[The relationship between ADHD, problem behaviour and academic achievement at the end of primary school]. / Der Zusammenhang von ADHS, Verhaltensproblemen und Schulerfolg am Beispiel der Grundschulempfehlung.

So far there are contradictory findings concerning the degree of negative influence of attention deficit disorders, external or socio-emotional disorders on academic development of a child. Therefore the present epidemiologic study analyses the relationship between clinically relevant problems and academic achievement of fourth graders (measured by recommendation for secondary school: A-level, B-level or C-level). Children (N = 3910) were rated by their parents by anonymised questionnaires (Child Behavior Checklist CBCL) at the end of primary school. Especially in the field of attention deficit, somatic and anxiety/depression disorders, many children were in a clinically relevant range compared to German norm data. It became obvious that future C-level pupils are particularly strong, multiply problem troubled, with constantly higher problems at all subscales. Mainly attention deficit disorders proved to be relevant for academic achievement, but also delinquent behaviour and social problems, which enhance the relative risk of recommendation for B- or C-level considerably. Early applied preventive interventions supporting social and cognitive development seem therefore of central importance for the school career of primary school children.

Explaining gender differences in non-fatal suicidal behaviour among adolescents: a population-based study.

BACKGROUND: While suicide is the second leading cause of death among young people in most industrial countries, non-fatal suicidal behaviour is also a very important public health concern among adolescents. The aim of this study was to investigate gender differences in prevalence and emotional and behavioural correlates of suicidal behaviour in a representative school-based sample of adolescents. METHODS: A cross-sectional design was used to assess suicidal behaviour and various areas of emotional and behavioural problems by using a self-report booklet including the Youth Self-Report. One hundred sixteen schools in a region of Southern Germany agreed to participate. A representative sample of 5,512 ninth-grade students was studied. Mean age was 14.8 years (SD 0.73); 49.8% were female. RESULTS: Serious suicidal thoughts were reported by 19.8% of the female students and 10.8% of the females had ever attempted suicide. In the male group, 9.3% had a history of suicidal thoughts and 4.9% had previously attempted suicide. Internalizing emotional and behavioural problems were shown to be higher in the female group (difference of the group means 4.41) while externalizing emotional and behavioural problems slightly predominated in male students (difference of the group means -0.65). However, the total rate of emotional and behavioural problems was significantly higher in the adolescent female group (difference of the group means 4.98). Using logistic regression models with suicidal thoughts or attempted suicide as dependent variables, the pseudo-R2 of gender alone was only 2.7% or 2.3%, while it was 30% or 23.2% for emotional and behavioural problems measured by the YSR syndrome scales. By adding gender to the emotional and behavioural problems only an additional 0.3% of information could be explained. CONCLUSIONS: The findings suggest that gender differences in non-fatal suicidal behaviour among adolescents can to a large extent be explained by the gender differences in emotional and behavioural problems during this age.

Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents.

OBJECTIVE: To determine the prevalence and the associated psychological and social factors of occasional and repetitive deliberate self-harming behavior in adolescents. DESIGN: Cross-sectional self-report survey. SETTING: One hundred twenty-one schools in Germany. PARTICIPANTS: A representative sample of 5759 ninth-grade students was studied between 2004 and 2005. OUTCOME MEASURES: Deliberate self-harm (DSH) and suicidal behaviors, emotional and behavioral problems (Youth Self-Report), living standard, family composition, parental conflict and illness, school type and performance, relationship to peers, bullying, body satisfaction and dieting, media consumption, smoking, and alcohol and drug use. RESULTS: Occasional forms of DSH within the previous year were reported by 10.9% of the ninth-grade students. Four percent of the students reported repetitive forms of DSH. Suicidal behavior was strongly associated with repetitive DSH, an association that held for both subtypes of DSH. The findings also indicated that social background factors were important concomitants of occasional DSH but were not related to an increased likelihood of repetitive DSH. Symptoms of depression/anxiety and delinquent/aggressive behavior were associated with self-harming behavior in both adolescent girls and boys. CONCLUSIONS: The data suggest that there is a link between social factors and occasional DSH and, especially in repetitive DSH, that there is a strong association between DSH and suicidal behavior as well as DSH and emotional and behavioral problems. These findings indicate a different pathway in the development of DSH in adolescents. The results support a need to investigate the possible neurobiological underpinnings of DSH within a longitudinal model to enhance the knowledge of this poorly understood behavior.

