Does the subjective quality of life of children with specific learning disabilities (SpLD) agree with their parents' proxy reports?

PURPOSE: The aim of the present study was to investigate agreement between child-parent proxy reports on quality of life (QoL) in children with specific learning disabilities (SpLD) and in a control group of typically developing children. METHODS: One hundred and sixteen children aged 8-14 years with SpLD, and 312 same age typically developing children with their parents (one or both), respectively, completed the child and parent versions of the KINDL(R) questionnaire. Values were analyzed with ANOVA and intra-class correlation coefficient (ICC). RESULTS: Significant mean differences were found between children with SpLD and their mother's proxy ratings. So, mothers reported significantly lower scores in the dimension of everyday functioning in school, but significantly higher scores regarding the child's physical and emotional well-being. For typically developing children, significant differences between children and parents' proxy ratings were found in physical well-being and self-esteem with both parents reporting higher scores. Concerning ICC, correlations were few and low in the SpLD group but more robust in the typically developing child-parent proxy ratings with values ranging from 0.22 to 0.46. CONCLUSION: In the case of SpLD, the child's problem area, which is reflected in the KINDL(R) dimension of everyday functioning in school, seems to be an issue of controversial value that may be differentially perceived by children and their mothers. Further, it can be argued that as mothers seemed to perceive in a more negative way the child's QoL at school, they were at the same time attempting to counterbalance their reactions by overestimating the child's physical and emotional well-being. Besides differences, there is a tendency even low for mothers and children with SpLD to converge toward similar perceptions regarding the child's physical and emotional well-being and satisfaction with friends that is showing some rather common understanding of the child's overall well-being and his/her relationships with peers. In the control group, agreement between children and parents seems to be more even and evident. Proxy assessments in children with SpLD and their parents may be useful for planning targeted support interventions for these families.

Psychoanalytic psychotherapy in times of social crisis: The impact on therapeutic relationship.

Discussion on defining therapy factors develops along two lines: one focusing on the interpretation and another focusing on the relationship. Changes in the socio-economic circumstances, cultural particularities, dismissal of institutions, constant negation, lack of boundaries, confusion of roles, various family secrets revealed due to "collapses," major conflicts, violence and aggression filling the individual as part of both the internal and the external reality - all are known risk factors causing the individual to experience trauma either due the nature of the received stimuli/threats or due to the loss of the enabling/supportive environment. Also, this situation affects the analyst's psychic structure as well. The analyst will have to strike a balance between their own internal objects, which under the circumstances activate the analyst's own suppressed conflicts, and the multiple intense projections of the analysand. First of all, the internal struggles taking place in the analyst's psychism regarding their own griefs, frustrations, and conflicts concerning their adjustment to the current reality, as well as individual griefs relating to their narcissistic doubts and the projections of omnipotence they receive. The question is whether the analyst will go through a destabilization process, being overwhelmed by psychic stimuli in multiple levels, or react with "manic defences" resulting, perhaps, in the prevalence of anti-psychoanalytic dynamics on the transference - countertransference axis. A second line of thought involves the internal struggles taking place in the psychic structure of the analysand, and often the "meeting" of the latter with the analyst through the "parallel process." Finally, we think about the multiple - due to psychic tensions - instances of enacting (or acting out) and the setting being put to the test in terms of frequency, fees, difficulty of symbolic processing, and aggressiveness towards the interpretations and demands of the analyst as object introjected to the superego and requiring "compliance" to certain standards, the setting principles. We refer to the internal processes resulting from conflicts in the therapists' psychic structure as regards their own internal objects, life experiences, frustrations in relation to the parent/authority, adolescent conflicts with the system, political views, life philosophy, and sense of fairness. Issues are more complex in the therapy of children and adolescents. Their mental condition is affected by that of their parents. When it is hard for the therapist to become an object of identification and idealization, since all institutions around them have been undermined, confirming the adolescent's guilt-ridden fantasy aggression? How, then, will the therapeutic process move forward when models crumble; when parents are being proved weak and unable to receive the aggressiveness of the independence-gaining process; and when reverie fantasies cease to exist? Today, more and more often we see adolescents who cannot develop because they are involved in their own parents' unprocessed situations. Despite the aforementioned difficulties, the therapy space as a setting with boundaries and empathetic functions could function as a "womb" that will give birth to new mental life. And this life will bloom as long as therapists preserve intact within them their values and principles - and their ability for reverie!

Adolescents' mental health during the financial crisis in Greece: The first epidemiological data.

