[Use of Electronic Cigarettes (e-cigs) and e-Shishas by Children and Adolescents: Evidence Paper of the Joint Addiction Commission of the German Societies and Professional Associations of Child and Adolescent Psychiatry and Psychotherapy]

Use of Electronic Cigarettes (e-cigs) and e-Shishas by Children and Adolescents: Evidence Paper of the Joint Addiction Commission of the German Societies and Professional Associations of Child and Adolescent Psychiatry and Psychotherapy Abstract. The particular risks associated with the consumption of electronic cigarettes (e-cigs) in children and adolescents are not sufficiently considered in the health policy discourse. The present article evaluates the current dissemination and consumption patterns of e-cigarettes as well as the health risks attached to children and adolescents. Based on data from current national and international studies, there has been a clear increase in the consumption of e-cigarettes over the past years. This stands in sharp contrast to the overall decline in tobacco consumption among both children and adolescents in Germany. Young people without tobacco experience are now consuming more frequently e-cigarettes than those who occasionally or regularly use tobacco. They also are experimenting more frequently with conventional cigarettes if they have previously consumed e-cigarettes. The largely unregulated availability of e-cigarette products to the newest generation, such as JUUL, led to a dramatic increase in their prevalence among high-school students in the USA. Products with high nicotine content and multiple flavors are being marketed intensively as trendy lifestyle products to young user groups via advertising and social media campaigns. These products are also becoming increasingly relevant in Germany. The success of tobacco prevention in recent years is presently jeopardized by the ongoing effective advertising for e-cigarettes. The Addiction Commission of the German Child and Youth Psychiatric Federations and Scientific Societies therefore call for an immediate, strict, and comprehensive ban of e-cigarette advertising.

[Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy]

Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy Abstract. Media-associated disorders (MAD) describe the problematic use of the internet, certain electronic devices in general as well as digital applications. During childhood and adolescence, digital games and social media are the most commonly used applications. In May 2019, as first MAD "gaming disorder" was included as a clinical diagnosis in the ICD-11. The prevalence of MAD in German children and adolescents is estimated to lie between 3 % and 5 %. In most cases, MAD are accompanied by psychiatric comorbidities. MAD ensue because of dysfunctional learning processes in combination with general and specific risk factors. They are associated with neural changes like those of substance-associated addictions. Diagnostics can be based on validated questionnaires and clinical exploration, though a standardized diagnostic path is not yet common. Treatment depends on the level of severity and generally comprises outpatient, day-clinic, and inpatient therapy approaches with elements from cognitive-behavioral therapy and under parental involvement. Suitable treatments are not yet available in all German regions and have also not been sufficiently evaluated. Moreover, only a few studies exist on the efficacy of prevention measures addressing MAD in children and adolescents. Thus, further research is strongly required.

[Validity of the Scale of Pervasive Developmental Disorder in a Clinical Sample of Adults with Intellectual Disability]

OBJECTIVES

The study assesses the diagnostic validity of the Scale of Pervasive Developmental Disorder in Mentally Retarded Persons (PDD-MRS).

METHODS

Unblinded conduct of PDD-MRS in a clinical psychiatric sample of adults with intellectual disability (ID; N = 109) and suspect of autism.

RESULTS

For a cut-off-score of 10, sensitivity was 89 %, specificity 62 % and the Area Under the Curve (AUC) 0.83. The total score was independent of age, gender and level of ID. However the diagnostic validity was better balanced in adults with mild to moderate ID (sensitivity/specificity: 85 %/73 %) compared to those with severe to profound ID (93 %/42 %). The SEAS-M total score was correlated with various ASD screening measures (r = .3-.6), while no correlation was found for scales assessing challenging behavior.

CONCLUSION

To conclude, the PDD-MRS is a screening instrument for diagnosing autism in adults with mild to moderate ID. Knowledge of the PDD-MRS results within the consensus conference may have led to an overestimation of its diagnostic validity.

Axis I comorbidity in adolescent inpatients referred for treatment of substance use disorders

BACKGROUND

To assess comorbid DSM-IV-TR Axis I disorders in adolescent inpatients referred for treatment of substance use disorders.

