Semantic decisions in adolescents with autism spectrum disorders - functional magnetic resonance imaging study

OBJECTIVES

Goal: to assess fMRI activation during semantic tasks in adolescents with ASD.

METHODS

Material: 44 right-handed male adolescents aged 12-19 (mean 14.3 ± 2.0) - 31 with autism spectrum disorders who met DSM-IV-TR criteria for Asperger's syndrome and 13 neurotypical adolescents matched according to age and handiness. Method: Functional testing (fMRI) was performed during semantic decisions tasks and phonological decisions in three categories of tasks: concrete nouns, verbs with plural meanings, words describing states of mind, as a control condition. Statistical analyzes were performed at the level of p <0.05 with FWE (family-wise error) correction and p <0.001.

RESULTS

Results: lower BOLD signal was demonstrated in many brain areas including precuneus, posterior cingulate gyrus, angular gyrus, parahippocampal gyrus, regardless of task category and processing method in the ASD group. The smallest differences in semantic processing were found for concrete nouns and the greatest ones for words describing states of mind.

CONCLUSIONS

Conclusions: the presence of different activation patterns in the ASD group suggests that far more than just the areas traditionally attributed to language processing, are involved in semantic deficits in ASD.

Attachment in adolescents with attention deficit hyperactivity disorder and oppositional defiant disorder

OBJECTIVES

To assess attachment styles among adolescents (13-16 years) with ADHD or ADHD and oppositional defiant disorders (ODD).

METHODS

The Parents and Peers Attachment (IPPA) and the Parent Bonding Questionnaire (PBI) were used in three groups of teenagers raised in biological families: (1) ADHD/ODD group (n = 40), (2) ADHD group (n = 40) and (3) K (control) group of teenagers (n = 40) who have not benefited from psychological or psychiatric care in the past or at present.

RESULTS

Parental attachment styles in the area of "Trust", "Communication" and "Alienation" (IPPA), and "Care" and "Control" (PBI) in the ADHD/ODD group differ significantly compared to the control group. Teens from the ADHD/ODD group report to have experienced significantly less "Trust" and "Communication" (IPPA), and "Care" (PBI) in relationships with parents and more "Alienation" (IPPA) and "Control" (PBI) than adolescents in the ADHD group. Attachment patterns with peers in both clinical and control groups differ significantly. The ADHD/ODD group is dominated by the anxious-avoidant style of attachment to the mother and father, in the ADHD group, a secure style in relation to the mother and anxious-avoidant in relation to the father. In relations with peers in the ADHD/ODD group and the ADHD group, the anxious-avoidant style dominates.

CONCLUSIONS

The attachment style is significantly different in adolescents diagnosed with ADHD and ODD than in adolescents with only ADHD. In the ADHD/ODD group and the ADHD group, unlike in the group of adolescents without a psychiatric diagnosis, insecure attachment styles for parents and peers dominate (mainly anxious-avoidant style).

Assessment of criterion validity of personality disorder diagnosis in adolescents and relations between attachment style and personality disorder diagnosis

OBJECTIVES

Assessment of criterion validity and temporal stability of personality disorder diagnosis in adolescents and relationships between attachment styles and personality disorder diagnosis.

METHODS

50 adolescents (46 girls and 4 boys, aged 15-17) hospitalized at the department of child and adolescent psychiatry were assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) and the Inventory of Parent and Peer Attachment (IPPA). After one year, adolescents meeting the criteria for apersonality disorder (PD) diagnosis were reassessed with the SCID-II.

RESULTS

In the first stage of assessment, diagnostic criteriafor different types of personality disorders were met by 41 adolescents (82%) (mean number of criteria = 5.9). Criteria were met most often for borderline personality disorder (BPD) (n = 26; mean number of criteria = 7.9). In the second stage of assessment, the interview was re-administered to 21 (51%) adolescents; the mean number of criteria was = 6.6. A statistically significant relationship between the number of PD diagnostic criteria in assessment one and the number of criteria in assessment two was obtained (r = 0.58; p < 0.01). 82% of the participants with PD were insecurely attached to their mothers. In the borderline group, 83% of the participants reported anxious-avoidant attachment style.

CONCLUSIONS

PD traits in adolescence, specifically BPD, are stable across one year.

