Family therapy and cognitive behavior therapy for eating disorders in children and adolescents in routine clinical care: a systematic review and meta-analysis.

Family therapy for eating disorders (ED) is well-established and represents the treatment choice for ED in children and adolescents according to guidelines, with cognitive behavior therapy (CBT) as a second line treatment. There is limited knowledge about how these treatments work in routine clinical care. The goal of the present meta-analysis is to investigate the effectiveness of family therapy and CBT for various EDs in children and adolescents when carried out in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were searched for articles published until December 2023. The outcome of family therapy and CBT, methodological quality, risk of bias, and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with ED efficacy studies. Forty-four effectiveness studies comprising 3251 family therapy or CBT patients were included. Large to very large within-group effect sizes (ES) were found for ED-psychopathology (0.80) and weight measures for AN (1.64) at post treatment. The attrition rate was 15%. Risk of bias was considerable. Moderate to large ES were found for family therapy and CBT, respectively. The benchmarking analysis showed that effectiveness studies had comparable ESs to efficacy studies (0.80 and 0.84 for the ED-psychopathology at post treatment). The findings support family therapy and CBT for ED in children and adolescents as effective treatments when delivered in routine clinical care, with effects comparable with those found in efficacy studies. The evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies.PROSPERO [CRD42023441794].

Psychometric properties of the Strengths and Difficulties Questionnaire in an Icelandic community sample.

PURPOSE: The current paper aimed to evaluate the psychometric properties of the Icelandic translation of the Strengths and Difficulties Questionnaire, for both parent and teacher reports. SDQ is a widely used questionnaire for screening mental problems among youth. However, only a few studies have conducted a factor analysis on the youngest and oldest cohorts using an adequate sample size. This study aims not only to examine the traditional 5-factor model and alternative models suggested in prior research but also to establish norm data for the Icelandic population. MATERIALS AND METHODS: The total sample consists of 1653 youth aged 5-16 years, thereof 316 parent reports and 271 teacher reports for the 5-year-old sample. We used confirmatory factor analysis to evaluate the factor structure. Special attention was given to the models' performance across different age groups and between genders. This cross-demographic evaluation is vital to ensure that the SDQ's utility is not limited by developmental or gender-specific variations in symptom expression or reporting. RESULTS: We found an acceptable fit for both the original five-factor model and the more recent three-factor model with higher-order internalizing and externalizing factors. The fit for the factor structures seemed to be quite similar across ages. However, we observed goodness-of-fit below the acceptable range for girls on the parent ratings. We also found evidence for the convergent and divergent validity of both models. CONCLUSIONS: The current study provides further evidence of the utility of the SDQ as a screening instrument, with an acceptable factor structure across ages.

Taste education - A food-based intervention in a school setting, focusing on children with and without neurodevelopmental disorders and their families. A randomized controlled trial.

Children with neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD) have high levels of fussy eating. However, no school-based food interventions exist for children with ASD and ADHD. To investigate the effect of Taste Education, 81 children with ND (n = 33), and without (n = 48), aged 8-12 years, and their parents, participated in a 7-week food intervention. Children were matched on age, ND, and sex, and randomized into Immediate-intervention and Delayed-intervention groups. Parents completed the Children's Eating Behaviour Questionnaire (CEBQ), and a food-variety questionnaire. After adjusting for baseline measures, repeated-measures analysis-of-variance with time-points, and condition as factors (Immediate intervention and Delayed intervention) were used to examine changes in CEBQ-scores, with a robust linear mixed-model fitted. Changes in percentage of accepted foods were tested using a logistic-regression model adjusting for baseline acceptance. Results showed superior results for Intervention compared to waiting, on Food fussiness, but not Enjoyment of food, with stable effects through six-months follow-up. There were non-significant differences between children with and without ND. Results also showed increased odds of accepting vegetables by a factor of 1.6 (95% Confidence Interval [CI]: 1.33-1.93, p < .001); nuts and seeds by a factor of 1.4 (95% CI: 1.27-1.6, p < .001), but no significant association for fruit (OR 1.12, 95% CI: 0.92-1.34, p = .244). Trends were similar for children regardless of ND-status. The Taste Education program, shows promise, as a simple, non-invasive way to decrease fussy eating and increase food variety in the long-term.

