Relationship between Traumatic Experiences, Circadian Preference and ADHD Symptoms in Adolescents with ADHD Residing in Institutional Care: A Controlled Study.

Circadian preference, describes biological and behavioural characteristics that influence the ability to plan daily activities according to optimal waking times. It is divided into three main categories: morning, evening and intermediate. In particular, the evening chronotype is associated with conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and Post Traumatic Stress Disorder (PTSD). This study was conducted in three groups aged 14-18 years: The first group consisted of 34 adolescents diagnosed with ADHD who had been in institutional care for at least two years and had not used medication in the last six months. The second group included 29 adolescents with ADHD living with their families who had not used medication in the last six months. The third control group consisted of 32 healthy adolescents. The study utilized sociodemographic data forms, the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S) to measure ADHD symptoms, the Childhood Chronotype Questionnaire (CCQ), and the Childhood Trauma Questionnaire (CTQ). In institutionalized adolescents with diagnosed ADHD, ADHD and disruptive behavior symptoms were more severe. Increased trauma scores were associated with higher ADHD and disruptive behaviour symptom severity and evening chronotype. In the conducted mediation analysis, evening chronotype was identified as a full mediator in the relationship between trauma symptoms and ADHD symptoms, while it was determined as a partial mediator in the relationship between trauma symptoms and PTSD symptoms. In conclusion, traumatic experiences in institutionalized adolescents with diagnosed ADHD may exacerbate ADHD and disruptive behavior symptoms. Evening chronotype is associated with ADHD and disruptive behavior symptoms, and therefore, the chronotypes of these adolescents should be assessed. Chronotherapeutic interventions may assist in reducing inattention, hyperactivity, and behavioral problems.

The relationship between executive functions and chronotype in healthy siblings of children with autism spectrum disorder.

The aim of this study is to examine executive functions in healthy siblings of children with autism spectrum disorder (ASD) and to evaluate the relationship between chronotype and executive functions (EF). This study included 40 healthy siblings (case group) of children with ASD and 40 healthy controls. Executive functions were evaluated by Stroop Test, Serial Digit Learning Test (SDLT) and Cancellation Test (CT). Children's Chronotype Questionnaire (CCTQ) and Autism Spectrum Screening Questionnaire (ASSQ) were administered to parents. It was determined that the Stroop Test and CT performances of the case group were significantly worse than the control group. There was no difference in SDLT. It was determined that the total CCTQ score of the case group was significantly higher. In addition, a significant positive correlation was found between the chronotype total score and the number of false targets in the second part of CT. In the logistic regression analysis; the chronotype total score, Stroop test fifth part correction number and CT fourth part error number were determined as possible factors in the differentiation of the case and control groups. More studies are needed to evaluate the relationship between executive functions and chronotype in siblings of children with ASD.

The Effect of Internet Addiction and Emotion Regulation on Trauma Reactions During the COVID-19 Pandemic in Adolescents With Anxiety Disorder.

ABSTRACT: In this study, we examined the relationship among trauma reactions, anxiety severity, Internet addiction (IA), and emotion regulation difficulties during the COVID-19 pandemic in adolescents with anxiety disorders. The sample of study consisted of 63 adolescents aged 12 to 18 years who were diagnosed with AD and their parents. IA scores and emotional regulation difficulties were significantly higher in the group with pathological trauma reactions than the group exhibiting nonpathological trauma reactions. The trauma scores of adolescents with AD were correlated with IA, emotional regulation difficulties, and anxiety scores. The results of mediation analysis found that IA was the full mediating factor in the relationship between anxiety and trauma scores and a partial mediating factor in the relationship between emotional regulation difficulties and trauma scores. As a result, monitoring adolescents' Internet use not exceeding healthy levels and developing and strengthening emotion regulation skills can help protect against trauma during the COVID-19 pandemic.

Perceived Expressed Emotion and Irritability in Adolescents With Attention-Deficit/Hyperactivity Disorder Inattentive Type: The Moderating Effect of Subtype.

The current study aimed to investigate perceived expressed emotion (EE) and irritability among adolescents with inattentive and combined type attention-deficit/hyperactivity disorder (ADHD-I and ADHD-C, respectively), and to assess whether the subtype plays a moderating role in the relationship between perceived EE and irritability. The current cross-sectional, case-control study comprised 37 adolescents with ADHD-I, 62 adolescents with ADHD-C, and 58 age- and sex-matched adolescents without ADHD. After controlling for confounding factors, adolescents with ADHD-C were found to exhibit significantly higher levels of perceived lack of emotional support than adolescents with ADHD-I (p = 0.029). Results of moderation analysis showed ADHD subtype to be a moderating factor in the relationship between perceived EE and irritability. [Journal of Psychosocial Nursing and Mental Health Services, 60(10), 11-20.].