Theory of Mind deficits in childhood mental and neurodevelopmental disorders

Theory of mind (ToM) is a complex cognitive mechanism which refers to our ability to understand that other people have beliefs, plans, desires, hopes, intentions, and knowledge that may differ from our own mental and emotional states. Theory of mind is critical for social and interpersonal functioning and allows people to make sense of other's behavior. Theinitial aim of theory of mind research was to record normative development in preschool age children. Almost 30 years ago, when researchers discovered that theory of mind is altered in individuals with autism spectrum disorder, they also explored impairments in ToM in different clinical disorders. Research results indicate the presence of ToM deficits in childhood mental and neurodevelopmental disorders, such as: autism spectrum disorders, attention deficit hyperactivity disorder, oppositional defiant disorder, Gilles de la Tourette Syndrome, fetus alcohol syndrome, mood disorders, eating disorders, or obsessive-compulsive disorder. This article reviews significant studies of theory of mind impairments in individual childhood disorders and selected mental disorders.

The Occurrence of Overweight and Obesity in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder According to Three Different Diagnostic Criteria for Obesity

Objective: This study aimed to assess the prevalence of overweight and obesity in the group of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) according to three different diagnostic criteria for obesity. The effect of ADHD treatment on the risk of obesity was controlled. Materials and Methods: The study group consisted of 58 subjects aged from 8 to 17 years with ADHD. Control group consisted of 62 healthy age- and sex-matched children and adolescents. Overweight and obesity were assessed according to International Obesity Task-Force (IOTF), World Health Organization (WHO) and European Childhood Obesity Group (ECOG) criteria. Results: There was a significantly higher incidence of obesity in ADHD group according to WHO (ADHD vs. Control: 17.2% vs. 3.2%, p = 0.01) and IOTF criteria (ADHD vs. Control: 10.3% vs. 1.6%, p = 0.04), but no significant difference according to ECOG criteria. There was significantly higher occurrence of overweight (20.7% vs. 12.8%, p < 0.001), obesity (10.3% vs. 3.5%, p < 0.001), and overweight and obesity (31.0% vs. 16.3%, p < 0.001) in the ADHD group compared to the Polish population. The analysis did not show a statistically significant relationship between the amount of taken psychostimulant and the occurrence of overweight and obesity. Conclusions: The prevalence of overweight and obesity in the group of ADHD children and adolescents varies depending on the choice of diagnostic criteria. At the same time, it is significantly more frequent than in the general population. We suggest that future studies should give a clear rationale for the selection of cutoff points to minimize errors that could confound data analysis and interpretation.

The role of factors associated with the course of pregnancy and childbirth in attention deficit hyperactivity disorder (ADHD)

OBJECTIVES

Assessment of the prevalence of risk factors associated with the course of pregnancy and childbirth and the condition of the child after birth in agroup of children and adolescents with ADHD and a control group.

METHODS

205 unrelated children and adolescents diagnosed with ADHD and 106 primary and secondary school students aged 7-17. Method. Mothers of children and adolescents diagnosed with ADHD, and those from the control group, were asked to provide a medical history in order to obtain data to supplement the Pregnancy and perinatal history questionnaire.

RESULTS

Statistically significant differences (p < 0.05) were demonstrated for the incidence rates of factors related to the course of pregnancy and childbirth such as: the occurrence of maternal diseases during pregnancy, especially in the I/II trimester, and other problems during pregnancy; exposure to stress and taking medication during pregnancy; smoking during pregnancy; mother's age at childbirth, i.e., < 25 years or > 35 years; use of pain reducing substances during labor and problems with the child during the delivery;an APGAR score in the range of 5-7 points; the occurrence of neonatal jaundice necessitating treatment, especially replacement transfusion; physical anomalies or other congenital problems in the newborn, as well as adaptive problems necessitating neonatal oxygen administration or placement in an incubator.

CONCLUSIONS

Significantly more frequent occurrence of risk factors related to the course of pregnancy, childbirth and the child's condition after birth in the ADHD group may indicate their potential role in the etiology of ADHD.

Cognitive impairments in Polish children and adolescents with perinatal HIV infection

OBJECTIVES

The aim of the study was to assess the presence of cognitive impairments in children and adolescents with vertically transmitted HIV infection and to determine possible relationships with clinical and socio-demographic variables.

METHODS

Fifty children with perinatal HIV infection aged 6-18 years were included in the experimental group (PHIV+). Two sex- and age-matched groups were recruited as reference groups: (1) a PHEU group that included 24 healthy children perinatally HIV-exposed but uninfected, and (2) an HIV-nA group that included 43 healthy children of uninfected parents. CANTAB Research Suite was used to assess cognitive functioning.

RESULTS

In comparison with the HIV-nA group, the PHIV+ group scored worse in movement execution, shifting and flexibility of attention, reversal learning and working memory. In comparison with the PHEU group, the PHIV+ group had significantly longer planning time in the memory task. The analysis of results for the 12-18 year-old age group revealed deterioration of cognitive functions in all tests of the PHIV+ children in comparison with the HIV-nA group. A higher logarithm of viral load at the start of the ARV treatment was associated with worse results in the use of feedback, shifting of attention, cognitive flexibility and worse information processing.

