Can we really use available scales for child and adolescent psychopathology across cultures? A systematic review of cross-cultural measurement invariance data.

In this systematic review, we assessed available evidence for cross-cultural measurement invariance of assessment scales for child and adolescent psychopathology as an indicator of cross-cultural validity. A literature search was conducted using the Medline, PsychInfo, Scopus, Web of Science, and Google Scholar databases. Cross-cultural measurement invariance data was available for 26 scales. Based on the aggregation of the evidence from the studies under review, none of the evaluated scales have strong evidence for cross-cultural validity and suitability for cross-cultural comparison. A few of the studies showed a moderate level of measurement invariance for some scales (such as the Fear Survey Schedule for Children-Revised, Multidimensional Anxiety Scale for Children, Revised Child Anxiety and Depression Scale, Revised Children's Manifest Anxiety Scale, Mood and Feelings Questionnaire, and Disruptive Behavior Rating Scale), which may make them suitable in cross-cultural comparative studies. The remainder of the scales either showed weak or outright lack of measurement invariance. This review showed only limited testing for measurement invariance across cultural groups of scales for pediatric psychopathology, with evidence of cross-cultural validity for only a few scales. This study also revealed a need to improve practices of statistical analysis reporting in testing measurement invariance. Implications for future research are discussed.

Parental knowledge, attitudes, and behaviors towards children with epilepsy in Belgrade (Serbia).

OBJECTIVE: The aim of our study was to assess knowledge, attitudes, and behaviors of parents whose children were diagnosed with epilepsy. METHODS: This cross-sectional study included 213 consecutive parents who accompanied their children, diagnosed with epilepsy, at regular checkups in the outpatient department of the Child and Adolescent Neurology and Psychiatry Clinic in Belgrade. Data were obtained through a questionnaire before completion of the child's neurological checkup, while clinical parameters of children with epilepsy were taken from medical records. RESULTS: Almost all respondents knew that epilepsy is not an infectious disease (99.5%), while the least proportion of parents (31.9%) knew that epilepsy is not, for the most part, hereditary. Parents felt that their family and friends should know that their child is suffering from epilepsy (average score: 4.3 out of 5). Also, parents felt the most confident in taking care of their child during seizures (4.7 out of 5), while they felt the least confident in letting their child go on school trips for several days (3.4 out of 5). Parental longer schooling (i.e., higher education level) was an independent predictor of higher epilepsy knowledge. Taking less number of medications was an independent predictor of more supportive parental behavior towards children with epilepsy. CONCLUSION: Some epilepsy-related issues still require improvement in parental knowledge. Ensuring education and support at community and school levels for both parents and children with epilepsy should be the principal goal of health-care service.

[Development of forensic psychiatry in Serbia].

The development of legislation in the field of mental health in our region is linked with the emergence and development of the oldest psychiatric hospitals in Serbia.The principle that the mentally ill who committed a criminal offense need to be placed in a psychiatric hospital instead of a prison was introduced at the same time as in the most developed European countries. The founders of the Serbian forensic psychiatry, Dr. Jovan Danic, Dr.Vojislav Subotic Jr. and Dr. Dusan Subotic, were all trained at the first Serbian Psychiatric Hospital ("Home for the Unsound of Mind") that was founded in 1861 in the part of Belgrade called Guberevac. Their successors were psychiatric enthusiasts Prof. Dr.Vladimir F.Vujic and Prof. Dr. Laza Stanojevic. A formal establishment of the School of Medicine of Belgrade, with acquirement of new experience and positive shifts within this field, based on the general act of the University in 1932, led to the formation of the Council of the School of Medicine, which, as a collective body passed expert opinions. Thus, the first Forensic Medicine Committee of the School of Medicine was formed and started its activities in 1931 when Forensic Medicine Committee Regulations were accepted. After the World War II prominent educators in the field of mental health, and who particularly contributed to further development of forensic psychiatry in Serbia were Prof. Dr. Uros Jekic, Prof Dr. Dusan Jevtic, Dr. Stevan Jovanovic, Prof. Dr. Borislav Kapamadzija, Prof. Dr. Maksim Sternic, Prof. Dr. Josif Vesel and Prof. Dr. Dimitrije Milovanovic.

