Occurrence and correlates of anxiety and depression in carers of autistic children across three nations.

Purpose: Caring for an autistic child is associated with elevated stress, anxiety and depression. Although some data suggest that 'child' or 'carer' factors may moderate the severity of carer distress, relatively few international comparisons have been made, limiting the generalizability of previous findings. This study aimed to address this issue. Method: A survey-based comparison was made of carers from three nations (Australia, Denmark, Greece), and the effects of demographic, child, and carer variables upon carer anxiety and depression were investigated. Results: Only limited cross-nation consistency was found for nation, child, or carer variables and their effects upon carer anxiety or depression. Conclusion: The application of universal treatment models for carer anxiety and depression may be of differing value across nations.

Investigating the DSM-5 and the ICD-11 PTSD symptoms using network analysis across two distinct samples.

OBJECTIVE: Posttraumatic stress disorder (PTSD) has long been debated with a recent focus on the consequences of having two different diagnostic descriptions of PTSD (i.e., the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition [DSM-5] and the International Classification of Diseases-11th Edition [ICD-11]). Research has modeled PTSD as a network of interacting symptoms according to both diagnostic systems, but the relations between the two systems remain unclear regarding which symptoms are more central or interconnected. To answer this question, the present study is the first study to investigate the combined network structure of PTSD symptoms according to both systems using validated measurements (i.e., the International Trauma Questionnaire [ITQ] and the Posttraumatic Stress Disorder Checklist 5 [PCL-5] across two distinct trauma samples [a community sample, N = 2,367], and a military sample, N = 657). METHOD: We estimated two Gaussian Graphical Models of the combined ICD-11 and DSM-5 PTSD symptoms across the two samples. RESULTS: Five of the six most central symptoms were the same across both samples. CONCLUSIONS: The results underline that a combination of five symptoms representing both diagnostic systems may hold central positions and potentially be important for treatment. However, the implications depend on if the different diagnostic descriptions can be reconciled in an indexical rather than constitutive perspective. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Remarkable high frequency of insecure attachment in children with ADHD persists in a three-year follow-up.

BACKGROUND: Studies have pointed to a complicated and mutual relationship between attention deficit hyperactivity disorder (ADHD) and attachment. In an observational follow-up study conducted in 2015 60 children from 7 years to 12 years recently diagnosed with ADHD were included and assessed according to attachment representation showing 85% of the children to be insecurely attached. AIM: The aim of this study was to investigate the stability of this remarkably high frequency of insecure attachment in the same cohort of children. METHODS: Children previously assessed using the child attachment interview (CAI) when diagnosed with ADHD were contacted three years later for a follow-up CAI assessment. RESULTS: At follow-up, 31 children participated in the CAI-interviews. Since their diagnosis with ADHD, the children had received treatment as usual. The CAI-interviews showed a continued high rate of insecure attachment with 90% of the children classifying as insecurely attached compared to expected 38% in the normal population. Of these, the majority of children (77%) were classified as dismissing. CONCLUSION: Our findings suggest that targeting ADHD-symptoms with our current treatment strategies does not in itself improve attachment security. Attachment security may in turn be a factor of importance when evaluating general functioning and prognosis.

Development and initial validation of the Odense Child Trauma Screening: a story stem screening tool for preschool and young schoolchildren.

BACKGROUND: Early identification of young children exposed to trauma who are at risk of developing post-trauma symptomatology such as posttraumatic stress disorder (PTSD) or other emotional or behavioral problems is important for allocating appropriate treatment and preventing long-term consequences. However, assessment of young children exposed to trauma is challenging because children may not be able to talk about their trauma or trauma reactions. Story stem tools combine storytelling and play to access the internal world of young children and can be used in the assessment of children exposed to trauma. OBJECTIVE: To examine reliability and validity of a new story stem tool, the Odense Child Trauma Screening (OCTS). OCTS was developed to screen for play-based behavior and narrative representations indicative of traumatization in preschool and young schoolchildren. METHOD: Forty-nine Danish children aged 4.5-8.9 years (M = 6.6, SD = 1.2) participated in the OCTS. Participants included a risk sample of 31 children exposed to traumas and a community sample of 18 children. Caregivers were interviewed about child symptoms of PTSD, major depressive disorder (MDD), and reactive attachment disorder (RAD) and answered the Strengths and Difficulties Questionnaire (SDQ). The community sample completed OCTS test-retests. RESULTS: Interrater reliability proved excellent (ICC = .96-1.00). Test-retest reliability was acceptable (ICC = .66). Significant moderate correlations were found between the OCTS total score and scales of PTSD, MDD and RAD and the SDQ Total Difficulties Scale. The ability of the OCTS to discriminate between children from the risk and community sample was good. CONCLUSIONS: The study provided preliminary evidence of reliability and validity of the OCTS as a screening tool for young children exposed to trauma. OCTS shows promise as a standardized, age-appropriate informant-based screening measure applicable for clinical assessment.

