a promising element for successfully motivating participants and serving as a guiding metaphor for self-compassion.
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Affiliation(s)
- L. M. van der Lubbe
- Computer Science, Vrije Universiteit Amsterdam, De Boelelaan 1111, Amsterdam, 1081HV The Netherlands
| | - C. Gerritsen
- Computer Science, Vrije Universiteit Amsterdam, De Boelelaan 1111, Amsterdam, 1081HV The Netherlands
| | - M. C. A. Klein
- Computer Science, Vrije Universiteit Amsterdam, De Boelelaan 1111, Amsterdam, 1081HV The Netherlands
| | - R. F. Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France
| | - K. V. Hindriks
- Computer Science, Vrije Universiteit Amsterdam, De Boelelaan 1111, Amsterdam, 1081HV The Netherlands
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Cain R, French M, Sedda L. Food insecurity, mental health and in-hospital mortality following the COVID-19 pandemic in a socially deprived UK coastal town. BMJ Nutr Prev Health 2023; 6:100-107. [PMID: 37559962 PMCID: PMC10407376 DOI: 10.1136/bmjnph-2022-000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/02/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Public health interventions are essential to prevent a long tail of costly, avoidable and worsening ill health in coastal communities following the COVID-19 pandemic, yet no research exists to guide policy and practice as to which groups within coastal communities are vulnerable and most in need of such interventions. Within this aim, we explore engrained and emerging vulnerabilities of food insecurity, health and well-being for different demographic groups within the deprived coastal community of Fleetwood, Lancashire, UK, before and after the pandemic. METHODS Routinely collected data of free school meal eligibility, community mental health referrals and hospital admissions between 28 March 2016 and 31 December 2021 were aggregated by locality and deprivation within Fleetwood. Temporal autoregressive models, generalised linear mixed models and survival analyses were employed to compare trends and associations in food insecurity, health and well-being indicators against deprivation indices, demographics, comorbidities (including COVID-19), the COVID-19 pandemic period and locality. RESULTS Areas with better housing and income, but higher health and disability deprivation, showed increased levels of free school meal eligibility following the pandemic. Mental health was insensitive to the first 14 months of pandemic yet is worsened by unemployment deprivation and cardiovascular and respiratory comorbidities, with a greater predisposition to poor mental health in adolescents and young adults. After accounting for the effect of COVID-19, hospital mortality risk increased with demographic influences in fitting with the typology of coastal communities having an older population, struggling healthcare and a greater prevalence of comorbidities. CONCLUSIONS Public health managers and policy makers seeking to prevent worsening health and well-being within coastal communities following the pandemic should focus on broader-scale patterns reflecting entrenched poor health typical of coastal communities, and emerging food insecurity within specific demographic and deprivation groups at finer scales.
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Affiliation(s)
- Russell Cain
- Lancaster Ecology and Epidemiology Group, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Maddy French
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Luigi Sedda
- Lancaster Ecology and Epidemiology Group, Lancaster Medical School, Lancaster University, Lancaster, UK
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Pan PY, Taylor MJ, Larsson H, Almqvist C, Lichtenstein P, Lundström S, Bölte S. Genetic and environmental contributions to co-occurring physical health conditions in autism spectrum condition and attention-deficit/hyperactivity disorder. Mol Autism 2023; 14:17. [PMID: 37085910 PMCID: PMC10122407 DOI: 10.1186/s13229-023-00548-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/13/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Autism spectrum condition and attention-deficit/hyperactivity disorder (ADHD) are associated with a range of physical health conditions. The aim of this study was to examine the etiological components contributing to co-occurring physical health conditions in autism and ADHD. METHODS In this nationwide Child and Adolescent Twin Study in Sweden, we analyzed data from 10,347 twin pairs aged 9 and 12. Clinical diagnoses of autism, ADHD, and physical health conditions were identified through the Swedish National Patient Register. Subclinical phenotypes of autism and ADHD were defined by symptom thresholds on a standardized parent-interview, the Autism-Tics, ADHD, and Other Comorbidities inventory. Associations between physical health conditions and autism/ADHD phenotypes were examined using generalized estimating equations. Bivariate twin models were applied to estimate the extent to which genetic and environmental risk factors accounted for physical health comorbidities. RESULTS Similar patterns of association with physical health conditions were found in clinical and subclinical autism/ADHD, with odds ratios ranging from 1.31 for asthma in subclinical ADHD to 8.03 for epilepsy in clinical autism. The estimated genetic correlation (ra) with epilepsy was 0.50 for clinical autism and 0.35 for subclinical autism. In addition, a modest genetic correlation was estimated between clinical autism and constipation (ra = 0.31), functional diarrhea (ra = 0.27) as well as mixed gastrointestinal disorders (ra = 0.30). Genetic effects contributed 0.86 for mixed gastrointestinal disorders in clinical ADHD (ra = 0.21). Finally, subclinical ADHD shared genetic risk factors with epilepsy, constipation, and mixed gastrointestinal disorders (ra = 0.30, 0.17, and 0.17, respectively). LIMITATIONS Importantly, since medical records from primary care were not included in the registry data used, we probably identified only more severe rather than the full range of physical health conditions. Furthermore, it needs to be considered that the higher prevalence of physical health conditions among autistic children and children with ADHD could be associated with the increased number of medical visits. CONCLUSIONS Shared genetic effects contribute significantly to autism and ADHD phenotypes with the co-occurring physical health conditions across different organ systems, including epilepsy and gastrointestinal disorders. The shared genetic liability with co-occurring physical health conditions was present across different levels of autism and ADHD symptom severity.
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Affiliation(s)
- Pei-Yin Pan
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Gävlegatan 22, 11330, Stockholm, Sweden.
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Berzelius Väg 8, Solna, 17165, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Berzelius Väg 8, Solna, 17165, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Berzelius Väg 8, Solna, 17165, Stockholm, Sweden
- Lung and Allergy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Eugeniavägen 23, Solna, 17164, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Berzelius Väg 8, Solna, 17165, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Kungsgatan 12, 41119, GothenburgGöteborg, Sweden
- Centre for Ethics, Law, and Mental Health, University of Gothenburg, Universitetsplatsen 1, 41124, Gothenburg, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Gävlegatan 22, 11330, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Solnavägen 1E, 113 65, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia
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Brown KR, Quinton ML, Tidmarsh G, Cumming J. Athletes' access to, attitudes towards and experiences of help-seeking for mental health: a scoping review protocol. BMJ Open 2023; 13:e062279. [PMID: 37024251 PMCID: PMC10083771 DOI: 10.1136/bmjopen-2022-062279] [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] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Athletes are not immune to mental health issues but are less likely to seek help than non-athletes and experience barriers including lack of access to services, lack of knowledge as to how to access services and negative past experiences for help-seeking. Formal (eg, university counsellors, general practitioners and psychologists) and semi-formal (eg, academic tutor, sports coach and physiotherapist) sources of support provided in healthcare, the sport context and higher education are key places for athletes to seek help for mental health, and there is a need to synthesise the evidence on athletes' access, attitudes to and experiences of these services, to understand how to improve these services specific to athletes' mental health needs. This protocol outlines a scoping review that will be used to map the evidence, identify gaps in the literature and summarise findings on athletes' access, attitudes to and experiences of help-seeking for their mental health. METHODS AND ANALYSIS The methodological frameworks of Arksey and O'Malley (2005), Levac et al (2010) and the Joanna Briggs Institute (2020 and 2021) were used to inform this scoping review protocol alongside the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols checklist and published scoping review protocols within sport and health. The six stages of Arksey and O'Malley's (2005) framework have been used for this scoping review. The searches were conducted between 30 March 2022 and 3 April 2022 in the following databases: APA PsycINFO (via OVID), Embase (via Ovid), MEDLINE (via Ovid), APA PsycArticles Full Text (via OVID), Web of Science Core Collection, SPORTDiscus (via EBSCO), CINAHL (via EBSCO), Scopus, ProQuest (Education Database), ProQuest (Education Collection), ProQuest (Health & Medical Collection), ProQuest (Nursing & Allied Health database), ProQuest (Psychology Database), ProQuest (Public Health Database) and ProQuest (Sports Medicine & Education). The main inclusion criteria of this review are: papers that focus on past help-seeking behaviour, attitudes towards help-seeking and future behavioural intentions, papers that refer to formal and semi-formal sources of support and peer-reviewed literature, primary research articles, systematic or scoping reviews and interventions. During title and abstract screening and full-text review, at least two reviewers will be involved. Data to be extracted from studies includes: details of the study population, whether the paper focuses on formal and/or semi-formal sources of support and whether the focus is on access, attitudes or experiences to help-seeking for mental health. ETHICS AND DISSEMINATION The evidence will be mapped numerically and through content analysis to describe studies and highlight key concepts, themes and gaps in the literature. The published scoping review will be disseminated to relevant stakeholders and policymakers including those in healthcare, the sporting context and the higher education system. The resulting outputs will be in the form of both peer-reviewed and non-peer reviewed publications (eg, multimedia in the form of a blog post and at conferences). The dissemination plan will be informed by patient and public involvement. Ethics approval was not required for this study.