Greek financial crisis has incurred adverse effects on the mental health of the population; however existing research is constrained in the adult population. Therefore, the present study aims to shed light on the mental health state of adolescents during the recession. In this context 2,150 adolescents were recruited from a random and representative sample of public and private schools in the greater Athens area. Mental health problems were assessed with the selfreport Strengths and Difficulties Questionnaire while additional questions enquired about students' socio-demographic characteristics. Findings indicate that roughly one out of ten adolescents scored above the cut off point for the total difficulties score, with the higher prevalence been recorded for the conduct problems sub-scale. More specifically, 7.7% of the sample scored above the abnormal cut-off point for the total difficulties score, 10.9% for emotional symptoms, 11.9% for conduct problems, 10.6% for hyperactivity and 4.8% for peer problems. Furthermore, adolescents who reported that during the previous month there was not enough food in their house displayed higher odds of manifesting mental health problems than adolescents who replied negatively in the particular query. On the grounds of these results, there is indication about the adverse effects of the financial crisis in the development of psychiatric symptomatology in adolescents in the Greek society. This is the first study providing epidemiological data on the current state of adolescents' mental health amid the recession in Greece, showing that the crisis impinges disproportionately on the most vulnerable socio-economic groups.

Attention Deficit/Hyperactivity Disorder (ADHD) symptoms and cognitive skills of preschool children.

Attention deficit/hyperactivity disorder (ADHD) constitutes a neurobehavioral disorder which may potentially adversely affect children's wellbeing and academic achievement. The onset of symptoms is present prior to 12 years of age, and often the symptoms are evident in the preschool years. In fact, it has been suggested that screening for ADHD symptoms may be initiated as early as four years of age. Preschool children with ADHD have been shown to present with poor pre-academic skills and might be at increased risk for numerous school-related problems, including functional impairment during elementary school years and persistent poor academic performance thereafter. Although preschool years are characterized by rapid cognitive growth, preschoolers with ADHD may present with poorer cognitive and neuropsychological functioning. Due to the early onset of ADHD symptoms, exploring the cognitive correlates of this condition among preschool children is thought to be of notable importance. The aim of the present study was to evaluate any association between ADHD symptoms and cognitive skills among preschool children. A cross-sectional study was conducted among a nationwide random sample of 4,480 preschool children. ADHD symptoms were assessed though interviews with parents and teachers based on DSM-IV-TR criteria. Cognitive skills were assessed through a standardized school readiness test (A' TEST). Among participants, the occurrence of ADHD symptoms was 4.6% (boys/girls: 3.4/1). The presence of ADHD symptoms among children was inversely associated with non-verbal and verbal cognitive skills; specifically, with abstract thinking (aOR 1.97, 95% CI 1.30-3.00), language (2.36, 1.55-3.59), critical reasoning (2.58, 1.84-3.62), visual perception (2.42, 1.38- 4.24), and visual motor skills (2.61, 1.91-3.55). Children with ADHD symptoms were five times as likely to have compromised organizational skills (4.92, 3.04-7.97). Abstract thinking was the least affected domain particularly among boys, while organizational skills were the most affected domain in both sexes, and possibly more among girls. Concluding, the present study confirms that even during preschool years, children with ADHD symptoms are more likely to present with concomitant cognitive difficulties. Thus, screening for the presence of ADHD, as well as cognitive and affective screenings among preschool aged children may facilitate the early detection and determent of the development of cognitive difficulties, and subsequently the early intervention for fostering skills that are amenable to change, such as organizational skills and planning. As a result, the study findings reveal the necessity for the evaluation of pre-academic skills among preschool children with ADHD symptoms in order to mitigate unfavorable academic functioning.

Comorbid psychopathology and clinical symptomatology in children and adolescents with obsessive-compulsive disorder.

