Finnish Psychotherapy Quality Register: rationale, development, and baseline results.

BACKGROUND: The push to systematically follow treatment outcomes in psychotherapies to improve health care is increasing worldwide. To manage psychotherapeutic services and facilitate tailoring of therapy according to feedback a comprehensive and feasible data system is needed. AIMS: To describe the Finnish Psychotherapy Quality Register (FPQR), a comprehensive database on availability, quality, and outcomes of psychotherapies. METHODS: We describe the development of the FPQR and outcome for outsourced psychotherapies for adults in Helsinki and Uusimaa hospital district (HUS). Symptom severity and functioning are measured with validated measures (e.g. CORE-OM, PHQ-9, OASIS, AUDIT, and SOFAS). Questionnaires on therapeutic alliance, risks, methods, and goals are gathered from patients and psychotherapist. RESULTS: During 2018-2021, the FPQR included baseline data for 7274 unique patients and 336 psychotherapists. Response rate of measures was 85-98%. The use of the register was mandatory for the outsourced therapist of the hospital districts, and the patients were strongly recommended to fulfill the questionnaires. We report outcome for three groups of patients (n = 1844) with final/midterm data. The effect sizes for long psychotherapy (Hedge's g = 0.65 of SOFAS) were smaller than those for short psychotherapy (g = 0.75-0.91). Within three months of referral, 26-60% entered treatment depending on short- or long-term therapy. CONCLUSION: The FPQR forms a novel rich database with commensurate data on availability and outcomes of outsourced psychotherapies. It may serve as a basis for a national comprehensive follow-up system of psychosocial treatments. The Finnish system seems to refer patients with milder symptoms to more intensive treatments and achieve poorer results compared to the IAPT model in UK, Norway, or Australia.

Cross-cultural temperamental differences in infants, children, and adults in the United States of America and Finland.

Cross-cultural differences in temperament were investigated between infants (n = 131, 84 Finns), children (n = 653, 427 Finns), and adults (n = 759, 538 Finns) from the United States of America and Finland. Participants from both cultures completed the Infant Behavior Questionnaire, Childhood Behavior Questionnaire and the Adult Temperament Questionnaire. Across all ages, Americans received higher ratings on temperamental fearfulness than Finnish individuals, and also demonstrated higher levels of other negative affects at several time points. During infancy and adulthood, Finns tended to score higher on positive affect and elements of temperamental effortful control. Gender differences consistent with prior studies emerged cross-culturally, and were found to be more pronounced in the US during childhood and in Finland during adulthood.

Sleep quantity, quality and optimism in children.

We tested the relationship of objectively measured sleep quantity and quality with positive characteristics of the child. Sleep duration, sleep latency and sleep efficiency were measured by an actigraph for an average of seven (range = 3-14) consecutive nights in 291 8-year-old children (standard deviation = 0.3 years). Children's optimism, self-esteem and social competence were rated by parents and/or teachers. Sleep duration showed a non-linear, reverse J-shaped relationship with optimism (P = 0.02), such that children with sleep duration in the middle of the distribution scored higher in optimism compared with children who slept relatively little. Shorter sleep latency was related to higher optimism (P = 0.01). The associations remained when adjusting for child's age, sex, body mass index, and parental level of education and optimism. In conclusion, sufficient sleep quantity and good sleep quality are related to children's positive characteristics. Our findings may inform why sleep quantity and quality and positive characteristics are associated with wellbeing in children.

Brain responses to surprising sounds are related to temperament and parent-child dyadic synchrony in young children.

This study investigated the relationship between temperament characteristics, parent-child dyadic synchrony and auditory event-related potentials (ERP) in 15 two-year-old children. Temperament was assessed with the Early Childhood Behavior Questionnaire, and parent-child dyadic synchrony was analyzed from video-taped play situations. Involuntary switching of attention toward surprising sounds was measured with auditory ERPs by quantifying the P3a response for repeated and nonrepeated novel, naturally varying sounds, presented in a continuous repetitive sound sequence. Lower negative emotionality, higher effortful control and higher dyadic synchrony were associated with larger P3a responses to repeated novel sounds. The results demonstrate that temperament is related to P3a responses in early childhood, and that parent-child synchrony associates with both temperament and P3a responses in a theoretically meaningful way.

Sleep quality and cognitive performance in 8-year-old children.

