The effect of coronavirus disease 2019 on anxiety levels of children with cystic fibrosis and healthy peers.

BACKGROUND: Cystic fibrosis (CF) is a chronic disease causing recurrent respiratory tract infections. Viral respiratory tract infections are more severe in CF. The first case of coronavirus disease 2019 (COVID-19) was seen in Turkey on March 11, 2020, and nationwide school closure and lockdown were implemented. School closure and home confinement might have adverse effects on children's physical and mental health. In this study, we aimed to compare the effect of the COVID-19 pandemic on psychological reactions of CF patients and healthy controls. METHODS: This is a controlled cross-sectional study including 7-18-year-old children with CF. The survey included questions regarding family environment and peer relations, self-care, and psychological reactions to the COVID-19 pandemic. The questionnaire was administered to children via telephone calls under parental supervision. RESULTS: We evaluated 132 CF patients and 135 of their healthy peers. Mean age was 11.5 ± 2.9 years in the CF group and 11.8 ± 3.2 years in the control group (P = 0.98). There were 55 girls (41.7%) in the CF group and 81 girls (60%) in the control group (P = 0.027). The socioeconomic status of their families was similar. The CF patients were found to be less anxious for family members at risk of COVID-19, less upset about school closure, and less anxious about the COVID-19 pandemic (P < 0.001, 0.02, 0.01, respectively). CONCLUSIONS: Cystic fibrosis patients seem to show more resilience in coping with the pandemic. Appropriate psychological support should be provided to them and resilience strategies in coping with the pandemic should be nurtured.

Emergency Department Visits for Non-suicidal Self-harm, Suicidal Ideation, and Suicide Attempts in Children and Adolescents.

Self-harm presentations to emergency departments (ED) have become a growing concern, yet little is known about self-harm visits in pediatric EDs. This study aimed to investigate the clinical and demographic characteristics of patients who presented to the pediatric ED between 2012 and 2017 with non-suicidal self-harm (NSSH, n = 63, 60.3% female, M = 14.25 years), suicidal ideation (SI, n = 75, 57.3% female, M = 14.83 years), and suicide attempts (SA, n = 461, 82.9% female, M = 15.41 years). Also, predictors of SA were investigated. Of the patients, 79.4% had at least a psychiatric disorder. Depression was the most common diagnosis in the SI and SA groups, and autism spectrum disorder and intellectual disability were the leading diagnoses in the NSSH group. Self-poisoning was the most common method, and older age, female sex, having relational problems, and prior or current psychiatric admissions were the most important predictive factors of SA. NSSH, SI, and SA exhibit different features in early life. EDs provide an important opportunity for initiating developmentally appropriate interventions to reduce future risks.

Caring for the Most Vulnerable: A Model for Managing Maladaptive Behavior in Children with Mental Special Needs During the COVID-19 Pandemic.

Background: This article presents the results of a comprehensive national model developed for managing maladaptive behaviors (MBs) in children with mental special needs (CMSNs) during the coronavirus disease 2019 (COVID-19) pandemic that combines telehealth-based Applied Behavioral Analyses, psychiatric interventions, and support from local psychosocial teams. This study aims to determine the effectiveness of a system that combined telehealth applications with local psychosocial support teams, allowing services from video calls to emergency interventions. Materials and Methods: The system combines the telehealth applications with the services from local psychosocial intervention teams. In addition to system records covering sociodemographic variables and initial complaints, a telephone survey questioning the effectiveness and satisfaction of the system was used as the main outcome. Results: In total, 347 individuals used the system with mothers constituting the majority of applicants (88.7%, n = 332). The overall satisfaction of the system was 8.8/10. In terms of effectiveness, 63.3% (n = 237) of caregivers reported an improvement in the reason of application. Counselors decided on a need for follow-up visits for 36.6% (n = 137) of applications. A referral to a psychiatrist was asked for 40 patients (10.6%). Discussion: To our best knowledge, this is the first study presenting a model for managing MBs of CMSNs during the COVID-19 outbreak. In general, therefore, it seems that there is a need for unique systems to handle behavioral problems of CMSNs. Conclusions: The findings of this study suggest that it is possible to establish an integrative multistep multidisciplinary telehealth-based approach in a short while.

The relationship between nomophobia and psychiatric symptoms in adolescents.