Internet-based cognitive behavioral therapy for anxiety in an outpatient specialized care setting: A qualitative study of the patients' experience of the therapy.

Knowledge about user experiences of internet-based cognitive behavioral therapy (iCBT) has mostly been drawn from non-clinical groups or with iCBT offered via self-referral. The present study therefore focused on patients who had undergone iCBT with minimal support while actively awaiting outpatient psychological treatment in the form of face-to-face CBT. To seek out barriers to adherence the study also included patients who had withdrawn from the iCBT treatment before completion. The study was performed in an outpatient clinic for anxiety disorders where twelve participants with a primary diagnosis of either social anxiety disorder or panic disorder were recruited from an ongoing randomized control trial for semi-structured interviews. Statements from the interviews showed that the iCBT treatment was unfavorably compared to the usual face-to-face treatment at the clinic. Despite this, a majority of the interview participants still expressed to have experienced various benefits from the treatment. Some participants did however, experience difficulties putting the materials to practical use. Furthermore, a large majority of the participants expressed a need for additional support, with a strong tendency for non-completers specifically expressing a need for face-to-face contact with a clinician. Implications for future research and implementation of iCBT in clinical practice are discussed.

Callous-Unemotional Traits Do Not Predict Functional Family Therapy Outcomes for Adolescents With Behavior Problems.

Despite the availability of evidence-based treatment models for adolescent behavior problems, little is known about the effectiveness of these programs for adolescents with callous-unemotional (CU) traits. Defined by lack of empathy, lack of guilt, flattened affect and lack of caring, CU traits have been linked to long-term anti-social behavior and unfavorable treatment outcomes and might be negatively related to outcomes in evidence-based programs such as Functional Family Therapy (FFT). This study used a single-group pre-post evaluation design with a sample of 407 adolescents (49.1% female, mean age = 14.4 years, SD = 1.9) receiving FFT to investigate whether outcomes in FFT are predicted by CU traits and to what extent reliable changes in CU traits can be observed. The results showed that although CU traits are related to increased problem severity at baseline, they predicted neither treatment dropout nor post-treatment externalizing behavior and family functioning. CU traits were related to diminished improvement ratings, in particular with respect to parental supervision. Reductions in CU traits were observed across the time of treatment, and these were most profound among adolescents with elevated levels of CU traits at baseline. Further research should investigate whether certain evidence-based treatment components are more suited for adolescents with CU, and if the addition of specific intervention elements for reducing CU-traits could further improve outcomes for this high-risk population.

The effects of practicing target-shooting sport on the severity of inattentive, hyperactive, and impulsive symptoms in children: a non-randomised controlled open-label study in Denmark.

Purpose: Target-shooting sport requires mental effort and concentration. Training may reduce inattentiveness and distractibility. There is little knowledge if children with symptoms of attention-deficit/hyperactivity disorder (ADHD) benefit from practicing target-shooting sport. Materials and methods: Our study aims to investigate this in a non-randomised controlled open-label study of 128 children, 10-14 years of age, with ADHD-symptoms. The intervention-group (n = 64) practiced target-shooting in local shooting associations once a week for 6 months. The control group (n = 64) received treatment as usual. Primary outcome: teacher-rated ADHD-RS-IV-total score. Secondary outcomes: (a) parent-rated ADHD-RS-IV-total score; (b) teacher- and parent-rated Strengths-and-Difficulties-Questionnaire (SDQ); (c) self-rated quality of life (KIDSCREEN-27-total score); and (d) four objective measurements of ADHD-symptoms using the QbTest™. The data were collected at baseline and after 6 months. Results: When estimating the marginal effect of the intervention on our primary outcome, the teacher-rated ADHD-RS-IV, we found no significant effect (mean change between groups (contrast)=2.23; p = 0.193). However, we did find significant beneficial effects on four of the eight secondary outcomes, including the parent-rated ADHD-RS-IV-total score (contrast = 4.76; p = 0.024), the parent-rated SDQ-total score (contrast = 2.09; p = 0.027), and on the QbTest™ measurements of the Reaction Time Variation (RTVar) (contrast = 36.96; p = 0.013), and of Omission Errors (contrast = 7.57; p = 0.019). Conclusions: Despite the negative result on the primary outcome, the robust findings on these secondary outcomes in this open-label study indicate proof of concept that practicing target-shooting sport may have some beneficial effects on the severity of ADHD-symptoms in children. No adverse events were reported. Randomised trials of this non-pharmacological intervention are needed.