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Affiliation(s)
- Kirsty R Brown
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Mary L Quinton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Grace Tidmarsh
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer Cumming
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Institute of Mental Health, University of Birmingham, Birmingham, UK
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16
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Dinkler L, Wronski ML, Lichtenstein P, Lundström S, Larsson H, Micali N, Taylor MJ, Bulik CM. Etiology of the Broad Avoidant Restrictive Food Intake Disorder Phenotype in Swedish Twins Aged 6 to 12 Years. JAMA Psychiatry 2023; 80:260-269. [PMID: 36723946 PMCID: PMC9978946 DOI: 10.1001/jamapsychiatry.2022.4612] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Importance Avoidant restrictive food intake disorder (ARFID) is characterized by an extremely limited range and/or amount of food eaten, resulting in the persistent failure to meet nutritional and/or energy needs. Its etiology is poorly understood, and knowledge of genetic and environmental contributions to ARFID is needed to guide future research. Objective To estimate the extent to which genetic and environmental factors contribute to the liability to the broad ARFID phenotype. Design, Setting, and Participants This nationwide Swedish twin study includes 16 951 twin pairs born between 1992 and 2010 whose parents participated in the Child and Adolescent Twin Study in Sweden (CATSS) at twin age 9 or 12 years. CATSS was linked to the National Patient Register (NPR) and the Prescribed Drug Register (PDR). Data were collected from July 2004 to April 2020, and data were analyzed from October 2021 to October 2022. Main Outcomes and Measures From CATSS, NPR, and PDR, all parent reports, diagnoses, procedures, and prescribed drugs that were relevant to the DSM-5 ARFID criteria were extracted when twin pairs were aged 6 to 12 years and integrated into a composite measure for the ARFID phenotype (ie, avoidant/restrictive eating with clinically significant impact, such as low weight or nutritional deficiency, and with fear of weight gain as an exclusion). In sensitivity analyses, autism and medical conditions that could account for the eating disturbance were controlled for. Univariate liability threshold models were fitted to estimate the relative contribution of genetic and environmental variation to the liability to the ARFID phenotype. Results Of 33 902 included children, 17 151 (50.6%) were male. A total of 682 children (2.0%) with the ARFID phenotype were identified. The heritability of ARFID was 0.79 (95% CI, 0.70-0.85), with significant contributions from nonshared environmental factors (0.21; 95% CI, 0.15-0.30). Heritability was very similar when excluding children with autism (0.77; 95% CI, 0.67-0.84) or medical illnesses that could account for the eating disturbance (0.79; 95% CI, 0.70-0.86). Conclusions and Relevance Prevalence and sex distribution of the broad ARFID phenotype were similar to previous studies, supporting the use of existing epidemiological data to identify children with ARFID. This study of the estimated genetic and environmental etiology of ARFID suggests that ARFID is highly heritable, encouraging future twin and molecular genetic studies.
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Affiliation(s)
- Lisa Dinkler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marie-Louis Wronski
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Nadia Micali
- Mental Health Services in the Capital Region of Denmark, Eating Disorders Research Unit, Psychiatric Centre Ballerup, Copenhagen, Denmark,Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Mark J. Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Psychiatry, University of North Carolina at Chapel Hill,Department of Nutrition, University of North Carolina at Chapel Hill
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17
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Akingbuwa WA, Hammerschlag AR, Allegrini AG, Sallis H, Kuja-Halkola R, Rimfeld K, Lichtenstein P, Lundstrom S, Munafò MR, Plomin R, Nivard MG, Bartels M, Middeldorp CM. Multivariate analyses of molecular genetic associations between childhood psychopathology and adult mood disorders and related traits. Am J Med Genet B Neuropsychiatr Genet 2023; 192:3-12. [PMID: 36380638 PMCID: PMC7615008 DOI: 10.1002/ajmg.b.32922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
Ubiquitous associations have been detected between different types of childhood psychopathology and polygenic risk scores based on adult psychiatric disorders and related adult outcomes, indicating that genetic factors partly explain the association between childhood psychopathology and adult outcomes. However, these analyses in general do not take into account the correlations between the adult trait and disorder polygenic risk scores. This study aimed to further clarify the influence of genetic factors on associations between childhood psychopathology and adult outcomes by accounting for these correlations. Using a multivariate multivariable regression, we analyzed associations of childhood attention-deficit/hyperactivity disorder (ADHD), internalizing, and social problems, with polygenic scores (PGS) of adult disorders and traits including major depression, bipolar disorder, subjective well-being, neuroticism, insomnia, educational attainment, and body mass index (BMI), derived for 20,539 children aged 8.5-10.5 years. After correcting for correlations between the adult phenotypes, major depression PGS were associated with all three childhood traits, that is, ADHD, internalizing, and social problems. In addition, BMI PGS were associated with ADHD symptoms and social problems, while neuroticism PGS were only associated with internalizing problems and educational attainment PGS were only associated with ADHD symptoms. PGS of bipolar disorder, subjective well-being, and insomnia were not associated with any childhood traits. Our findings suggest that associations between childhood psychopathology and adult traits like insomnia and subjective well-being may be primarily driven by genetic factors that influence adult major depression. Additionally, specific childhood phenotypes are genetically associated with educational attainment, BMI and neuroticism.
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Affiliation(s)
- Wonuola A Akingbuwa
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anke R Hammerschlag
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Child Health Research Centre, the University of Queensland, Brisbane, Queensland, Australia
| | - Andrea G Allegrini
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Division of Psychology and Language Sciences, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Hannah Sallis
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kaili Rimfeld
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundstrom
- Centre for Ethics Law and Mental Health, Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Robert Plomin
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michel G Nivard
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Meike Bartels
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Christel M Middeldorp
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Child Health Research Centre, the University of Queensland, Brisbane, Queensland, Australia
- Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Services, Brisbane, Queensland, Australia
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18
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Griese M, Schwerk N, Carlens J, Wetzke M, Emiralioğlu N, Kiper N, Lange J, Krenke K, Seidl E. Minimal important difference in childhood interstitial lung diseases. Thorax 2022; 78:476-483. [PMID: 36572533 PMCID: PMC10176404 DOI: 10.1136/thorax-2022-219206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/25/2022] [Indexed: 12/27/2022]
Abstract
BackgroundMonitoring disease progression in childhood interstitial lung diseases (chILD) is essential. No information for the minimal important difference (MID), which is defined as the smallest change in a parameter that is perceived as important prompting a clinician to change the treatment, is available. We calculated MIDs for vital signs (respiratory rate, peripheral oxygen saturation in room air, Fan severity score) and health-related quality of life (HrQoL) scores.MethodsThis study used data from the Kids Lung Register, which is a web-based management platform that collects data of rare paediatric lung disorders with a focus on chILD. Data of vital signs and HrQoL scores (Health Status Questionnaire, chILD-specific questionnaire and PedsQL V.4.0) were collected. MIDs were calculated according to distribution-based (one-third SD) and anchor-based methods (using forced expiratory volume in 1 s and forced vital capacity) as anchors.ResultsBaseline data of 774 children were used to calculate the following MIDs: respiratory rate 1.3 (z-score), O2saturation in room air 3.0%, Fan severity score 0.2–0.4, Health Status Questionnaire 0.4–0.8, chILD-specific questionnaire 4.4%–8.2%, physical health summary score 7.8%–8.9%, psychosocial health summary score 3.4%–6.9% and total score 5.1%–7.4%. Results of the responsiveness analysis generally agreed with the MIDs calculated.ConclusionsFor the first time, we provide estimates of MIDs for vital signs and HrQoL scores in a large cohort of chILD using different methods.
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Affiliation(s)
- Matthias Griese
- Munich University Hospital, Dr von Hauner Children's Hospital, German Center for Lung Research (DZL), Munchen, Germany
| | - Nicolaus Schwerk
- Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Julia Carlens
- Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Martin Wetzke
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | | | - Nural Kiper
- Pediatric Pulmonology, Hacettepe University, Ankara, Turkey
| | - Joanna Lange
- Department of Pediatric Pneumology and Allergy, Warszawski Uniwersytet Medyczny, Warszawa, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Warszawski Uniwersytet Medyczny, Warszawa, Poland
| | - Elias Seidl
- Munich University Hospital, Dr von Hauner Children's Hospital, German Center for Lung Research (DZL), Munchen, Germany
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19
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Chen C, Lu Y, Lundström S, Larsson H, Lichtenstein P, Pettersson E. Associations between psychiatric polygenic risk scores and general and specific psychopathology symptoms in childhood and adolescence between and within dizygotic twin pairs. J Child Psychol Psychiatry 2022; 63:1513-1522. [PMID: 35292971 PMCID: PMC9790278 DOI: 10.1111/jcpp.13605] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although polygenic risk scores (PRS) predict psychiatric problems, these associations might be attributable to indirect pathways including population stratification, assortative mating, or dynastic effects (mediation via parental environments). The goal of this study was to examine whether PRS-psychiatric symptom associations were attributable to indirect versus direct pathways. METHODS The sample consisted of 3,907 dizygotic (DZ) twin pairs. In childhood, their parents rated them on 98 symptoms. In adolescence (n = 2,393 DZ pairs), both the parents and the twins rated themselves on 20 symptoms. We extracted one general and seven specific factors from the childhood data, and one general and three specific factors from the adolescent data. We then regressed each general factor model onto ten psychiatric PRS simultaneously. We first conducted the regressions between individuals (β) and then within DZ twin pairs (βw ), which controls for indirect pathways. RESULTS In childhood, the PRS for ADHD predicted general psychopathology (β = 0.09, 95% CI: [0.06, 0.12]; βw = 0.07 [0.01, 0.12]). Furthermore, the PRS for ADHD predicted specific inattention (β = 0.04 [0.00, 0.08]; βw = 0.09 [0.01, 0.17]) and specific hyperactivity (β = 0.07 [0.04, 0.11]; βw = 0.09 [0.01, 0.16]); the PRS for schizophrenia predicted specific learning (β = 0.08 [0.03, 0.13]; βw = 0.19 [0.08, 0.30]) and specific inattention problems (β = 0.05 [0.01, 0.09]; βw = 0.10 [0.02, 0.19]); and the PRS for neuroticism predicted specific anxiety (β = 0.06 [0.02, 0.10]; βw = 0.06 [0.00, 0.12]). Overall, the PRS-general factor associations were similar between individuals and within twin pairs, whereas the PRS-specific factors associations amplified by 84% within pairs. CONCLUSIONS This implies that PRS-psychiatric symptom associations did not appear attributable to indirect pathways such as population stratification, assortative mating, or mediation via parental environments. Rather, genetics appeared to directly influence symptomatology.
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Affiliation(s)
- Cen Chen
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Yi Lu
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Sebastian Lundström
- Centre for Ethics, Law and Mental Health (CELAM)University of GothenburgGothenburgSweden,Gillberg Neuropsychiatry CentreUniversity of GothenburgGothenburgSweden
| | - Henrik Larsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden,School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Erik Pettersson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
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20
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Frosch IR, Damme KSF, Bernard JA, Mittal VA. Cerebellar correlates of social dysfunction among individuals at clinical high risk for psychosis. Front Psychiatry 2022; 13:1027470. [PMID: 36532176 PMCID: PMC9752902 DOI: 10.3389/fpsyt.2022.1027470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Social deficits are a significant feature among both individuals with psychosis and those at clinical high-risk (CHR) for developing psychosis. Critically, the psychosis risk syndrome emerges in adolescence and young adulthood, when social skill development is being fine-tuned. Yet, the underlying pathophysiology of social deficits in individuals at CHR for psychosis remains unclear. Literature suggests the cerebellum plays a critical role in social functioning. Cerebellar dysfunction in psychosis and CHR individuals is well-established, yet limited research has examined links between the cerebellum and social functioning deficits in this critical population. Method In the current study, 68 individuals at CHR for developing psychosis and 66 healthy controls (HCs) completed social processing measures (examining social interaction, social cognition, and global social functioning) and resting-state MRI scans. Seed-to-voxel resting-state connectivity analyses were employed to examine the relationship between social deficits and lobular cerebellar network connectivity. Results Analyses indicated that within the CHR group, each social domain variable was linked to reduced connectivity between social cerebellar subregions (e.g., Crus II, lobules VIIIa and VIIIb) and cortical regions (e.g., frontal pole and frontal gyrus), but a control cerebellar subregion (e.g., lobule X) and was unrelated to these social variables. Discussion These results indicate an association between several cerebellar lobules and specific deficits in social processing. The cerebellum, therefore, may be particularly salient to the social domain and future research is need to examine the role of the cerebellum in psychosis.