Emotion Dysregulation, ODD and Conduct Problems in a Sample of Five and Six-Year-Old Children.

Previous studies examining the relationship between emotion dysregulation and externalizing behavior problems have, so far, focused on using general screening questionnaires capturing a wide range of externalizing behaviors and emotion dysregulation has mostly been assessed through direct observation using negative mood induction and behavioral tasks. The purpose of this study was to explore this relationship using a multi-informant rated clinical questionnaires. Parents and teachers of 609 5-6-year-old children (46% girls, 54% boys) completed the ERC, DBRS, and SDQ. ODD symptoms/conduct problems and lability/negativity were more severe among boys but girls had better emotion regulation. The results also showed a significant main effect for emotion dysregulation and ODD symptoms/conduct problems and that gender had no moderating effect on the relationship. These findings show a strong association between emotion dysregulation and concurrent ODD symptoms/conduct problems and suggest that emotional difficulties should be considered when exploring causes of behavior difficulties in daily life.

Incorporating Appetite Awareness Training Within Family-Based Behavioral Treatment of Pediatric Obesity: A Randomized Controlled Pilot Study.

Objective: To assess additive effects of incorporating appetite awareness training (AAT), a strategy to encourage eating in response to hunger and satiety cues, within a family-based behavioral treatment (FBT) for childhood obesity. Methods: Total 84 families with a child with obesity in the age range of 8-12 years, Body Mass Index Standard Deviation Score (BMI-SDS) ≥ 2, and a participating parent were randomly allocated to two conditions; standard FBT was compared with FBT incorporating AAT strategies (FBT-AAT). Treatment consisted of group therapy sessions (held separately for children and parents) as well as single-family (parent-child dyad) sessions (24 sessions total) delivered over 18 weeks at a tertiary care outpatient clinic. One booster session was provided 1-year posttreatment and a final follow-up assessment was conducted at 2 years. The primary outcome was change in child standardized body mass index (BMI-SDS). Results: The two conditions did not differ significantly at posttest, but the FBT-AAT group was at a significantly lower weight compared with FBT at both the first-year, F(1, 82) = 4.150, p<.05, and the second-year follow-ups, F(1, 82) = 14.912, p <.001. It was notable that over the second-year of follow-up, the FBT-AAT group continued to show improvement, whereas the FBT group did not. Conclusions: Incorporating specific self-regulatory training in attending to hunger and fullness signals during a standardized family-based treatment may have enhanced the long-term maintenance of treatment effects. Findings are promising and warrant further study.

Do Youth with Separation Anxiety Disorder Differ in Anxiety Sensitivity From Youth with Other Anxiety Disorders?

Studies on the relationship between separation anxiety disorder (SAD) in childhood and panic disorder (PD) in adolescence and adulthood have yielded results which suggest a common underlying vulnerability for both disorders. In this study, we examined whether one such possible vulnerability-anxiety sensitivity-differed for youth diagnosed with SAD versus other anxiety disorders. Anxiety sensitivity was assessed using the Childhood Anxiety Sensitivity Index (CASI) in 315 clinic-referred youth (ages 6-17, 113 girls). 145 children (46%) were diagnosed with one or more primary anxiety disorder, including SAD (n = 22), generalized anxiety (GAD) (n = 79), social anxiety (SocA) (n = 55), and specific phobia (SP) (n = 45). Children with SAD reported higher levels of anxiety sensitivity and fears of physical symptoms than children with SP and SocA, but not children with GAD. We speculate that children who have SAD and GAD and high anxiety sensitivity may be more vulnerable to develop PD.

Usage and Daily Attrition of a Smartphone-Based Health Behavior Intervention: Randomized Controlled Trial.