Validation of the Diagnostic Infant and Preschool Assessment in a Danish, trauma-exposed sample of young children.

BACKGROUND: There exist only few developmentally sensitive assessment instruments for identifying posttraumatic stress disorder (PTSD) and other potentially comorbid affective and behavioral symptomatology in preschool children. Consequently, young children who exhibit post-trauma symptomatology risk not being identified and not receiving the appropriate treatment. One of the few instruments that exist is the Diagnostic Infant and Preschool Assessment (DIPA). OBJECTIVE: To examine internal reliability and convergent validity of the Danish version of the DIPA, a semi-structured interview of caregivers about their child's mental health. METHOD: In total, 62 caregivers of trauma-exposed children aged 1-6 years were interviewed with the DIPA and completed the Strengths and Difficulties Questionnaire (SDQ). RESULTS: The children had experienced between one and eight traumas (Mdn = 3). Based on the DIPA, 48.4% of the children exhibited PTSD. The DIPA showed good to excellent internal consistency for the disorders of major depressive disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, separation anxiety disorder and overall internal consistency of PTSD and reactive attachment disorder. Internal consistency was lower for each symptom cluster of PTSD and the overall consistency of sleep disorder with Cronbach's alpha ranging between 0.54 and 0.69. Correlations between continuous scores of eight disorders of the DIPA and SDQ scales provided support for convergent validity of the DIPA. CONCLUSION: The study provides preliminary evidence to support the Danish version of DIPA as a valid measure of symptoms of young children exposed to psychological trauma. As a standardized assessment tool, the DIPA can aid in early and structured assessment of young children exposed to trauma and can help guide treatment for those in need.

Influence of motor skills training on children's development evaluated in the Motor skills in PreSchool (MiPS) study-DK: study protocol for a randomized controlled trial, nested in a cohort study.

BACKGROUND: Good motor skills are considered important for children's physical, social, and psychological development, but the relationship is still poorly understood. Preschool age seems to be decisive for the development of motor skills and probably the most promising time-window in relation to preventive strategies based on improved motor skills. This research program has four overall aims: (1) investigation of the effect of a structured program aimed at improving motor skills in 3-6-year-old children on current and future motor skills, health, cognition, and wellbeing; (2) establish reference data on motor skills in 3-6-year-olds; (3) description of early development of musculoskeletal problems; and (4) establishment of a population-based cohort of 3-6-year-olds. METHODS: Over a four-year period, all preschools in a Danish municipality, Svendborg, will implement a new program aimed at optimizing children's motor skills. By introducing the program into a subset of the preschools at onset and comparing these children to another subset (control) that will not receive the intervention the first three years, it is possible to document a potential effect of the intervention. At the same time, a cohort will be established including all children attending preschools in the municipality with extensive baseline data collection: gross and fine motor skills; movement patterns; musculoskeletal complaints; physical activity; anthropometry; general wellbeing; cognitive abilities; language status; medical history; demographic background; and more. The children are aged 3-6 years at baseline. A total of 1461 children have been invited into the cohort, 368 to the intervention arm and 359 to the control arm. Follow-up time for the trial is 2.5 years. The cohort is planned to run at least until the children leave school at age 15-16 years. Longer follow-up will depend on future funding. DISCUSSION: If the results of the trial are positive, the intervention can be implemented in other similar settings with reasonable ease and at a relatively low initial cost. This is due to the extensive end-user involvement, the broad population base, and the pragmatic nature of the intervention. The cohort will provide important information about the influence of early motor skills on children's development across many domains and the potential interactions between these domains. TRIAL REGISTRATION: ISRCTN registry, ISRCTN23701994 . Registered on 13 October 2016.