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Affiliation(s)
- Isabelle R. Frosch
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Katherine S. F. Damme
- Department of Psychology, Northwestern University, Evanston, IL, United States
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, United States
| | - Jessica A. Bernard
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
- Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX, United States
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, United States
- Department of Psychiatry, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
- Institute for Policy Research, Northwestern University, Chicago, IL, United States
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21
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Tate AE, Akingbuwa WA, Karlsson R, Hottenga JJ, Pool R, Boman M, Larsson H, Lundström S, Lichtenstein P, Middeldorp CM, Bartels M, Kuja-Halkola R. A genetically informed prediction model for suicidal and aggressive behaviour in teens. Transl Psychiatry 2022; 12:488. [PMID: 36411277 PMCID: PMC9678913 DOI: 10.1038/s41398-022-02245-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022] Open
Abstract
Suicidal and aggressive behaviours cause significant personal and societal burden. As risk factors associated with these behaviours frequently overlap, combined approaches in predicting the behaviours may be useful in identifying those at risk for either. The current study aimed to create a model that predicted if individuals will exhibit suicidal behaviour, aggressive behaviour, both, or neither in late adolescence. A sample of 5,974 twins from the Child and Adolescent Twin Study in Sweden (CATSS) was broken down into a training (80%), tune (10%) and test (10%) set. The Netherlands Twin Register (NTR; N = 2702) was used for external validation. Our longitudinal data featured genetic, environmental, and psychosocial predictors derived from parental and self-report data. A stacked ensemble model was created which contained a gradient boosted machine, random forest, elastic net, and neural network. Model performance was transferable between CATSS and NTR (macro area under the receiver operating characteristic curve (AUC) [95% CI] AUCCATSS(test set) = 0.709 (0.671-0.747); AUCNTR = 0.685 (0.656-0.715), suggesting model generalisability across Northern Europe. The notable exception is suicidal behaviours in the NTR, which was no better than chance. The 25 highest scoring variable importance scores for the gradient boosted machines and random forest models included self-reported psychiatric symptoms in mid-adolescence, sex, and polygenic scores for psychiatric traits. The model's performance is comparable to current prediction models that use clinical interviews and is not yet suitable for clinical use. Moreover, genetic variables may have a role to play in predictive models of adolescent psychopathology.
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Affiliation(s)
- Ashley E. Tate
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Wonuola A. Akingbuwa
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Robert Karlsson
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Jouke-Jan Hottenga
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - René Pool
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Magnus Boman
- grid.5037.10000000121581746Division of Software and Computer Systems, School of Electrical Engineering and Computer Science KTH, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Solna, Sweden
| | - Henrik Larsson
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Sebastian Lundström
- grid.8761.80000 0000 9919 9582Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Christel M. Middeldorp
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands ,grid.1003.20000 0000 9320 7537Child Health Research Centre, the University of Queensland, Brisbane, QLD Australia ,grid.512914.a0000 0004 0642 3960Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Services, Brisbane, QLD Australia
| | - Meike Bartels
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ralf Kuja-Halkola
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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22
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Markoulakis R, Arora SRA, Kodeeswaran S, Di Febo M, Kuuter L, Fleming J, Walsh C, Hauser A, Cleverley K, Hitzig SL, Kokorelias K, Cheung A, Willis D, Levitt A. Navigation for youth mental health and addictions: protocol for a realist review and synthesis of approaches and practices (The NavMAP standards project). BMJ Open 2022; 12:e068211. [PMID: 36332944 PMCID: PMC9639113 DOI: 10.1136/bmjopen-2022-068211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Mental health and/or addiction (MHA) concerns affect approximately 1.2 million children and youth in Canada, yet less than 20% receive appropriate treatment for these concerns. Youth who do not receive appropriate support may disengage from care and may experience lasting MHA issues. Families of these youth also support them in finding and accessing care. Thus, system supports are needed to help youth and their families find and equitably access appropriate care. Navigation is an innovation in MHA care, providing patient-centred support and care planning that helps individuals and families overcome barriers to care. Despite the increasing availability of navigation services for youth with MHA concerns, practices and models vary, and no single source has synthesised evidence regarding approaches and outcomes for this population into comprehensive standards. METHODS AND ANALYSIS The proposed research will bring together evidence in youth MHA navigation, to establish this important system support as a factor that can enhance the integration and continuity of care for these youth. Our team, which includes researchers, administrators, clinical leads, an MHA navigator and youth and caregivers with lived experience, will be involved in all project stages. Realist Review and Synthesis methodology will be used, the stages of which include: defining scope, searching for evidence, appraising studies and extracting data, synthesising evidence and developing conclusions, and disseminating findings. ETHICS AND DISSEMINATION Ethics approval is not required, as the study involves review of existing data. Dissemination plans include scientific publications and conferences and online products for stakeholders and the general public.
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Affiliation(s)
- Roula Markoulakis
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Liisa Kuuter
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James Fleming
- Youth Advisory Council, Family Navigation Project at Sunnybrook, Toronto, Ontario, Canada
| | - Cathy Walsh
- Family Advisory Council, Family Navigation Project at Sunnybrook, Toronto, Ontario, Canada
| | - Adina Hauser
- Michael Garron Hospital, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Amy Cheung
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David Willis
- Keystone Child, Youth, and Family Services, Owen Sound, Ontario, Canada
| | - Anthony Levitt
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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23
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Ojala O, Kuja-Halkola R, Bjureberg J, Ohlis A, Cederlöf M, Norén Selinus E, Lichtenstein P, Larsson H, Lundström S, Hellner C. Associations of impulsivity, hyperactivity, and inattention with nonsuicidal self-injury and suicidal behavior: longitudinal cohort study following children at risk for neurodevelopmental disorders into mid-adolescence. BMC Psychiatry 2022; 22:679. [PMID: 36329415 PMCID: PMC9635086 DOI: 10.1186/s12888-022-04311-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The knowledge of how the separate Attention-Deficit/Hyperactivity Disorder (ADHD) subdimensions (impulsivity, hyperactivity, and inattention) are associated with nonsuicidal self-injury (NSSI) and suicidal behavior (SB) is limited. The objective of this study was to investigate the associations of childhood ADHD subdimensions with NSSI and SB in children at risk of neurodevelopmental disorders (NDDs; including ADHD). METHODS The sample (N = 391) included twin pairs where at least one twin screened positive for at least one NDD or common comorbidity at age 9 or 12. Data on ADHD subdimensions was collected through a telephone interview with a caregiver/legal guardian at age 9 or 12, and data on NSSI and SB was collected through an in-person clinical assessment at age 15. The associations between the ADHD subdimensions and NSSI or SB were tested in three different models: (1) univariable, (2) together with the other ADHD subdimensions, and (3) in a confounder-adjusted model including other NDD symptoms in addition to ADHD subdimensions, for NSSI and SB separately. RESULTS A total of 32 (8.2%) adolescents reported life-time engagement of NSSI, and 18 (4.6%) SB. Childhood impulsivity was associated with SB and childhood inattention with NSSI, in all models. Hyperactivity was not meaningfully associated with any of the outcomes. CONCLUSION Impulsivity and inattention, but not hyperactivity, may be of particular importance in understanding SB and NSSI. Brief screening for impulsivity and inattention in childhood could facilitate detection of children vulnerable to NSSI and SB and indicate valuable information for preventive and intervention strategies.
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Affiliation(s)
- Olivia Ojala
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl, SE-11364, Stockholm, Sweden.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl, SE-11364, Stockholm, Sweden
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Anna Ohlis
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl, SE-11364, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Cederlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl, SE-11364, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Eva Norén Selinus
- Region Vastmanland - Uppsala University, Centre for Clinical Research, Vastmanland Hospital, Vasteras, Sweden
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Centre for Ethics, Law and Mental health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl, SE-11364, Stockholm, Sweden
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24
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Sodi T, Quarshie ENB, Oppong Asante K, Radzilani-Makatu M, Makgahlela M, Nkoana S, Mutambara J. Mental health literacy of school-going adolescents in sub-Saharan Africa: a regional systematic review protocol. BMJ Open 2022; 12:e063687. [PMID: 36127093 PMCID: PMC9490578 DOI: 10.1136/bmjopen-2022-063687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Assessing mental health literacy has implications for the identification and treatment of mental health problems. Adolescents have been identified as a particularly important target group for initiating and improving mental health literacy. However, much of what we know about adolescent mental health literacy comes from high-income countries. This proposed review seeks to synthesise the available published primary evidence from sub-Saharan Africa on the status and measurement of mental health literacy among school-going adolescents. METHODS AND ANALYSIS We will perform a systematic review reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA-2020). We will systematically search selected global databases (EMBASE, PsycINFO, PubMed and MEDLINE) and regional electronic databases (African Index Medicus and African Journals OnLine) up to December 2021 for observational and qualitative studies published in English and French. The standard quality assessment criteria for evaluating primary research papers from a variety of fields (QualSyst criteria) will be used to appraise the methodological quality of the included studies. The Petticrew-Roberts 3-step approach to narrative synthesis will be applied to the included studies. ETHICS AND DISSEMINATION We will not seek ethical approval from an institutional review board, as this is a systematic review of available and accessible literature. When completed, the full report of this review will be submitted to a journal for peer-reviewed publication; the key findings will be presented at local and international conferences with-partial or full-focus on (adolescent) mental health (literacy). PROSPERO REGISTRATION NUMBER CRD42021229011.