BACKGROUND: Although most adolescents have access to smartphones, few of them use mobile health (mHealth) apps for health improvement, highlighting the apparent lack of interest in mHealth apps among adolescents. Adolescent mHealth interventions have been burdened with high attrition rates. Research on these interventions among adolescents has frequently lacked detailed time-related attrition data alongside analysis of attrition reasons through usage. OBJECTIVE: The objective was to obtain daily attrition rates among adolescents in an mHealth intervention to gain a deeper understanding of attrition patterns, including the role of motivational support, such as altruistic rewards, through analysis of app usage data. METHODS: A randomized controlled trial was conducted with 304 adolescent participants (152 boys and 152 girls) aged 13-15 years. Based on 3 participating schools, participants were randomly assigned to control, treatment as usual (TAU), and intervention groups. Measures were obtained at baseline, continuously throughout the 42-day trial period (research groups), and at the trial end. The mHealth app is called SidekickHealth and is a social health game with the following 3 main categories: nutrition, mental health, and physical health. Primary measures were attrition based on time from launch, and the type, frequency, and time of health behavior exercise usage. Outcome differences were obtained through comparison tests, while regression models and survival analyses were used for attrition measures. RESULTS: Attrition differed significantly between the intervention and TAU groups (44.4% vs 94.3%; χ21=61.220; P<.001). The mean usage duration was 6.286 days in the TAU group and 24.975 days in the intervention group. In the intervention group, male participants were active significantly longer than female participants (29.155 vs 20.433 days; χ21=6.574; P<.001). Participants in the intervention group completed a larger number of health exercises in all trial weeks, and a significant decrease in usage was observed from the first to second week in the TAU group (t105=9.208; P<.001) but not in the intervention group. There was a significant increase in health exercises in the intervention group from the fifth to sixth week (t105=3.446; P<.001). Such a significant increase in usage was not evident in the TAU group. The research group was significantly related to attrition time (hazard ratio 0.308, 95% CI 0.222-0.420), as well as the numbers of mental health exercises (P<.001) and nutrition exercises (P<.001). CONCLUSIONS: Differences in attrition rates and usage between groups of adolescents were identified. Motivational support is a significant factor for lowering attrition in adolescent mHealth interventions. The results point to sensitivity periods in the completion of diverse health tasks, and emphasis on time-specific attrition, along with the type, frequency, and time of health behavior exercise usage, is likely a fruitful avenue for further research on mHealth interventions for adolescent populations, in which attrition rates remain excessive. TRIAL REGISTRATION: ClinicalTrials.gov NCT05912439; https://clinicaltrials.gov/study/NCT05912439.

Changes in Anxiety following Taste Education Intervention: Fussy Eating Children with and without Neurodevelopmental Disorders.

Despite the surge in studies on fussy eating in recent years, anxiety as an associated factor is generally not considered, even though children with fussy eating and those with neurodevelopmental disorders, including Autism Spectrum Disorder or Attention Deficit/Hyperactivity Disorder (ADHD) often have higher levels of anxiety than typically developing children. The current study investigated changes in anxiety scores during a Taste Education intervention, a seven-week school-based intervention for 71 children with fussy eating. Comparisons were made based on neurodevelopmental status (between children with (n = 30) and without (n = 41) neurodevelopmental disorders). Participants were paired based on age, sex, and neurodevelopmental disorder. The Multidimensional Anxiety Scale for Children (MASC) was administered at delayed intervention (for those waiting 7 weeks before starting the intervention), pre-intervention, post-intervention, and at six-month follow-up. Results did not indicate elevated anxiety based on mean MASC T-scores. MASC Total T-scores ranged from slightly elevated to average, decreasing significantly between pre-intervention and post-intervention, plateauing at six-month follow-up. Significant reductions between measurement points were seen for the physical symptoms, social anxiety, and separation anxiety subscales, but not for harm avoidance. Repeated measures analysis of variance with neurodevelopmental disorders as between-subjects factors did not reveal a significant interaction effect between neurodevelopmental disorders and changes in MASC Total score or subscales. The results indicated that our food-based intervention did not elevate MASC scores in fussy eating children, with or without neurodevelopmental disorders.

Changes in Eating Behaviors Following Taste Education Intervention: Focusing on Children with and without Neurodevelopmental Disorders and Their Families: A Randomized Controlled Trial.

