[The German S3 guideline for depressive disorders in childhood and adolescence: new developments]. / S3-Leitlinie Depressive Störungen im Kindes- und Jugendalter: Wo geht es hin?

The German guideline for the treatment of depressive disorders in children and adolescents was first published in July 2013. Currently, this guideline is undergoing revision, in which the recommendations of the original version of the guideline are revisited and updated. This report aims to give an overview of the current status and the next steps for this revision.As part of the revision process, the key questions posited in the original version were expanded upon. In this, new questions were added regarding complementary therapies, that is, therapies meant to be administered in addition to the usual treatment, as well as regarding the transitionary period from adolescence into adulthood. For all key questions, new systematic literature searches were conducted in order to update the relevant evidence. For this, randomized controlled studies, systematic reviews, and non-controlled intervention studies were included and rated according to their relevance as well as possible risks of bias. Thus, all studies could be assigned a level of evidence that takes into account both the quality and the importance of the study to the guideline.This report will give a brief overview of the most important insights resulting from the new evidence base identified for the revision. While insights regarding psychotherapy are largely unchanged, there are changes in the evidence for certain antidepressants. In the field of complementary therapies, new evidence has been found for physical activity. In general, it is likely that most recommendations of the original guideline regarding first- and second-line treatments will be updated. The completion of the revision and the publishing of the revised guideline are expected to take until the end of 2023.

State or trait? Auditory event-related potentials in adolescents with current and remitted major depression.

OBJECTIVE: Event-related potential (ERP) studies have revealed abnormal neurophysiological patterns underlying selective attention in patients with Major Depression (MD). Only few included both patients in acute and remitted state to address the question whether these abnormalities are state- or trait- dependent and none focused on adolescent MD. Thus, the aim of our study was to address this question in an adolescent sample. METHODS: 22 adolescents with acute MD, 20 adolescents with remitted MD (rMD) and 32 healthy controls (HC) performed a standard two-tone auditory oddball task while ERPs (N100, P200, N200, P300) were collected. RESULTS: Adolescents with rMD showed a reduced N200 amplitude to target tones across frontal, central and parietal recording sites. Adolescents with MD exhibited a reduced N200 amplitude to targets in the frontal region compared to HC. No differences emerged between rMD and the MD group. CONCLUSIONS: The reduced N200 amplitude in adolescents with rMD and MD presumably reflects difficulties in stimulus classification and response selection. Our results indicate that this neurophysiological characteristic is a trait marker of adolescent depression.

Cortical responses to tone and phoneme mismatch as a predictor of dyslexia? A systematic review.

Evidence from event-related-potential (ERP) studies has repeatedly shown differences in the perception and processing of auditory stimuli in children with dyslexia compared to control children. The mismatch negativity (MMN) - an ERP component reflecting passive auditory change detection ability - has been found to be reduced, not only in children with a diagnosis of dyslexia, but also in infants and preschool children at risk of developing dyslexia. However, the results are controversial due to the different methods, age of the children and stimuli used. The aim of the present review is to summarize and evaluate the MMN research about at-risk children in order to identify risk factors that discriminate between children with and without dyslexia risk and to analyze if the MMR (the abbreviation refers to positive and negative mismatch responses) correlates with later reading and spelling ability. A literature search yielded 17 studies reporting MMR to speech or non-speech stimuli in children at risk of dyslexia. The results of the studies were inconsistent. Studies measuring speech MMR often found attenuated amplitudes in the at-risk group, but mainly in very young children. The results for older children (6-7years) and for non-speech stimuli are more heterogeneous. A moderate positive correlation of MMR amplitude size with later reading and spelling abilities was consistently found. Overall, the findings of this review indicate that the MMR can be a valuable part of early dyslexia identification, which can enable efficient support and intervention for a child before the first problems appear.

Letter-sound processing deficits in children with developmental dyslexia: An ERP study.