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Affiliation(s)
- Tholene Sodi
- Psychology Department, University of Limpopo, Sovenga, South Africa
| | - Emmanuel Nii-Boye Quarshie
- Department of Psychology, College of Humanities, University of Ghana, Accra, Ghana
- School of Psychology, University of Leeds, Leeds, UK
| | - Kwaku Oppong Asante
- Department of Psychology, College of Humanities, University of Ghana, Accra, Ghana
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | | | | | - Shai Nkoana
- Psychology Department, University of Limpopo, Sovenga, South Africa
| | - Julia Mutambara
- Department of Psychiatry, Midlands State University, Gweru, Zimbabwe
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25
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Castruita PA, Piña-Escudero SD, Rentería ME, Yokoyama JS. Genetic, Social, and Lifestyle Drivers of Healthy Aging and Longevity. CURRENT GENETIC MEDICINE REPORTS 2022; 10:25-34. [PMID: 38031561 PMCID: PMC10686287 DOI: 10.1007/s40142-022-00205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
Purpose of Review "Healthy aging" is the state of the aging process in which a person can maintain physical, social, mental, and spiritual wellness. This literature review presents an overview of recent studies that explore how biological, social, and environmental factors contribute to healthy aging. Recent Findings A number of genome-wide association studies have been conducted recently for traits related to healthy aging, such as frailty index, healthspan, muscle strength, and parental longevity, leading to the discovery of dozens of genetic variants associated with these traits. In parallel, associations between healthy aging measures and multiple non-biological environmental elements have been identified as key moderators of the aging process, indirectly influencing day-to-day homeostatic processes. Summary Individual variations in lifespan and healthspan are influenced by genetic factors, with a heritability of ~ 25% in developed countries. Non-genetic risk variance is explained in part by social, cultural, and lifestyle conditions. Altogether, these factors contribute to a multifaceted state of wellness over time, shaping individual risk to frailty and resilience during the aging process. Notably, "Blue Zone" populations, which are characterized by an abundance in healthy lifestyles across generations, share some commonalities regarding determinants of health.
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Affiliation(s)
- Patricia Alejandra Castruita
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
- Health Equity Research Lab, San Francisco State University, San Francisco, CA, USA
| | - Stefanie Danielle Piña-Escudero
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Miguel E. Rentería
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
- Mental Health & Neuroscience Program, QIMR Berghofer Medical Research Insitute, Brisbane, QLD, Australia
| | - Jennifer S. Yokoyama
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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26
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Mårland C, Nilsson T, Larsson H, Gillberg C, Lubke G, Lundström S. Measuring autism in males and females with a differential item functioning approach: Results from a nation-wide population-based study. Psychiatry Res 2022; 314:114674. [PMID: 35716480 DOI: 10.1016/j.psychres.2022.114674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/30/2022] [Accepted: 06/04/2022] [Indexed: 12/27/2022]
Abstract
Existing screening instruments for Autism Spectrum Disorder (ASD) might be prone to detect a male manifestation of ASD. Here, we examined the 17 items from the ASD domain in the Autism-Tics, ADHD and other Comorbidities inventory (A-TAC) for Differential Item Functioning (DIF). Data were obtained from the Child and Adolescent Twin Study in Sweden (CATSS) in which parents have responded to the A-TAC. Information regarding a registered diagnosis of ASD were retrieved from the National Patient Register. The cohort was divided into a developmental sample for evaluation of DIF, and a validation sample for examination of the diagnostic accuracy of the total ASD domain, and a novel male and female short form. Our main finding included the identification of DIF for six items, three favouring males and three favouring females. The full, 17 item, ASD domain and the male and female short form showed excellent ability to capture ASD diagnoses in both males and females up to the age of nine years. The full ASD domain in A-TAC is psychometrically largely equivalent across sex and the limited differences between males and females diminish the need for a sex-specific scoring when utilizing the 17 item total score.
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Affiliation(s)
- Caroline Mårland
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Rågården hus 1, SU- Östra Sjukhuset, Gothenburg 416 85, Sweden.
| | - Thomas Nilsson
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Rågården hus 1, SU- Östra Sjukhuset, Gothenburg 416 85, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karoliska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Gitta Lubke
- Department of Psychology, University of Notre Dame, Notre Dame, USA
| | - Sebastian Lundström
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Rågården hus 1, SU- Östra Sjukhuset, Gothenburg 416 85, Sweden; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Rizvi Jafree S, Mahmood QK, Mujahid S, Asim M, Barlow J. Narrative synthesis systematic review of Pakistani women's health outcomes from primary care interventions. BMJ Open 2022; 12:e061644. [PMID: 35914906 PMCID: PMC9345069 DOI: 10.1136/bmjopen-2022-061644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/07/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Women living in Pakistan have complex health problems including infectious and non-communicable diseases, accident and injuries, and mental health problems. While a majority of these women rely on primary healthcare services for all of their healthcare needs, there has to date been no overview of the extent of their effectiveness. The objective of this review was to (1) synthesise the available evidence regarding the effectiveness of primary care based interventions aimed at improving women's mental and physical health and (2) identify the factors that promote effectiveness for women's health outcomes. METHODS Five academic databases were searched, including PubMed, BMC Medicine, Medline, CINAHL and the Cochrane Library. A search was also made of the grey literature. The quality of included studies was assessed using a standardised critical appraisal tool, and the findings summarised using a narrative synthesis. RESULTS In total, 18 studies were included in the review. Eight involved evaluations of counselling interventions, three health education and awareness interventions, two social and psychosocial interventions, and five were evaluations of combination interventions. Twelve of the included studies were randomised controlled trials. Of these 14 reported significant outcomes, and 4 further interventions showed partially favourable results. However, interventions mostly targeted women's mental or reproductive health. CONCLUSIONS While the evidence is limited in terms of quality and what has been evaluated, a number of interventions appear to be effective in improving outcomes for women. The three key approaches include the adoption of an active door-to-door and group-based approach; utilisation of community peers who can deliver care cost-effectively and who are more accepted in the community; and the integration of financial vouchers to support uptake in poor populations. PROSPERO REGISTRATION NUMBER CRD42020203472.
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Affiliation(s)
| | | | - Sohail Mujahid
- Department of Sociology, University of Chakwal, Chakwal, Punjab, Pakistan
| | - Muhammad Asim
- Department of Community Health Sciences, Aga Khan University Hospital Clinical Laboratories, Karachi, Federal Capital Territory, Pakistan
| | - Jane Barlow
- Department of Social Policy, University of Oxford, Oxford, UK
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Doering S, Halldner L, Larsson H, Gillberg C, Kuja-Halkola R, Lichtenstein P, Lundström S. Childhood-onset versus adolescent-onset anxiety and depression: Epidemiological and neurodevelopmental aspects. Psychiatry Res 2022; 312:114556. [PMID: 35461120 DOI: 10.1016/j.psychres.2022.114556] [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: 07/04/2021] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
Abstract
Anxiety and depression are common in youth and are frequently accompanied by attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, it is unclear how common ADHD, ASD, and other neurodevelopmental disorders (NDDs, i.e., ADHD, ASD, developmental coordination disorder, learning disorder, and tic disorders) are in children versus adolescents with anxiety and depression. We aimed to delineate whether different anxiety/depression age-of-onset groups show distinguishable NDD patterns. The study was based on 4492 twins born in Sweden between 1998 and 2003 from the nation-wide population-based Child and Adolescent Twin Study in Sweden. Prevalence and odds ratios were calculated using screening measures of anxiety and depression at ages 9 and 15, and NDDs at age 9. Individuals with childhood-onset anxiety/depression had a substantially higher NDD prevalence compared to individuals with adolescent-onset anxiety/depression. Highest prevalence was found for individuals with anxiety/depression both in childhood and adolescence. In this group, individuals also had substantially higher odds of having at least one NDD (14.7, 95% CI 6.3 - 34.0) compared to individuals without anxiety/depression. This emphasizes the need to further investigate the etiology of childhood and adolescent anxiety/depression, as they most likely represent different constructs depending on age-of-onset, lending support for possibly different treatment approaches.
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Affiliation(s)
- Sabrina Doering
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Linda Halldner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Collins J, Horton K, Gale-St Ives E, Murphy G, Barnoux M. A Systematic Review of Autistic People and the Criminal Justice System: An Update of King and Murphy (2014). J Autism Dev Disord 2022:10.1007/s10803-022-05590-3. [PMID: 35637365 DOI: 10.1007/s10803-022-05590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
The purpose of this paper was to determine whether recommendations made by King & Murphy (Journal of Autism and Developmental Disorders 44:2717-2733, 2014) in their review of the evidence on autistic people in contact with the criminal justice system (CJS) have been addressed. Research published since 2013 was systematically examined and synthesised. The quality of 47 papers was assessed using the Mixed Methods Appraisal Tool. Findings suggest a limited amount of good quality research has been conducted that has focused on improving our understanding of autistic people in contact with the CJS since 2013. Methodological limitations make direct comparisons between autistic and non-autistic offenders difficult. Autistic people commit a range of crimes and appear to have unique characteristics that warrant further exploration (i.e., vulnerabilities, motivations for offending).
