Research review: A meta-analysis of the international prevalence and comorbidity of mental disorders in children between 1 and 7 years.

BACKGROUND: Children younger than 7 years can develop mental disorders that might manifest differently than in older children or adolescents. However, little is known about the prevalence of mental disorders at this early age. METHODS: We systematically searched the literature in the databases Web of Science, PsycINFO, PSYNDEX, MEDLINE, and Embase to identify epidemiological studies of community samples published between 2006 and 2020. A series of meta-analyses was conducted to estimate the pooled worldwide prevalence of mental disorders in general, specific mental disorders, and comorbidity in young children. RESULTS: A total of ten epidemiological studies reporting data on N = 18,282 children (12-83 months old) from eight countries met the inclusion criteria. The pooled prevalence of mental disorders in general was 20.1%, 95% CI [15.7, 25.4]. Most common disorders were oppositional defiant disorder (4.9%, 95% CI [2.5, 9.5]) and attention-deficit hyperactivity disorder (4.3%, 95% CI [2.5, 7.2]). The prevalence of any anxiety disorders was 8.5%, 95% CI [5.2, 13.5], and of any depressive disorders was 1.1%, 95% CI [0.8, 1.6]. Comorbidity was estimated at 6.4%, 95% CI [1.3, 54.0]. CONCLUSIONS: The literature search reveals that the epidemiology of mental disorders in children younger than 7 years is still a neglected area of research. The findings also indicate that there are a significant number of young children suffering from mental disorders who need appropriate age-adapted treatment.

Influence of executive functions on the self-reported health-related quality of life of children with ADHD.

PURPOSE: ADHD is regarded as a neurodevelopmental disorder associated with deficits in executive functions (EF). The presence of these deficits is associated with increased symptom severity. However, so far there is little knowledge, whether deficits in EFs relate to a reduced health-related quality of life (HRQoL) in children with ADHD. METHODS: Hence, n = 100 children with a confirmed ADHD diagnosis were compared with a non-cases group (n = 100) with regard to their HRQoL (6-12 years old). The clinical group was divided into ADHD-specific drug treatment intake (drug treatment: n = 42; no drug treatment: n = 58) or deficits in EF (n = 29; no deficits in EF: n = 71). RESULTS: Children with ADHD (without medication) reported a significantly worse HRQoL than healthy children (d = .72), when controlled for age and sex. Even if they were treated with drug treatment, they reported a lower HRQoL than the non-case group in the area Family (d = .53). Drug treatment of ADHD leads to a significant difference in HRQoL in school area (d = .39). Children with ADHD and EF problems reported impairments in the social context of HRQoL compared to healthy children (d = .51 to .70). In addition, a significant negative association between set-shifting and HRQoL in children with ADHD (without drug treatment) was demonstrated (r = - .27 to r = - .35). CONCLUSIONS: By assessing the HRQoL, an impairment in the functioning of children with ADHD can be detected, which is essential for the diagnosis. Furthermore, executive problems have an influence on the social sphere, which should be clarified and improved in therapy with the involvement of parents.

Systematic review showed that low and moderate prenatal alcohol and nicotine exposure affected early child development.

AIM: We systematically reviewed the literature on the influence of low and moderate amounts of prenatal alcohol and nicotine exposure on early child development. This paper also suggests possible directions for future research in order to tackle the controversial findings identified. METHODS: The PubMed and Web of Science electronic databases were searched together with the reference lists of the selected papers. Empirical studies were included if they focused on the effects of low or moderate exposure, reported outcomes on child development within the first 2 years of life and were published in English between January 2009 and December 2019. The eligibility of the included studies was based on three authors reading the full text. RESULTS: The final sample comprised 17 papers. Of these, 13 focused on the effects of prenatal alcohol exposure and they reported decreased sensory sensibility, smaller body sizes and increased cognitive capacities. The other four looked at prenatal nicotine exposure, and they primarily found impairments in children's orienting, communication and motor skills. CONCLUSION: Any amount of prenatal alcohol and nicotine exposure appeared to risk healthy child development. There were many reasons for consumption and numerous effects on the child, but representative data from interdisciplinary research were missing.