Measuring positive and negative affect and physiological hyperarousal among Serbian youth.

This study extended previous cross-cultural work regarding the tripartite model of anxiety and depression by developing Serbian translations of the Positive and Negative Affect Scale for Children (PANAS-C), the Physiological Hyperarousal Scale for Children (PH-C), and the Affect and Arousal Scale (AFARS). Characteristics of the scales were examined using 449 students (M age = 12.61 years). Applying item retention criteria established in other studies, PH-C, PANAS-C, and AFARS translations with psychometric properties similar to English-language versions were identified. Preliminary validation of the scales was conducted using a subset of 194 students (M age = 12.37 years) who also completed measures of anxiety and depression. Estimates of reliability, patterns of correlations among scales, and age and gender differences were consistent with previous studies with English-speaking samples. Findings regarding scale validity were mixed, although consistent with existing literature. Serbian translations of the PH-C, PANAS-C, and AFARS mirror the original English-language scales in terms of both strengths and weaknesses.

Self-assessment of the quality of life of children and adolescents in the child welfare system of Serbia.

BACKGROUND/AIM: Children and adolescents who enter a child welfare system are at higher risk of suffering from mental disorders, physical health, and/or social and educational problems than the general population of the same age is. This study was organized with the aim to evaluate the general characteristics of quality of life (QOL) in children and adolescents living in residential and foster care in Serbia. METHODS: Two hundred and sixteen children and adolescents, aged 8-18 years, from residential and foster care and 238 children and adolescents from the general population participated in the study. QOL was assessed using the Pediatric Quality of Life Inventory (PedsQL) - Serbian version. Three groups were created: residential care group (RCG), foster care group (FCG), and control group (children and adolescents from biological families - CG). Descriptive data were calculated for all questionnaires' scores, while t-test and ANOVA were used to compare them. RESULTS: The mean value of the total PedsQL was lower in the RCG, 67.47 +/- 17.75, than in the FCG and the CG, 88.33 +/- 11.27 and 80.74 +/- 11.23, respectively. Additionally, the RCG reported lower all PedsQL Scale scores, but the lowest value was for the psychosocial domain. These differences were statistically significant (F value ranged from 17.3 to 49.89, p < 0.000). However, only the scores of the RCG were statistically different from the FCG and the CG, while the differences between the FCG and the CG were statistically insignificant (p > 0.05). CONCLUSION: Children and adolescents living in residential care have significantly poorer QOL than those living in foster care or in biological families. On the other side, QOL in children and adolescents from foster care is similar to the one of those living in biological families.

Autism and autistic spectrum disorders in the context of new DSM-V classification, and clinical and epidemiological data.

Autism is one of disorders from the autism spectrum, besides Asperger syndrome, atypical autism and pervasive developmental disorder not otherwise specified. They are classified as mental disorders as being manifested by a wide range of cognitive, emotional and neurobehavioural abnormalities. Key categorical characteristics of the disorder are clear impairments of the development of the child's socialisation, understanding and production of verbal and non-verbal communication and restricted and repetitive patterns of behaviour. Demarcation boundaries are not clear, neither within the very group of the disorders from the autistic spectrum, nor with respect to the autistic behavioural features in the general population. For this reason, the term spectrum points out the significance of the dimensional assessment of autistic disorders, which will most likely be the basis of the new diagnostic classification of the disorders belonging to the current group of pervasive developmental disorders in the new DSM-V classification. The understanding, as well as the prevalence of the autistic spectrum disorders has changed drastically in the last four decades. From the previous 4 per 10,000 people, today's prevalence estimates range from 0.6 to around 1%, and the increase of prevalence cannot be explained solely by better recognition on the part of experts and parents or by wider diagnostic criteria. The general conclusion is that the autistic spectrum disorders are no longer rare conditions and that the approach aimed at acknowledging the warning that this is an urgent public health problem is completely justified.

