The Challenges of Caregivers of Children with Autism Spectrum Disorders Comorbidity during the COVID-19 Pandemic in Serbia.

BACKGROUND: Children with Autism Spectrum Disorders (ASD) experience significantly higher prevalence of other mental disorders, which amplifies their need for overall support. The outbreak of novel coronavirus (COVID-19) resulted in restrictions and limited access to different services with great challenge for families and children with ASD. SUBJECTS AND METHODS: We used an electronic SurveyMonkey questionnaire to examine the experiences of 114 caregivers of children with ASD. We compared: (a) level of support by the child's school, changes in child behavior, and priority needs for families of ASD and ASD with comorbidities (ASD+) children, during pandemic, and (b) developmental history and diagnosis for ASD and ASD+ children before the pandemic. RESULTS: Our research shows significant behavioral difficulties in the population with ASD and ASD+ that arose in the field of altered living conditions and overall functioning during the COVID-19 pandemic. Statistically significant results comparing ASD to ASD+ children we found in area of getting additional help and support before the outbreak of the pandemic (47.1% vs 16.0%, p=0.002), as well as in worsening of sleep problems, statistically significant more common in children with ASD+ (ASD+ 47.7% vs. ASD 25.7%, p=0.046). CONCLUSIONS: Our findings can contribute to the faster development and implementation of protocols for dealing with situations such as pandemics, related to the vulnerable population of children with ASD and their caregivers.

First report on the nationwide prevalence of paediatric type 1 diabetes in Serbia and temporal trends of diabetes ketoacidosis at diagnosis-a multicentre study.

We aimed to collect data on all paediatric patients who were diagnosed with type 1 diabetes mellitus (T1DM) between the years 2000 and 2019 in Serbia and estimate for the first time its prevalence. Also, the trends of diabetes ketoacidosis (DKA) occurrence at the time of diagnosis are monitored. We collected and retrospectively analysed the data of patients <19 years with newly diagnosed T1DM. T1DM was diagnosed in 3134 patients (53.2% male). Total number of youth <19 years with T1DM was 1735 with prevalence of 135.25/100000 at the end of study period. T1DM was diagnosed most frequently between the ages of 5 and 11 years (42.1%). At the time of diagnosis, 35.7% presented in DKA. The incidence and severity of DKA were more significant at the youngest age (p<0.001). There were significant annual percentage increase (2.2%) in the number of new cases of DKA (p=0.007). Conclusion: This first report of nationwide prevalence of T1DM in youth shows that Serbia is among countries with high prevalence of T1DM in youth. System changes are needed in order to provide better quality of health care to these patients.

The risk for nonpsychotic postpartum mood and anxiety disorders during the COVID-19 pandemic.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) appears to be the largest pandemic of our times. The aim was to recognize the risk factors for nonpsychotic postpartum mood and anxiety disorders (NPMADs) in women during the pandemic and state of emergency police lockdown in Serbia. METHODS: We assessed 108 postpartum women who completed the Edinburgh Postnatal Depression Scale (EPDS) and an additional survey constructed for this study. We also used the additional, previously mentioned survey, in 67 healthy age-matched women with children who were ≥2 years of age. The additional survey allowed us to gain insight into the impact of the pandemic as well as postpartum period on the risk of NPMADs. RESULTS: In 16 (14.8%) subjects we found a score ≥10 on EPDS. Higher rates on the EPDS were noticed in elderly, single, and unemployed, women who lost their jobs due to the pandemic, or women who were dissatisfied with their household income (p < 0.05). The risk of NPMADs was linked significantly to quarantine, and social isolation, the absence of social support, as well as having emotional problems. Postpartum women, compared to non-postpartum women, were more anxious and had feelings of helplessness during social isolation. CONCLUSION: Understanding the factors that increase the risk of NPMADs during the pandemic could help prevent mental disorders during a possible future pandemic.

Nonsuicidal self-injury among adolescents in south-east Serbia.