[Applicability of the SON-R 2-8 in Children with Special Educational Needs and Children with German as a Second Language]. / Zur Aussagekraft des SON-R 2-8 bei Kindern mit kognitiven Auffälligkeiten und Kindern mit Deutsch als Zweitsprache.

Applicability of the SON-R 2-8 in Children with Special Educational Needs and Children with German as a Second Language The SON-R 2-8 is an intelligence test that allows a non-verbal assessment of the general cognitive abilities of children with difficulties or limitations in the field of speech and language development and communication. The validity of the SON-R 2-8 in children with cognitive impairments and children with German as a second language is examined with matched groups. It is shown that the SON-R 2-8 can differentiate well between normal children and cognitive impaired children and is suitable for use in children with German as a second language.

Posttraumatic Stress Disorder in Very Young Children: Diagnostic Agreement Between ICD-11 and DSM-5.

The prevalence of posttraumatic stress disorder (PTSD) in very young children depends on the diagnostic criteria. Thus far, studies have investigated the International Classification of Diseases (11th rev.; ICD-11) criteria for PTSD only in samples of children older than 6 years of age. The aim of this study was to test the diagnostic agreement between the ICD-11 and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for children who are 6 years old and younger. Caregivers of children aged 3-6 years in foster care in Germany (N = 147) and parents of children aged 1-4 years who had attended a hospital in Switzerland following burn injuries (N  = 149) completed a questionnaire about children's PTSD. Rates of PTSD were calculated according to ICD-11 (considering a specific and a more general conceptualization of intrusive memories) and DSM-5 criteria and were compared using McNemar's tests and Cohen's kappa. The proportion of children who met the ICD-11 criteria was 0.6-25.8% lower than the proportion of PTSD cases according to the DSM-5 criteria. The diagnostic agreement between each ICD-11 algorithm and DSM-5 was moderate, κ = 0.52-0.66. A systematic investigation of adaptions of the ICD-11 avoidance cluster identified alternative symptom combinations leading to higher agreement with the DSM-5 requirements. Furthermore, DSM-5 had higher predictive power for functional impairment than the ICD-11 algorithms. In conclusion, the findings suggest that the ICD-11 criteria show less sensitivity in very young children, which can be explained by the more stringent avoidance cluster.

[The Significance of Work Motivation for Rehabilitation Success]. / Die Bedeutung von Arbeitsmotivation für den Reha-Erfolg.

AIM OF THIS STUDY: Apart from the reduction of symptoms and the restoration of working ability, return to work is a long-term goal of medical rehabilitation. The aim of this study is to analyze the influence of work motivation on the outcome of rehabilitation. METHODS: The data basis consists of N=998 patients at the psychosomatic department of the Oberharz Rehabilitation Center as well as data from insurance accounts. Using multiple linear regression analysis the predictive power of work motivation on rehabilitation outcome as well as different facets of work motivation in their function as predictors are analyzed. RESULTS: Only minor statistical relations could be found between work motivation and rehabilitation success when also taking employment status of the previous year and subjective vocational disability into account. A small predictive power can be attributed to work motivation as a factor in rehabilitation success in the sense of a reduction of symptoms. Particular facets of work motivation are suitable to predict rehabilitation success. Patients with a work motivation risk profile differ from patients with a normal work motivation profile as regards their capacity to work in the year following rehabilitation treatment. CONCLUSION: Work motivation represents a relevant construct in rehabilitation success but is strongly influenced by individual factors. During rehabilitation, individual problems which influence work motivation should be taken into account more strongly.