Comorbid psychopathology in children and adolescents with obsessive-compulsive disorder (OCD) has been investigated in a number of studies over the last twenty years. The aim of the present study was to investigate the phenomenology of illness and broader psychopathology in a group of Greek children and adolescents with OCD. The investigation of parental psychopathology in children and adolescents with OCD was a secondary aim of the present study. We studied 31 children and adolescents with OCD (n=31, age range 8-15 years) and their parents (n=62, age range 43-48 years) and compared to children and adolescents with specific reading and written expression learning disorders (n=30, age range 7-16 years) and their parents (n=58, age range 40-46 years). Appropriate testing showed specific reading and learning disorders, which were of mild to moderate severity for the 85% of this latter group. The diagnosis of learning disorder of reading and written expression was made through the use of standardized reading material, appropriate for ages 10-15 years. Reading comprehension and narration were tested. The written expression (spelling, syntax, content) was examined by a written text, in which the subject developed a certain theme from the reading material. Based on their level of education and occupation, the index families were classified as high (29%), average (45%) and low (26%) socioeconomic status, whereas 6.7% of control families belonged to high, 63.3% to average, and 30% to low status. In order to investigate psychopathology, the Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Life-time version was administered to children and their parents, as well as the Child Behavior Checklist 4/18 (CBCL) to both parents and adolescents (Youth Self-Report). Also the Yale- Brown Obsessive Compulsive Scale (Y-BOCS) was rated for both children and parents. Moreover, the children were given the Children's Depression Inventory (CDI) and the Revised Children's Manifest Anxiety Scale (RCMAS). In the OCD group, 48% had contamination obsessions, 42% aggressive obsessions and 52% had washing and cleaning compulsions. Moreover, 32% had one additional disorder and 16.1% had two additional disorders. In comparison, only 17.2% of the control group children had one comorbid disorder. The OCD proband group had higher Total Problems score, as well as higher Anxiety/Depression, Thought Problems and Externalizing scores on the CBCL. When proband parents and control parents (29 mothers and 21 fathers) were compared, the percentage of fathers in the clinical range was significantly higher in the study group (Fisher's exact test: p=0.011, two tailed), whereas for mothers the difference did not attain significance (Fisher's exact test: p=0.106, two tailed). The fathers and mothers of children with OCD were more clinically affected than those of controls. Mothers of probands differed from controls in compulsions, compared to fathers, who differed in both obsessions and compulsions. Comorbidity rate was higher to children and adolescents with OCD. A considerable number of children and adolescents with OCD had higher symptomatology of anxiety and depression than controls, as well as higher rates of thought problems. Children and adolescents with OCD also exhibited higher rates of externalizing problems. This latter finding is considered as important and needs to be highlighted in terms of case management and treatment. Moreover, the parents of children and adolescents with OCD had more OCD symptomatology than the parents of children and adolescents with learning disorders. The symptomatology of the parents may create difficulties in interactions within the family and become burdensome for a vulnerable child. In turn, the child's symptomatology may create or increase some of the symptoms in the parents i.e. anxiety and depression. These findings suggest that at least for a percentage of children and adolescents with OCD, parental and especially paternal influence may contribute to the development and severity of their symptoms, not only through hereditary factors but also through the control exerted and the anxiety created in the family context.

Comparing immigrant children with native Greek in self-reported-Quality of Life.

UNLABELLED: Research on an international and national context regarding immigrant children and adolescents' quality of life (QoL) is rather scarce. Few international studies have been conducted investigating the presence of psychopathology and providing evidence of behavioural and psychological problems in immigrant adolescents. Regarding immigrant quality of life, thus far investigation was directed mainly to adult immigrant individuals and not to their children. The aim of the present study was to investigate the quality of life (QoL) of immigrant children and young adolescents who live in the greater Athens area, and to compare them with their native Greek peers living in the same communities and attending the same schools. METHOD: Sixty three immigrant children, from Albanian and Eastern European origin (mean age 11.9 years) and 489 native children (mean age 11.33 years) were administered a QoL instrument specifically developed for children and adolescents: the Kid-KINDL® Questionnaire for 8-12 years old and the Kiddo-KINDL® Questionnaire for 13-16 years old. The dimensions examined in the KINDL® questionnaire refer to: physical wellbeing, emotional well-being, self- esteem, friends, family life and everyday life (school life). The Greek version is reported to show satisfactory values of validity and reliability. Administration of questionnaires was conducted at school after parent consent. Analysis included student's t-test, chi-square test, and multivariate linear regression analysis, as to investigate the relationship between KINDL® QoL dimensions' scores and nationality status, after controlling for gender and age. The results indicated that self-reported QoL scores of immigrant children were significantly poorer in comparison to native children in the domains of self-esteem and family life, as well as in the total QoL scores. In the rest of the QoL domains, similar scores were reported in both immigrant and their native classmates, that is in the dimensions of physical well-being, emotional well-being, friends and school. Investigating the effect of gender in KINDL® QoL parameters, after controlling for nationality and age, no evidence was found for differences between male and female children. Regarding the effect of age, older compared to younger in age children scored significantly lower in emotional well-being, self-esteem, and friends, school and total QoL. The results provide evidence of QoL deficits in self-esteem and family life in immigrant children. QoL deficits seem to increase in more areas as immigrant children grow older. Dimensions regarding self-perception and family may be interrelated, mutually influencing one another. It may be suggested that immigrant children seem to experience reduced self-esteem and distressful feelings within family interpersonal relations. As they grow older, distress seems to become more evident in emotional and social areas of QoL. Mental health interventions should take into account the multilevel impact of family interpersonal experiences on child's psychosocial development, as to design and deliver appropriate interventions supporting parenting for immigrant groups of individuals. Also, specialized mental health promotion programs need to be provided for adolescent immigrant individuals.