OBJECTIVE: The time course during letter-sound processing was investigated in children with developmental dyslexia (DD) and typically developing (TD) children using electroencephalography. METHOD: Thirty-eight children with DD and 25 TD children participated in a visual-auditory oddball paradigm. Event-related potentials (ERPs) elicited by standard and deviant stimuli in an early (100-190 ms) and late (560-750 ms) time window were analysed. RESULTS: In the early time window, ERPs elicited by the deviant stimulus were delayed and less left lateralized over fronto-temporal electrodes for children with DD compared to TD children. In the late time window, children with DD showed higher amplitudes extending more over right frontal electrodes. Longer latencies in the early time window and stronger right hemispheric activation in the late time window were associated with slower reading and naming speed. Additionally, stronger right hemispheric activation in the late time window correlated with poorer phonological awareness skills. CONCLUSIONS: Deficits in early stages of letter-sound processing influence later more explicit cognitive processes during letter-sound processing. SIGNIFICANCE: Identifying the neurophysiological correlates of letter-sound processing and their relation to reading related skills provides insight into the degree of automaticity during letter-sound processing beyond behavioural measures of letter-sound-knowledge.

[Complementary treatment methods for depression in children and adolescents]. / Komplementäre Ansätze zur Behandlung von depressiven Störungen bei Kindern und Jugendlichen.

Depressive disorders are among the more common mental illnesses around the world, about 1- 3% of prepubertal children and 6% of postpubertal children and adolescents are affected. They markedly impair psychosocial development and are associated with higher rate of morbidity and mortality throughout life. Many physicians are unsure about which treatment approaches are effective and how the treatment should be planned. A systematic literature search was carried out in electronic databases and study registries and as a manual search. More than 450 studies (mostly randomized controlled trials = RCTs) were identified and summarized in evidence tables. The ensuing recommendations were agreed upon in a consensus conference. The review summarizes the evidence of complementary treatment methods. The evidence for complementary treatment methods (art and music therapy, sleep deprivation, exercise, electroconvulsive therapy, massage, transcranial magnetic stimulation, relaxation, bibliotherapy, computer based therapy, light therapy, omega-3 treatment) is low or there is no evidence due to missing studies or studies of poor quality. For some methods, i. e. light therapy, relaxation and stress reduction and sleep deprivation there is limited indication for effectiveness without sufficient evidence for a practical guidance. There is an urgent need for adequately informative comparative studies on treatment of depression in children and adolescents considering also complementary methods.

The Depression Screener for Teenagers (DesTeen): a valid instrument for early detection of adolescent depression in mental health care.

OBJECTIVE: Diagnosis of comorbid depressive disorder is challenging, even in mental health care. Screening instruments could be economic tools in indicating depression. For the first time, the current study investigates the validity of the newly developed Depression Screener for Teenagers (DesTeen) and its abbreviated five-item form DesTeen-a in a mental health setting. METHODS: A total of 88 patients aged 13-16 years were recruited in institutions specialized in child and adolescent psychiatry, psychotherapy or psychosomatic medicine. DSM-IV-TR diagnoses of major depression or dysthymia based on a structured diagnostic interview served as the gold standard for validation. For assessing the criterion validity of the DesTeen and the DesTeen-a, areas under the receiver operating characteristic curve (AUC) were calculated. Specificity and sensitivity were computed for optimal cut-off scores according to the Youden Index. RESULTS: Point prevalence of depression was 27.3%. Diagnostic accuracy of the DesTeen was high (AUC=.94). Using a cut-off score of ≥ 18, sensitivity was .96 and specificity was .86. The DesTeen-a showed no loss in validity (AUC=.94). At a cut-off point of ≥ 6, sensitivity remained excellent (.96), while specificity was slightly lower (.80). LIMITATIONS: The limited representativeness and the small sample size restrict the generalizability of the findings. CONCLUSIONS: The DesTeen and its abbreviated version are valid instruments to screen for adolescent depression in mental health care. Since structured interviews to diagnose comorbid mental disorders are rarely applied, the DesTeen and the DesTeen-a can support mental health specialists in making the diagnostic process more efficient, thus facilitating effective treatment planning.