[Associations between cognitive performance in a dementia screening test (SKT) and an intelligence test (WAIS IV) : Which deficits in cognitive performance in old age indicate a possible pathological deterioration process?] / Zusammenhänge zwischen den kognitiven Leistungen in einem Demenzscreening (SKT) und in einem Intelligenztest (WAIS-IV) : Welche kognitiven Leistungseinbußen im Alter sprechen für einen möglichen pathologischen Abbauprozess?

BACKGROUND: Which deficits in cognitive performance indicate the onset of a pathological deterioration process in older persons? AIM AND OBJECTIVES: Based on an established dementia screening test in elderly adults, a differentiation can be made between healthy cognitive performance and the onset of pathological deficits in performance (in the sense of mild cognitive impairment). The aim of the study was to investigate whether cognitive decline assessed with a dementia screening instrument is reflected in an intelligence test for adults. The dementia screening measured disorders in memory and attention, the intelligence testing battery measured information processing, working memory, perceptual reasoning, logical thinking and verbal comprehension. MATERIAL AND METHODS: A total of 253 cognitively healthy, self-dependent and non-dementia persons (129 women and 124 men), aged between 60 and 91 years (M = 71.98 years; SD = ±7.13) were tested with the complete Wechsler adult intelligence scale (WAIS-IV) and the short performance test (SKT), based on the new normalization from 2015. The SKT enables an assessment of the degree of cognitive deterioration based on coloring codes of traffic lights. Green indicates normal aging, yellow mild cognitive impairment and red stands for abnormal cognitive aging. RESULTS AND CONCLUSION: There were significant correlations between the total SKT score as a measure of total cognitive impairment and the indices of the WAIS-IV, such as information processing, working memory and perceptual reasoning. No significant covariation was found for verbal comprehension. The results suggest that in old age cognitive deterioration starts with reduced speed of information processing and impairment in the working memory log before deficits in memory are present. This finding was reflected in significant mean differences between the subjects in the category green versus yellow in the indices information processing and working memory. Under these aspects there were medium effect strengths (d = 0.60) and the second largest (insignificant) differences were shown in working memory (d = 0.39).

[Mental health of preschool foster care children: How do foster families influence the way children cope with trauma?] / Psychische Gesundheit von Pflegekindern im Vorschulalter: Wie stark hängt die Bewältigung traumatischer Erfahrungen von der Pflegefamilie ab?

Mental health of preschool foster care children: How do foster families influence the way children cope with trauma? Abstract. Parents and other significant persons have an important role when preschool children develop or cope with psychological symptoms following traumatic experiences. The underlying mechanisms of the interaction between traumatic experiences and influences of the foster family are still unclear. This study investigates foster parents' stress levels and parenting styles as moderators or mediators in the context of trau- matic experiences. Foster parents of 286 children between three and seven years participated in an online or paper-and-pencil survey. The results suggest a connection between the traumatic experiences of foster children and the stress levels as well as the parenting styles of their foster parents. While verbosity and laxness as parenting styles moderated the impact of traumatic experiences on externalising symptoms, stress levels mediated the impact of traumatic experiences on children's internalising and externalising symptoms. The results underscore the necessity of standardized preparation of and support for foster parents in order to avoid deterioration of psychological symptoms following traumatic events.

[Functional and dysfunctional emotion regulation strategies for depressive symptoms in adolescents]. / Zur Bedeutung funktionaler und dysfunktionaler Emotionsregulations- strategien für die depressive Symptomatik bei Jugendlichen.

Objective: Dysfunctional and functional emotion regulation strategies in adolescence have so far been examined separately, but not in interaction. Our aim is to analyze a possible compensation of dysfunctional regulation strategies through functional strategies in depressive symptoms. Method: The Regulation of Emotions Questionnaire (REQ) was used to examine the ability of emotion regulation in 247 adolescents between 12 to 17 years (M = 14.41, SD = 1.39). To measure depressive symptoms, Allgemeine Depressionsskala (ADS) was established. Results: Results speak for a compensation of internal-dysfunctional emotion regulation strategies with internal-functional emotion regulation strategies in girls. In boys, functional emotion regulation strategies strengthen the relationship between internal-dysfunctional emotion regulation strategies and depressive symptoms. Other strategies do not interact with each another. Conclusions: Results indicate a compensative effect in girls, while in boys functional emotion regulation seems to have an amplifying effect on depressive symptoms. Results suggest that boys use functional strategies in a dysfunctional way, while girls are able to use them appropriately. An exploration of the understanding of functional emotion regulation may enable approaches to treatment.