OBJECTIVE: This study aimed to find out whether nomophobia levels are higher in adolescents with internalising or externalising disorders than healthy adolescents and to investigate the correlation of nomophobia levels with externalising and internalising symptoms. METHODS: K-SADS (Kiddie Schedule for Affective Disorders and Schizophrenia) was applied to 139 adolescents (ages 13-18) and they were asked to fill No Mobile Phone Questionnaire (NMP-Q) and Revised Child Anxiety and Depression Scale (RCADS), while the parents were asked to complete Conners Parent Rating Scale-48 (CPRS-48). RESULTS: There were no significant differences in nomophobia total scores between the three study groups. However, losing connectedness (LC) and not being able to access information (NAI) subscores were significantly higher in group with internalising disorder than healthy controls and there was no significant difference between group with externalising disorder and healthy group. Separation anxiety, social phobia, total anxiety, depression, hyperactivity and oppositional problems positively correlated with nomophobia total score. Conduct problems correlated with only LC. Total anxiety and hyperactivity predicted nomophobia total score. CONCLUSIONS: Since anxiety and hyperactivity were predictors of nomophobia according to the study, adolescents with attention deficit hyperactivity disorder or anxiety disorder should be examined for nomophobia as well.Key pointsNomophobia levels of internalising and externalising disordered groups did not differ.Internalising group had higher scores in two sub-dimensions of nomophobia.All anxiety and depression symptoms correlated with nomophobia.Hyperactivity and oppositional symptoms correlated with nomophobia.Total anxiety and hyperactivity were predictors of nomophobia.

The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T).

AIM: The aim of this study was to determine the prevalence of childhood psychopathologies in Turkey. METHOD: A nation-wide, randomly selected, representative population of 5830 children (6-13 years-old) enrolled as a 2nd,3rd or 4th grade student in 30 cities were evaluated for presence of a psychiatric or mental disorder by a Sociodemographic Form, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and DSM-IV-Based Screening Scale for Disruptive Behavior Disorders in Children and Adolescents scales. Impairment criterion was assessed via a 3 point-Likert scale by the parent and the teacher independently. RESULTS: Overall prevalence of any psychopathology was 37.6% without impairment criterion, and 17.1% with impairment criterion. Attention-deficit hyperactivity disorder was the most frequent diagnosis, followed by anxiety (19.5% and 16.7% without impairment, 12.4% and 5.3% with impairment, respectively). Lower education level and presence of a physical or psychiatric problem of the parents were independent predictors of any psychopathology of the offspring. CONCLUSION: This is the largest and most comprehensive epidemiological study to determine the prevalence of psychopathologies in children and adolescents in Turkey. Our results partly higher than, and partly comparable to previous national and international studies. It also contributes to the literature by determining the independent predictors of psychopathologies in this age group.

Metacognitive Awareness and Emotional Resilience in Children with Attention Deficit Hyperactivity Disorder.

Background: This study explored the metacognitive awareness and emotional resilience levels of children suffering from attention deficit hyperactivity disorder (ADHD) (n=60) with typically developing children (n=30). Methods: Measures included Metacognitive Awareness Inventory and Resiliency Scales for Children and Adolescents filled out by participants, the List of Adverse Life Events, Turgay DSM-IV-Based Disruptive Behavior Disorders Scale, and Revised Child Anxiety and Depression Scale-Parent Form filled out by parents. Results: Metacognitive awareness and emotional resilience were found to be low in the children with ADHD. Emotional resilience increases as metacognitive awareness increases. Metacognitive awareness decreased in the presence of heightened ADHD, anxiety, and/or depression symptoms expressed by the parents' questionnaires (p < 0.001, r = -0.438; p < 0.001, r = -0.403; and p < 0.001, r = -0.421). Conclusions: Findings identified that metacognitive skills and emotional resilience are affected in ADHD.

Psychosocial problems and cognitive functions in children with spina bifida.