Regulatory T cells in children with attention deficit hyperactivity disorder: A case-control study.

OBJECTIVE: The pathophysiology of attention deficit hyperactivity disorder (ADHD) are still not fully elucidated. Immune system dysregulation has emerged as a major etiological focus as a result of the high comorbidity of allergic disease, inflammatory biomarkers, and genetic research. The present study aimed to evaluate peripheral lymphocyte subpopulations and regulatory T cells (Tregs) in children with ADHD. METHODS: This single-center cross-sectional case-control study assessed 49 children with ADHD and 35 age- and gender-matched healthy children aged 7-12 years (9.10 ± 2.37 and 9.45 ± 2.13, respectively). The participants were screened for psychopathology using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, while the severity of ADHD symptoms was measured by means of the distracted-Continuous Performance Test. Peripheral lymphocyte subpopulations and Tregs were analyzed with flow-cytometry. RESULTS: There is no significant difference in peripheral blood lymphocyte subsets between ADHD and control groups The children diagnosed with ADHD exhibited significantly higher levels of CD3+ CD4+ CD25+ Foxp3+ (Tregs) than the healthy control subjects (8.23 ± 2.09 vs. 6.61 ± 2.89; z = 2.965, p = .004). The Tregs cell (Exp(B) = 1.334; p = .042; CI = 1.011-1.761) levels were determined to be statistically significant according to regression analysis and were associated with an increased probability of ADHD. CONCLUSION: Elevated Treg levels were linked to an increased likelihood of ADHD. This study suggested that changes in immune regulatory cells represent an important part of research in treatment of ADHD.

Chronotypes, sleep problems and trauma reactions in adolescents with anxiety disorders during the COVID-19 pandemic.

This study aims to investigate the relationship between chronotype preferences/sleep problems and trauma symptoms during the COVID-19 outbreak of adolescents diagnosed with Anxiety Disorder (AD) in the pre-COVID-19 period. The sample of this study consisted of 71 adolescents with AD. Trauma symptoms were evaluated using the Children's Event Impact Scale (CRIES-13); sleep habits were assessed using the Pittsburgh Sleep Quality Index (PSQI); and chronotype was evaluated using the Children's Chronotype Questionnaire (CCQ). The CRIES-13 arousal scores and PSQI sleep latency scores were significantly higher in the eveningness type group compared with the non-eveningness type group. The CRIES-13 arousal scores of adolescents with AD were related to the CCQ and PSQI scores. In linear regression analysis, sleep problems were found to be an associated factor on the CRIES-13 scores. The findings of the present study suggest that during the COVID-19 pandemic, the chronotype may play an important role in the adversities experienced by adolescents with AD. In addition, it was thought that the association between sleep problems and trauma in adolescents with AD who spent a lot of time in the home environment during the pandemic period needs further evaluation.

The relationship between irritability and autism symptoms in children with ASD in COVID-19 home confinement period.

OBJECTIVE: This study investigated the impact of COVID-19 home confinement on autism spectrum disorder (ASD) symptoms and irritability in children and adolescents with ASD. METHOD: The study participants included 46 drug-naive children aged 4-17 years diagnosed with ASD. Parents of the participants completed the Autism Behaviour Checklist (AuBC) and Affective Reactivity Index (ARI) scales for both normal conditions and COVID-19 home confinement. RESULTS: All subscale scores for AuBC (sensory, relating, body and object use, language, and social and self-help) and ARI scores significantly increased during the COVID-19 home confinement period (P < .05). The participants' irritability and ASD symptoms were significantly worse during the COVID-19 outbreak and home confinement period compared to normal conditions. The variables that predicted irritability were the social and self-help subscales of AuBC. DISCUSSION: These results have alerted us of the importance of focusing on the symptoms such as irritability exhibited by extremely vulnerable populations during disease outbreaks and of the necessity of developing new strategies to avoid such adverse outcomes in similar situations.

The Relationship of Comorbid Overweight-Obesity With Cold Executive Functions, Verbal Short-Term Memory, and Learning in Attention Deficit Hyperactivity Disorder.