BACKGROUND: Nonsuicidal self-injury (NSSI) refers to the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned. The aim of this study was to explore the variety of self-injury behaviors as well as the function of NSSI among adolescents in South-East Serbia. METHODS: The study included 50 adolescents of both sexes, aged 13-18 years, who had deliberately engaged in self-injury at least once. A general socio-demographic questionnaire and the Inventory of Statements About Self-Injury (ISAS) were used in the study. RESULTS: The average age of the respondents was 15 (1.17); the most common NSSI methods were cutting (60%), followed by biting and severe scratching (14%); the average age of onset was 14.12 (0.77); the majority confirmed experiencing pain during self-injury (42%); the respondents more commonly performed NSSI when they were alone (68,0%); in 90% of the cases, the time elapsed between sensing the urge to self-injury and acting on it was less than 1 h; the majority of the respondents stated that they did not want to stop self-injuring (56%). In terms of the NSSI function, the obtained scores were the highest for affect regulation 3.36 (1.47), self-punishment 1.90 (1.39) and marking distress 1.72 (1.26). In terms of gender, there was a statistically significant difference for the antidissociation (P = .043), interpersonal influence (P = .004) and revenge (P = .019). CONCLUSION: The results may have practical implications when it comes to taking preventive and therapeutic measures in the vulnerable adolescent population.

Perceptions on Support, Challenges and Needs among Parents of Children with Autism: the Serbian Experience.

BACKGROUND: Autism spectrum disorders (ASD) significantly impact lives of affected individuals and their families. They confront daunting challenges and multiple demands in their daily life, when compared to parents of children with other disabilities or parents of typically developing children. SUBJECTS AND METHODS: Participants completed The Caregiver Needs Survey, the survey intended for parents or primary caregivers of children with a diagnosis of ASD. During the study, 231 parents were interviewed; 167 mothers and 64 fathers. Parents were recruited from the patient database comprised of families from the two largest cities in Serbia. All of them were contacted before the study, either via phone or at the child's regular check-in visit. RESULTS: Over 90 percent of the parents reported that additional support at schools, home, and improved relationships with service providers are necessary and important. The most important challenges related to care were child's communication difficulties, social interaction difficulties, and problems with daily living skills. The significant predictors of lower overall satisfaction were parent's higher education, having a first concern related to problems of the child's interaction with others or playing alone, and parent frustration with accessing services in the past 12 months. Greater overall satisfaction, on the other hand, was related to having an in-school tutor training or assistance in managing child's needs or implementing treatments, and having primary care doctor or pediatrician as a source of information on autism. CONCLUSIONS: Future efforts to develop ASD-related policies and services should also take the following into consideration: the low level of awareness among caregivers and health care providers about the early signs of autism; disparities in access to services; educational problems and significant levels of dissatisfaction with the overall care and stigma.

Relationship between the Manner of Mobile Phone Use and Depression, Anxiety, and Stress in University Students.

Objectives: There is insufficient evidence regarding the potential risk of mobile phone use on mental health. Therefore, the aim of this research was to examine the relationship between mobile phone use and mental health by measuring the levels of depression, anxiety, and stress among university students in Serbia and Italy. Methods: This cross-sectional study was carried out at two distinguished universities in Serbia and Italy from March to May of the 2015/2016 academic year and included 785 students of both genders. The questionnaire was compiled and developed from different published sources regarding the manner and intensity of mobile phone use, along with the Depression Anxiety Stress Scale (DASS 42) for measuring psychological health. The statistical analysis of the data included the application of binary logistic regression and correlation tests. Results: Statistical analysis indicates that anxiety symptoms are somewhat more present in younger students (odds ratio (OR) = 0.86, 95% confidence interval (CI): 0.76-0.96), in those who send more text messages SMSs (OR = 1.15, 95% CI: 1.11-1.31), and in those who browse the internet less frequently (OR = 0.84, 95% CI: 0.73-0.95). Stress is more common in students who make fewer calls a day (OR = 0.79, 95% CI: 0.64-0.97), as well in those who spend more time talking on the mobile phone per day (OR = 1.28, 95% CI: 1.12-1.56). The strongest predictor of high stress levels was keeping the mobile phone less than 1 m away during sleeping (OR = 1.48, 95% CI: 1.12-2.08). Conclusions: The results indicated that the intensity and modality of mobile phone use could be a factor that can influence causal pathways leading to mental health problems in the university student population.

Evaluating empathy in adolescents with conduct disorders.

BACKGROUND/AIM: According to currently available data, there is no research dealing with evaluating empathy in adolescents with conduct disorders in our region. The aim of the research was to examine the differences in the severity of cognitive and affective empathy in adolescents with and with no conduct disorder, as well as to examine the relationship between cognitive and affective empathy and the level of externalization in adolescents with conduct disorder. METHODS: This research was conducted on 171 adolescents, aged 15 to 18, using the Interpersonal Reactivity Index, Youth Self-Report and a Questionnaire constructed for the purpose of this research. RESULTS: The results showed that adolescents with conduct disorder had significantly lower scores for Perspective Taking (t = 3.255, p = 0.001), Fantasy (t = 2.133, p = 0.034) and Empathic Concern (t = 2.479, p = 0.014) compared to the adolescents in the control group, while the values for Personal Distress (t = 1.818,p = 0.071) were higher compared to the control group, but the difference was not statistically significant. The study showed a statistically significant negative correlation between Perspective Taking and aggression (r = -0.318, p = 0.003) and a negative correlation between Perspective Taking and the overall level of externalizing problems (r = -0.310, p = 0.004) in the group of adolescents with conduct disorder. CONCLUSION: This research contributes to better understanding of behavioral disorders in terms of individual factors, especially empathic reactivity. Preventive work with young people who have behavioral problems associated with empathy deficit disorder proved to be an important tool in preventing the development, or at least relieving the symptoms, of this ever more common disorder.