CONCLUSIONS

Results of the research indicate deterioration of executive functioning in the PHIV+ group associated with longer duration of HIV neuroinfection and severity of infection before treatment.

Morphometric evaluations based on Voxel Based Morphometry on adolescents with autism spectrum disorders

OBJECTIVES

Goal: to evaluate changes in the grey matter volume using the VBM method in a group of adolescents with ASD, who met the criteria for Asperger's Syndrome.

METHODS

Material and methods: Morphometric evaluations based on Voxel Based Morphometry (VBM) were performed on 37 male adolescents aged 12 to 19 (M = 14.3 ± 2.0), with autism spectrum disorders, who met the DSM-IV-TR criteria for Asperger's Syndrome and 15 neurotypical adolescents matched by age. Significance was set at p<0.007 without FWE correction and p<0.05 with FWE correction.

RESULTS

Results: the decrease in the volume of the grey matter was observed in ASD group including the pre- and postcentral gyrus, the superior and middle frontal gyrus, the inferior and superior parietal lobule, the praecuneus, the anterior and posterior cingulate cortex, the fusiform gyrus, the parahippocampal gyrus, the lingual gyrus, the middle occipital region, the cuneus and the angular gyrus, the regions of calcarine sulcus and the cerebellum. The majority of changes was localized bilaterally.

CONCLUSIONS

Conclusions: the decrease in the volume of grey matter observed in ASD group can be related functionally with the characteristics of deficits observed in autism spectrum disorders which highlights the role of abnormal organization of numerous CNS structures in the genesis of symptoms observed in cognitive and behavioural domains.

The Association between Executive Functions and Body Weight/BMI in Children and Adolescents with ADHD

Despite the increasing body of research on Attention Deficit Hyperactivity Disorder (ADHD), the results of the studies assessing the relationship between executive function deficit and the risk of obesity in people with ADHD are incongruent. Our study aimed to assess the relationship between measures of executive functions and body weight and Body Mass Index (BMI) in children and adolescents with ADHD and control subjects. The study group consisted of 58 subjects aged from 8 to 17 years with ADHD. The Control group consisted of 62 healthy age and sex-matched participants from primary and secondary schools. Weight, height, and BMI measurements were standardized. The Sustained Attention to Response Test (SART) and the Attention Network Test (ANT) were used to assess executive functions. Based on the analysis of the correlation and analysis of moderation, we found that subjects with higher weight in the study group presented a lower efficiency of the inhibition processes and gave more impulsive and incorrect answers. The occurrence of impulsive reactions might contribute to the risk of excessive weight in children and adolescents with ADHD.

The functioning of families of teens with Attention Deficit Hyperactivity Disorder and Opposition Defiant Disorders

OBJECTIVES

Comparison of the functioning of families of teens (13-16 years) with the diagnosis of attention deficit hyperactivity disorder (ADHD) or ADHD and oppositional defiant disorder (ODD).

METHODS

Assessment using the Family Assessment Questionnaire in three groups of adolescents growing up in biological families: (1) ADHD/ODD group (n = 40), (2) ADHD group (n = 40) and (3) group C (control group) adolescents (n = 40) who have not used psychological or psychiatric care in the past or at present.

RESULTS

Mothers, fathers and adolescents from the ADHD/ODD group scored significantly lower in all important aspects of family functioning compared to the control group. In the ADHD group, less favorable mother's and father's assessment was shown for all areas of family functioning compared with the control group. Adolescents' assessment in the dimension of "Role performance", "Emotionality", "Affective involvement", and "Control" was also lower. The ADHD/ODD group participants and their parents rated the functioning of the family lower compared with the ADHD group: mothers - in all described areas, teenagers - in most of the described areas except the dimension of "Control", and fathers - in most areas except the dimension of "Emotionality".

CONCLUSIONS

The functioning of families of patients with ADHD and ODD, and families of patients with ADHD significantly differs in all or most of the examined dimensions compared with families of people without diagnosis, while the functioning of families of patients with ADHD and oppositional defiant patients can be described as more abnormal than that of families of ADHD patients.