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Affiliation(s)
- J Collins
- Tizard Centre, University of Kent, Canterbury, CT2 7NF, UK.
| | - K Horton
- Tizard Centre, University of Kent, Canterbury, CT2 7NF, UK
| | - E Gale-St Ives
- Tizard Centre, University of Kent, Canterbury, CT2 7NF, UK
| | - G Murphy
- Tizard Centre, University of Kent, Canterbury, CT2 7NF, UK
| | - M Barnoux
- Tizard Centre, University of Kent, Canterbury, CT2 7NF, UK
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Imran N, Rahman A, Chaudhry N, Asif A. Effectiveness of a school-based mental health intervention for school teachers in urban Pakistan: a randomized controlled trial. Child Adolesc Psychiatry Ment Health 2022; 16:33. [PMID: 35505362 PMCID: PMC9066809 DOI: 10.1186/s13034-022-00470-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schools have a major role in promoting children's physical and psychological health and well-being and the mental health literacy of all key stakeholders, especially teachers, is critical to achieving this goal. Teachers' knowledge and beliefs about psychological problems influence the way they deal with their students' mental health issues. This study is a preliminary investigation evaluating the effectiveness and feasibility of a School Mental Health Programme (SMHP) developed by the World Health Organization's Eastern Mediterranean Regional Office (WHO-EMRO) in improving mental health literacy and self-efficacy among school teachers in an inner-city area of urban Lahore. METHODS Teachers were randomly assigned to 3 days standardized WHO-EMRO School Mental Health Manual based Intervention (n = 118) or to a wait list delayed intervention control group (n = 113). Teachers were assessed pre and post training and at 3 months follow up using measures for mental health literacy (Primary outcome) and self-efficacy. School Heads completed the WHO School Psychosocial Profile and students reported socioemotional skills and psychological problems using Strengths and Difficulties questionnaire at baseline and 3 months post intervention. RESULTS Compared with waitlist group, teachers in intervention group presented a significant increase in mental health literacy (F2,181 = 8.92; P < 0.001), as well as better teacher's self-efficacy in classroom management and student engagement (F2,181 = 16.45; P ≤ 0.000 and F2,181 = 4.65; P ≤ 0.011, respectively). Increase confidence in helping students with mental health problems was also noted in the intervention arm (F2,181 = 15.96 P ≤ 0.000). Improvement in overall school environment was also found. No statistical difference in the emotional and behavioural difficulties in students was noticed at 3 months. CONCLUSION This study is one of the first preliminary investigation of WHO-EMRO school mental health intervention in Pakistan. The study showed that intervention led to significant improvement in mental health literacy and self-efficacy among teachers, which was largely sustained over time. Despite a major limitation of lack of clustering and likely contamination affecting follow up outcomes, the study showed promising results in the context of mental health promotion, prevention and early intervention in schools in Lahore, Pakistan. A larger cluster randomised trial is justified, given the level of participant engagement and acceptability by schools. TRAIL REGISTRATION ClinicalTrials.gov registry (NCT02937714) Registered 13th October 2016, https://register. CLINICALTRIALS gov .
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Affiliation(s)
- Nazish Imran
- Department of Child and Family Psychiatry, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
| | - Atif Rahman
- grid.10025.360000 0004 1936 8470Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Nakhshab Chaudhry
- grid.414714.30000 0004 0371 6979Department of Basic Sciences, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Aftab Asif
- grid.412129.d0000 0004 0608 7688Department of Psychiatry Behavioural Sciences, King Edward Medical University, Lahore, Pakistan
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31
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Lundström S, Taylor M, Larsson H, Lichtenstein P, Kuja-Halkola R, Gillberg C. Perceived child impairment and the 'autism epidemic'. J Child Psychol Psychiatry 2022; 63:591-598. [PMID: 34363395 DOI: 10.1111/jcpp.13497] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of diagnosed Autism Spectrum Disorder (ASD) has increased substantially across the world. Much - or even most - prevalence increase seems to reflect changes in diagnostic practice and ascertainment. A key part of ASD assessment is to document that the relevant symptoms are associated with clinical impairment. The aim of the present study is to capitalize on a nationwide longitudinal study spanning 15 consecutive birth year cohorts in order to investigate whether there has been a secular change in how parents perceive the impairment and suffering conferred by autism symptomatology in their children. METHODS Data came from the Child and Adolescent Twin Study in Sweden (27,240 individuals), where parents had reported on their child's ASD symptoms and impairment. Impairment due to ASD symptoms was regressed on an ASD symptom score across time. This was done for five 3-year birth cohorts (1995-1997, 1998-2000, 2001-2003, 2004-2006, and 2007-2009). RESULTS Reported impairment increased with consecutively later birth cohorts. This was evident across all levels of autism symptomatology. At clinically relevant levels of symptomatology, parents of those born 2007-2009 reported a 23% higher degree of impairment as compared with parents of those born in 1995-1997. The relative difference, however, was even greater at levels that previously would have been considered below the diagnostic threshold. DISCUSSION The results presented here contribute to the notion of a growing diffuseness in the conceptualization of the ASD diagnosis by adding the element of secular changes in the parental perception of the consequences of ASD symptom expression.
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Affiliation(s)
- Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Center for Ethics, Law and Mental health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mark Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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32
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Doering S, Larsson H, Halldner L, Gillberg C, Kuja-Halkola R, Lundström S. Internalizing symptoms in adolescence are modestly affected by symptoms of anxiety, depression, and neurodevelopmental disorders in childhood. BMC Psychiatry 2022; 22:233. [PMID: 35365103 PMCID: PMC8976364 DOI: 10.1186/s12888-022-03875-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/22/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Internalizing disorders, such as anxiety and depressive disorders, are common mental disorders in young people, but a detailed understanding of the symptom continuity from childhood to adolescence that additionally includes a variety of neurodevelopmental disorder (NDD) symptoms is lacking. We therefore aimed to assess the extent to which parent-reported anxiety, depression, and NDD symptoms in childhood predict parent-reported internalizing symptoms in adolescence. METHODS We used the nation-wide population-based Child and Adolescent Twin Study in Sweden, comprising 4492 twins born in Sweden between 1998 and 2003 that were assessed at age 9, and then again at age 15. Linear regression in a structural equation modelling framework was used to analyze the data. RESULTS Overall, our results indicate that 15.9% of the variance in internalizing symptoms at age 15 can be predicted by anxiety, depression, and NDD symptoms at age 9. Anxiety and NDD symptoms in childhood predicted the largest amount of internalizing symptoms in adolescence. CONCLUSIONS Adolescent internalizing symptoms are modestly affected by childhood symptoms of anxiety, depression, and NDDs, suggesting that they may represent different constructs across age. Future studies should further empirically investigate differences in etiology and trajectories of childhood versus adolescent internalizing symptoms.
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Affiliation(s)
- Sabrina Doering
- Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Linda Halldner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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33
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Nilsson G, Lundström S, Fernell E, Gillberg C. Neurodevelopmental problems in children with febrile seizures followed to young school age: A prospective longitudinal community-based study in Sweden. Acta Paediatr 2022; 111:586-592. [PMID: 34717006 DOI: 10.1111/apa.16171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/13/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022]
Abstract
AIM To estimate the accumulated prevalence of neurodevelopmental problems from preschool to school age in children with a history of febrile seizures (FS). METHODS In a community-based cohort of children with previous FS, 25/73 clinically assessed children met diagnostic criteria for neurodevelopmental disorders or had major indications of such problems at the age of 4-5 years. Parents of 54 of the 73 children accepted to take part in an interview according to the Autism-Tics, ADHD and other Comorbidities (A-TAC) inventory, when the children were 9-10 years. RESULTS There was a trend for ADHD symptom scores to be higher in the FS group. Non-participants at age 9-10 years had had much higher rates of neurodevelopmental problems at 4-5 years, and the total number of such problems at either 4-5 or age 9-10 was 41% (30/73). CONCLUSION High rates of neurodevelopmental problems (41%) were found at either age 4-5 or 9-10 years or both in this group of 73 children with FS. Non-participants at 9-10 years had had much higher rates of neurodevelopmental problems at 4-5 years. Further follow-up of this cohort is needed before definite conclusions can be drawn about whether FS should be considered a marker for more complex neurodevelopmental problems.
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Affiliation(s)
- Gill Nilsson
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology Sahlgrenska Academy Gothenburg University Gothenburg Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology Sahlgrenska Academy Gothenburg University Gothenburg Sweden
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Løke D, Løvstad M, Andelic N, Andersson S, Ystrom E, Vassend O. The role of pain and psychological distress in fatigue: a co-twin and within-person analysis of confounding and causal relations. Health Psychol Behav Med 2022; 10:160-179. [PMID: 35173998 PMCID: PMC8843118 DOI: 10.1080/21642850.2022.2033121] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Daniel Løke
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen-Bjornemyr, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen-Bjornemyr, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway
| | - Stein Andersson
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Psychosomatic and CL Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Eivind Ystrom
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Olav Vassend
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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Selinus EN, Durbeej N, Zhan Y, Lichtenstein P, Lundström S, Ekblom M. Inattention and hyperactivity symptoms in childhood predict physical activity in adolescence. BMC Psychiatry 2021; 21:629. [PMID: 34922483 PMCID: PMC8684227 DOI: 10.1186/s12888-021-03603-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity has been documented to influence several aspects of physical and mental health. Growing evidence shows that physical activity can improve attention. Less is known about how symptoms of inattention and hyperactivity / impulsivity in childhood are associated with physical activity in adolescence. We aimed to explore this relationship further. METHODS We used a cohort of 3949 Swedish children (1884 boys and 2065 girls) with data collected at ages 9 (or 12) and 15. We investigated the influence of symptoms of inattention and hyperactivity / impulsivity in childhood - age 9/12 (inattention and hyperactivity/impulsivity separately) on self-rated physical activity at age 15, using multiple logistic regression models. We considered potential confounders such as sex, parental education level, physical activity in childhood and neurodevelopmental comorbidity. A cluster robust sandwich estimator was applied to adjust the standard errors for the nested twin data when computing the regression models. RESULTS Symptoms of inattention in childhood (9/12) predicted less physical activity in adolescence (age 15) (OR = 0.83 CI = 0.78-0.89), whereas the opposite was true for hyperactivity/impulsivity (OR = 1.08 CI = 1.02-1.10). These associations still remained when taking possible confounders into account including neurodevelopmental and neurodevelopmental related comorbidity. CONCLUSIONS These findings support the importance of helping children and adolescents with inattention symptoms to engage in physical activity in suitable settings.
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Affiliation(s)
- Eva Norén Selinus
- Region Vastmanland - Uppsala University, Centre for Clinical Research, Vastmanland Hospital Vasteras, Uppsala, Sweden. .,The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
| | - Natalie Durbeej
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research & Education, Karolinska Institutet & Stockholm County Council, Stockholm, Sweden ,grid.8993.b0000 0004 1936 9457Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Yiqiang Zhan
- German Center for Neurogenerative Diseases, Ulm, Germany ,grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- grid.8761.80000 0000 9919 9582Center for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Göteborg, Sweden ,grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, University of Gothenburg, Göteborg, Sweden
| | - Maria Ekblom
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research & Education, Karolinska Institutet & Stockholm County Council, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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36
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Rensfeldt Flink A, Boström P, Gillberg C, Lichtenstein P, Lundström S, Åsberg Johnels J. Exploring co-occurrence of sensory, motor and neurodevelopmental problems and epilepsy in children with severe-profound intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104114. [PMID: 34689027 DOI: 10.1016/j.ridd.2021.104114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/30/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Severe to profound intellectual disability (SPID) is associated with multiple neurodevelopmental disorders and problems. In the most severe cases, the term profound intellectual and multiple disabilities (PIMD) is used. This study aimed to explore the co-occurring disorders and neurodevelopmental problems in a sample of twins where the proband had SPID. METHOD Within a population-based sample of (30 312) twins, 20 individuals with a national patient register SPID diagnosis were identified. Parent telephone interview data (screening of neurodevelopmental disorders) and register data (APGAR, birth weight, intellectual disabilities, epilepsy, motor and sensory disorders) were gathered for probands and co-twins. RESULTS The 20 individuals with SPID all had between one and five additional disorders or problems, with autistic traits, motor problems and epilepsy being the most common. Clear discordance was found for ID and all additional disorders and problems between probands with SPID and their non-SPID co-twins. CONCLUSION Children with SPID almost never present without neurodevelopmental and/or sensory and/or motor comorbidities. This heterogeneity should be reflected in clinical routine and in research targeting individuals with SPID. The results support a previously suggested conceptualization of a S/PIMD "spectrum". Autism may be considered for inclusion in future elaborations of such a S/PIMD spectrum.