Fussy-eating children often display problematic behaviors around mealtimes, such as irritation, opposition, or may even throw tantrums. This may lead to reduced food variety and poor nutritional profiles, which may increase parents' worries about their children's diet, particularly when the children also have neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD). To investigate the effect of Taste Education on problematic mealtime behaviors, 81 children aged 8-12 years, with ND (n = 33) and without (n = 48), and their parents, participated in a 7-week Taste Education intervention. Children were matched on age, sex, and ND, and allocated at random into Immediate-intervention and Delayed-intervention groups. Parents completed the Meals in Our Household Questionnaire (MiOH). To examine changes in MiOH-scores, repeated-measures analysis-of-variance with time-points were used, with condition as factors (Immediate intervention and Delayed intervention). Baseline measures were adjusted for, and a robust linear mixed-model was fitted. Results showed superior outcomes for Intervention compared to waiting on all measures of MiOH, with stable effects through six-month follow-up. Differences were non-significant between children with and without ND. The Taste Education program suggests a promising, simple, and non-intrusive way to reduce children's problematic mealtime behaviors in the long term.

The Effects of Emotion Regulation Treatment on Disruptive Behavior Problems in Children: A Randomized Controlled Trial.

Disruptive behavior problems are a frequent reason for children's referrals to psychological services and can have negative effects on social and academic functioning. Most treatment programs involve parents as recipients and implementation of intervention programs in school is low. Deficits in emotion regulation have recently been implicated in the development of disruptive behavior disorders, making child directed early intervention programs focusing on increasing emotion regulation skills feasible. The purpose of this study was to assess the effects of Tuning Your Temper, a brief cognitive behavioral program for children with disruptive behavior problems, in a randomized controlled trial. A total of 125 children with disruptive behavior problems at school, aged 6-11 years old were randomized to either intervention or wait-list control condition. Treatment was conducted at school. Assessments included teacher and parent ratings on the Strengths and Difficulties Questionnaire (SDQ) and the Disruptive Behavior Rating Scale (DBRS) pre- and post-treatment and at 6-month follow-up. Results showed a significant reduction in behavior problems for the treatment condition on both measures and effects were maintained at 6-month follow-up. Results were more robust for teacher ratings, with medium to large effect sizes. Tuning Your Temper appears to be a promising early intervention program for children with disruptive behavior problems at school.

Odds of fussy eating are greater among children with obesity and anxiety.

BACKGROUND: Fussy eating has been associated with autism spectrum disorder (ASD), attention-deficit/hyperactive disorder (ADHD), anxiety, and depression. Despite these disorders being prevalent in obesity treatment, no studies have been published on the association of fussy eating in children with obesity and these disorders. Understanding fussy eating in children with obesity and comorbid disorders is important as acceptance of healthy foods tends to be low, especially in children with sensory sensitivities. OBJECTIVES: Investigate the prevalence of fussy eating in a cross-sectional sample of children with obesity and ASD, ADHD, anxiety, and depression; and whether they were more likely to be fussy eaters, comparing those with and without these disorders. METHODS: One hundred and four children referred to family-based obesity treatment in Iceland 2011-2016, mean age 12.0 (SD = 3.0), mean body mass index standard deviation score 3.5 (SD = 0.9). Binary logistic regression was used to estimate the relationship between fussy eating and disorders, adjusting for medication use. RESULTS: A large minority (41.6%) were fussy eaters and 48.9% had at least one comorbid disorder. Over a third of children rejected bitter and sour tastes, and 1.9% and 7.9% rejected sweet and salty tastes, respectively. Compared with those without disorders, the odds of being a fussy eater were increased by a factor of 4.11 when having anxiety (95% confidence intervals) (1.02-16.58, p = 00.046), adjusting for medication use. The odds of being a fussy eater were not increased for other disorders; ASD, ADHD, or depression. CONCLUSIONS: In children attending obesity treatment, fussy eating was common. Clinical care models in pediatric obesity treatment should address fussy eating, especially in children with anxiety.

Usage and Weekly Attrition in a Smartphone-Based Health Behavior Intervention for Adolescents: Pilot Randomized Controlled Trial.