Therapeutic programs aimed at developing the theory of mind in patients with autism spectrum disorders - available methods and their effectiveness

Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by the presence of deficits in social skills and communication as well as repetitive patterns of behavior and interests. Among the theories explaining the mechanisms of the formation of the above cited symptoms, an important role is attributed to the theory of the mind, or the ability to draw conclusions about the state of mind of other people, assigning mental states to others and interpreting their behaviors. According to guidelines of the National Institute for Health and Care Excellence on the therapeutic procedures in autism spectrum disorders, the proceedings include various methods, adjusted to the level of functioning and presented difficulties. In the most widely used behavioral social skills trainings, the goal is to practice behaviors using modelling and role-playing techniques. Less attention is devoted to the issue of social understanding, theory of mind or the cognitive aspects of therapeutic interventions. There are studies demonstrating the possibility of developing competence in the theory of mind in people with ASD, as well as generalizing the acquired skills. The article reviews the literature on the use of therapeutic programs aimed at developing the theory of mind in patients with ASD and their effectiveness. As it seems, these are promising interventions, although they require further assessment.

The change in the intensity of symptoms in children and adolescents with attention deficit hyperactivity disorder after "Workshops for Parents of Hyperactive Children"

OBJECTIVES

To evaluate changes in the intensity of ADHD symptoms and size effects after the completion of the twelve-week "Workshops for Parents of Hyperactive Children".

METHODS

Intervention group included parents (N = 199) of children and adolescents diagnosed with ADHD, who completed the twelve-week parental training. The reference group included parents (N = 24) of children and adolescents diagnosed with ADHD, who received 1-2 standard psychiatric visits within twelve weeks (treatment-as-usual). The following questionnaires were completed by the participants at the beginning and at the end of the training: CBCLand Conners-IOWA-10 (parent's assessment of the child), TRF and Conners-RCTRS-28 (assessment of the child by the teacher/educator), and YSR (in children of 11 years and over). The same diagnostic regime was used in the reference group - the patients were assessed during the first visit and after twelve weeks.

RESULTS

The majority of attendees were parents of boys diagnosed with: ADHD mixed type with or without ODD and ADHD predominantly inattentive type. The intervention resulted in significant reduction of inattentive-impulsive-hyperactive and oppositional-defiant symptoms in Conners-IOWA-10 and significant reduction of symptoms in the following CBCL scales: "Social problems", "Attention problems", "Aggressive behavior", "Externalizing behavior", as well as the overall score, as rated by mothers. The improvement was age, diagnosis and pharmacotherapy independent.

CONCLUSIONS

The therapeutic program used in our study resulted in small to moderate reduction of symptoms in children and adolescents with attention deficit hyperactivity disorder irrespective of subtype, comorbid disorders or pharmacotherapy (if implemented).

General health, sense of coherence and coping styles in parents participating in Workshops for Parents of Hyperactive Children

OBJECTIVES

The assessment of changes in the general health, sense of coherence and stress coping styles in parents of children and adolescents with ADHD, participating in 12-week Workshops for Parents of Hyperactive Children.

METHODS

The experimental group included 186 mothers and 139 fathers (parents of 199 children); the reference group included 23 mothers and 19 fathers (parents of 24 children), attending 1-2 standard medical visits within a 12-week period (treatment as usual). Parents from both groups were assessed twice using (1) the General Health Questionnaire (GHQ), (2) the Life Orientation Questionnaire (SOC-29), and (3) the Coping Inventory for Stressful Situations (CISS).

RESULTS

(1) The experimental group showed a significant improvement in the severity of somatic symptoms and anxiety/insomnia in mothers and the general well-being of mothers and fathers. We observed the influence of workshops on manageability and reduction of the emotion-oriented coping in mothers; (2) the participation in the workshops was associated with a statistically significant effect (mostly moderate) in relation to general health of mothers, while TAU was mostly associated with a low or insignificant effect.

CONCLUSIONS

The assessed form of interventions improves the functioning of parents of children with ADHD.

Prevalence of Overweight and Obesity in Children and Adolescents With ADHD: The Significance of Comorbidities and Pharmacotherapy

OBJECTIVE

Assessment of the prevalence of overweight and obesity in children and adolescents with ADHD with emphasis on pharmacological treatment and comorbid disorders.

METHOD

We analyzed 408 medical records of patients with ADHD aged 7 to 18.

RESULTS

The prevalence of overweight (14.71% vs. 12.83%, χ² = 3,586.43, p < .001) and obesity (6.37% vs. 3.45%, χ² = 3,588.19, p < .001) was significantly higher in children with ADHD compared with the population. There was significantly higher incidence of obesity in patients with comorbid diagnosis of adjustment disorder (22.22% vs. 4.42%, χ² = 5.66, p = .02) and mental retardation (19.05% vs. 4.42%, χ² = 7.63, p = .005). Pharmacological treatment was associated with a higher incidence of obesity (8.37% vs. 2.76%, χ² = 4.92, p = .03).