Comparison of weight and length at birth of non-Roma and Roma newborn in Serbia.

OBJECTIVES: Roma infants tend to be smaller and are diagnosed as SGA more often than non-Roma infants, suggesting that specific anthropometric norms for these infants may be useful. We aimed to construct population-based centile, gender-specific charts for birth weight and length for singleton Roma infants born from 35 to 42 weeks of gestation and to compare it with anthropometric data of non-Roma infants. METHODS: We analyzed data on 27,602 non-Roma (53 % males) and 2235 Roma (51 % males) singleton live infants delivered from 2006 to 2012 in South East Serbia. The LMS method was used to estimate the birth weight and length centiles. RESULTS: Roma infants were up to 12 % lighter and up to 4 % shorter than non-Roma infants. Estimated centile charts for Roma males and females were constructed showing the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles. CONCLUSIONS: We created the separate centile charts for Roma ethnic group. The sample size was sufficient to demonstrate differences in mean birth weights and lengths of at term infants born during the study period.

Astasia-Abasia and Ganser Syndrome in a Preadolescent Girl: A Case Report.

INTRODUCTION: Astasia is the inability to maintain an upright body position without assistance in the absence of motor weakness or sensory loss. Abasia is described as the inability to walk or as uncoordinated walking, while preserving mobility of the lower limbs. Ganser syndrome is described as a dissociative disorder characterized by approximate answers, somatic conversion symptoms, clouding of consciousness, as well as visual and auditory pseudohallucinations. The aim of this study is to present a case that seemed like a combination of neurological and internal disturbances, but actually represented a psychogenic disorder. CASE OUTLINE: This paper presents the case of a 13-year-old patient with the first manifestation of the inability to walk and stand. Medical history, diagnostic instruments and differential diagnostic methods have been presented in detail. The clinical manifestation was initially interpreted as a neurological disorder. However, after the application of diagnostic procedures and a change in family circumstances, the patient was diagnosed with a psychogenic movement disorder, astasia-abasia, with progressive clinical presentation that included dissociative psychotic reactions (Ganser syndrome). Differential diagnosis as well as the elements of the therapeutic approach have been discussed. CONCLUSION: Presenting a case of psychogenic astasia-abasia in children contributes to a better understanding and differentiating between conditions with a clinical presentation of signs and symptoms dealt with by other branches of medicine.

Changes Needed in the Classification of Anxiety Disorders in Childhood: Options for ICD-11.

Considering the intensive preparation of the 11th revision of the International Classification of Diseases (ICD-11), we discussed the justification of the existing classification of emotional disorders with onset specific to childhood. This paper presents the citations from the ICD-10 (F93 block) and the authors' comments as a critical review of the justification of further existence of emotional disorders with onset specific to childhood as a separate block in ICD-11 classification. We concluded that the block F93 is insufficiently defined and should be completely changed or removed from the ICD-11 classification. Additionally, the specificities of the clinical picture of anxiety disorders in children should be adequately described within the future category of anxiety and phobic disorders by giving an explicit set of instructions for identifying clinical manifestations which vary by age.

Perceived parental acceptance/rejection, some family characteristics and conduct disorder in adolescents.