Predictors and characteristics of anxiety among adolescent students: a Greek sample.

In the Greek society, there is a strong cultural tendency to overestimate the value of University studies. So students are under high emotional pressure during the long lasting period of the preparation for the university entrance exams. The aim of the present study was to evaluate the level of anxiety in a general adolescent population of senior high school students in Athens, Greece. Also to examine the association between the anxiety's severity with various demographic and socio-cultural factors, as well as with academic performance, extracurricular activities, sleep duration and presence of somatic problems. The sample consisted of 696 adolescent students of three Senior High Schools (SHS) (391 girls and 305 boys). Two of the schools were general education institutions (GE1 and GE2, N=450), while the third was a technical one (TE, N=246). The school sample was selected to reflect the proportion between the two different types of SHSs in Athens as well as other major urban areas in Greece. The State-Trait Anxiety Inventory was administered and personal data were also collected. Statistical significance was set at p<0.05 and analyses were conducted using STATA 7.0. 567 adolescents lived with both parents and 121 with one or none of them. Father's educational level was low for 138, middle for 154, high for 195 and mother's was low for 135, middle for 417, high for 140. The average sleep duration was 7.5 hours per day (SD=1.3). The average time per week spent in school related activities was 7.94 hours (SD=7.56) and in extracurricular activities was 9.02 hours (SD=12.44). 107 adolescents reported somatic complaints in the last year The academic achievement was poor for 233, good for 264, excellent for 196 students. Adolescents with extracurricular activities for more than 11 hours per week had lower scores, both on State and Trait scales. More hours in school-related activities were associated with greater levels of Trait anxiety. Adolescents whose father had a high educational level had lower scores on State anxiety compared to those whose father had a low educational level. Adolescents who reported the presence of somatic problems had a higher score in Trait anxiety. A significant negative correlation was found between sleep duration and both State (r=-0.14, p<0.001) and Trait anxiety (r=-0.10, p=0.008) scores. Stepwise linear regression analyses confirmed the association of gender and of father's educational level with both State and Trait subscale scores. The association of somatic problems with Trait anxiety was greater for girls compared to boys. The hypothesis that there is exam-related anxiety in our sample was not confirmed. There were no differences between school years and GE and TE schools. Also there was not an association of anxiety level with academic achievement and the number of parents the adolescent was living with. This study shows that girls, especially those reporting somatic problems, and adolescents coming from families with low parental education, are particularly prone to higher level of anxiety and that extracurricular activities are linked to lower level of anxiety. These findings could contribute to the planning of preventive measures for student's anxiety.

[Specific developmental disorder of speech and language in adulthood].

Specific developmental disorder of speech and language is part of a more general category of neurodevelopmental disorders, which is encountered in 7-10% of the childhood population. These children exhibit a significant impairment in speech and language development, which cannot be justified by hearing impairment, cognitive impairment, neuromuscular or orofacial disorders, as well as by emotional or environmental factors. Specific developmental disorders of speech and language are often comorbid with other neurodevelopmental disorders, such as motor coordination disorder and ADHD. These disorders are usually detected in early childhood and commonly treated during the preschool and school years. Despite this fact clinical and empirical evidence suggest that often these disorders persist beyond the school years, even though the symptomatology may be differentiated. In this literature review, we address the question of whether specific developmental language disorders are encountered only during childhood, and, if they persist, how they are manifested in adulthood. Finally, possible factors which may lead to these manifestations are analyzed. A considerable body of research has shown that even though the symptoms of children with specific developmental language disorders are resolved before the end of childhood, a significant part of this population continues to have persisting difficulties through adolescence and into adulthood. The continuity of this disorder may sometimes be directly linked to language disorder, as in the case of learning impairments or, on the other hand, symptoms may be related with those of conduct disorders, social adjustment disorder, emotional and psychiatric disorders in adolescence and adulthood. It therefore appears that specific developmental language disorder is often an early symptom of other disorders in the future. Even though the precise mechanisms which are responsible for these disorders are not yet known, it is possible that a fragile neurobiological substratum in these disorders may explain why early symptoms are usually manifested as language disorders and later develop into other disorders over time. However, these symptom changes may be linked to other parameters, such as the increasing social and emotional demands made on these individuals with increasing age, which may be a contributing environmental parameter to an already vulnerable system. Despite all of the limitations in the longterm study of these children, it is suggested that in some way, and not in all cases, pathology may continue into adulthood, although with a different symptomatology, which is linked to behavioural and social adjustment, as well as with more pervasive psychiatric disorders. In conclusion, it is suggested that a continuum of services may be necessary for these cases into adulthood.