CONCLUSION

Standardized body mass index (BMI), prevalence of overweight, and obesity was higher in patients with ADHD compared with the population. Higher incidence of obesity was shown in patients with analyzed comorbidities.

Obsessive-compulsive symptoms and physical activity in patients with anorexia nervosa - possible relationships

OBJECTIVES

The aim of the study was to find relationship between obsessive-compulsive symptoms and level and characteristic of physical activity among patients with anorexia nervosa (AN).

METHODS

Material and methods. 76 female patients, aged 14.8 +/ - 1.8 years with AN completed the Polish version of the Leyton Obsessional Inventory-Child Version (LOI-CV). In order to assess the level and type of physical activity, Physical Activity Questionnaire was developed.

RESULTS

35 (46%) subjects were qualified to HR group (Obsessive-Compulsive Disorder "High-risk group") (25 or more points on the Interference Score of LOI-CV) and 41 (54%) to nHR group (no "High-risk group"). nHR patients spent less studying in a standing position, significantly more often used elevators rather than stairs and, according to their parents, devote less time for physical activity. Positive correlation between the caregiver's perception of patient's weekly activity and the number of "YES" answers in LOI-CV, positive trend between Patient's Activity Index or summarised Activity Index and the number of "YES" answers in LOI-CV were found. We also found negative correlation between the time spent studying at school and the number of "YES" answers in LOI-CV.

CONCLUSIONS

The results show that there is a connection between obsessive-compulsive symptoms and the hyperactivity in AN patients.

Personality disorders in adolescence

Adult personality disorders are well recognized and described in the literature. The discussion about the possibility of the presence of personality disorders in adolescents started about 20 years ago. Some authors claim the before the age of 18 it is only possible to identify precursors of future personality disorders and such a standpoint is reflected in diagnostic criteria. This is based on the assumption that personality in adolescence is still not well established. Consequently, the criterion on the persistence of symptoms for the period of time cannot be met (the persistence of symptoms of personality disorders for the period of at least two years). Other approach postulates that problems presented in adolescence should not be exclusively limited to Axis I according to DSM. The proponents of this approach claim that current diagnostic tools are not adjusted to adolescents, thus it is very difficult to measure stability and persistence of symptoms in this age group. This paper presents literature review on personality disorders in adolescence.

Mechanisms shaping the development of personality and personality disorders in children and adolescents

Until the end of the nineties last century personality disorders could not be diagnosed before the age of eighteen. Nevertheless, the results of studies published in the last decade have revealed that personality disorders can be observed in children and adolescents and that personality disorders diagnosed in adult patients had been present as early as in childhood. The knowledge of possible mechanisms shaping personality disorders in childhood is unsatisfactory and needs to be expanded. Developmental psychology explains the development of abnormal personality through inappropriate attachment patterns and abnormal transitions between developmental phases. Genetic and temperamental factors are also important in the aetiology of personality disorders as well as early maladaptive schemas resulting from personal experiences and interactions with others. The aim of this article is to review the current knowledge on the mechanisms shaping the development of personality and personality disorders in childhood and adolescence.

The application of computer assisted technologies (CAT) in the rehabilitation of cognitive functions in psychiatric disorders of childhood and adolescence

First applications of computer-assisted technologies (CAT) in the rehabilitation of cognitive deficits, including child and adolescent psychiatric disorders date back to the 80's last century. Recent developments in computer technologies, wide access to the Internet and vast expansion of electronic devices resulted in dynamic increase in therapeutic software as well as supporting devices. The aim of computer assisted technologies is the improvement in the comfort and quality of life as well as the rehabilitation of impaired functions. The goal of the article is the presentation of most common computer-assisted technologies used in the therapy of children and adolescents with cognitive deficits as well as the literature review of their effectiveness including the challenges and limitations in regard to the implementation of such interventions.

[The influence of obsessive compulsive symptoms on the course of anorexia nervosa]

OBJECTIVE

to assess the prevalence of obsessive-compulsive disorder (OCD) or OC symptoms in patients with anorexia nervosa (AN) and to find a possible relationship between the presence of OC symptoms and the course of AN.

METHOD

137 adolescent female patients with AN, aged 14.8 +/- 1.8 years, completed the Polish version of the LOI-CV. Two groups, High-risk (HR) and no High-risk (nHR), were defined according to the cut-off score of LOI-CV. The diagnosis of OCD was confirmed with the Polish version of K-SADS-PL. The relationship between the number and intensity of OC symptoms and the following data were analyzed: age of onset and on admittance to a psychiatric facility, weight loss, BMI on admittance and its changes, age of first menstruation, time of amenorrhea and of restitution of menses, length of treatment and number of relapses.