BACKGROUND/AIM: Conduct disorder is characterized by repetitive and persistent presence of dissocial, aggressive and defiant behavioral patterns, thus represents important public issue with comprehensive and far-reaching consequences both for the individual and society. The aim of this study was to investigate the differences in sociodemographic family characteristics and the prominence of parental acceptance/rejection dimensions in groups of adolescents with and without conduct disorder, as well as to examine the connection between parental acceptance/rejection dimensions and externalizing symptoms in the group of adolescents with conduct disorder. METHODS: This research was conducted on 134 adolescents, aged 15 to 18, using the Parental Acceptance/Rejection Questionnaire (PARQ child), Youth Self-Report (YSR), and a questionnaire constructed for the purpose of this survey. RESULTS: The results showed that the number of adolescents with conduct disorder coming from divorced families was significandy higher than from complete families (44.8% vs 13.4%, respectively; p < 0.001). Also, in this group of adolescents there was a statistically significantly higher number of parents suffering from psychiatric disorders compared to the controls (31.3% vs 8.9%; respectively; p = 0.001). The perceived rejection dimension and the total index of maternal acceptance/rejection were significantly higher in adolescents with conduct disorder than in those with no such disorder (132.30 ± 38.05 vs 93.91 ± 26.29 respectively; p < 0.001). Similar results were found for paternal acceptance/rejection dimension (129.40 ± 39.58 vs 86.10 ± 15.95 respectively; p < 0.001). Adolescents with conduct disorder and severe perceived maternal and paternal rejection showed a significantly higher average score on the subscale of externalizing symptoms (14.55 ± 4.45 and 13.27 + 5.05) compared to adolescents with conduct disorder and lower total index of parental acceptance/rejection (8.32 ± 5.05 and 8.28 ± 5.08). CONCLUSION: The results suggest that adolescents with conduct disorder perceive their parents as more rejecting and less warm and supportive compared to adolescents without conduct disorder. The perception of significant and severe parental rejection was associated with a significantly higher averaged score on the subscale of externalizing symptoms in the group of adolescents with conduct disorder compared to those with no such disorder. It was found that adolescents with conduct disorder most often come from large families, have divorced parents or parents with multiple psychiatric disorders.

A preview of the efficiency of systemic family therapy in treatment of children with posttraumatic stress disorder developed after car accident.

BACKGROUND/AIM: Traumatic stress refers to physical and emotional reactions caused by events which represent a life threat or a disturbance of physical and phychological integrity of a child, as well as their parents or gaerdians. Car accidents are the main cause of posttraumatic stress disorder (PTSD) in children. The aim of this study was to preview clinical efficiency of systemic family therapy (SFT) as therapy intervention in treatment of children with posttraumatic stress disorder (PTSD) traumatized in car accident under identical circumstances of exposure. We pointed out the importance of specific family factors (family cohesion and adaptability, emotional reaction of the parents) on PTSD clinical outcome. METHODS: The sample of this clinical observational study included 7-sixth grade pupiles--5 boys and 2 girls, aged 13. All of the pupils were involved in car accident with one death. Two groups were formed--one group included three children who were involved in 8 SFT sessions together with their families. The second group included 4 children who received an antidepressant sertraline in the period of three months. RESULTS: Two months after the car accident, before the beginning of the therapy, all of the children were the members of rigidly enmeshed family systems, considering the high average cohesion scores and the low average adaptability scores on the FACES III. Three months after the received therapy, having evaluated the results of the therapeutic approaches, we established that the adaptability scores of the families included in the SFT were higher than the scores of the families of the children who received pharmacotherapy with one boy still meeting the criteria for PTSD. CONCLUSION: Systemic family therapy was efficient in the treatment of children with PTSD, traumatized in car accident. Therapy efficiency was higher when both parents and children were included in SFT than in the case when they were not included in the family therapy. The change in the functioning of the family systems was not accidental or simply time-dependant, but it depended on the therapy which was applied and the increased level of family adaptability as the main risk factor of retraumatization.

Disturbed family functioning in patients suffering from posttraumatic stress disorder.

AIM: To investigate whether the presence of posttraumatic stress disorder (PTSD) symptomatology is related to specific family problems. METHODS: The study included 94 subjects who were divided into three groups: a group with posttraumatic stress disorder (based on PCL for DSM-IV National Center for PTSD) (N=31), a group with problems in postwar functioning but without posttraumatic stress disorder (N=33), a group of subjects who were mobilized but with no combat exposure experience (N=30). The first and the second group had the experience of combat exposure. The first group was experimental, being diagnosed with PTSD. The second and the third group were control groups (the first and the second control group). The groups were compared by intensity and quality of family dysfunction, in relation to parameters, determined by specific instruments used in this research. RESULTS: The subjects with the experience of combat exposure had the problems in family functioning independently of the existence of PTSD diagnosis. Many of these problems were caused by the damage of combat experience. We also found a high level of secondary traumatization among other family members. CONCLUSION: The combat experience causes problems in postwar family functioning of combatants independently of PTSD diagnosis being confirmed. It is, therefore, necessary to help all of the combatants and their families reintegrate, regardless of their PTSD diagnosis.

Autism and autistic spectrum disorders in the context of new DSM-V classification, and clinical and epidemiological data.