Objectives: This study aims to assess psychosocial functioning in relation to lesion level and ambulatory status in children with spina bifida (SB) and compare them to their peers. Patients and methods: Between March 2013 and May 2013, a total of 31 patients with SB (11 males, 20 females; mean age: 9.4 years; range, 6 to 14.7 years) and 36 typically developing peers (16 males, 20 females; mean age: 9.8 years; range, 6.5 to 14.8 years) were included in the study. All participants were assessed using a semi-structured psychiatric diagnostic interview via the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL), Wechsler Intelligence Scale for Children-Revised (WISC-R), Behavioral Rating Inventory of Executive Functions (BRIEF) parent form, Social Responsiveness Scale (SRS), and Aberrant Behavior Checklist (ABC). Results: In the SB group, the rate of psychiatric disorders was significantly higher (p=0.001) and the SRS scores and the planning and organizational components of the executive function were higher than their peers (p=0.02 and p=0.007, respectively). The psychiatric diagnosis rate, BRIEF, and SRS total scores did not significantly differ according to lesion level and ambulatory status. The BRIEF initiate and organization of materials subtest scores and ABC scores were significantly lower at high lesion levels (p=0.02, p=0.02, and p=0.02, respectively) and non-community walkers (p=0.002, p=0.03, and p=0.003, respectively). Conclusion: Psychiatric disorders, impairment in social responsiveness, and planning and organization components of the executive function are prevalent in children with SB with no intellectual disabilities, compared to their peers. Therefore, psychosocial counseling and multidisciplinary follow-up for SB patients seem to be beneficial.

Effect of Impairment on the Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder in a National Survey: Nation-Wide Prevalence and Comorbidities of ADHD.

OBJECTIVE: This study aimed to determine the prevalence and comorbidities of attention-deficit hyperactivity disorder (ADHD) by evaluating a large-scale nation-wide sample of children. METHOD: The inclusion criterion was being enrolled as a 2nd, 3rd, or 4th-grade student. A semi-structured diagnostic interview (K-SADS-PL), DSM-IV-Based Screening Scale for Disruptive Behavior Disorders, and assessment of impairment (by both parents and teachers) were applied to 5,842 participants. RESULTS: The prevalence of ADHD was 19.5% without impairment and 12.4% with impairment. Both ADHD with and without impairment groups had similar psychiatric comorbidity rates except for oppositional defiant disorder (ODD) and conduct disorder (CD) diagnoses. Impairment in the ADHD group resulted in significantly higher ODD and CD diagnoses. CONCLUSION: Even when impairment is not described, other psychiatric disorders accompany the diagnosis of ADHD and may cause impairment in the future. Impairment in the diagnosis of ADHD significantly increases the likelihood of ODD and CD.

Sleep habits, parasomnias and associated behaviors in school children with attention deficit hyperactivity disorder (ADHD).

Considerable clinical data support an association between sleep problems and attention deficit hyperactivity disorder (ADHD). We aimed to investigate the sleep habits, associated parasomnias and behavioral symptoms in primary school children with ADHD. Forty primary school children with a clinical diagnosis of ADHD and 40 age-sex-matched healthy community controls were recruited. The Children's Sleep Habits Questionnaire providing information regarding sleep habits and nighttime and daytime symptoms was used. About 22% of children with ADHD (versus 2.9% of the controls) needed their parents to accompany them while going to sleep (p: 0.008). Transitional objects were needed by 8.1% of ADHD children in contrast to 2.9% of controls. Nightmares, overactivity during sleep, habitual snoring, and bed-wetting were significantly higher in the ADHD group. ADHD children needed significantly more time to go to sleep on school days (p < 0.02). Children undergoing evaluation for ADHD should be routinely screened for sleep disturbances.

Evaluation of 5-HTTLPR Gene Polymorphism and Resilience Components on the Development of Psychopathology in Adolescent Sexual Abuse Cases.

INTRODUCTION: More than one-fourth adolescents are exposed to unexpected frightening experiences and traumas until adulthood. In this study, we aimed to determine the potential role of serotonin transporter (5-HTT) gene polymorphism regarding resilience factors in the symptom variability of individuals exposed to sexual abuse. METHODS: Adolescents aged 11-17 years, who were admitted to the Marmara University Child Psychiatry Outpatient Clinic Forensic division with sexual abuse experience history, were informed about the research, and volunteers were included in the study. Turkish versions of "Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (K-SADS-PL)" was used to assess the psychopathology and functionality. The evaluation of participants also included self-reports based on "Eysenck Personality Inventory" and "Ways of Coping Inventory" for reflecting the resilience domain. RESULTS: The sample included 16 girls (88.9%) and 2 boys (11.1%), and the mean (±standard deviation) age was 14.58±1.97 years. Genotyping of the insertion/deletion polymorphism (5-HTTLPR) in the 5-HTT gene's transcriptional control zone was established, and 8 participants (44.4%) were determined to be of the LL genotype, while 7 (38.8%) were LS and 3 (16.6%) were SS carriers. Considering the relationship between coping styles regarding resilience and genetic variants, 87.5% of participants (n=7) exhibiting problem-focused coping style were determined found to carry the LL allele, while 90% (n=9) who exhibited emotion-focused coping styles were the SS-LS allele carriers (p=0.003). CONCLUSION: Our findings suggest that 5-HTTLPR gene polymorphism has a significant impact on the formation of coping styles. More studies are needed to determine other factors involved in the complex relationship between 5-HTTLPR gene polymorphism and development of psychopathology.