Effectiveness of treatment approaches for children and adolescents with reading disabilities: a meta-analysis of randomized controlled trials.

Children and adolescents with reading disabilities experience a significant impairment in the acquisition of reading and spelling skills. Given the emotional and academic consequences for children with persistent reading disorders, evidence-based interventions are critically needed. The present meta-analysis extracts the results of all available randomized controlled trials. The aims were to determine the effectiveness of different treatment approaches and the impact of various factors on the efficacy of interventions. The literature search for published randomized-controlled trials comprised an electronic search in the databases ERIC, PsycINFO, PubMed, and Cochrane, and an examination of bibliographical references. To check for unpublished trials, we searched the websites clinicaltrials.com and ProQuest, and contacted experts in the field. Twenty-two randomized controlled trials with a total of 49 comparisons of experimental and control groups could be included. The comparisons evaluated five reading fluency trainings, three phonemic awareness instructions, three reading comprehension trainings, 29 phonics instructions, three auditory trainings, two medical treatments, and four interventions with coloured overlays or lenses. One trial evaluated the effectiveness of sunflower therapy and another investigated the effectiveness of motor exercises. The results revealed that phonics instruction is not only the most frequently investigated treatment approach, but also the only approach whose efficacy on reading and spelling performance in children and adolescents with reading disabilities is statistically confirmed. The mean effect sizes of the remaining treatment approaches did not reach statistical significance. The present meta-analysis demonstrates that severe reading and spelling difficulties can be ameliorated with appropriate treatment. In order to be better able to provide evidence-based interventions to children and adolescent with reading disabilities, research should intensify the application of blinded randomized controlled trials.

The treatment of depressive disorders in children and adolescents.

BACKGROUND: Depressive disorders are among the more common mental illnesses around the world. About 3% of prepubertal children and 6% of postpubertal children and adolescents are affected. Many physicians are unsure about which treatment approaches are effective and how the treatment should be planned. METHOD: A systematic literature search was carried out in electronic databases and study registries and as a manual search. More than 450 studies (mostly randomized controlled trials [RCTs]) were identified and summarized in five evidence tables. The ensuing recommendations were agreed upon in a consensus conference in which 23 organizations were represented. RESULTS: The recommended treatment of first choice for children from age 8 onward and for adolescents is either cognitive behavioral therapy (CBT) (Cohen's d [effect strength]: 0.5-2) or interpersonal psychotherapy (Cohen's d: 0.5-0.6). Fluoxetine is recommended for drug treatment (Cohen's d: 0.3-5.6), either alone or in combination with CBT. The analysis revealed a lower level of evidence for psychodynamic or systemic psychotherapy or for drug treatment with escitalopram, citalopram, or sertraline. For mild or moderate depression, psychotherapy is recommended; for severe depression, combination therapy. Particularly for children, there is a lack of adequately informative comparative studies on these treatment approaches as well as on other, complementary interventions (e.g., art therapy, sleep deprivation, youth welfare services). CONCLUSION: There is adequate evidence to support some recommendations for the treatment of depressive disorders in adolescents, but evidence for children is lacking. There is a pressing need for intervention research in this area for both children and adolescents.

N300 indexes deficient integration of orthographic and phonological representations in children with dyslexia.