BACKGROUND: The majority of adolescents own smartphones, although only 8% of them use health apps. Attrition rates from adolescent mobile health (mHealth) interventions for treating mental health problems such as anxiety and depression are an issue with a high degree of variation. Attrition in mHealth interventions targeting adolescent populations is frequently presented in a two-point fashion, from initiation of the intervention to the end of treatment, lacking more time-specific information on usage and times of attrition. Self-efficacy could provide an avenue to lower attrition rates, although a better understanding of the relationship between mental health factors and time-specific attrition rates is needed. OBJECTIVE: The aims of this study were to obtain time-specific attrition rates among adolescents in an mHealth intervention, and to describe the intervention's usage and feasibility in relation to adolescent self-efficacy levels, and emotional and physical health. METHODS: A single-center randomized controlled public school pilot trial was undertaken with 41 adolescents. Outcome measures were assessed at baseline and after 6 weeks, while in-app activity and attrition rates were continually assessed throughout the intervention period. The primary outcome was attrition based on time and type of in-app health behavior usage, and feasibility of the mHealth app. Secondary outcome measures were self-efficacy levels, depressive and anxiety symptoms, as well as standardized BMI and sleep. Analyses of group mean variances with adjusted α levels through Bonferroni corrections were used to assess main outcome effects. RESULTS: The attrition from initiation of the intervention to 6-week follow up was 35%. Attrition started in the third week of the intervention and was related to daily time of app usage (Rt=0.43, P<.001). The number of average weekly in-app health exercises completed decreased significantly from the first week of the intervention (mean 55.25, SD 10.96) to the next week (mean 13.63, SD 2.94). However, usage increased by 22% between week 2 and the last week of the intervention (mean 16.69, SD 8.37). Usability measures revealed satisfactory scores (mean 78.09, SD 9.82) without gender differences (P=.85). Self-reported daily physical activity increased by 19.61% in the intervention group but dropped by 26.21% among controls. Self-efficacy levels increased by 8.23% in the invention arm compared to a 3.03% decrease in the control group. CONCLUSIONS: This pilot study demonstrated the feasibility and usability of an mHealth intervention among adolescent participants. Indications were toward beneficial effects on physical and mental health that warrant further research. Focus on time-specific attrition measures alongside daily times of usage and ways to increase participants' self-efficacy levels appear to be a promising avenue for research on mHealth interventions for adolescent populations with the aim to ultimately lower attrition rates.

The Role of Perspective Taking and Self-Control in a Preventive Intervention Targeting Childhood Disruptive Behavior.

Prevention studies typically focus on outcome variables such as reductions in problem behavior, rather than targeted factors (e.g., cognitions), or the relation between change in targeted factors and outcomes. Therefore, the current study examined the effect of a targeted prevention program for childhood disruptive behavior on targeted factors (i.e., perspective taking and self-control) and associations between change in targeted factors and outcomes (i.e., aspects of disruptive behavior). The sample consisted of 173 children (Mage = 10.2 years) who were randomly assigned to an intervention condition (n = 70) or waitlist control condition (n = 103). Assessment took place at pre-, post- and follow-up measurements. For ethical considerations, follow-up data was not available for children on the waitlist. Findings revealed a direct intervention effect on self-control. From pre-test to follow-up, children who received the intervention improved in perspective taking and self-control. Moreover, improvements in self-control were associated with and predicted reductions in teacher-reported symptoms of oppositional defiant disorder. No associations were found between changes in perspective taking and disruptive behavior. These findings suggest that self-control may be an important target factor in reducing childhood disruptive behavior in targeted prevention.

Cognitive behavior therapy for externalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis.

Various Cognitive Behavioral Therapy (CBT) programs for externalizing disorders in children and adolescents are supported by a substantial body of empirical evidence. Most of the research evidence comes from efficacy studies conducted in university settings, but there is less knowledge about the effect of these treatments in routine clinical care. The purpose of this meta-analysis was to investigate the effectiveness of CBT in non-university settings for Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). Embase OVID, Ovid MEDLINE and PsycINFO were systematically searched for eligible studies published up to May 2020. In total, 51 treatment effectiveness studies involving 5295 patients were included. The average within-group effect size at post-treatment was significant (g = 0.91), and there were large effect sizes for both ADHD (g = 0.80) and CD/ODD (g = 0.98). At post treatment, remission rates were 38% for ADHD and 48% for CD/ODD, and the overall attrition rate was 14%. Benchmarking against efficacy studies showed that CBT in routine clinical care yields remission rates, within-group effect sizes and attrition rates that are very similar to those found in university settings. The findings support the transportability of CBT for externalizing disorders from university settings to routine clinical care. PROSPERO registration: CRD42020147524.