ABSTRACT: The aim of this study was to investigate the relationship between comorbid obesity/overweight and cold executive functions, verbal short-term memory, and learning in children with attention deficit and hyperactivity disorder (ADHD). Our study was conducted on 100 drug-naive participants, including 70 patients with ADHD and 30 healthy controls. In our study, patients diagnosed with ADHD were divided into two groups according to body mass index as above the 85th percentile and at or below the 85th percentile. Cold executive functions were evaluated by the Stroop Test (ST) and Cancellation Test (CT). Serial Digit Learning Test (SDLT) was administered to measure verbal short-term memory and learning capacity. To evaluate the severity of ADHD objectively, the parents completed the Conners' Parents Rating Scale-Revised Short Version (CPRS-RS). There was no statistically significant difference in ST, SDLT, CT scores, and CPRS-RS subscale scores between the two groups with ADHD. This study show that overweight/obesity comorbid with ADHD may not be associated with cold executive functions, verbal short-term memory, learning, or ADHD symptom severity.

Chronotypes and trauma reactions in children with ADHD in home confinement of COVID-19: full mediation effect of sleep problems.

This study aimed to investigate the relationship between chronotype preference/sleep problems and symptom severity of children with Attention Deficit Hyperactivity Disorder (ADHD) during the COVID-19 outbreak and to assess the chronotype preference/sleep problems that may play a mediating role in the relationship between the reactions to trauma and severity of ADHD symptoms. The sample of this single-center cross-sectional study consisted of 76 children with ADHD and their parents. Trauma symptoms were evaluated with the Children's Impact of Event Scale (CRIES-8); sleep habits were assessed using the Children's Sleep Habits Questionnaire (CSHQ); and chronotype was assessed using the Children's Chronotype Questionnaire (CCQ). There were significant differences in CRIES-8 and CSHQ scores between the eveningness type group and the non-eveningness type group. The CRIES-8 scores of children with ADHD were related to the CCQ and CSHQ scores and severity of ADHD symptoms. In mediation analyses, sleep problems were found to be the full mediating factor in the relationship between CRIES-8 scores and severity of ADHD symptoms and the relationship between CCQ scores and the severity of ADHD symptoms. Our findings indicate that chronotype plays an important role on the negative effects of home confinement of ADHD children during the COVID-19 outbreak. The role of the full mediator of sleep problems in the path from cognition to the behavior of young ADHD and non-ADHD children confined to the home environment during the pandemic period requires further assessment.

The relationship between chronotype, sleep, and autism symptom severity in children with ASD in COVID-19 home confinement period.

This study aimed to investigate the relationship between chronotype preference/sleep problems and symptom severity of children with Autism spectrum disorder (ASD) during the confinement and social isolation of the COVID-19 outbreak. This study included 46 drug-naive children aged 4-17 y diagnosed with ASD. The Autism Behavior Checklist (AuBC), Children's Sleep Habits Questionnaire (CSHQ), and Children's chronotype questionnaire (CCQ) were filled out before and at the end of the COVID-19 mandated home confinement by the children's parents. Children with ASD during the home confinement reported higher chronotype scores, i.e., eveningness chronotype, sleep problems, and autism symptom scores compared to the normal non-hone confinement state. The chronotype score and sleep problems of children with ASD during the home confinement period varied according to the AuBC score. The sleep problems of the children with ASD during the home confinement period mediated the relationship between chronotype score and severity of autism symptoms. It is essential to validate the role of the mediator effect of sleep problems and chronotype in larger samples of children with ASD with restricted to home confinement during the pandemic period. If sleep problems can be controlled with parental education, pharmacotherapy, and psychotherapeutic interventions, the impact on children with ASD of home confinement can be reduced.

Risky cyber behaviors in adolescents with depression: A case control study.

OBJECTIVE: This study aimed to compare adolescents diagnosed with major depressive disorder (MDD) and healthy adolescents with regard to cyberbullying, cyber victimization, internet addiction, and digital game addiction. MATERIALS AND METHODS: This cross-sectional study was performed in Selçuk University Hospital. The study sample consisted of 34 adolescents with MDD and 39 controls without any psychopathology. A socio-demographic data form, the Cyber bullying Scale (CBS), Cyber Victimization Scale (CVS), Cyber bullying Sensibility Scale (CBSS), Internet Addiction Scale (IAS), Digital Game Dependence Scale (DGA-7), and Children's Anxiety and Depression Scale-Refurbished (RCADS) were administered to all participants. RESULTS: CBS, CVS, IAS and DGAS-7 scores of the MDD group were significantly higher than those of the control group. The significant differences persisted even after controlling for confounding factors such as age, gender, socio-economic level, and parental educational levels with MANCOVA. A strong positive correlation existed between CBS and CVS scores, and higher IAS scores were associated with higher CBS scores in the MDD group. CBSS scores negatively correlated with DGAS-7 scores in the MDD group. LIMITATIONS: Due to the cross-sectional design of this study, conclusions about causality remain speculative. CONCLUSION: This study demonstrated the importance of assessing problems related to the online environment in the presence of depression in adolescents. Our results suggested that evaluating the use of technology with a view to the potential for cyber bullying and cyber victimization as well as internet addiction and addiction to digital games may be necessary as a holistic approach in the follow-up of adolescent depression.