The influence of participation in target-shooting sport for children with inattentive, hyperactive and impulsive symptoms - A controlled study of best practice.

BACKGROUND: Practising target-shooting sport requires focused attention and motoric steadiness. A previous non-controlled pilot study suggests that children with impairing symptoms of attention-deficit/hyperactivity disorder (ADHD) benefit from participating in target-shooting sport in local shooting associations, as rated by parents and teachers. This study aims at examining if, and to which extent, target-shooting sport reduces parent- and teacher-reported severity of inattentiveness, hyperactivity, and impulsivity in children with attention difficulties, and if, and to which extend, target-shooting sport improves the children's wellbeing and quality of life. METHODS: A mixed method approach is applied. A non-blinded, waiting list controlled study is combined with a case study, consisting of interviews and observations. The intervention consists of children practising target-shooting sport, by attending a local shooting association, once a week for six months, during regular school hours. Data from questionnaires (ADHD-RS, SDQ, Kidscreen-27), as well as a computerized continued performance test (Qb test), measure the children's activity and attention. The study includes 50 children in an intervention group and 50 children in a waiting list control group. The Qb test collects data from at least 20 children from the intervention group and at least 20 children from the waiting list control group. Data from the questionnaires and Qb-test is collected at baseline, and six months post intervention. In addition, a case study is carried out, consisting of interviews of at least five children from the intervention group, their parents, teachers and shooting instructors. Observations are carried out, when children are in school and while they are attending the local shooting association. The case study adds to an in-depth understanding of children's participation in target-shooting sports. DISCUSSION: At present, little is known about the effects and influence of practising target-shooting sport for children experiencing difficulties with inattentiveness, hyperactivity and impulsivity. This study is expected to contribute to an understanding of the influence of participating in target-shooting sports on inattentive, hyperactive and impulsive symptoms, and the effects on the children's psychological wellbeing and quality of life. TRIAL REGISTRATION: Current Controlled Trials NCT02898532 . Retrospectively registered 14 September 2016.

Being aware of own performance: how accurately do children with autism spectrum disorder judge own memory performance?

Self-awareness was investigated by assessing accuracy of judging own memory performance in a group of children with autism spectrum disorder (ASD) compared with a group of typically developing (TD) children. Effects of stimulus type (social vs. nonsocial), and availability of feedback information as the task progressed, were examined. Results overall showed comparable levels and patterns of accuracy in the ASD and TD groups. A trend level effect (p = 061, d = 0.60) was found, with ASD participants being more accurate in judging own memory for nonsocial than social stimuli and the opposite pattern for TD participants. These findings suggest that awareness of own memory can be good in children with ASD. It is discussed how this finding may be interpreted, and it is suggested that further investigation into the relation between content, frequency, and quality of self-awareness, and the context of self-awareness, is needed.

Follow-up at mid-school age (9-13 years) of children assessed for autism spectrum disorder before the age of four.

BACKGROUND: Studies of diagnosis and outcome in mid-school age children (9-13 years) referred early in life for a suspected autism spectrum disorder (ASD) are scarce. AIMS: This study aimed to describe outcome, developmental change and the stability of the early diagnosis in mid-school age. METHODS: Children consecutively referred to a specialized autism unit at a regional psychiatric diagnostic centre in Denmark before the age of 4 were contacted in mid-school age (9-13 years). 14 children with ASD and 9 children diagnosed outside the spectrum were included. Current clinical diagnosis, autism characteristics, intellectual abilities and adaptive functioning were assessed at follow-up, and investigated in relation to early measures of intellectual abilities and difficulties in social and communicative situations. RESULTS: The stability of an early ASD diagnosis was confirmed. However, a high degree of change into the autism spectrum was found for children who were initially diagnosed with another developmental disorder. A positive change with regard to IQ level was evident at the individual level. At group level, there was a tendency for lower functioning in the children diagnosed early with ASD. Early measures of intellectual abilities, and of social and communicative difficulties, predicted between 16% and 50% of the variance in intellectual abilities and adaptive functioning. CONCLUSIONS: The findings are in line with follow-up studies in preschool and early school age but highlight the need to monitor early diagnostic decisions, and the need for more nuanced baseline and outcome measures that may help increase our prognostic understanding.