["How Beautiful Must I be?"- Physical Attractiveness and Mental Health in Adolescents]. / "Wie schön muss ich sein?" ­ Körperliche Attraktivität und psychische Gesundheit bei Jugendlichen.

"How Beautiful Must I be?"- Physical Attractiveness and Mental Health in Adolescents Physical attractiveness is a high priority for young people. The beauty ideals and presentations spread in the media often reinforce self-doubt and self-insecurity. In 730 adolescents (age 13 to 20 years) it was measured, how they experience appearance-related social pressure (FASD), the extent to which physical deficits are perceived (BDDQ), and how these features are related to mental symptoms (SDQ). The results demonstrate that young people are very concerned about their appearance (30.7 %) and are overly concerned with perceived physical defects (29.5 %). In addition, there is a strong appearance-related social pressure through peers and parents. The young people particularly affected in these areas report more emotional and behavioral problems. The results suggest that attention should be given to physical self-assessment as an important factor in diagnosis and therapy.

[Gender-specific Differences in the Degree of Burden on Children and Adolescents Taken into Custody]. / Geschlechtsspezifische Unterschiede im Belastungsausmaß bei in Obhut genommenen Kindern und Jugendlichen (§42, SGB VIII).

Gender-specific Differences in the Degree of Burden on Children and Adolescents Taken into Custody Children and adolescents who were taken into care are a high-risk group for mental disorders such as externalizing problems or conduct disorders. 95 children and adolescents who were taken into care were tested with the Screening Child Trauma Questionnaire (CTQ) and the Massachusetts Youth Screening Instrument 2 (MAYSI-2). In a large proportion of those children and adolescents emotional and physical neglect and abuse was identified. There were sex differences in suicidal thoughts, somatoform disorders, and emotional abuse. The knowledge of mental disorders as well as the gender-specific characteristics is important for specialists of inhospital institutions, in order to optimize their quality of care.

Attention-Deficit/Hyperactivity Disorder Symptoms and Life Satisfaction in a Representative Adolescent and Adult Sample.

Although it is well documented that attention-deficit/hyperactivity disorder (ADHD) is associated with reduced life satisfaction, the mechanisms that might explain this co-occurrence are unclear. We examined the correlation of ADHD symptoms with life satisfaction and whether this association is mediated by (lacking) social support and depressive symptoms. Self-reported ADHD symptoms, life satisfaction, social support, and depressive symptoms were assessed in a representative, predominantly adult sample from the general population (14-91 years, N = 2517). Attention-deficit/hyperactivity disorder symptoms correlated negatively with life satisfaction (r = -0.41, p < 0.01), even after demographic factors (gender, age, income) and common risk factors (not being in a relationship, being unemployed) were controlled for (r = -0.39, p < 0.01). Social support mediated up to 23% and depressive symptoms up to 44% in the association between ADHD symptoms and life satisfaction. Counteracting problems with social relationships and treating depressive symptoms may help to increase life satisfaction in adults with ADHD symptoms.

Posttraumatic Stress Symptoms in Preschool Children in Foster Care: The Influence of Placement and Foster Family Environment.