The clinical validity and reliability of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA).

This study investigates the construct validity and reliability of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) in a psychiatric clinical sample of toddlers. The sample consisted of a psychiatric clinical sample (N=112) (male, n=79; female, n=33) of toddlers (12- to 42-months old). Both mothers and fathers completed the BITSEA and mothers completed the Child Behavior Checklist 2/3 (CBCL). Children and their parents were administered a comprehensive psychiatric evaluation. Parents were also given the Autistic Behavior Checklist (AuBC) and the Aberrant Behavior Checklist-Community (ABC). The internal consistency of BITSEA scores was good to excellent for both parents. The BITSEA/Problem (P) scores were significantly correlated with Internalizing, Externalizing and Total Problem scores of the CBCL, all subscores of ABC and total score of AuBC. The BITSEA/Competence (C) scores were significantly inversely correlated with ABC total and AuBC lethargy scores. With respect to a community sample, BITSEA/P scores were significantly higher in the disruptive behavior disorder (DBD) and anxiety/depression (Anx/Dep) groups and BITSEA/C scores were significantly lower in the autism group. These results support the reliability and validity of the BITSEA as a screening tool that may be employed in primary health care services and in psychiatric clinical settings for assessing social-emotional/behavioral problems and delays in competence in infants and toddlers.

The reliability and validity of the Turkish version of the brief infant-toddler social emotional assessment (BITSEA).

In this study the reliability and validity of the Turkish version of the brief infant-toddler social emotional assessment (BITSEA) were investigated in a community sample. The sample consisted of 462 children (mean age: 24.60+/-7.93 [12-42] months) who had applied to Turkish health centers for immunization. Both parents completed the BITSEA; mothers completed the child behavior checklist 2/3 (CBCL). Internal consistencies of the BITSEA-problem (P) and competence (C) scales were good to excellent (Cronbach's alpha=0.82 and 0.72, respectively). Interrater reliability between parents and test-retest reliability were good. BITSEA/P scores were significantly correlated with CBCL internalizing, externalizing and total problem scores (p<0.001). Maternal BITSEA/P cutpoint scores revealed that 30.6% of male toddlers and 28.6% of females were in the subclinical range and 13.1% of males and 17.6% of females were in clinical range. Results reveal that the Turkish version of BITSEA is a reliable, valid and simply applicable instrument for screening social, emotional and behavioral problems among toddlers. Clinical validation of the BITSEA/C and BITSEA/P is warranted.

Interrater reliability and clinical efficacy of Children's Yale-Brown Obsessive-Compulsive Scale in an outpatient setting.

OBJECTIVE: To evaluate the interrater reliability of the Turkish version of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and to measure the clinical efficacy using a clinician-rated impression scale in a clinical outpatient setting. METHOD: Data were collected from 19 nonmedicated children and adolescents (6 girls, 13 boys, mean age 14 +/- 2.25 years) with obsessive-compulsive disorder (OCD). Interrater reliability was assessed by 3 raters through videotape recordings of evaluation. Correlational analyses were maintained by comparing CY-BOCS scores to self-ratings of Children's Depression Inventory (depression), 20-item Leyton Obsessional Inventory-Child Version (obsessive-compulsive symptoms), and Child Behavior Checklist (parent ratings of behavioral problems). The Clinical Global Impression for OCD was administered to measure the clinical efficacy of CY-BOCS. RESULTS: Internal consistency was .77 for the total 10 items. The interrater reliabilities, defined as the intraclass correlation for the compulsion subscale, the obsession subscale, and the CY-BOCS total scores were .85, .94, and .89, respectively. Although the sample size was small, CY-BOCS total score was correlated with the Clinical Global Impression score (P < .01) and showed a significantly higher correlation with Leyton Obsessional Inventory-Child Version scores when compared with Children's Depression Inventory and Child Behavior Checklist scores. CONCLUSION: Our results indicate that the Turkish version of CY-BOCS yielded good interrater reliability and was significantly correlated with a clinician-rated global impression scale. Although the small sample size hinders a conclusion, CY-BOCS showed significant results regarding validity measures. Therefore, our results support that CY-BOCS has the potential to fulfill the need in clinical research settings.