Olanzapine-Associated Pisa Syndrome in an Autistic Adolescent.

OBJECTIVES: The objective of this study is to report a case of Pisa syndrome due to olanzapine use in an autistic adolescent. METHODS: The patient was a 12-year-old adolescent girl who was taking olanzapine for autism-related behavioral problems. Abnormal posture and balance problems appeared in the third month of olanzapine treatment. The patient was diagnosed as having Pisa syndrome after clinical evaluation. Biperiden was started on the patient whose complaints continued despite olanzapine treatment was stopped. Patient's complaints regressed with biperiden treatment. RESULTS: According to our knowledge, there is no an autistic adolescent case of Pisa syndrome previously reported in the literature. Further studies are needed to clarify the etiology and treatment of Pisa syndrome. CONCLUSIONS: In patients with balance problems and abnormal posture as a result of olanzapine use, the clinician should keep in mind Pisa syndrome.

The relationship between chronotype and obesity in children and adolescent with attention deficit hyperactivity disorder.

Children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) have a high prevalence of obesity, but the relationship between these two problems is not clear. Chronotype preferences may be one of the possible mechanisms underlying the link between ADHD and obesity. This is the first study to investigate whether chronotype preferences are a mechanism linking ADHD symptoms to obesity in children and adolescents. This cross-sectional study included 110 drug-naive children and adolescents aged 7-17 years with ADHD. The Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) was used to diagnose ADHD or to exclude psychiatric comorbidity. The Conners' Parents Rating Scale-Revised Short Version (CPRS-RS) and Children's Chronotype Questionnaire (CCQ) were used to assess the severity of ADHD symptoms and chronotype preferences. Body mass index (BMI) was calculated and classified according to national age- and gender-specific reference values. The participants were divided into three groups as normal weight (<85%, n = 38), overweight (85%-95%, n = 30) and obesity (>95%, n = 42) according to their BMI percentile. There were statistically significant differences between the three groups in terms of chronotype preference (p = .000). Morningness preference was 86.84% in the normal BMI group and 26.19% in the obese BMI group. Eveningness preference was 7.89% in the normal BMI group and 61.90% in the obese BMI group. There was a correlation between the BMI percentile scores and the morningness/eveningness scale (M/E) scores. Moreover, there was a correlation between the BMI percentile scores and the oppositional and ADHD index scores. According to logistic regression analysis, the odds ratio of having evening type for obesity was 5.66 and the odds ratio of having morning type for normal weight was 13.03. Independently from ADHD symptoms, eveningness was directly related to obesity and morningness was directly related to normal weight. Prospective studies should be performed to better understand the relationship between ADHD, overweight/obesity and chronotype.

Effect of adenotonsillectomy on sleep problems, attention deficit hyperactivity disorder symptoms, and quality of life of children with adenotonsillar hypertrophy and sleep-disordered breathing.

OBJECTIVE: Chronic adenotonsillar hypertrophy is the most common etiologic reason for upper airway obstruction in childhood and has been found to be associated with a variety of psychiatric disorders and poor quality of life. In the present study, we investigated the impact of adenotonsillectomy on attention deficit hyperactivity disorder symptoms, sleep problems, and quality of life in children with chronic adenotonsillar hypertrophy. METHODS: The parents of children with chronic adenotonsillar hypertrophy filled out the Conners's Parent Rating Scale-Revised Short form (CPRS-RS), Children's Sleep Habits Questionnaire (CSHQ), and Pediatric Quality of Life Inventory, Parent version (PedsQL-P) before and six months after adenotonsillectomy. RESULTS: A total of 64 children were included in the study (mean age = 6.8 ± 2.4 years; boy:girl ratio= 1). The mean attention deficit hyperactivity disorder index and oppositionality subdomain scores of the CPRS-RS and all of the CSHQ subdomain scores (bedtime resistance, sleep-onset delay, sleep anxiety, night waking, parasomnias, sleep-disordered breathing, and daytime sleepiness) except for sleep duration significantly decreased after adenotonsillectomy ( p < 0.05). The PedsQL-P total score and both PedsQL-P physical health and psychosocial health subdomain scores were significantly higher at six months after adenotonsillectomy ( p < 0.001). CONCLUSIONS: Child and adolescent psychiatrists should check the symptoms of chronic adenotonsillar hypertrophy to identify children with chronic adenotonsillar hypertrophy who suffer from sleep disturbance, attention deficit hyperactivity disorder symptoms, and oppositionality. Adenotonsillectomy seems to be beneficial for coexisting attention deficit hyperactivity disorder and sleep disorder symptoms and quality of life in these children.