In transparent orthographies, like German, children with developmental dyslexia (DD) are mainly characterized by a reading fluency deficit. The reading fluency deficit might be traced back to a scarce integration of orthographic and phonological representations. In order to address this question, the present study used EEG to investigate the N300, an ERP component which has been associated with the integration of orthographic and phonological representations. Twenty children without DD and 18 children with DD performed a phonological (P)-orthographic (O) matching task (P-O condition), which tapped the integration of orthographic and phonological representations. A control task was applied which did not require the integration of orthographic and phonological representations and consisted only of orthographic information (O-O condition). The O-O condition revealed a similar N300 distribution between groups with a bilateral activity over fronto-temporal electrodes. However, in the P-O condition N300 differentiated the 2 groups of children. The control group revealed greater activity over left fronto-temporal electrodes, whereas the N300 was distributed bilaterally in the group of children with DD suggesting deficient integration of orthographic and phonological representations. These findings might be related to the reading fluency deficit as it was also observed that better reading fluency was correlated with higher (r=-.36) and earlier peaking (r=-.33) N300 amplitudes in the left hemisphere and attenuated N300 amplitudes (r=.45) in the right hemisphere. Standardized low-resolution electromagnetic tomography analysis (sLORETA) revealed that children with DD rely more on right temporo-parietal brain areas compared to children without DD. Furthermore, in order to rule out that earlier deficient processes might influence the group differences found in the N300, we analyzed the N170 for group differences. We did not find significant differences between children without DD and children with DD. In conclusion the results suggest deficient integration of orthographic and phonological representations in dyslexia, as indexed by the N300, and further highlight how this activity is relevant for fluent reading.

Children with dyslexia reveal abnormal native language representations: evidence from a study of mismatch negativity.

Although a deficit perceiving phonemes, as indexed by the mismatch negativity (MMN), is apparent in developmental dyslexia (DD), studies have not yet addressed whether this deficit might be a result of deficient native language speech representations. The present study examines how a native-vowel prototype and an atypical vowel are discriminated by 9-year-old children with (n = 14) and without (n = 12) DD. MMN was elicited in all conditions in both groups. The control group revealed enhanced MMN to the native-vowel prototype in comparison to the atypical vowel. Children with DD did not show enhanced MMN amplitude to the native-vowel prototype, suggesting impaired tuning to native language speech representations. Furthermore, higher MMN amplitudes to the native-vowel prototype correlated with more advanced reading (r = - .47) and spelling skills (r = - .52).

An investigation of prototypical and atypical within-category vowels and non-speech analogues on cortical auditory evoked related potentials (AERPs) in 9 year old children.

The present study examined cortical auditory evoked related potentials (AERPs) for the P1-N250 and MMN components in children 9 years of age. The first goal was to investigate whether AERPs respond differentially to vowels and complex tones, and the second goal was to explore how prototypical language formant structures might be reflected in these early auditory processing stages. Stimuli were two synthetic within-category vowels (/y/), one of which was preferred by adult German listeners ("prototypical-vowel"), and analogous complex tones. P1 strongly distinguished vowels from tones, revealing larger amplitudes for the more difficult to discriminate but phonetically richer vowel stimuli. Prototypical language phoneme status did not reliably affect AERPs; however P1 amplitudes elicited by the prototypical-vowel correlated robustly with the ability to correctly identify two prototypical-vowels presented in succession as "same" (r=-0.70) and word reading fluency (r=-0.63). These negative correlations suggest that smaller P1 amplitudes elicited by the prototypical-vowel predict enhanced accuracy when judging prototypical-vowel "sameness" and increased word reading speed. N250 and MMN did not differentiate between vowels and tones and showed no correlations to behavioural measures.

Clinical neurophysiology of visual and auditory processing in dyslexia: a review.

Neurophysiological studies on children and adults with dyslexia provide a deeper understanding of how visual and auditory processing in dyslexia might relate to reading deficits. The goal of this review is to provide an overview of research findings in the last two decades on motion related and contrast sensitivity visual evoked potentials and on auditory event related potentials to basic tone and speech sound processing in dyslexia. These results are particularly relevant for three important theories about causality in dyslexia: the magnocellular deficit hypothesis, the temporal processing deficit hypothesis and the phonological deficit hypothesis. Support for magnocellular deficits in dyslexia are primarily provided from evidence for altered visual evoked potentials to rapidly moving stimuli presented at low contrasts. Consistently ERP findings revealed altered neurophysiological processes in individuals with dyslexia to speech stimuli, but evidence for deficits processing certain general acoustic information relevant for speech perception, such as frequency changes and temporal patterns, are also apparent.