METHODS

151 patients (mean age 16.95 years, SD = 1.76; range 13 - 22) were consecutively assessed with the Composite International Diagnostic Interview (CIDI) and standardized clinical questionnaires to assess mental disorders, symptom distress, psychosocial variables and detailed aspects of drug use. A consecutively referred subgroup of these 151 patients consisting of 65 underage patients (mean age 16.12, SD = 1.10; range 13 - 17) was additionally assessed with the modules for attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) using The Schedule for Affective Disorders and Schizophrenia for school-aged children (K-SADS-PL).

RESULTS

128 (84.8%) of the 151 patients were dependent on at least one substance, the remaining patients fulfilled diagnostic criteria for abuse only. 40.5% of the participants fulfilled criteria for at least one comorbid present Axis I disorder other than substance use disorders (67.7% in the subgroup additionally interviewed with the K-SADS-PL). High prevalences of present mood disorder (19.2%), somatoform disorders (9.3%), and anxiety disorders (22.5%) were found. The 37 female participants showed a significantly higher risk for lifetime comorbid disorders; the gender difference was significantly pronounced for anxiety and somatoform disorders. Data from the underage subgroup revealed a high prevalence for present CD (41.5%). 33% of the 106 patients (total group) who were within the mandatory school age had not attended school for at least a two-month period prior to admission. In addition, 51.4% had been temporarily expelled from school at least once.

CONCLUSIONS

The present data validates previous findings of high psychiatric comorbidity in adolescent patients with substance use disorders. The high rates of school refusal and conduct disorder indicate the severity of psychosocial impairment.

[The Kaufman Test System during adolescence: structure and application of the Kaufman-Test zur Intelligenzmessung (K-TIM)]

OBJECTIVE

The Kaufman-Test zur Intelligenzmessung (K-TIM) is the German-language adaptation of the Kaufman Adolescent and Adult Intelligence Test, serving the sophisticated assessment of intellectual abilities within the age range from 11 to over 85 years. Founded on the respective models of cognitive development by Horn and Cattell, Luria, and Piaget, the battery comprises 10 subtests, structured into fluid intelligence, crystallized intelligence, and assessment of delayed recall, reflecting the test concept.

METHOD

In addition to early trials during the translation and adaptation as well as the novel construction of items with a high verbal or cultural load, studies to evaluate test criteria were performed stepwise. Norms for the final version were developed using a sample of 2,320 persons from Germany, Austria, Switzerland, and South Tyrol. Also, test criteria were analyzed again.

RESULTS

Test reliability was very high (.96 to .98 for the scales). Validity of the developmental criterion important in adolescence, and that of the construct criterion was ensured by means of correlational and factor analyses. Concurrent validity was confirmed using correlational studies with other tests as external criteria.

CONCLUSIONS

The adaptation did not result in any structural changes within the test concept. For the German-speaking countries as well the K-TIM is thus an interesting alternative to the differential assessment of intelligence in adolescents.

Quality of life in children with traumatic brain injury--basic issues, assessment, and recommendations

An international Task Force was convened under the guidance of BMBF Conference so as to review the "State of the art" for measuring quality of life (QoL) in children who have suffered traumatic brain injury (TBI). After expert review of instruments and evaluation of two independent literature reviews this work group established "inclusion criteria" for the review of current tools that could contribute to the measurement of QoL in children with TBI. Six instruments were determined to meet all or most of the criteria required to be used in current clinical practice and research for children with TBI.

An Early Onset Rehabilitation Program for Children and Adolescents after Traumatic Brain Injury (TBI): Methods and First Results

Survived traumatic brain injuries (TBI) are one of the most serious challenges to the patient's future life. Recent literature increasingly questions the long believed protective effects of functional cerebral plasticity in children. Although TBI in children and adolescents is frequent, they are less frequently admitted to rehabilitation centers as in-patients than adults. This emphasizes the role of out-patient treatment. The progressing study described here aims to achieve a contribution to a comprehensive approach in TBI-rehabilitation for youngsters. A two-stage multimethodal program, starting with stimulation in coma while the patient is on the intensive care unit, and neuropsychological therapy after regaining consciousness is to be evaluated in a controlled, prospective and randomized study. After including nearly 50 % of the planned sample (100 persons), some preliminary results can be mentioned with all applicable caution. The effectiveness of the applied therapy can be stated here with respect to the posttraumatic development of intellectual abilities in the 6- and 12 months follow ups. Moreover, in the control group development of psychopathological alterations was found to a considerable degree and also lower ratings in a quality of life questionnaire, compared to the experimental group. It is expected to prove these differences statistically, after the total sample has been included, and thus equal distributions have been achieved in all predictive variables.