The Relationship Between Parental Affective Temperament Traits and Disruptive Behavior Disorders Symptoms in Children With ADHD.

OBJECTIVE: This study investigated the relationship between parental affective temperaments and the oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms of children with ADHD. METHOD: The sample consisted of 542 treatment-naive children with ADHD and their biological parents. Children were assessed via both parent- and teacher-rated behavioral disorder scales. Parental affective temperament and ADHD symptoms were measured by self-report inventories. The relationships between psychiatric variables were evaluated using structural equation modeling. RESULTS: According to parent-rated behavioral disorder scales, paternal cyclothymic and maternal irritable temperaments were associated with ODD scores, and maternal depressive temperament was associated with CD scores. In terms of teacher-rated behavioral disorder scales, maternal anxious temperament was associated with ODD scores, and paternal cyclothymic and maternal depressive temperaments were associated with CD scores. CONCLUSION: These results suggest that certain parental affective temperaments are related to an increase in symptoms of disruptive behavioral disorders in children with ADHD.

Intelligence, Functioning, and Related Factors in Children with Cerebral Palsy.

INTRODUCTION: Cerebral palsy (CP) is the most common significant motor impairment in childhood. CP is defined as a primary disorder of posture and movement; however, intellectual impairment is prevalent in children with CP. The purpose of this study was to examine the intelligence level associated with gross motor function and hand function, type of CP, the presence of comorbid disorders such as epilepsy, and other factors. METHODS: In total, 107 children with CP were included. Age, gender, prenatal/natal/postnatal risk factors, type of CP, and presence of other neurodevelopmental disorders were recorded as demographic findings. Intellectual functions of the patients were determined by clinical assessment, adaptive function of daily life, and individualized, standardized intelligence testing. The gross motor function and hand function of the patients were classified using the "Gross Motor Function Classification System" and "Bimanual Fine Motor Function" measurements, respectively. RESULTS: The mean age of the patients was 8.10±3.43 years (2-16 years). The study included 63 (58.9%) male patients and 44 (41.1%) female patients. During clinical typing, 80.4% of the patients were spastic, 11.2% were mixed, 4.7% were dyskinetic, and 3.7% were ataxic. Intellectual functioning tests found 26.2% of the children within the intellectual norm and that 10% of the children had a borderline intellectual disability, 16% of them had a mild intellectual disability, 17% of them had a moderate intellectual disability, and 30.8% of them had a severe intellectual disability. No significant relationship was determined between the CP type and intellectual functioning (p>0.05). Intellectual functioning was found to be significantly correlated with hand functions and motor levels (p<0.001). Factors related with intellectual functioning were neonatal convulsion, epilepsy, and speech disorders. CONCLUSION: Intelligence assessment should be an essential part of CP evaluation and research. There is not enough reliable knowledge, unanimity regarding validity data, and population-specific norms in the intelligence assessments of children with CP. Research is required to assess properly intelligence for children with CP.

Association of Reactive-Proactive Aggression and Anxiety Sensitivity with Internalizing and Externalizing Symptoms in Children with Attention-Deficit/Hyperactivity Disorder.

This study evaluates the associations among the symptoms of anxiety, depression, and disruptive behavioral disorders (DBD) in the context of their relationships with reactive-proactive aggression and anxiety sensitivity in children with attention-deficit/hyperactivity disorder (ADHD). The sample consisted of 342 treatment-naive children with ADHD. The severity of ADHD and DBD symptoms were assessed via parent- and teacher-rated inventories. Anxiety sensitivity, reactive-proactive aggression and severity of anxiety and depression symptoms of children were evaluated by self-report inventories. According to structural equation modeling, depression and anxiety scores had a relation with the DBD scores through reactive-proactive aggression. Results also showed a negative relation of the total scores of anxiety sensitivity on DBD scores, while conduct disorder scores had a positive relation with anxiety scores. This study suggests that examining the relations of reactive-proactive aggression and anxiety sensitivity with internalizing and externalizing disorders could be useful for understanding the link among these disorders in ADHD.