[Development and implementation of an outpatient clinic at an initial reception centre for asylum seekers in the German federal state of Baden-Wuerttemberg]. / Entwicklung und Implementierung einer Medizinischen Ambulanz in einer Erstaufnahmeeinrichtung für Asylsuchende des Landes Baden-Württemberg.

In 2015, more than 890,000 asylum seekers were registered in Germany. The provision of medical and psychosocial care for asylum seekers is facing numerous obstacles. Access to health care is mostly insufficient, particularly in initial reception centres. The present article describes the development and implementation of an interdisciplinary outpatient clinic for asylum seekers at the main registration authority in the state of Baden-Wuerttemberg operated by physicians of the University Hospital of Heidelberg and the local Medical Association in Heidelberg. A steering committee was appointed to plan and implement the interdisciplinary outpatient clinic. Semi-structured interviews with nine steering committee members were conducted to elucidate perceived barriers during the planning and implementation phase. The steering committee's strong personal commitment and the health authorities' impartial management were cited as the main contributing factors to the success of the implementation process. Significant barriers were seen in the funding of personnel, equipment, and language mediation as well as in legal liability and billing-related aspects. Results are discussed with a focus on financing, administrative and legal framework as well as language mediation, documentation and further matters that are essential to ensure high-quality care.

[Parent- and teacher-reported behavior problems of first graders]. / Verhaltensauffälligkeiten bei Erstklässlern aus Sicht der Eltern und der Lehrerinnen.

Parents information about behavior, problems and life situation of children before and after first year of school were analysed and compared with data from teacher reports. At the end of first grade 131 parents were asked about behavior problems of their children using the child behavior checklist (CBCL) and additional items about living condition of the familiy and child. Findings were compared with those of a large epidemiological study conducted one year before in the same area using the same instruments. Additional teacher-reported data about behavior problems and school achievement were included. Comparing data before and after first year of school, no significant change in average CBCL total score could be observed. From parents view oppositional behavior was the most prevalent problem. There was a decrease of social problems. Children became more independent having more contact with peers. More children have their own television and computer at the end of first grade. Prevalence of headache and perfectionism as well as symptoms of tension and irritation increased. The most important problems from teachers' view are lack of attention and concentration affecting 32% of the first graders. Compared to the parents, teachers report only few oppositional and aggressive behavior. Achievement at school and behavior problems are highly correlated. Especially attention problems go along with low achievement at school. Parents' and teachers' ratings show an average correlation of r = .28 with the highest accord for attention problems and school achievement. The results of the study contribute to the question how children deal and cope with the new situation coming to school. The findings of a high rate of attention problems at school and the close relationship between behavior problems and achievement lead to the conclusion that an early prevention of behavior problems is essential to promote school performance.

[Behavioral symptoms in preschool children at the time of school entrance from the perspective of parents--data regarding prevalence and risk factors in an epidemiological study]. / Verhaltensauffälligkeiten im Einschulungsalter aus elterlicher Perspektive--Ergebnisse zu Prävalenz und Risikofaktoren in einer epidemiologischen Studie.

Behavioral and emotional problems based on parents information from the Child Behavior Checklist (CBCL) were investigated in a large epidemiological sample of 4363 six year old pre-school children from the area of Heidelberg and Rhein-Neckar county. An overview about symptom frequencies of boys and girls is given, taking age specific evaluations into account. Considering symptoms and syndromes, externalizing and attention problems show high prevalence, especially for boys. Family problems are the most important predictors of child global symptomatology, explaining about 10% of variance of the CBCL total score. Other factors like gender, chronical illness, adverse living conditions, family constellation or amount of TV consumption prove as additional independent predictors. An overall model explains about 20% of variance of child symptomatology. Results are discussed from the view of normal child development, developmental psychopathology, changing norms and altered socio-cultural conditions.