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Affiliation(s)
- Anna Rensfeldt Flink
- Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden; Habilitation and Health, Region Västra Götaland, Gothenburg, Sweden.
| | - Petra Boström
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | | | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Jakob Åsberg Johnels
- Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden; Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
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37
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Reed ZE, Larsson H, Haworth CMA, Rai D, Lundström S, Ronald A, Reichenberg A, Lichtenstein P, Davis OSP. Mapping the genetic and environmental aetiology of autistic traits in Sweden and the United Kingdom. JCPP ADVANCES 2021; 1:e12039. [PMID: 35992618 PMCID: PMC9379966 DOI: 10.1002/jcv2.12039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background Autistic traits are influenced by both genetic and environmental factors, and are known to vary geographically in prevalence. But to what extent does their aetiology also vary from place to place? Methods We applied a novel spatial approach to data on autistic traits from two large twin studies, the Child and Adolescent Twin Study in Sweden (CATSS; N = 16,677, including 8307 twin pairs) and the Twins Early Development Study in the UK (TEDS; N = 11,594, including 5796 twin pairs), to explore how the influence of nature and nurture on autistic traits varies from place to place. Results We present maps of gene‐ and environment‐ by geography interactions in Sweden and the United Kingdom (UK), showing geographical variation in both genetic and environmental influences across the two countries. In Sweden genetic influences appear higher in the far south and in a band running across the centre of the country. Environmental influences appear greatest in the south and north, with reduced environmental influence across the central band. In the UK genetic influences appear greater in the south, particularly in more central southern areas and the southeast, the Midlands and the north of England. Environmental influences appear greatest in the south and east of the UK, with less influence in the north and the west. Conclusions We hope this systematic approach to identifying aetiological interactions will inspire research to examine a wider range of previously unknown environmental influences on the aetiology of autistic traits. By doing so, we will gain greater understanding of how these environments draw out or mask genetic predisposition and interact with other environmental influences in the development of autistic traits.
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Affiliation(s)
- Zoe E. Reed
- MRC Integrative Epidemiology Unit University of Bristol Bristol UK
- Department of Population Health Sciences Bristol Medical School University of Bristol Bristol UK
| | - Henrik Larsson
- School of Medical Sciences Örebro University Örebro Sweden
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Solna Sweden
| | - Claire M. A. Haworth
- National Institute for Health Research Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and the University of Bristol Bristol UK
- School of Psychological Science University of Bristol Bristol UK
- The Alan Turing Institute London UK
| | - Dheeraj Rai
- Department of Population Health Sciences Bristol Medical School University of Bristol Bristol UK
- National Institute for Health Research Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and the University of Bristol Bristol UK
- Avon and Wiltshire Partnership NHS Mental Health Trust Bath UK
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre Centre for Ethics, Law and Mental Health University of Gothenburg Gothenburg Sweden
| | - Angelica Ronald
- Department of Psychological Sciences Birkbeck, University of London London UK
| | - Abraham Reichenberg
- Department of Psychiatry and Seaver Autism Center for Research and Treatment Ichan School of Medicine at Mount Sinai New York City New York USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Solna Sweden
| | - Oliver S. P. Davis
- MRC Integrative Epidemiology Unit University of Bristol Bristol UK
- Department of Population Health Sciences Bristol Medical School University of Bristol Bristol UK
- National Institute for Health Research Biomedical Research Centre University Hospitals Bristol NHS Foundation Trust and the University of Bristol Bristol UK
- The Alan Turing Institute London UK
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38
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Bourke EM, Say DF, Carison A, Hill A, Craig S, Hiscock H, Babl FE, O'Donnell SM. Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder. J Paediatr Child Health 2021; 57:1572-1579. [PMID: 33963626 DOI: 10.1111/jpc.15535] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/13/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
AIM To characterise the key features and management of young people presenting to the emergency department (ED) with a mental health (MH) complaint and a known diagnosis of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD). METHODS Retrospective review of all ED MH presentations in children aged 7-17 years, presenting over a 12-month period from the 1st of January 2018 to the 31st of December 2018, to the Royal Children's Hospital in Melbourne, Australia. Univariate analyses were carried out to examine the relationship between an underlying diagnosis of ASD and/or ADHD and a number of key presentation variables. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for ED management outcomes. RESULTS There were 374 presentations in this cohort, representing 28% of the total MH presentations in 2018. The most common reason for presentation was acute severe behavioural disturbance. Young people with ASD and ADHD were at increased risk of having an acute crisis team response activated (ASD RR 2.3, CI 1.6-3.3, ADHD RR 2.2, CI 1.2-4.1). Compared to those without either diagnosis, young people with ASD were more likely to be physically restrained (RR 2.8, CI 1.7-4.6), managed in seclusion (RR 3.3, CI 1.7-6.4) and to receive medication to assist with behavioural de-escalation (RR 2.8, CI 1.6-4.9). CONCLUSIONS Children with ASD and/or ADHD represent one-quarter of all children presenting to the ED with MH complaints. They experience high rates of acute severe behavioural disturbance. Future research is needed to co-design, implement and evaluate better approaches for their management.
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Affiliation(s)
- Elyssia M Bourke
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Daniela F Say
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anna Carison
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ashley Hill
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Simon Craig
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Health Services Research Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.,Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Sinead M O'Donnell
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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Satisfaction with in-patient child and adolescent psychiatric treatment: development and psychometric properties of the BEST questionnaires for adolescents and for parents. Child Adolesc Psychiatry Ment Health 2021; 15:46. [PMID: 34481525 PMCID: PMC8418705 DOI: 10.1186/s13034-021-00395-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/12/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Interest in the assessment of patient satisfaction with in-patient psychiatric treatment has steadily increased and several measurement tools are available for the quantification of patients' experience. However, they are often uni-dimensional or focus mainly on therapeutic relationship and environment, and neglect other important issues such as information about treatment and participation. The BEST questionnaires were developed as comprehensive instruments that include items on all of the mentioned topics. The present study evaluates the psychometric properties of the BEST in a version for adolescents and for parents. Furthermore, the dimensionality of the satisfaction ratings is analyzed. METHOD Descriptive statistics were applied to data of 1582 adolescents (mean age = 15.0 years, SD = 1.65; 62.4% female) and 1998 parents/guardians assessed in seven in-patient units across Germany. The factorial structure of the BEST questionnaires was determined by exploratory and confirmatory factor analyses, including a bifactor model. RESULTS The psychometric quality of the scales was strong. Correlations with another assessment instrument of patient satisfaction were good to high, indicating good convergent validity. Exploratory factor analyses revealed three factors in adolescents that were labelled as: Therapeutic relationship, environment, and general satisfaction and treatment success. For parents, the same three factors could be distinguished. Confirmatory bifactor models suggested that the vast majority of variance was accounted for by the general factor; the three specific factors provided some additional information. Agreement between the subscales of adolescents and their parents was only moderate. Parents were usually more satisfied. CONCLUSIONS The BEST questionnaires can be considered as reliable and valid instruments to not only assess the "classical" aspects of patient satisfaction, but to also assess newer fundamental topics such as children's rights and treatment participation. For scientific usage, the total score seems superior because of the high explained variance by the general factor, but the subscale scores provide further information. The use of single items seems advantageous for quality management purposes.
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Brimo K, Dinkler L, Gillberg C, Lichtenstein P, Lundström S, Åsberg Johnels J. The co-occurrence of neurodevelopmental problems in dyslexia. DYSLEXIA (CHICHESTER, ENGLAND) 2021; 27:277-293. [PMID: 33759268 DOI: 10.1002/dys.1681] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 01/13/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
The primary aim of this study was to explore the overlaps between dyslexia and a range of neurodevelopmental disorders and problems (NDPs), specifically symptoms of attention-deficit/hyperactivity disorder, autism spectrum disorder, atypical sensory perception and developmental coordination disorder. Capitalizing on a population-based sample of twins, secondary aims included estimating the heritability of dyslexia and reporting on the measurement characteristics of the scale used to assess dyslexia. A telephone interview regarding symptoms of dyslexia and other NDPs was conducted with parents of 1,688 nine-year-old twins. The prevalence and the heritability of dyslexia were estimated at 8 and 52%, respectively. The boy: girl ratio was 1.5:1. Results revealed that there was more than an eight-fold increase in (diagnostic proxy) NDPs prevalence in the dyslexia group as compared to typical readers. Quantitatively measured symptoms of inattention, oral language problems and atypical sensory perception significantly predicted dyslexia status in a multivariate analysis. By contrast, ASD-related inflexibility was inversely associated with dyslexia in the multivariate model. In sum, dyslexia often overlaps with other NDPs. The current study provides new knowledge supporting the position to move beyond isolated diagnostic categories into behavioural profiles of co-occurring problems when trying to understand the pattern of strengths and needs in individuals with dyslexia.
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Affiliation(s)
- Katarzyna Brimo
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Jakob Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Speech and Language Pathology unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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41
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Baraskewich J, von Ranson KM, McCrimmon A, McMorris CA. Feeding and eating problems in children and adolescents with autism: A scoping review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1505-1519. [PMID: 33653157 PMCID: PMC8323334 DOI: 10.1177/1362361321995631] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
LAY ABSTRACT Feeding problems, such as picky eating and food avoidance, are common in youth with autism. Other, broader difficulties with feeding and eating (eating disorder symptoms such as restricting food intake or preoccupation with body shape or weight and insistence on specific food presentation) are also common in autistic individuals. Here, we describe the nature and extent of feeding and eating problems in youth with autism. We found no common characteristics (such as severity of autism symptoms) that best describe autistic youth who experience problems with feeding or eating. Almost all studies we reviewed focused on problems with feeding (selective or picky eating), and only a few studies focused on eating disorder symptoms (concern with weight, shape, and/or body image). However, some researchers reported that eating disorder symptoms may occur more often in autistic individuals compared to their peers without autism. Many studies used the terms "feeding" and "eating" problems interchangeably, but understanding the difference between these problems is important for researchers to be consistent, as well as for proper identification and treatment. We suggest future researchers use "eating problems" when behaviors involve preoccupation with food, eating, or body image, and "feeding problems" when this preoccupation is absent. We highlight the importance of understanding whether feeding or eating problems are separate from autism traits, and the role of caregivers and other adults in the child's treatment. Considerations for health-care providers to assist with diagnosis and treatment are also provided.