Children in foster care often experience traumatic events which increase their risk for posttraumatic stress symptoms (PTSS). Until now, no research has investigated the developmentally sensitive PTSS criteria for preschoolers among children in foster care. The current study estimated the prevalence of potentially traumatic experiences and clinical PTSS in German foster care children aged 3 to 7 years. The foster parents of 324 children completed questionnaires about children's PTSS, foster parental stress, parenting, and family functioning. Linear regression models tested trauma-related variables, placement history, and foster family characteristics as predictors of PTSS. Approximately 45.4% of the foster children had experienced at least one traumatic event and 15.4% had clinical PTSS. Physical abuse, ß = .34, p < .001; hospitalization, ß = -.17, p = .026; witnessing someone being hurt, ß = -.15, p = .047; and parental stress, ß = .43, p < .001, were significantly associated with PTSS. Results demonstrate the impact the foster family has on children who are coping with trauma, and suggest the necessity of trauma-sensitive trainings for foster parents, with stress management as an important component.

[Leisure activities, resilience and mental stress in adolescents]. / Freizeitaktivitäten, Resilienz und psychische Gesundheit von Jugendlichen.

Objective: To date, the factors contributing to emergence of resilience in different stages of adolescence have yet to be sufficiently examined. This study looks at the influence of extracurricular activities on resilience. Method: The sample consists of 413 adolescents (f = 14.8) reporting personal problems (mood, concentration problems, behavior). The effect of extracurricular activities on resilience (gathered by the RS25) was analyzed by linear regression models. Predictor variables in these models were extracurricular activities (sport, hobbies, club memberships, household duties) and the subscales of the SDQ (Strengths and Difficulties Questionnaire). Because of the lack of homoscedasticity, two different regression models (model A: Realschule and Grammar School. Model B: Hauptschule) were specified. Results: The explained variance of both models (model A: R = .516; model B: R = .643) is satisfactory. In both models "prosocial behavior" (SDQ) turns out to be a significant positive predictor for resilience (model A: b = 2.815; model B; b = 3.577) and emotional symptoms (model A: b = -1.697; model B: b = -2.596) are significant negative predictors for resilience. In addition, model A presents significant positive influences of sport (b = 16,314) and significant negative influences of "hyperactivity" (SDQ). In contrast, in model B "club memberships" (b = 15.775) and" peer relationship problems" (b = 1.508) are additional positive predictors. Conclusions: The results of the study demonstrate the important role of prosocial behavior and emotional competence in the manifestation of resilience. The effect of extracurricular activities proves to depend on the social environment (type of school). Thus, these results could form the basis for further more specific developmental programs.

[Resilient or Risk Group? Psychological Burden at Unaccompanied Refugee Minors (URM) in Germany]. / Resilient oder Risikogruppe?

Resilient or Risk Group? Psychological Burden at Unaccompanied Refugee Minors (URM) in Germany Unaccompanied minors (umA in German) are considered as a risk group for psychological disorders. In international studies a high prevalence for trauma, anxiety, and depression were reported. A sample of N = 52 unaccompanied minors living in Germany was questioned on symptom severity as well as stress experience with the Refugee Health Screening-15. More than each second unaccompanied minor shows clinically relevant symptom severity and stress experience. In age-specific analyses the highest stress levels were found among the youngest unaccompanied minors. Therefore, specifically adapted settings for care should be applied for this high-risk group.

Psychometric Properties of the German Version of the Child Post-Traumatic Cognitions Inventory (CPTCI-GER).

Dysfunctional trauma-related cognitions are associated with posttraumatic stress disorder (PTSD). The psychometric properties of the German version of the Child Post-Traumatic Cognitions Inventory (CPTCI-GER) were assessed in a sample of 223 children and adolescents (7-16 years) with a history of different traumatic events. Confirmatory factor analyses supported the original two-factor structure--permanent and disturbing change (CPTCI-PC) and fragile person in a scary world (CPTCI-SW). The total scale and both subscales showed good internal consistency. Participants with PTSD had significantly more dysfunctional trauma-related cognitions than those without PTSD. Dysfunctional posttraumatic cognitions correlated significantly with posttraumatic stress symptoms (PTSS; r = .62), depression (r = .71), and anxiety (r = .67). The CPTCI-GER has good psychometric properties and may facilitate evaluation of treatments and further research on the function of trauma-related cognitions in children and adolescents. (Partial) correlations provide empirical support for the combined DSM-5 symptom cluster negative alterations in cognitions and mood.