Increased frequency and service delivery for children with pervasive developmental disorders.

Many investigators have reported the increasing incidence of pervasive developmental disorders (PDD), noting that this is probably due to more precise diagnoses, as a result of professionals' increased awareness and knowledge, as well as increased publicawareness. Child mental health services are usually the first to examine these patients and consequently are required to deal with this increase on a practical basis. The aim of this study is to investigate the factors which may be responsible for this increase in PDD cases in a communitymental health centre over a ten year period and to examine whether this has led to a differentiation in service delivery. Consequently, two sets of factors are investigated: factors pertaining to the children themselves, as well as their families and factors related to service provision and delivery.48 children, aged between 2 and 6 years (Mean: 3,5 yrs) with pervasive developmental disorder, as well as their families are divided into two groups according to year of intake. Data collected from patient files included prenatal and perinatal information; medical the and developmental history;family functioning; and hereditary factors. Data from the Service included professionals involved in each case; number of diagnostic sessions; referral for further examinations; patient's symptoms and level of functioning; cognitive functioning; recommendations and outcome. There was no significantdifference in age at intake between groups. The number of cases with pervasive developmental disorder has doubled over a ten year period at our Service. There was no significant difference between groups, with regard to conception, perinatal, developmental and medical histories. Thereis a trend for increased non-medical referrals. Service delivery has not differentiated over the ten year period. In conclusion, no specific factors were identified to justify the increase in PDD cases at our Service over a ten year period, however the trend for more non-medical referrals seems toimply a rise in public awareness of these disorders. Despite augmented patient intake without the complementary increase in staff, service provision at our setting has remained stable, delivered according to a multidisciplinary model and designed according to individual patient needs.

Behaviour assessment and reading ability in second grade greek school children.

Studies on ADHD show high comorbidity with behavioural and learning disorders. However, the specific association of behavioural and attention factors with learning disorders is not clear. The aim of this study is to examine the relationships between hyperactivity, inattentionand reading ability in a non-referred sample in Greece. Data were collected from 201 pupils attending second grade in public school in an Athens district. The CBCL was administrated to parents in order to evaluate behavioural disorders, inattention and hyperactivity. Teachers completedthe CBCL and the Conner's scale. Reading ability was assessed by a reading test appropriate for second grade. Attention difficulties reported by the teacher were associated with lower readingskills, but hyperactivity and behaviour disorders were not. Correlations of reading skills with CBCL scores were very low, especially through parental ratings. Girls showed better reading skills and less"hyperactivity" than boys. There was consistency in teachers' ratings between the Conner's and the CBCL. Teacher-parent concordance on CBCL was very low or absent. Report of hyperactivity without report of attention problems was not associated with reading difficulties in a non-referred Greek sample of second grade schoolchildren. This observation must be considered when therapeutic and/or educational planning is undertaken.

Psychoanalysis and the public health sector: The Greek experience.

The question of whether psychoanalysis -outside the original psychoanalytical setting- can co-exist with the public sector of health services has been substantially answered by the development of relevant psychoanalytic theory and the evolution of novel psychotherapeutic techniques. Psychoanalysis has a non specific and a specific effect on the public sector. The first explores how psychoanalytic concepts formulate a special understanding of mental disorders in everyday clinical practice; both in the organisation of services and a personalised approach of particular circumstances and needs of patients. The second explores how different kinds of psychoanalytic therapies are incorporated in the public sector. The setting is as crucially important here as are the appropriate funding, the recruitment of an adequate number of specialists and psychoanalytic training. Unfortunately psychoanalysis is not considered as cost-efficient by the majority of decision makers. In Greece, psychoanalysis has been present since the late 20's, initially as an instrument of perfection of children's understanding and education and also as a specific therapeutic method, appropriate for human psyche's understanding and for the treatment of some mental diseases. In the last 30 years psychoanalysis has been more closely implicated in the development of public health services and, by extension, in the psychiatric reform taking place in the country. Psychoanalytic supervision is mainly implemented in outpatient clinical practice. Brief psychoanalytic psychotherapies are implemented in outpatient and inpatient settings.