Intelligence and cognitive function in children and adolescents with spinal muscular atrophy

Spinal muscular atrophy is a chronic disease characterised by loss of motor function. The aim of the study was to analyse cognitive functions in a large group of patients with spinal muscular atrophy. It was hypothesised that their intelligence is comparable to controls, but not above average as previously postulated. Ninety-six children and adolescents with spinal muscular atrophy I-III, aged 6.0-18.11 years, 45 non-affected siblings and 59 healthy, matched controls were examined with one- (CPM/SPM), as well as multi-dimensional intelligence tests (Kaufman-ABC; Wechsler tests). The mean IQ measured with the CPM/SPM tests was 109.6 for the spinal muscular atrophy group, 107.3 for the sibs and 104.1 for the healthy controls (no significant difference). In the older children and adolescents (SPM only) the mean IQ was significantly higher for the spinal muscular atrophy patients (109.6) than for the controls (95.4). The standard score in the 'mental processing composite' scale of the Kaufman-ABC was identical in the spinal muscular atrophy group and controls (103.8). The cognitive profile was relatively homogeneous. However, the older children and adolescents did have a significantly higher verbal IQ (113.8) than controls (104.6) in the Wechsler tests. There were no significant differences in any of the tests among different grades of severity (spinal muscular atrophy types I-III). It can be concluded that children and adolescents with spinal muscular atrophy have a general intelligence in the normal range. By adolescence, environmentally mediated aspects of intelligence are higher in patients with spinal muscular atrophy. It could be speculated that the development of cognitive skills and knowledge is a creative way to compensate the many restrictions due to their physical handicap.

Psychische und neuropsychologische Folgen von Schädel-Hirn-Traumen im Kindesalter

Zusammenfassung. Die Folgezustände eines schweren Schädel-Hirn-Traumas für das neuropsychologische Leistungsverhalten sind oft sehr weitgehend und beeinträchtigen die spätere soziale Integration der betroffenen Kinder erheblich. Dennoch ergibt sich weder im Verhalten noch im Leistungsbereich ein typisches Syndrommuster, das einem regelhaft auftretenden psychoorganischen Syndrom (POS) entspricht. Aufgrund eigener empirischer Ergebnisse wird deshalb gefordert, die Beurteilung der Auswirkungen eines Schädel-Hirn-Traumas mit spezifischen Untersuchungsmethoden für die psychopathologischen und neuropsychologischen Defizite getrennt voneinander zu erheben. Die sich aus einem solchen differenzierten Vorgehen ableitbaren Befunde besitzen nicht nur akademische Bedeutung, denn erst durch ein entsprechend gründliches Vorgehen lassen sich funktionsspezifische Rehabilitationsmaßnahmen einleiten, die im Interesse der sozialen, schulischen und emotionalen Entwicklung der betroffenen Kinder möglichst früh und gezielt eingesetzt werden sollten.

Neuropsychologische Diagnostik im Kindes- und Jugendalter

Zusammenfassung: Bei einer Vielzahl von Fragestellungen und Störungsbildern sollte neuropsychologische Diagnostik einen festen Stellenwert haben, sowohl in der initialen wie auch in der Verlaufsbeurteilung. Mit Blick auf die Anwendung in der Kinder- und Jugendpsychiatrie ist zunächst eine beschreibende Definition dieses Bereichs psychologischer Diagnostik zu versuchen. Dabei bestehen methodisch grundlegend unterschiedliche Zugangswege, die in ihren Auswirkungen auf Psychometrie wie Interpretation zu erörtern sind. Unabhängig davon, dass die gegenwärtige Verfügbarkeit standardisierter neuropsychologischer Diagnostik nur in einigen Bereichen befriedigen kann, wird eine Darstellung der in klinischer Praxis und/oder Forschung anwendbaren Verfahren versucht. Neben einzelnen Testbatterien werden Einzeltestverfahren für die Bereiche visuelle und auditive Gedächtnisfunktionen, Aufmerksamkeitsfunktionen, sprachassoziierte Funktionen und Exekutivfunktionen besprochen. Der aktuelle Stand neuropsychologischer Diagnostik führt zu wesentlichen Aufgaben ihrer Weiterentwicklung. Dies gilt sowohl für kurzfristig erreichbare Ziele wie Adaptation oder Normierung verfügbarer Instrumente als auch für längerfristige Forschungsaufgaben.