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Affiliation(s)
- Jessica Baraskewich
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
| | - Kristin M von Ranson
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
| | - Adam McCrimmon
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
| | - Carly A McMorris
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
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Slob EMA, Brew BK, Vijverberg SJH, Dijs T, van Beijsterveldt CEM, Koppelman GH, Bartels M, Dolan CV, Larsson H, Lundström S, Lichtenstein P, Gong T, Maitland-van der Zee AH, Kraneveld AD, Almqvist C, Boomsma DI. Early-life antibiotic use and risk of attention-deficit hyperactivity disorder and autism spectrum disorder: results of a discordant twin study. Int J Epidemiol 2021; 50:475-484. [PMID: 33179025 PMCID: PMC8248483 DOI: 10.1093/ije/dyaa168] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background Development of the gut-brain axis in early life may be disturbed by
antibiotic use. It has been hypothesized that this disturbance may
contribute to development of neurodevelopmental disorders, including autism
spectrum disorder and attention-deficit hyperactivity disorder. We aimed to
assess the association between antibiotic use in early life and the risk of
developing attention-deficit hyperactivity disorder or autism spectrum
disorder, while controlling for shared genetic and environmental factors in
a discordant twin design. Methods We conducted a cohort study in twins (7–12 years;
25 781 twins) from the Netherlands Twin Register (NTR) and a
replication study in the Childhood and Adolescent Twin Study in Sweden
(CATSS; 7946 9-year-old twins). Antibiotic use was recorded before age 2
years. Attention-deficit hyperactivity disorder and autism spectrum disorder
were parent-reported in the Netherlands Twin Register and register-based in
the Childhood and Adolescent Twin Study in Sweden. Results Early-life antibiotic use was associated with increased risk of
attention-deficit hyperactivity disorder development [pooled odds ratio (OR)
1.10, 95% confidence interval (CI) 1.02-1.17] and autism spectrum
disorder (pooled OR 1.15, 95% CI 1.06-1.25) in a case-control
design. When restricting to monozygotic twin pairs discordant for the
outcome, associations disappeared for both disorders in both cohorts
(attention-deficit hyperactivity disorder OR 0.90, 95% CI 0.48-1.69
and OR 0.80, 95% CI 0.37-1.76, and autism spectrum disorder OR 0.66,
95% CI 0.38-1.16 and OR 0.29, 95% CI 0.02-4.50,
respectively). Conclusions Our findings suggest that the association between early-life antibiotic use
and risk of attention-deficit hyperactivity and autism spectrum disorder may
be confounded by shared familial environment and genetics.
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Affiliation(s)
- Elise M A Slob
- Department of Respiratory Medicine, Amsterdam University Medical Centers, DE Amsterdam, The Netherlands.,Department of Paediatric Pulmonology, Amsterdam University Medical Centers, DE Amsterdam, The Netherlands
| | - Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health & Department of Women's and Children's Health, UNSW, Sydney, NSW, Australia
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Amsterdam University Medical Centers, DE Amsterdam, The Netherlands.,Department of Paediatric Pulmonology, Amsterdam University Medical Centers, DE Amsterdam, The Netherlands
| | - Talitha Dijs
- Department of Respiratory Medicine, Amsterdam University Medical Centers, DE Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Gerard H Koppelman
- Department of Paediatric Pulmonology & Paediatric Allergology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma & COPD (GRIAC), University Medical Center Groningen, Groningen, The Netherlands
| | - Meike Bartels
- Department of Biological Psychology, Netherlands Twin Register, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Conor V Dolan
- Department of Biological Psychology, Netherlands Twin Register, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anke H Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Centers, DE Amsterdam, The Netherlands.,Department of Paediatric Pulmonology, Amsterdam University Medical Centers, DE Amsterdam, The Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Paediatric Allergy and Pulmonology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Dorret I Boomsma
- Department of Biological Psychology, Netherlands Twin Register, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Virtanen S, Kuja-Halkola R, Lundström S, D'Onofrio BM, Larsson H, Suvisaari J, Mataix-Cols D, Lichtenstein P, Latvala A. Longitudinal Associations of Childhood Internalizing Psychopathology With Substance Misuse: A Register-Based Twin and Sibling Study. J Am Acad Child Adolesc Psychiatry 2021; 60:593-603. [PMID: 32621868 DOI: 10.1016/j.jaac.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/07/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The pathways from internalizing psychopathology to substance misuse remain largely unclear. We estimated associations between childhood internalizing problems and subsequent substance misuse in 2 family-based samples. We also investigated sex differences and the role of externalizing comorbidity. METHOD We studied associations of childhood internalizing psychopathology with register-based substance misuse after age 13 years. Sample 1 included all individuals born in Sweden from 1984 to 2000 (N = 1,768,516). Depressive and anxiety disorders were included as register-based International Classification of Diseases Ninth Revision (ICD-9) or Tenth Revision (ICD-10) diagnoses before age 13. Sample 2 was a subsample within the population sample, the Child and Adolescent Twin Study in Sweden (CATSS) twin cohort (n = 12,408; born 1992-1998), with mood and anxiety problems assessed at age 9/12 by parents. In both samples, substance misuse was defined as an ICD-9/10 alcohol/drug use disorder or an alcohol/drug-related criminal conviction until December 2013. To account for familial effects, stratified analyses were conducted within siblings and twin pairs. RESULTS In the population sample, both depressive (hazard ratio [HR] = 2.75, 95% CI = 2.36-3.20) and anxiety disorders (HR = 1.52, 95% CI = 1.35-1.73) were associated with substance misuse. Childhood mood problems (HR = 2.28, 95% CI = 1.69-3.08) were associated with substance misuse in the CATSS sample. The associations were partially explained by familial factors, and comorbid externalizing disorders explained the associations in men but not in women. CONCLUSION Childhood mood problems were associated with substance misuse, but familial factors shared by siblings partially explained the associations. The relationship of anxiety with substance misuse was complex and depended on measurement and the type of anxiety disorder. Internalizing problems may be especially important for substance misuse risk in women.
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Affiliation(s)
- Suvi Virtanen
- Institute of Criminology and Legal Policy, University of Helsinki, Finland; Karolinska Institutet, Stockholm, Sweden.
| | | | | | - Brian M D'Onofrio
- Karolinska Institutet, Stockholm, Sweden; Indiana University, Bloomington
| | - Henrik Larsson
- Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Sweden
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Helsinki, Finland
| | - David Mataix-Cols
- Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | | | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Finland; Karolinska Institutet, Stockholm, Sweden
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44
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Taylor MJ, Ronald A, Martin J, Lundström S, Hosang GM, Lichtenstein P. Examining the association between childhood autistic traits and adolescent hypomania: a longitudinal twin study. Psychol Med 2021; 52:1-10. [PMID: 33827724 DOI: 10.1017/s0033291721000374] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is evidence that autism spectrum disorders (ASDs) co-occur with bipolar disorder (BD) relatively frequently. Individuals with BD often report symptoms of mania and hypomania during adolescence, prior to the age of onset for BD. It is unknown whether these symptoms are associated with ASDs. We examined whether diagnoses of ASDs and autistic traits were associated with hypomania in a large, population-based Swedish twin sample. METHODS Parental structured interviews assessed autistic traits, and were used to assign screening diagnoses of ASDs, when twins were aged 9 or 12 (N = 13 533 pairs). Parents then completed questionnaires assessing hypomania when the twins were aged 15 and 18 (N = 3852 pairs at age 15, and 3013 pairs at age 18). After investigating the phenotypic associations between these measures, we used the classical twin design to test whether genetic and environmental influences on autistic traits influence variation in adolescent hypomania. RESULTS Autistic traits and ASD diagnoses in childhood were associated with elevated scores on the measures of adolescent hypomania. Twin analyses indicated that 6-9% of the variance in hypomania was explained by genetic influences that were shared with autistic traits in childhood. When repeating these analyses for specific autistic trait domains, we found a stronger association between social interaction difficulties and hypomania than for other autistic trait domains. CONCLUSIONS These results indicate a genetic link between autistic traits and hypomania in adolescence. This adds to the growing evidence base of genetic factors associated with ASDs showing links with psychiatric outcomes across childhood and into adulthood.
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Affiliation(s)
- Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Angelica Ronald
- Genes Environment Lifespan Laboratory, Department of Psychological Science, Centre for Brain and Cognitive Development, University of London, Birkbeck, UK
| | - Joanna Martin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
- Centre for Ethics, Law and Mental Health, University of Gothenburg, Gothenburg, Sweden
| | - Georgina M Hosang
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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45
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Doering S, Lichtenstein P, Gillberg C, Kuja-Halkola R, Lundström S. Internalizing and neurodevelopmental problems in young people: Educational outcomes in a large population-based cohort of twins. Psychiatry Res 2021; 298:113794. [PMID: 33596506 DOI: 10.1016/j.psychres.2021.113794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/04/2021] [Indexed: 01/20/2023]
Abstract
Adolescent internalizing problems such as anxiety and depression have been associated with subsequent educational underachievement. However, it has not been investigated if the association is accounted for by neurodevelopmental disorders (NDDs, i.e., attention-deficit/hyperactivity disorder, autism spectrum disorder, developmental coordination disorder, tic disorder, learning disorder). This study is the first to describe the relationship between internalizing problems at age 15 and educational outcomes in later adolescence while controlling for a wide range of NDDs in childhood, and applying a genetically sensitive design. We used the nation-wide population-based Child and Adolescent Twin Study in Sweden, comprising 4997 fifteen-year-old Swedish twins born between 1994 and 1998. Internalizing problems and NDDs were measured with parental report. Educational outcomes were merit rating and upper secondary education eligibility, retrieved from the National School Register. Internalizing problems at age 15 were found to be negatively associated with educational outcomes in later adolescence. Additive genetics accounted for 89% of the covariation between internalizing problems and merit rating, out of which roughly half were unique genetic effects of internalizing problems and the remaining half due to NDDs. In conclusion, internalizing problems form an important risk factor for subsequent educational underachievement, going beyond the risk conferred by childhood NDDs.