RESULTS

OCD was not diagnosed in any subject, but 25% of the examined patients had OC symptoms which qualified them to High-risk group. Differences in HR and nHR groups were found between duration of AN before hospitalization, age and body mass after release from hospital. Negative correlation was found between "Yes" Score and Interference Score in LOI-CV and the age of patient at the time of release from hospital.

CONCLUSIONS

the results of our study do not support the observations about a high co-occurrence of AN and OCD, but indicate the frequent co-occurrence of OK symptoms.

[Psychiatric disorders and cognitive outcomes in children and adolescent with perinatally acquired HIV--a review]

The main focus of research on consequences of HIV infection is on adult population and not much attention is given to children, especially to children with perinatally acquired HIV. Researches have shown higher frequency of mental disorders in this group. HIV infection also has a negative impact on cognitive functions, especially attention concentration. Among the possible causes of mental disorders and cognitive impairment, attention is not only paid to the neurotoxic effects of HIV on the CNS, but also on other factors, such as awareness of chronic disease, the impact of opportunistic infections and side effects of antiviral therapy. Comorbid psychiatric disorders correlate with worse compliance and higher prevalence of risk behaviors among infected adolescents. This article reviews what is known about psychiatric disorders and cognitive disorders among perinatal HIV-infected children.

[Self-esteem of boys with attention deficit hyperactivity disorder - pilot study]

AIM

To compare the self concept of boys with ADHD and health subjects; to determine which symptoms ofADHD, oppositional defiant disorder (ODD) or conduct disorder (CD) have the greatest impact on self-concept.

METHOD

Polish version of The Harter Self-Esteem Questionnaire (HSEQ) was filled by boys with ADHD and control group. In addition, a diagnosis of ODD and CD was made in ADHD group.

RESULTS

A significant difference was observed between boys with ADHD and control group on the following scales of HSEQ: Global Self-Esteem Subscale, Social Acceptance Subscale and Scholastic Performance Subscale. No significant influence of the quantity and intensity of ADHD and ODD symptoms on self-esteem was found. A significant correlation was indicated between all scales of HSEQ and quantity and intensity of symptoms ofADHD.

CONCLUSIONS

Boys with ADHD have lower self-esteem than their healthy peers and their global self-esteem, social acceptance and school skills are most affected. The presence of conduct disorder (CD) had the greatest impact on the decrease of self esteem in ADHD group.

[Seeking the aetiology of autistic spectrum disorder. Part 2: Functional neuroimaging]

Multiple functional imaging techniques help to a better understanding of the neurobiological basis of autism-spectrum disorders (ASD). The early functional imaging studies on ASD focused on task-specific methods related to core symptom domains and explored patterns of activation in response to face processing, theory of mind tasks, language processing and executive function tasks. On the other hand, fMRI research in ASD focused on the development of functional connectivity methods and has provided evidence of alterations in cortical connectivity in ASD and establish autism as a disorder of under-connectivity among the brain regions participating in cortical networks. This atypical functional connectivity in ASD results in inefficiency and poor integration of processing in network connections to achieve task performance. The goal of this review is to summarise the actual neuroimaging functional data and examine their implication for understanding of the neurobiology of ASD.

[Seeking the aetiology of autistic spectrum disorder. Part 1: Structural neuroimaging]

Although the aetiology of autistic-spectrum disorder (ASD) remains unclear, great advances have been made to clarify the underlying neuroanatomical abnormalities and brain-behaviour relationships in autism. There is variability in the literature on structural neuroimaging findings in ASD. Early brain overgrowth is probably the most replicated finding in this subgroup. Additionally some specific brain regions are particularly implicated, including the frontal, limbic, basal ganglia and cerebellar regions. There is also evidence of volume abnormalities in both grey and white matter. New techniques, such as cortical-thickness measurements, surface morphometry and diffusion tensor imaging help to understand in more detail the patterns of abnormalities. More work is required, involving the use of large and homogeneous samples, to investigate the neuroanatomical determinants and their role in aetiology of ASD. The goal of this review is to summarise the available structural neuroimaging data and examine their implication for understanding of the neurobiology of ASD.

[Comorbidity and characteristic of obsessive-compulsive symptoms in anorexia nervosa]

There is constant interest in possible relations between obsessive-compulsive disorder (OCD) and eating disorders, particularly anorexia nervosa (AN). The comorbidity rate for OCD and AN is reported to be between 10% and even 40%. There is also an increased incidence of prior AN in OCD patients and high number of anorectic patients with obsessional premorbid personality. Similarities between AN and OCD lie in the symptoms of the disorders: intrusive, fearful thoughts, a compulsive need to perform rituals aimed at reducing the level of anxiety and obsessions maintaining these rituals. In case of AN, these behaviours revolve around food and thinness, whereas in OCD they are of more general and differential in type. Research on AN-OCD relations provides interesting insights, but also presents some limitations. The purpose of this review is to analyse and discuss the specificity of relations between symptoms of AN and OCD.