OBJECTIVE: The present study examined how sleep duration and sleep quality are associated with cognitive performance in 8-year-old children using standardized neurocognitive tests. METHODS: Two hundred ninety children aged 7.4-8.8years participated in the study. Sleep duration and quality were measured using actigraphs and the Sleep Disturbance Scale for Parents. Cognitive performance was measured using four subtests of the Wechsler Intelligence Scale for Children III, the Beery Developmental Test of Visual-Motor Integration (VMI), and the Narrative memory subtest of the Developmental Neuropsychological Assessment for Children. RESULTS: When adjusting for age, sex, and maternal education, shorter sleep duration, but not sleep quality, was associated with lower visuospatial abilities (p-values 0.043). Sleep duration and quality were not associated with verbal abilities (p-values0.18). With regard to the individual test results, shorter sleep duration was associated with worse performance in Visual-Motor Integration (p=0.028), and when excluding children with high depression scores the same was also true with Block Design (p-values0.047). Moreover, poor sleep efficiency was associated with worse performance in Similarities (p=0.004). CONCLUSIONS: In a community sample of 8-year-old children, those who slept less or had poorer sleep quality had lower test scores in cognitive tasks, particularly those pertaining to visuospatial performance, although the association was not very strong.

Poor sleep and altered hypothalamic-pituitary-adrenocortical and sympatho-adrenal-medullary system activity in children.

CONTEXT: Neuroendocrine alterations, with well-known links with health, may offer insight into why poor sleep is associated with poor health. Yet, studies testing associations between sleep and neuroendocrine activity in children are scarce. OBJECTIVE: The aim of this study was to determine whether actigraphy-based sleep pattern is associated with hypothalamic-pituitary-adrenocortical axis and sympatho-adrenal-medullary system activity in children. DESIGN AND SETTING: We conducted a cross-sectional study in a birth cohort in Helsinki, Finland. PARTICIPANTS: We studied 282 8-yr-old children. MAIN OUTCOME MEASURES: We measured diurnal salivary cortisol and salivary cortisol and alpha-amylase (a sympatho-adrenal-medullary system marker) responses to the Trier Social Stress Test for Children (TSST-C). RESULTS: Children with short (77.4%) displayed higher diurnal cortisol levels across the entire day (P < 0.03), higher cortisol levels after the TSST-C stressor (P < 0.04), and higher overall alpha-amylase levels across the entire TSST-C protocol (P < 0.05). The effects were not confounded by factors that may alter sleep or hormonal patterns. CONCLUSIONS: Poor sleep may signal altered neuroendocrine functioning in children. The findings may offer insight into the pathways linking poor sleep with poor health.

Sleep duration and regularity are associated with behavioral problems in 8-year-old children.

BACKGROUND: Relatively little is known about the significance of normal variation in objectively assessed sleep duration and its regularity in children's psychological well-being. PURPOSE: We explored the associations between sleep duration and regularity and behavioral and emotional problems in 8-year-old children. METHODS: A correlational design was applied among an epidemiological sample of children born in 1998. Sleep was registered with an actigraph for seven nights (range 3 to 14) in 2006. Mothers (n = 280) and fathers (n = 190) rated their child's behavioral problems with the Child Behavior Checklist. RESULTS: Children with short sleep duration had an increased risk for behavioral problems, thought problems, and Diagnostic and Statistical Manual of Mental Disorders, 4th Edition-based attention-deficit hyperactivity problems according to maternal ratings. Based on paternal ratings, short sleep duration was associated with more rule-breaking and externalizing symptoms. Irregularity in sleep duration from weekdays to weekends was associated with an increased risk for specifically internalizing symptoms in paternal ratings. CONCLUSIONS: The results highlight the importance of sufficient sleep duration and regular sleep patterns from weekdays to weekends. Short sleep duration was associated specifically with problems related to attentional control and externalizing behaviors, whereas irregularity in sleep duration was, in particular, associated with internalizing problems.

Maternal licorice consumption and detrimental cognitive and psychiatric outcomes in children.

Overexposure to glucocorticoids may link prenatal adversity with detrimental outcomes in later life. Glycyrrhiza, a natural constituent of licorice, inhibits placental 11-beta-hydroxysteroid dehydrogenase type 2, the feto-placental "barrier" to higher maternal levels of cortisol. The authors studied whether prenatal exposure to glycyrrhiza in licorice exerts detrimental effects on cognitive performance (subtests of the Wechsler Intelligence Scale for Children III as well as the Children's Developmental Neuropsychological Assessment and the Beery Developmental Test of Visual-Motor Integration) and psychiatric symptoms (Child Behavior Checklist) in 321 Finnish children 8.1 years of age born in 1998 as healthy singletons at 35-42 weeks of gestation. In comparison to the group with zero-low glycyrrhiza exposure (0-249 mg/week), those with high exposure (>or=500 mg/week) had significant decrements in verbal and visuospatial abilities and in narrative memory (range of mean differences in standard deviation units, -0.31 to -0.41; P < 0.05) and significant increases in externalizing symptoms and in attention, rule-breaking, and aggression problems (range of odds ratios, 2.15 to 3.43; P < 0.05). The effects on cognitive performance appeared dose related. Data are compatible with adverse fetal "programming" by overexposure to glucocorticoids and caution against excessive intake of licorice-containing foodstuffs during pregnancy.

Prenatal origins of poor sleep in children.