Prevalence and Gender Differences of ODD, Anxiety, and Depression in a Sample of Children With ADHD.

Objective: Studies on comorbidity in children diagnosed with ADHD have relied more on parent/teacher reports instead of self-reported data and have focused on the frequency of comorbid symptoms instead of scores above clinical cutoffs. The purpose of this study was to examine the prevalence of oppositional defiant disorder (ODD), anxiety, and depression in children with ADHD, using self-report measures for internalizing symptoms and parent-reported measures for externalizing symptoms for increased accuracy. Gender differences were also assessed. Method: Parents of 197 children diagnosed with ADHD answered the Disruptive Behavior Rating Scale, and 112 of the children filled out the Multidimensional Anxiety Scale for Children and the Children's Depression Inventory. Results: Results revealed that 19.28% of the children met cut-off criteria for ODD, 41.96% for anxiety, and 21.43% for depression. Conclusion: Our findings indicate a relatively lower prevalence of ODD and a slightly higher prevalence of anxiety symptoms than previously reported. Possible explanations and future directions are discussed.

The factor structure of the Children's Eating Behaviour Questionnaire: A comparison of four models using confirmatory factor analysis.

AIMS: The Child Eating Behavior Questionnaire (CEBQ) consists of 8 subscales measuring different aspects of eating behavior and is a widely used instrument in pediatric settings, both in relation to eating disorders and overweight/obesity. However, despite its widespread usage, research results have, to this date, been inconsistent in regard to the factor structure of the CEBQ, with several factorial models suggested. The purpose of this study was to systematically compare the 4 factor structures commonly reported in the literature on the 35-item CEBQ, using confirmatory factor analysis in the same sample. METHODS AND RESULTS: In total, parents of 560 children aged 5 to 12 years old completed the CEBQ; 70 questionnaires were incomplete, resulting in a final sample of 490. Confirmatory factor analyses tested the 4 competing models: a 6-factor model, 2 seven-factor models, and an 8-factor model. The 8-factor model provided an acceptable fit to the data and turned out to be the best fitting model. Correlation coefficients between the 8 factors never exceeded r = .77, supporting the construct uniqueness of the 8 subscales. Results also indicated that the CEBQ subscales have good factorial validity and internal reliability (α ≥ .75). CONCLUSION: In summary, this study of Icelandic children supports the appropriateness of using the CEBQ as a measure of 8 distinct dimensions of eating behavior style in school-aged children.

Long-term health of children following the Eyjafjallajökull volcanic eruption: a prospective cohort study.

Background: More than 500 million people worldwide live within exposure range of an active volcano and children are a vulnerable subgroup of such exposed populations. However, studies on the effects of volcanic eruptions on children's health beyond the first year are sparse. Objective: To examine the effect of the 2010 Eyjafjallajökull eruption on physical and mental health symptoms among exposed children in 2010 and 2013 and to identify potential predictive factors for symptoms. Method: In a population-based prospective cohort study, data was collected on the adult population (N = 1615) exposed to the 2010 Eyjafjallajökull eruption and a non-exposed group (N = 697). The exposed group was further divided according to exposure level. All participants answered questionnaires assessing their children´s and their own perceived health status in 2010 and 2013. Results: In 2010, exposed children were more likely than non-exposed children to experience respiratory symptoms (medium exposed OR 1.47; 95% CI 1.07-2.03; high exposed OR 1.52; 95% CI 1.03-2.24) and anxiety/worries (medium exposed OR 2.39; 95% CI 1.67-3.45; high exposed OR 2.77; 95% CI 1.81-4.27). Both genders had an increased risk of symptoms of anxiety/worries but only exposed boys were at increased risk of experiencing headaches and sleep disturbances compared to non-exposed boys. Within the exposed group, children whose homes were damaged were at increased risk of experiencing anxiety/worries (OR 1.62; 95% CI 1.13-2.32) and depressed mood (OR 1.55; 95% CI 1.07-2.24) than children whose homes were not damaged. Among exposed children, no significant decrease of symptoms was detected between 2010 and 2013. Conclusions: Adverse physical and mental health problems experienced by the children exposed to the eruption seem to persist for up to a three-year period post-disaster. These results underline the importance of appropriate follow-up for children after a natural disaster.