[Asperger's syndrome: continuum or spectrum of autistic disorders?]

Pervasive Developmental Disorders (PPD) refers to the group of disorders characterised by delayed or inappropriate development of multiple basic functions including socialisation, communication, behaviour and cognitive functioning. The term,,autistic spectrum disorders" was established as a result of the magnitude of the intensity of symptoms and their proportions observed in all types of pervasive developmental disorders. Asperger's Syndrome (AS) remains the most controversial diagnosis in terms of its place within autism spectrum disorders. AS if often described as an equivalent of High Functioning Autism (HFA) or as a separate spectrum-related disorder with unique diagnostic criteria. Another important issue is the relationship between AS and speech disorders. Although it is relatively easy to draw a line between children with classical autism and speech disorders, the clear cut frontiers between them still remain to be found. The main distinguishing feature is the lack of stereotypic interests and unimpaired social interaction observed in children with speech disorders, such as semantic-pragmatic disorder.

[Obsessive-compulsive symptoms, tics, stereotypic movements or need for absolute consistency? The occurrence of repetitive activities in patients with pervasive developmental disorders--case studies]

Repetitive and stereotyped behaviours in the form of stereotyped interests or specific routine activities are one ofthe diagnostic criteria in pervasive developmental disorders. The occurrence of repetitive behaviours in patients with pervasive developmental disorders is a starting point for questions about the type and classification criteria of such behaviours. The aim of the article is to present case studies of patients with pervasive developmental disorders and co-morbid symptoms in the form of routine activities, tics, obsessive-compulsive symptoms or stereotyped behaviours. The first case study describes a patient with Asperger's syndrome and obsessive compulsive symptoms. The diagnostic problems regarding complex motor tics are discussed in the second case study which describes a patient with Asperger's syndrome and Gilles de la Tourette syndrome. The third and fourth case study describes mono-zygotic twins with so called High Functioning Autism whose repetitive activities point to either obsessive compulsive symptoms, stereotypic movements, need for absolute consistency or echopraxia. The possible comorbidity of pervasive developmental disorders and symptoms in the form of repetitive behaviours, possible interactions as well as diagnostic challenges is discussed in the article.

Epidemiology and phenomenology of obsessive-compulsive disorder in non-referred young adolescents: a Polish perspective

OBJECTIVE

The aim of this study was to investigate the frequency and phenomenology of obsessive-compulsive disorder (OCD) and subclinical OCD in a non-referred population of young Polish adolescents.

METHOD

A two stage ascertainment procedure (school screening and diagnostic evaluation) was used to identify affected individuals. In the first stage, 3,100 pupils were asked to complete the Polish version of the 20-item Leyton Obsessional Inventory-Child Version (LOI-CV). In the diagnostic stage, the presence of obsessions and compulsions was assessed with the author's structured interview questionnaire based on DSM-IV and ICD-10 diagnostic criteria for OCD; the Polish version of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was used to rate the symptom severity.

RESULTS

A frequency of 0.38 % was found for OCD and 2.7 % for subclinical OCD. There was no significant difference in the phenomenology, demographic characteristic or socio-familial variables comparing the diagnosed OCD and subclinical OCD subjects.

CONCLUSIONS

The identified OCD cases had characteristics similar to those of previously described clinical and non-referred samples.

[Altered visual information processing in anorectic girls--the study on potentials related to the test of attention]

AIM

Combined biological and psychological basis of anorexia nervosa, related to increased self-control, low self-esteem and peculiar motivation, makes a synthetic approach still hard to achieve. The presented study assessed cognitive functions in anorectic patients with respect to both neuropsychological (test of attention) and biological (electrophysiology of information processing) approaches, and their reciprocal interrelations as well.

METHODS

Eleven adolescent anorectic females and 10 control subjects performed the Continuous Attention Test CAT. Parameters of potentials elicited by the visual CAT items were referred to the CAT results.

RESULTS

The anorectic girls were more accurate during CAT performance, revealing a lower index of errors, especially of commissions. On the other hand, they revealed a lower amplitude of the P2 component (correlated with index of commissions) and shortened latency of the frontal N2 component (correlated with a lower index of errors). The groups differed in relations between psychometric and biological parameters referring to the earlier stages of information processing. In the control group, high index of detections was correlated to right-sided P1 and P2 components. In the patient group, correlations linked a lowered index of commissions with right-sided N1 and bilateral P2 amplitudes.