STUDY OBJECTIVES: We examined whether small body size at birth and prenatal tobacco or alcohol exposure predict poor sleep and more sleep disturbances in children. DESIGN: An epidemiologic cohort study of 289 eight-year-old children born at term. MEASUREMENTS AND RESULTS: Sleep duration and efficiency were measured by actigraphy for 7 consecutive nights (mean = 7.1, SD = 1.2). We used both continuous measures of poor sleep and binary variables of short sleep and low sleep efficiency ( < or = 10th percentiles). Parents completed the Sleep Disturbance Scale for Children. Lower birth weight and shorter length at birth were associated with lower sleep efficiency. For every 1-SD decrease in weight and length at birth, the odds for low sleep efficiency increased by 1.7 fold (95% confidence interval [CI]: 1.1 to 2.7) and 2.2 fold (95% CI: 1.3 to 3.7), respectively. For every 1-SD decrease in ponderal index at birth, the risk of parent-reported sleep disorders increased by 1.4 fold (95% CI: 1.0 to 2.0). Moreover, children exposed prenatally to alcohol had a 2.9-fold (95% CI: 1.1 to 7.6) and 3.6-fold (95% CI: 1.3 to 10.0) increased risk for having short sleep and low sleep efficiency, respectively. The associations were not confounded by sex, gestational length, prenatal and perinatal complications, body mass index at 8 years, asthma, allergies, or parental socioeconomic status. CONCLUSIONS: Poor sleep in children may have prenatal origins. Possible mechanisms include alcohol consumption during pregnancy and other conditions associated with small body size at birth.

Short sleep duration and behavioral symptoms of attention-deficit/hyperactivity disorder in healthy 7- to 8-year-old children.

OBJECTIVE: It has been hypothesized that sleep deprivation may manifest in children as behavioral symptoms rather than as tiredness, but only a few studies have investigated this hypothesis. The objective of our study was to evaluate whether short sleep is associated with behavioral symptoms of attention-deficit/hyperactivity disorder in 7- to 8-year-old children. METHODS: We performed a cross-sectional study of children born in 1998 in Helsinki, Finland. The participants included 280 (146 girls, 134 boys) children with a mean age of 8.1 years (SD: 0.3; range: 7.4-8.8). Sleep quality was measured by using actigraphs. The Sleep Disturbance Scale for Children and the Attention-Deficit/Hyperactivity Disorder Rating Scale IV were administered to parents. RESULTS: Children whose average sleep duration as measured by actigraphs was short (<10th percentile, ie, <7.7 hours) and had a higher hyperactivity/impulsivity score (9.7 vs 7.8 or 7.5) and a higher attention-deficit/hyperactivity disorder total score (17.3 vs 14.5 or 13.1) but a similar inattention score (7.6 vs 6.7 or 5.6) compared with children sleeping 7.7 to 9.4 hours or >9.4 hours. In multivariate statistical models, short sleep duration remained a statistically significant predictor of hyperactivity/impulsivity, and sleeping difficulties were associated with hyperactivity/impulsivity, inattention, and the total score. There were no significant interactions between short sleep and sleeping difficulties. CONCLUSIONS: Children's short sleep duration and sleeping difficulties increase the risk for behavioral symptoms of attention-deficit/hyperactivity disorder.

Continuity of father-rated temperament from infancy to middle childhood.

Continuity of father-rated temperament in Finnish children (n=115) aged from 6 months (the IBQ) to 5.5 years (the CBQ) was explored within the theoretical framework developed by Rothbart. Father-rated activity level, smiling and laughter and distress to limitations showed significant differential homotypic and heterotypic continuity, while soothability, duration of orienting and fear showed significant differential heterotypic continuity. On the level of latent superconstructs, father-rated positive and negative infant affectivity accounted for 5.1, 22.7 and 10.0% of the variance in childhood extraversion, effortful control and negative affectivity, respectively. Inter-parental comparisons (n=109 family units) revealed that father-rated continuity was similar to mother-rated continuity. These findings give empirical credence to Rothbart's theory and to father-rated temperamental continuity from infancy onwards.

Continuity of temperament from infancy to middle childhood.

Continuity of temperament from 6 months (the IBQ) to 5.5 years (the CBQ) was explored in Finnish children (n=231) within the theoretical framework deviced by Rothbart. Activity level, smiling and laughter, distress to limitations and fear showed significant differential homotypic and heterotypic continuity, while soothability and duration of orienting showed significant differential heterotypic continuity. On the level of latent superconstructs, infant positive and negative affectivity accounted for 4.6, 22.3, and 6.0% of the variance in childhood extraversion, effortful control and negative affectivity, respectively. Infant and childhood temperament clustered into profile types named "resilient", "undercontrolled", and "overcontrolled" mirroring ipsative continuity. These findings give empirical credence to Rothbart's theory by replicating and extending previous findings in significant ways.