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Affiliation(s)
- Sabrina Doering
- Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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46
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Dinkler L, Taylor MJ, Råstam M, Hadjikhani N, Bulik CM, Lichtenstein P, Gillberg C, Lundström S. Anorexia nervosa and autism: a prospective twin cohort study. J Child Psychol Psychiatry 2021; 62:316-326. [PMID: 32496594 DOI: 10.1111/jcpp.13265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) and autism spectrum disorder (ASD) may be phenotypically and etiologically linked. However, due to the absence of prospective studies, it remains unclear whether the elevation of autistic traits in AN is evident in early childhood. Here, we prospectively investigated autistic traits before and after the first diagnosis of AN. METHODS In a population-based sample of 5,987 individuals (52.4% female) from the Child and Adolescent Twin Study in Sweden, parents reported autistic traits at ages 9 and 18. AN and ASD diagnoses were retrieved from the Swedish National Patient Register. In addition, AN diagnoses were ascertained by parent-reported treatment for AN. We compared whether individuals with and without AN differed in autistic traits before the first diagnosis of AN (age 9) and after the first diagnosis of AN (age 18). RESULTS We did not find evidence for elevated autistic traits in 9-year-old children later diagnosed with AN. At age 18, however, there was a marked elevation in restricted/repetitive behavior and interests, but only in the subgroup of individuals with acute AN. A less pronounced elevation was observed for social communication problems. CONCLUSIONS Coping strategies in individuals with ASD and the somewhat different female ASD phenotype may explain why we did not find elevated autistic traits in children who later developed AN. Alternatively, it is possible that elevated autistic traits were not present prior to the onset of AN, thus questioning the previously reported elevated prevalence of ASD in AN. Future studies should use tailored measurements in order to investigate whether autistic traits in individuals with AN are best conceptualized as an epiphenomenon of the acute AN phase or whether these symptoms indeed represent ASD as a clinically verifiable neurodevelopmental disorder.
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Affiliation(s)
- Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Råstam
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Nouchine Hadjikhani
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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47
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Gajwani R, Dinkler L, Lundström S, Lichtenstein P, Gillberg C, Minnis H. Mania symptoms in a Swedish longitudinal population study: The roles of childhood trauma and neurodevelopmental disorders. J Affect Disord 2021; 280:450-456. [PMID: 33242716 DOI: 10.1016/j.jad.2020.10.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/13/2020] [Accepted: 10/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adult psychiatric disorders are associated with both childhood traumatic experiences (CTEs) and neurodevelopmental disorders (NDDs). CTEs and NDDs frequently co-occur in childhood, but their combined risk effect on the emergence of juvenile mania symptoms has not yet been examined. METHODS In a population-representative Swedish twin study, CTEs and NDDs were assessed in 3,348 nine-year old twins born between 1998 and 2001, and treated as dichotomous predictors (any CTEs, any NDDs). Follow-up data were gathered at age 15 through parental reports of mania symptoms, yielding a symptom count score. RESULTS Both CTEs and NDDs at age 9 contributed uniquely to an increase in mania symptoms at age 15. Children with both risk factors had 1.6 times the rate of mania symptoms as children with CTEs-only (Incidence rate ratio [IRR] 1.63, 95% CI 1.37-1.93), and 1.3 times the rate of mania symptoms as children with NDDs-only (IRR 1.26, 95% CI 1.06-1.50). There was no evidence for an interactive effect of CTEs and NDDs. NDDs showed a trend towards having a larger effect on mania symptoms than CTEs (NDDs-only vs. CTEs-only: IRR 1.29, 95% CI 0.99-1.68). LIMITATIONS Although it is a strength of the study that the data on exposures and outcome were collected prospectively, parental recall of CTEs was required and CTEs may be under-reported. CONCLUSIONS NDDs are at least as important as CTEs in the development of mania symptoms, and their risk is additive. Those with a history of both CTEs and NDDs should be monitored closely for the development of more severe psychiatric presentations.
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Affiliation(s)
- Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Christopher Gillberg
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
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48
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Johansson V, Norén Selinus E, Kuja-Halkola R, Lundström S, Durbeej N, Anckarsäter H, Lichtenstein P, Hellner C. The Quantified Behavioral Test Failed to Differentiate ADHD in Adolescents With Neurodevelopmental Problems. J Atten Disord 2021; 25:312-321. [PMID: 30024318 DOI: 10.1177/1087054718787034] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The Quantified Behavioral Test (QbTest) is a computerized diagnostic test for ADHD, used in clinical psychiatric care, but its validity may be questioned. We analyzed the QbTest's diagnostic validity and its relation to cognitive ability and psychosocial factors in an adolescent population with a high occurrence of neurodevelopmental disorders. Method: In total, 340 participants aged 15 years, completed the QbTest, along with questionnaires, clinical and intelligence quotient (IQ) assessments. Results: The clinical assessment resulted in 89 (26%) participants with ADHD. Area under curve (AUC) scores indicated a random to poor validity of the QbTest (AUC range = 0.48-0.64). QbTest scores of inattention and impulsivity correlated with IQ. Conclusion: The QbTest was insufficient as a diagnostic test for ADHD, and was not able to differentiate ADHD from other neurodevelopmental conditions. Clinicians should be aware of the dubious discriminating power of the QbTest.
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Affiliation(s)
- Viktoria Johansson
- Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Sweden
| | - Eva Norén Selinus
- Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Sweden
| | | | | | - Natalie Durbeej
- Karolinska Institutet, Stockholm, Sweden.,Uppsala University, Sweden
| | | | | | - Clara Hellner
- Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Sweden
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Kaltenegger HC, Doering S, Gillberg C, Wennberg P, Lundström S. Low prevalence of risk drinking in adolescents and young adults with autism spectrum problems. Addict Behav 2021; 113:106671. [PMID: 33080544 DOI: 10.1016/j.addbeh.2020.106671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/07/2020] [Accepted: 09/19/2020] [Indexed: 12/28/2022]
Abstract
Individuals with Autism Spectrum Disorder (ASD) have high rates of "comorbidity". Research on concurrent substance use (disorder) in ASD, however, is scarce and findings have been inconsistent. This study aims at assessing the prevalence of risk drinking in adolescent and young adult twins with and without autism spectrum problems. Data from a Swedish longitudinal nationwide twin study were analyzed. Across three age groups of 15- (N = 10,050), 18- (N = 7,931) and 24-year-olds (N = 2,882) prevalence rates of risk drinking were compared between twins with and without an ASD proxy diagnosis and between different ASD subgroups based on comorbid proxies for attention-deficit/hyperactivity disorder (ADHD) and/or Learning Disorder (LD). ASD, ADHD, and LD were assessed using the Autism-Tics, ADHD, and other Comorbidities inventory (A-TAC), and risk drinking was captured by the Alcohol Use Disorders Identification Test (AUDIT; age 18 and 24) and another set of self-report questions (age 15). In each age group, the prevalence of risk drinking in ASD was lower than in individuals without ASD, yet increasing continuously with age. Exploratory subgroup ASD analyses showed a trend towards risk drinking being more common among individuals with co-existing ADHD or LD problems than among those without "comorbidity", although sample sizes were too small to draw any certain conclusions. This study indicates low prevalence of risk drinking in adolescents and young adults with autism spectrum problems and highlights the need for further research on alcohol use in individuals with ASD and comorbid disorders.
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Hirvikoski T, Lajic S, Jokinen J, Renhorn E, Trillingsgaard A, Kadesjö B, Gillberg C, Borg J. Using the five to fifteen-collateral informant questionnaire for retrospective assessment of childhood symptoms in adults with and without autism or ADHD. Eur Child Adolesc Psychiatry 2021; 30:1367-1381. [PMID: 32710229 PMCID: PMC8440248 DOI: 10.1007/s00787-020-01600-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 07/08/2020] [Indexed: 11/25/2022]
Abstract
Due to lack of previous studies, we aimed at evaluating the use of the Five to Fifteen (FTF) questionnaire in adults with neurodevelopmental disorders (NDD) and in controls without NDD. The NDD group consisted of adults with autism spectrum disorder ASD (n = 183) or attention-deficit/hyperactivity disorder (ADHD) (n = 174) without intellectual disability, recruited from a tertiary outpatient clinic. A web survey was used to collect data from general population adult control group without NDD (n = 738). The participants were retrospectively rated by their parents regarding childhood symptoms, using five to fifteen-collateral informant questionnaire (FTF-CIQ). Adults with NDD had higher FTF-CIQ domain and subdomain scores than controls, and displayed similar test profiles as children with corresponding diagnosis in previous studies. Based on the FTF-CIQ domain scores, 84.2% of the study participants (93% of the controls; 64% of the adults with NDD) were correctly classified in a logistic regression analysis. Likewise, Receiver Operating Characteristic (ROC) curve analysis on FTF-CIQ total sum score indicated that a cut-off value of 20.50 correctly classified 90% of the controls and 67% of the clinical cases, whilst a cut-off value of 30.50 correctly classified 84% of the controls and 77% of the clinical cases. The factor analysis revealed three underlying components: learning difficulties, cognitive and executive functions; social skills and emotional/behavioural symptoms; as well as motor and perceptual skills. Whilst not designed as a diagnostic instrument, the FTF-CIQ may be useful for providing information on childhood symptoms and associated difficulties in individuals assessed for NDD as adults.
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Affiliation(s)
- Tatja Hirvikoski
- Pediatric Neuropsychiatry Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
- Habilitation and Health, Region Stockholm, Stockholm, Sweden.
- Center for Psychiatry Research, Region Stockholm, Stockholm, Sweden.
- Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), CAP Research Center, Gävlegatan 22B, 11330, Stockholm, Sweden.
| | - S Lajic
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska InstitutetKarolinska University Hospital, Stockholm, Sweden
| | - J Jokinen
- Center for Psychiatry Research, Region Stockholm, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E Renhorn
- Pediatric Neuropsychiatry Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Habilitation and Health, Region Stockholm, Stockholm, Sweden
| | | | - B Kadesjö
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - C Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Borg
- Center for Psychiatry Research, Region Stockholm, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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