[Neuropsychological testing in childhood and adolescence]

Among a number of issues and disorder pictures neuropsychological diagnostics should occupy a solid position, both in the initial assessment, as well as in that of the course. With an eye towards its use in child and adolescent psychiatry, a descriptive definition of this area of psychological diagnostics must be provided. In so doing, several essentially different approaches arise, whose effects on psychometrics and interpretation must be examined. Regardless of the fact that the current availability of standardized neuropsychological diagnostics is satisfactory only in certain areas, the methods used in clinical practice and/or research are presented. In addition to the individual test batteries, individual test methods for the areas of visual and auditory memory functions, attention functions, functions associated with speech, and executive functions are discussed. The current status of neuropsychological diagnostics generates essential tasks towards its further development. This is true with regard to goals attainable in the short term, such as adaptation or standardization of available instruments, as well as for long-term research tasks.

An early onset rehabilitation program for children and adolescents after traumatic brain injury (TBI): Methods and first results

Survived traumatic brain injuries (TBI) are one of the most serious challenges to the patient's future life. Recent literature increasingly questions the long believed protective effects of functional cerebral plasticity in children. Although TBI in children and adolescents is frequent, they are less frequently admitted to rehabilitation centers as in-patients than adults. This emphasizes the role of out-patient treatment. The progressing study described here aims to achieve a contribution to a comprehensive approach in TBI-rehabilitation for youngsters. A two-stage multimethodal program, starting with stimulation in coma while the patient is on the intensive care unit, and neuropsychological therapy after regaining consciousness is to be evaluated in a controlled, prospective and randomized study. After including nearly 50 % of the planned sample (100 persons), some preliminary results can be mentioned with all applicable caution. The effectiveness of the applied therapy can be stated here with respect to the posttraumatic development of intellectual abilities in the 6- and 12 months follow ups. Moreover, in the control group development of psychopathological alterations was found to a considerable degree and also lower ratings in a quality of life questionnaire, compared to the experimental group. It is expected to prove these differences statistically, after the total sample has been included, and thus equal distributions have been achieved in all predictive variables.

[Kaufman Assessment Battery for Children. Differential evaluation of (partial) intellectual ability of mentally handicapped adults]

The use of the Kaufman-Assessment Battery for Children (K-ABC) was evaluated with a sample of 50 mentally disabled adults in a wide age range, as there exist no special tests for this group of patients. Intercorrelation--and factor analyses, and correlations with the German adaptation of the Wechsler Adult Intelligence Scale (HAWIE-R) proved the use of the K-ABC to be valid. As an assessment battery for children designed for the wide age range from 2-6 to 12-5 years is more adequate to the capability of intellectually impaired adults, the K-ABC delivers results on individual strengths and weaknesses, based on a neuropsychological theory. Thus the individual cognitive abilities can be assessed with more differentiation, and that gives an important base for intervention, partial remediation, and placement.

[Revision of the Kaufman Assessment Battery for Children for German speaking regions. Part 2: Areas of application and criteria of reliability]

Adaptation, structure and standardization of the German version of the K-ABC, a test of intelligence and achievement in children comprising 16 subtests, were discussed in the first part of this article. Part 2 deals with aspects of test administration intended to make the procedure simple, objective and appealing to children. Also discussed are possibilities for internal and external comparison of test scores, approaches to interpretation and ideas for remedial measures that are an integrated feature of the K-ABC concept. Assessment of numerous psychometric properties of the K-ABC demonstrated the reliability and validity of this test.

[Adaptation of the Kaufman Assessment Battery for Children for German- speaking areas. Part 1: Introduction of the battery]

The German version of the K-ABC is an adaptation of Alan and Nadeen Kaufman's test, published in the USA in 1983. The battery comprises a total of 16 subtests, organized in different scales, for the assessment of mental processing and achievement in children in the age range of 2-6 to 12-5 years. The underlying theory of intelligence measurement is based on findings in the fields of cognitive psychology and neuropsychology. It differentiates from sequential simultaneous information processing. The present article provides information about adaptation and structure of the German version, and about the standardization performed with a sample of 3098 children. Part 2 of this article, to appear soon, will survey application of the test battery, diagnostic relevance, and reliability and validity scores.