Planteamiento: Más de 500 millones de personas en todo el mundo viven dentro del área de exposición de un volcán activo y los niños son un subgrupo vulnerable de dichas poblaciones que se encuentran expuestas. Sin embargo, hasta la fecha, los estudios sobre los efectos de las erupciones volcánicas en la salud de los niños más allá del primer año son escasos. Objetivo: Examinar el efecto de la erupción del Eyjafjallajökull en 2010 en los síntomas de salud física y mental entre niños expuestos en 2010 y 2013 e identificar los posibles factores predictivos de los síntomas. Método: En un estudio de cohortes prospectivo basado en la población, se recopiló información sobre la población adulta (N = 1615) que estuvo expuesta a la erupción del Eyjafjallajökull en 2010 y un grupo que no estuvo expuesto (N = 697). El grupo expuesto se dividió además según el nivel de exposición. Todos los participantes respondieron cuestionarios que evaluaban el estado de salud que percibían tanto sus hijos como de sí mismos en 2010 y 2013. Resultados: En 2010, los niños expuestos tenían más probabilidades que los niños no expuestos de experimentar síntomas respiratorios (OR exposición media 1.47, IC 95% 1.07-2.03, OR exposición elevada 1.52, IC 95% 1.03-2.24) y ansiedad/preocupaciones (OR exposición media 2,39; IC del 95%: 1,67 a 3,45; OR exposición elevada, 77; IC del 95%: 1,81 a 4,27). Ambos sexos tenían un mayor riesgo de síntomas de ansiedad/preocupaciones, pero solo los niños expuestos tenían un mayor riesgo de experimentar dolores de cabeza y trastornos del sueño en comparación con los niños no expuestos. Dentro del grupo expuesto, los niños cuyas casas sufrieron daños tenían un mayor riesgo de experimentar ansiedad/preocupaciones (OR 1.62, IC 95% 1.13-2.32) y estado de ánimo deprimido (OR 1.55, IC 95% 1.07-2.24) que los niños cuyas casas no estaban dañado. Entre los niños expuestos, no se detectó una disminución significativa de los síntomas entre 2010 y 2013. Conclusiones: Los problemas físicos y mentales adversos experimentados por los niños expuestos a la erupción parecen persistir durante un período de hasta tres años después del desastre. Estos resultados subrayan la importancia de un seguimiento adecuado para los niños y la identificación de los posibles grupos de riesgo después de un desastre natural.

[A Review and Recommendations of Evidence-Based Treatments for Pediatric Obsessive-Compulsive Disorder].

UNLABELLED: Pediatric obsessive-compulsive disorder (OCD) is characterized by recurrent obsessions and compulsions. In this review we depict evidence-based treatments for pediatric OCD patients. We searched PubMed for relevant publications including randomized controlled trials, reviews, and expert guidelines. Substantial evidence for cognitive behavior therapy (CBT) and specific serotonin reuptake inhibitors (SSRIs) among treatment-naïve patients shows that both treatments are effective. CBT is significantly more effective than SSRI based on head-to-head trials. The evidence for CBT- or SSRI-resistant patients is limited but indicates that CBT and SSRI are effective treatments for CBT non-responders while a combination of CBT and SSRI is the most effective treatment for SSRI non-responders with no prior exposure to CBT. The current data support clinical guidelines indicating that when CBT expertise is present, one can successfully treat patients with CBT. CBT is also as effective as SSRI in non-responders after 14 weeks of CBT. The results did not indicate that combined treatment of CBT and SSRI is more effective than CBT delivered by experts. However, combined treatment is more effective than SSRI in SSRI non-responders. KEY WORDS: Obsessive-compulsive disorder, children and adolescents, treatment, Cognitive behavior therapy, selective serotonin reuptake inhibitors, atypical antipsychotics, treatment-resistant, treatment-refractory. Correspondence: Guðmundur Skarphedinsson, gudmundur.skarphedinsson@r-bup.no.

[Family-based behavioral treatment for obese children - results and two year follow up]. / Fjölskydumidud atferlismedferd fyrir of feit börn.