Depressive symptoms as a side effect of the sustained release form of methylphenidate in a 7-year-old boy with attention-deficit hyperactivity disorder.

INTRODUCTION: Hyperkinetic disorder or attention-deficit hyperactivity disorder (ADHD) is a clinical entity consisting of a cluster of symptoms including hyperactivity, attention disorder and impulse control disorder group. In the context of ADHD etiology we may say that genetic, clinical and imaging studies point out a disruption of the brain dopamine system, which is corroborated by the clinical effectiveness of stimulant drugs, which increase extracellular dopamine in the brain. Basically, it is a biological and not psychological disorder, which is important both for the comprehension and therapeutical approach to this problem. Today, the best recommended approach regarding children with ADHD is a combination of two therapeutic modalities: pharmacotherapy and behavioral treatment. The first-choice drugs for this disorder belong to the group of sympathomimetics--psychostimulants and atomoxetine (more recently). As the first-choice therapy, methylphenydate in sustained release form has numerous advantages. Like all drugs, methylphenidate has its unwanted side effects. Most common are: loss of appetite, weight loss, sleeping disorders, irritability, headache. These side effects are well-known and documented in the literature. By analysing the available literature we have found cases of psychiatric side effects such as: psychosis, mania, visual hallucinations, agitation, suicidal ideas. We have not found examples of ADHD in children who use increased dosage of sustained release of methylphenidate leading to depressive symptomatology. On the other side, methylphenidate may be prescribed for off-label use in treatment-resistant cases of depression. CASE REPORT: The case of a 7-year-old boy diagnosed with ADHD was on a minimal dose of sustained release form of methylphenidate. After initial titration of the drug, i.e. after raising the dose to the next level the boy developed clinical signs of depression. The treatment was ceased and depressive symptoms were withdrawed. CONCLUSION: Manifestation of depressive symptomatology after dose increasement of sustained release form of methylphenidate in a 7-year-old boy with ADHD represents an uncommon side effect. Precise drug activity mechanisms responsible for the appearance of these symptoms remains to be explained.

Eating disorders.

Eating disorders are considered chronic diseases of civilization. The most studied and well known are anorexia and bulimia nervosa. Anorexia is considered one of the most common psychiatric problems of girls in puberty and adolescence. Due to high mortality and morbidity as well as the increasing expansion of these diseases, it is clear why the amount of research on these diseases is growing worldwide. Eating disorders lead to numerous medical complications, mostly due to late diagnosis. The main characteristic of these diseases is changed behavior in the nutrition, either as an intentional restriction of food, i.e. extreme dieting, or overeating, i.e. binge eating. Extreme dieting, skipping meals, self-induced vomiting, excessive exercise, and misuse of laxatives and diuretics for the purpose of maintaining or reducing body weight are characteristic forms of compensatory behavior of patients with eating disorder. The most appropriate course of treatment is determined by evaluating the patient's health condition, associated with behavior and eating habits, the experience of one's own body, character traits of personality, and consequently the development and functioning of the individual. The final treatment plan is individual. Eating disorders are a growing medical problem even in this part of the world. Prevention should be planned in cooperation with different sectors so as to stop the epidemic of these diseases.

The impact of depression and anxiety disorder symptoms on the health-related quality of life of children and adolescents with epilepsy.