[Coping Process in Women with FGM from Ethiopia - The Contribution of Attitude]. / Belastungsbewältigung bei Frauen mit FGM aus Äthiopien ­ Zur Rolle der Einstellung.

The Female Genital Mutilation (FGM) is still practiced in many countries and mainly performed for traditional reasons. In this study, the relationship of the FGM type (type I and type III) with anxiety, depression, and posttraumatic stress disorder as well as the attitude toward FGM was analyzed. For this purpose the data of N=109 of FGM type I and III affected women from Ethiopia were collected. Analyses show moderation effects. It was found that the symptoms of depression and PTSD were less pronounced with a positive attitude towards the FGM in the sample of severely mutilated women (type III). It seems that the attitude toward FGM plays a major role in enhancing social recognition of those affected, thus better coping can take place. As well, this study shows the importance of the attitude of FGM tradition in the population to protect young girls prone for FGM.

Episodic memory and executive functioning in currently depressed patients compared to healthy controls.

At present, little is still known about the link between depression, memory and executive functioning. This study examined whether there are memory-related impairments in depressed patients and whether the size of such deficits depends on the age group and on specific types of cognitive measures. Memory performances of 215 clinically depressed patients were compared to the data of a matched control sample. Regression analyses were performed to determine the extent to which executive dysfunctions contributed to episodic memory impairments. When compared with healthy controls, significantly lower episodic memory and executive functioning performances were found for depressed patients of all age groups. Effect sizes appeared to vary across different memory and executive functioning measures. The extent to which executive dysfunctions could explain episodic memory impairments varied depending on the type of measure examined. These findings emphasise the need to consider memory-related functioning of depressed patients in the context of therapeutic treatments.

[Day-care vs. inpatient psychosomatic rehabilitation]. / Ganztägig ambulante- vs. stationäre psychosomatische Rehabilitation.

BACKGROUND AND OBJECTIVE: The present study compares patient characteristics and treatment outcome of 138 patients from a day-care psychosomatic rehabilitation and 540 patients from an inpatient psychosomatic rehabilitation. It was analyzed if patients differ in demographic-, clinical- and socio-medical characteristics, if there are different treatment effects between the 2 types of rehabilitations and if other patient characteristics can predict success of treatment. METHODS: Data was assessed twice (at intake and at discharge of rehabilitation) by self-reported surveys and external assessment of clinical discharge reports. Success of treatment was measured by changes in somatic and mental complaints, psychological well-being, work motivation, subjective forecast of employment, and externally estimated ability to work. RESULTS: RESULTS indicate that day-care patients were higher burdened than inpatients at intake. They showed more complaints, had a higher number of days of incapacity and a higher chance of work difficulties. Furthermore, the prevalence of a migration background was higher. Both kinds of rehabilitation were successful in reducing somatic and mental complaints and in increasing psychological well-being. The "Würzburger Screening", which measures the subjective forecast of employment and occupational stress, turned out to be the best predictor for success of treatment. CONCLUSION: Both day-care- and inpatient rehabilitation were mostly successful, even if day-care patients were more burdened at intake. Therefore day-care rehabilitation can be seen as a good alternative to inpatient rehabilitation.

[Clinical diagnostics of ADHD in preschool-aged children]. / Klinische Diagnostik der ADHS im Vorschulalter.

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in childhood and adolescence and has many negative consequences for both the child and the family. Early identification of children with ADHD would be helpful for the prevention of long-term consequences. This review appraises questionnaires and clinical interviews that can be used for the diagnosis of ADHD in preschool-aged children (3-5 years). We compare and discuss both German and international methods. The role of questionnaires and clinical interviews in the diagnostic process of ADHD is discussed.