Autism is one of disorders from the autism spectrum, besides Asperger syndrome, atypical autism and pervasive developmental disorder not otherwise specified. They are classified as mental disorders as being manifested by a wide range of cognitive, emotional and neurobehavioural abnormalities. Key categorical characteristics of the disorder are clear impairments of the development of the child's socialisation, understanding and production of verbal and non-verbal communication and restricted and repetitive patterns of behaviour. Demarcation boundaries are not clear, neither within the very group of the disorders from the autistic spectrum, nor with respect to the autistic behavioural features in the general population. For this reason, the term spectrum points out the significance of the dimensional assessment of autistic disorders, which will most likely be the basis of the new diagnostic classification of the disorders belonging to the current group of pervasive developmental disorders in the new DSM-V classification. The understanding, as well as the prevalence of the autistic spectrum disorders has changed drastically in the last four decades. From the previous 4 per 10,000 people, today's prevalence estimates range from 0.6 to around 1%, and the increase of prevalence cannot be explained solely by better recognition on the part of experts and parents or by wider diagnostic criteria. The general conclusion is that the autistic spectrum disorders are no longer rare conditions and that the approach aimed at acknowledging the warning that this is an urgent public health problem is completely justified.

Determinants of atherosclerosis in children and adolescents with diabetes type 1.

INTRODUCTION: To evaluate the degree of atherosclerosis in children and adolescents with type 1 diabetes and its correlation with risk factors, traditional and other, such as anti-oxidative capacity of circulating blood and level of lipid peroxidation. MATERIAL AND METHODS: Forty children and adolescents with type 1 diabetes with mean age 13.7 years were compared with 20 age- and sex-matched healthy control subjects. Association of carotid artery intima-media thickness (cIMT) with different risk factors measured in children with type 1 diabetes was evaluated. RESULTS: Mean carotid IMT was higher in subjects with diabetes (p 〈 0.01) and was strongly associated with total cholesterol with an odds ratio of 4.08 (p = 0.016), LDL-cholesterol with an odds ratio of 2.78 (p = 0.037), length of disease with an odds ratio of 1.87 (p = 0.007) and positive family history (first- and second-degree relatives) of diabetes and early CVD (heart attack and/or stroke before the age of 60 years) with an odds ratio of 6.8 (p = 0.007). CONCLUSIONS: We found significantly increased cIMT in the diabetic patients compared to the healthy control subjects. Risk factors for the development of atherosclerosis included higher total and LDL-cholesterol, higher systolic blood pressure, positive family history of diabetes and early CVD and longer diabetes duration. In spite of the documented increased oxidative stress, we failed to establish a correlation between the oxidative stress parameters and cIMT values.

General characteristics of adolescent sexual behaviour: national survey.

INTRODUCTION: Investigation of adolescent sexual behaviour carried out on a large sample is primarily motivated by health and social problems which can occur when young people practice sex without protection and necessary information. There is no data that the national study on adolescent sexual behaviour has been conducted in the Serbian speaking area. OBJECTIVE: Monitoring and follow-up of trends in adolescent sexual behaviour. METHODS: The investigation sample comprised 1101 adolescents (472 male and 629 female), aged 13-25 years. As an instrument of polling, the questionnaire "Sexual Behaviour" was used specifically designed for the purpose of this investigation. RESULTS: Eighty-four percent of males and 65% of females reported having sexual experience. The age of the first sexual experience, total number of partners, number of sexual partners in the last year and the last month were investigated, and the number of loved and sexual partner compared. In addition, the length of foreplay, frequency of sexual activity, masturbation, sexual dreams and sexual daydreams and engagement into alternative sexual activities (oral sex, anal sex, group sex, exchange of partners) were estimated, as well as the reasons for their practicing. Sexual desire and its correlation with personality dimensions, the frequency of sexual disorders (erectile and ejaculation problems, anorgasmia), abortion, rape and identification of the rapist, the use of condoms and other methods of contraception were assessed. CONCLUSION: It could be postulated that biological influence on sexual behaviour is powerful and resistant to the influence of time and place, as well as socio-cultural religious influences. A high rate of premarital sexual activity with a number of sexual partners, a relatively low rate of condom use and the fact that 4% of the female adolescents in this sample had an induced abortion suggest that there are gaps in the education provided to adolescents about sexual and reproductive risks within the Serbian speaking territory. An alarming statistic is that 5% of the female adolescents in this sample reported that they had been raped, or forced to participate in non-consensual sex within an ongoing relationship with a regular partner. There is a need for systemic changes within the field of sexual education and protection from sexually risky behaviour among young adults.