This study evaluated the effects of depression and anxiety disorder symptoms on the health-related quality of life (HRQOL) of children and adolescents with epilepsy. Sixty children and adolescents and their parents participated in the study. Symptoms of anxiety disorders were identified by the Screen for Child Anxiety Related Emotional Disorders questionnaire (SCARED) and symptoms of depression by the Mood and Feeling Questionnaire (MFQ). The Pediatric Quality of Life Inventory (PedsQL) was used for HRQOL assessments. A series of simple and partial correlations revealed that the levels of HRQOL significantly decrease as symptoms of depression or anxiety disorders increase and vice versa. Stepwise regression method of children's ratings resulted in a final model of school achievement and symptoms of generalized anxiety and separation anxiety disorder as predictors that explain 50.9% of the variation in HRQOL (F = 11.21, p < 0.000). For parents' ratings, the final model included symptoms of depression and separation anxiety disorder as predictors that explain 38.4% of the variation in HRQOL (F = 10.82, p < 0.000). In summary, symptoms of depression and generalized and separation anxiety disorders have the most significant impact on HRQOL.

Some psychometric properties of the Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL™) in the general Serbian population.

PURPOSE: The aim of this study was to evaluate the general measurement properties of the Serbian version of the Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL™) self-report versions for children and adolescents (8-18 years). METHODS: The PedsQL™ was completed by 238 children and adolescents. The version was descriptively analyzed first. Afterward, internal consistency and construct and convergent validity were analyzed using the classic test theory psychometrical procedures. RESULTS: The PedsQL™ scale score means ranged 70.65-88.34, with the total score was 80.74. Scale internal consistency reliability determined by Cronbach's coefficient was above 0.7 for all except the School, 0.65, and Emotional Functioning Scale, 0.69. The statistics assessing the adequacy of the model in confirmatory factor analysis revealed poor model fit for the current structure of the PedsQL™. Finally, the PedsQL™ total and psychosocial health showed convincing negative correlations with emotional and conduct problems, hyperactivity/inattention, and peer relationship problems. CONCLUSIONS: The Serbian PedsQL™ scales have appropriate internal consistency reliability, sufficient for group evaluations, and good convergent validity against psychological constructs. However, there are problems regarding its current construct validity (factorial validity).

Presence of different forms of compensatory behaviours among eating disordered patients.

INTRODUCTION: Eating disorders indicate unhealthy habits in nutrition and/or behaviour in the feeding and maintaining of body weight. The main characteristic of these diseases is changed behaviour in nutrition, either as an intentional restriction of food, namely extreme dieting or overeating, i.e. binge eating. Extreme dieting, skipping meals, self-induced vomiting, excessive exercise, and misuse of laxatives and diuretics for the purpose of maintaining or reducing body weight are the forms of compensatory behaviour. OBJECTIVE: The purpose of the present research was to determine the presence of different inappropriate compensatory behaviours among eating disordered patients. METHODS: The experimental group included 35 female eating disordered patients of 23.02 +/- 3.46 years on average, with anorexia or bulimia nervosa. The control group consisted of 70 girls aged 23.1 +/- 3.0 years on average. Each participant completed a "24-hour Recall Questionnaire" and the "Eating Disorder Diagnostic Scale". RESULTS: A high statistically significant difference existed in the presence of all compensatory behaviours in the experimental and control group, regarding vomiting (chi2 = 40.6; p < 0.001), misuse of laxatives and diuretics (chi2 = 33.7; p < 0.001), extreme dieting (chi2 = 23.4; p < 0.001) and excessive exercising (chi2 = 27.1; p < 0.001). CONCLUSION: Eating disordered patients showed a significantly higher incidence of all evaluated forms of compensatory behaviour in comparison with the control group. This report confirms the presence of specific symptomatology of anorexia and bulimia patients.

Health-Related Quality of Life Measure for Children with Epilepsy (CHEQOL-25): preliminary data for the Serbian version.

The objectives of this study were to translate into Serbian the Health-Related Quality of Life Measure for Children with Epilepsy (CHEQOL-25) and to provide preliminary data on its measurement properties. Translation, cultural adaptation, and pretesting were performed first, followed by evaluation of several reliability aspects of this version administered to 50 children with epilepsy and their parents. The mean scores of the CHEQOL-25 subscales ranged from 12.2 to 14.4 for children and from 12.4 to 15 for parents (possible range: 5-20). The internal consistency coefficients of the subscales ranged from 0.11 to 0.87. Between the children's and parents' reports, there was a moderate level of agreement (0.43-0.57). It was concluded that the Serbian version is a feasible measure, all subscales except one demonstrate sufficient reliability, and a parent form could be used as a proxy measure.