INTRODUCTION: Childhood obesity has become a worldwide epidemic and Icelandic children have not been exempt from increasing rates of obesity. Epstein´s family-based behavioral treatment for childhood obesity has demonstrated favorable outcomes in research settings, but research in clinical settings has been called for. The objective of this study was to replicate and confirm the effects observed in the US research setting. MATERIAL AND METHODS: Participants were 84 obese children (age-range: 8-13 years) and a participating parent. Sixty-one families completed a 12 week treatment lasting 18 weeks, and were followed for one and two years post-treatment. Measurements at baseline and end of treatment included height and weight, daily activity, daily fruit and vegetable consumption, blood pressure, blood profiles and measures of psychological well-being. Measurements also included parental height, weight and depression scores. RESULTS: Among treatment completers BMI-SDS (body-mass index standard deviation score) decreased significantly from pre- to post- treatment (F(2.60)=110.31, p<0.001) which was maintained at one-year (F(2.60)=1.33, p=0.253) and two-years (F(2.60)= 3,19, p=0.079) post treatment. There was a significant reduction in blood pressure (upper: t(59)=-2.01, p<0.05, lower: t(59)=-4.00, p<0.001). Among a subsample (n=23) of participants, significant reductions were observed in fasting insulin levels, (t(22)=6.1, p<0.05), triglycerides (t(22)=0.31, p<0.05) and total cholesterol (t(22)=0.35, p<0.05). Significant improvements were observed for measures of psychological well-being (depressive symptoms: (F(1.59)=6.67, p<0.05); anxiety: (F(1,57)= 4.54, p%lt;0.05) and children´s self-concept (F(1.59)=19.2, p<0.001). A significant reduction was observed in parental BMI scores from pre- to post- treatment (F(1.59)= 71.54, p%lt;0.001) but a significant increase was evident at one year post-treatment (F(1.59)=41.87, p%lt;0.001). Improvements were observed for measures of parental depression from pre- to post- treatment (F(1.60)= 12.93, p<0.01). CONCLUSION: Epstein´s family-based behavioural treatment showed promising effects on weight status, and emotional as well as physical markers, both in the short and long term in a clinical sample of obese Icelandic children.

Childhood obesity and co-morbid problems: effects of Epstein's family-based behavioural treatment in an Icelandic sample.

OBJECTIVE: This study assessed the effects of Epstein's family-based behavioural treatment in a clinical sample of obese children in Iceland. Also, it explored whether co-morbid concerns affect treatment outcome. METHODS: Eighty-four obese children [mean body-mass-index standard-deviation-scores (BMI-SDS) = 3.11, aged 7.5-13.6 years] and a participating parent initiated treatment in response to a school-based screening. Sixty-one families completed treatment and were followed for 1 year post treatment. Measurements included height, weight, reports of psychological well-being (Strengths and Difficulties Questionnaire, Multidimensional Anxiety Scale for Children, Children's Depression Inventory, Piers-Harris Self Concept Scale, Social Skills Rating System) and academic competencies. RESULTS: Among treatment completers a large effect size was obtained for change in BMI-SDS during treatment (mean difference = -0.40, SD = 0.29). Psychological well-being improved and treatment effects were maintained at 1-year follow-up. At baseline, 69% of the children presented with one or more co-morbid concerns. Children who scored above cut-off for concern on parent-reported hyperactivity (Strengths and Difficulties Questionnaire subscale T-score ≥ 65) reduced their BMI-SDS less during treatment than children with lower hyperactivity scores whereas children who scored in the clinical range for social anxiety (Multidimensional Anxiety Scale for Children subscale T-score ≥ 65) reduced their BMI-SDS significantly more than children with lower social anxiety scores. The social anxiety effect was still present at 1-year follow-up, but not the hyperactivity effect (P > 0.05). No differential response was shown for children with higher depression scores, lower self-concept or low academic competencies. CONCLUSIONS: Epstein's family-based behavioural treatment produced promising effects in both the short and the longer term in a clinical sample of Icelandic children with substantial rates of co-morbid concerns. Co-morbid problems affect outcome and tailoring treatment to address co-morbid concerns might improve outcomes for certain subgroups.