CONCLUSIONS

Increased self-control in anorexia nervosa, reflected by lower frequency of needless reactions, is related to alterations in biological visual information processing yet on its early, preconscious stage.

[Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). A report of two cases]

AIM

To critically review the past years of research on paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections in children and adolescents.

METHOD

Literature on PANDAS published from 1995 onward was systematically reviewed. The review focuses on definition and diagnostic consideration aetiological and therapeutical issues. To illustrate the clinical characteristic of PANDAS authors present two cases of children with a severe course of obsessive-compulsive disorder and Tourette's syndrome.

RESULTS

Post-streptococcal autoimmunity has been postulated as an aetiologic factor in the development of childhood-onset obsessive-compulsive disorder, tic disorders including Tourette's disorder. This hypothesis arose from a series of clinical observations including the documentation of obsessive-compulsive symptoms of children affected by Sydenham's chorea, a variant of rheumatic fever characterised by neurological dysfunction and also by concomitant investigations of childhood-onset OCD and Tourette's syndrome.

CONCLUSION

Results of these studies led to the identification of children whose clinical course is characterised by abrupt and dramatic symptom exacerbations which are temporally related to group A beta-hemolytic streptococcal infections. The identification of such a subgroup will allow for testing of the model of pathogenesis as well as development of novel treatment and prevention strategies. Future research are needed to explore the nature of PANDAS and their relationship with different psychiatric disorders in children and adolescents.

[Psychotherapeutic methods in the treatment of obsessive-compulsive disorder (OCD) in children and adolescents]

The psychiatric and psychological literature was systematically reviewed for studies applying psychotherapeutic principles to young persons with obsessive-compulsive disorder. Abundant clinical and empirical evidence suggest that cognitive-behavioral psychotherapy, alone or in combination with pharmacotherapy, is an effective treatment for OCD in children and adolescents. Thirty-two investigations, most of them single case reports, showed some benefit for such kind of interventions. Graded exposure and response prevention form the core of treatment; anxiety management training and specific family interventions may play an adjunctive role.

Psychogenic seizures in obsessive-compulsive disorder with poor insight: a case report

Psychogenic seizures or psychogenic nonepileptic seizures occur in various mental disorders. Obsessive-compulsive symptoms can also imitate epileptic partial seizures, but detailed observations of this phenomenon are rare in the literature. A girl of 13 years was referred to the Department of Child Psychiatry because of sudden falls that had occurred during a 1-year period, mainly at school. She had been diagnosed previously as having epilepsy or conversion seizures. After a fall, she demonstrated no response for periods up to 10 minutes, postictal somnolence had occasionally been observed. From the age of 10 years, the patient was reported to have had intrusive recurrent thoughts about dirt and contamination and had also demonstrated some signs of separation anxiety disorder. She was diagnosed as having obsessive-compulsive disorder with poor insight. The chronic falling disappeared completely when behavioral therapy was begun, but the girl still exhibits obsession and separation anxiety.

[Obsessive-compulsive disorder in children and adolescents: a literature review. Part II]

This paper presents opinions about obsessive-compulsive disorder in children and adolescents. Washing, checking, repeating, touching, counting and scrupulosity are the most commonly seen rituals. Almost all patients reported a change in their principal symptom over time. There appear to be no significant intercultural differences in phenomenology. Childhood OCD seems to be associated with depression, eating disorders and anxiety disorders (in several cases the secondary diagnosis was mild), whereas there seems to be no convincing relation between OCD and schizophrenia. Follow-up studies of the course of OCD with a childhood onset are still very few in number. OCD is disabling disorder with bad prognosis for one third to one half of the patients. The behavior therapy is an effective treatment for childhood-onset OCD, while numerous systematic investigations have demonstrated the efficacy of clomipramine treatment. Fluoxetine and other drugs which inhibit serotonin reuptake also may be helpful.

[Obsessive-compulsive disorder in children and adolescents: literature review. Part I]

The literature on obsessive-compulsive disorder (OCD) in children and adolescents is reviewed. The disorder is characterized by obsessions (recurrent troublesome thoughts) and compulsions (ritualized thoughts or behaviors performed repetitively in response to an irresistible urge). OCD is far more common among children and adolescents than was previously believed. Good epidemiological studies from different parts of the world are still needed to determine if prevalence is equally high. Boys seem to have an earlier age of onset of OCD than girls. Male female ratio changed with age of onset, with males predominating in early onset and increasing numbers of females occurring during adolescence. Increasing evidence supports a neurobiological theory for etiology of OCD, specifically a frontal lobe--basal ganglia dysfunction.