The psychometric study of the Serbian KINDL questionnaire for health-related quality of life assessment in children and adolescents.

OBJECTIVES: Health-related quality of life (HRQOL) is the most frequently evaluated patient-reported outcome. It is unexplored in Serbia and there are no methods for its evaluation. This study was aimed to analyse the psychometric properties of the Serbian version of the KINDL questionnaire for HRQOL assessment in children and adolescents. METHODS: The KINDL-Kid-S completed 100 children and the KINDL-Kiddo-S 92 adolescents. Both versions were descriptively analysed and explored the items-sub-scales relationships. Cronbach's coefficient was used to explore the reliability of the versions. RESULTS: The means of all sub-scales were located on the positive side of the response scale. The total score was 78.84 for the KINDL-Kid-S and 75.51 for the KINDL-Kiddo-S. Within the versions, the items showed significant correlations with its sub-scale total score and the total score. Between the sub-scales, there were significant relationships also. The Cronbach's coefficient exceeded 0.8 for the internal consistency reliability of the total score in both, and ranged 0.45-0.7 for the sub-scales. CONCLUSIONS: Besides substantial inter- and intra-sub-scale correlations, the reliability coefficients of some sub-scales are low in the Serbian KINDL, emerging the needs for revisions before extensive uses.

[Richard Morton (1637-1698)--the distinguished physician of the 17th century].

Richard Morton was a distinguished physician of the 17th century. He was born in Suffolk, England, on July 30th 1637. Morton published three works but his landmark paper was "Phthisiologia, seu exercitationes de phthisi, tribus libris comprehensae" published in 1689, dedicated to William III. The book established his reputation at home and abroad lasting for over a century. Pulmonary tuberculosis was very frequent in the 17th century in England. He was the first physician ever to state that tubercles were always present in its pulmonary form. When we add to these momentous observations and their rational explanation the facts that he was the first physician to state categorically that tubercles are always present in phthisis, we must agree that Morton richly deserves his honoured place in the long list of those who have contributed to the solution of the problem of tuberculosis. Morton first described and gave conclusions of numerous today well known and already examined illnesses. In 1694 he gave first notes about the psychiatric illness which we today call "anorexia nervosa", calling it "nervous consumption". His chapters on treatment are long and contain a sound basis of common sense as indicated by his instructions on general management. He stresses the need for an adequate diet, an environment free from fog and smoke, and the desirability of ensuring a moderate amount of exercise. All Morton's therapeutic dicta are in their humanity and thoughtful care in striking contrast to the regimen of copious bleeding and semi-starvation inflicted by the later generation of physicians. Confirmation of his achievements and his teaching can be found in today's medical practice.

Prevalence of the fragile X syndrome in Yugoslav patients with non-specific mental retardation.

Mutations at two fragile sites, FRAXA and FRAXE, loci are caused by an expansion of a CGG/GCC trinucleotide repeat and are characterized by mental retardation. Here we report molecular screening survey of 97 unrelated individuals diagnosed with non-specific mental retardation (MR), which produced positive test for FRAXA in two boys and none positive for the FRAXE mutation. In addition, we studied allelic frequency distribution for the FRAXA locus in this group of mentally retarded patients, as well as in the 99 healthy subjects of Yugoslav population. The distribution of FMR1 CGG repeat size in both groups was similar: the most common allele contained 29 repeats (32.86% in the healthy population and 54.54% in MR population), followed by the allele with 28 CGG repeats (21.43% in the healthy and 12.2% in MR population). Premutation alleles with more than 45 repeats were not found in control nor in the MR group.