Does Decreased Surgical Stress Really Improve the Psychosocial Health of Early-onset Scoliosis Patients?: A Comparison of Traditional Growing Rods and Magnetically-controlled Growing Rods Patients Reveals Disappointing Results.

STUDY DESIGN: Cross-sectional case-control study. OBJECTIVE: Compare psychosocial profile of magnetically-controlled growing rod (MCGR) patients to traditional-growing rod (TGR) with an array of psychiatric tools, expecting improvement in MCGR due to decreased number of surgical procedures. SUMMARY OF BACKGROUND DATA: TGR treatment has had positive clinical and radiographic results; however, upward of 10 surgical sessions and high complication rates have called into question the quality of life of these children. Improvement with the introduction of the MCGR is expected. METHODS: GR patients with minimum of 2-years follow-up were recruited. None had neurological conditions. All underwent testing with the Wechsler Intelligence Scale for Children-Revised, and only those in the normal range were included. Patients filled out questionnaires with mental health professionals to measure psychosocial status. MCGR patients' results were compared to TGR patients. RESULTS: Twenty-seven patients met criteria (10 MCGR, 17 TGR): average age at enrollment 11.8 years (range 5.9-17). MCGR group was significantly younger (9.1 vs. 13.3 yr) and had significantly shorter follow-up (45.6 vs. 82.8 mo) (P < 0.05). TGR patients underwent an average of 16 surgical procedures, MCGR an average of 1.5 (including complications, P < 0.05). Age at index surgery (6 yr), preoperative and postoperative major curve magnitudes (60°, 40° respectively) were statistically similar.There was no difference in current psychiatric diagnoses between the groups. MCGR patients scored worse than TGR patients in general functionality domains. TGR patients showed increased functionality and prosocial scores with increased number of procedures. This effect was not observed in MCGR. CONCLUSIONS: The expected improvement in psychosocial status with the MCGR was not observed at a 31.6-month-follow-up. It appears that provided the patient spends enough time in the treatment process to notice benefit and does not experience major complications, noninvasiveness of lengthening procedures does not show up as an advantage with the psychosocial tools utilized in this study. LEVEL OF EVIDENCE: 3.

[Motor Proficiency in Children with Attention Deficit Hyperactivity Disorder: Associations with Cognitive Skills and Symptom Severity]. / Dikkat Eksikligi Hiperaktivite Bozuklugu Olan Çocuklarda Motor Yeterlilik: Bilissel Beceriler ve Belirti Siddeti ile Iliskisi.

OBJECTIVES: Of children with Attention Deficit Hyperactivity Disorder (ADHD), 45-70% have motor skill problems, which can adversely affect social competence, peer relations, and academic skills. The aim of this study is to assess motor skills in school-aged children with ADHD, and to elucidate if there are any relationships between ADHD symptoms and cognitive function. METHOD: Included in this study were 58 children (38 ADHD, 20 controls) between 8-11 years of age. Children were diagnosed with ADHD via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children Present and Lifetime Version. The parents were asked to fill out the Conner's' Parent Rating Scale - Revised Short Turkish Form to determine the symptom domains and the symptom severity. The Wechsler Children's Intelligence Scale-IV was used to assess cognitive skills, and the Bruininks -Oseretsky Motor Proficiency Test was used to assess motor skills. RESULTS: Children with ADHD had impaired performance in many motor skill areas compared to the controls. Impairments in fine motor skills were correlated with problems in attention, working memory, and processing speed. In the ADHD group, age was not correlated with motor skills enhancement. CONCLUSION: The multistage clinical evaluation of ADHD should include screening for problems in motor skills. If deficiencies are found, the child should be clinically evaluated for motor proficiency and, if necessary, should be referred for appropriate objective assessment and intervention programs.

Psychological Profile of Children Who Require Repetitive Surgical Procedures for Early Onset Scoliosis: Is a Poorer Quality of Life the Cost of a Straighter Spine?

STUDY DESIGN: Cross-sectional study. OBJECTIVE: Assess the psychosocial status of children with early-onset scoliosis (EOS) undergoing multiple procedures and evaluate associations with other variables. SUMMARY OF BACKGROUND DATA: EOS may require repetitive surgical procedures to control deformity and preserve growth. These procedures impact patients' psychosocial status because of the repetitive surgeries. METHODS: EOS patients 6-18 years, undergoing traditional growing rod treatment with more than 5 surgical procedures, and neurologically/mentally intact were included. Patients were screened for psychiatric disorders before inclusion. The Quality of Life Scale for Children (PedsQL), Strengths and Difficulties Questionnaire (SDQ) self-report form, Beck Depression Inventory, Children Depression Inventory (CDI), Beck Anxiety Inventory (BAI), and the Self-Report for Childhood Anxiety Related Disorders (SCARED) were completed by the children. PedsQL Parental Form and SDQ Parent Form were completed by their parents. RESULTS: Twenty-one patients (9 male, 12 female) met the inclusion criteria. Average age was 6.4 years (4-10.5) at index surgery, and 13.5 years (8-17) at final follow-up. The mean number of procedures was 13 (6-18). Mean follow-up was 83.9 months (36-122). Depression was observed in 23.8% of patients, and generalized anxiety disorder in 42.8%. Patients in the study group were more likely than the general population to have a psychiatric diagnosis. Number of procedures undergone was found to correlate negatively with BAI, SCARED, and the behavioral difficulties domain of SDQ parent form score and positively with emotional functioning, psychosocial health summary score, PedsQL total score, and increased social and physical functioning. Nonidiopathic etiology was found to be related to increased behavioral difficulties and lower functioning. CONCLUSION: A higher prevalence of depressive and anxiety symptoms was observed in patients with EOS along with dysfunctional areas of daily life. Other comorbidities may also contribute to dysfunction and difficulties. Determination of the aspects of EOS treatment that have a negative impact on psychosocial functioning may allow for more competent help for these patients.

A late-diagnosed phenylketonuria case presenting with autism spectrum disorder in early childhood.

Phenylketonuria is one of the most prevalent autosomal recessive hereditary disorders in Turkey. If untreated, it results in severe brain damage and can also be associated with autism in certain patients. We present a three-year old boy who exhibited the symptoms of autism and was subsequently diagnosed with phenylketonuria. This case illustrates that because the majority of autism cases are idiopathic, an occasional patient with a metabolic disorder might be overlooked especially in the era of newborn screening. We also discuss the possible pathogenetic processes leading to autistic symptoms in phenylketonuria, and wish to draw attention to the possibility of cases missed in the screening program because of less than 100% coverage or insufficient food intake before blood sampling. Clinicians should keep in mind the possibility of treatable disorders in children with autism even when such disorders appear unlikely.

Munchausen syndrome by proxy presented as recurrent respiratory arrest and thigh abscess: a case study and overview.

While many physicians are familiar with the sexual or physical abuse of children, there is little awareness about Munchausen syndrome by proxy (MSBP). As case reports of MSBP increase, awareness among physicians is thought to increase as well. We thus present herein a 16-month-old girl who admitted to Hacettepe University Ihsan Dogramaci Children's Hospital with the complaint of seizure, recurrent apnea and thigh abscess, who was later diagnosed as MSBP. The case was being followed by the Child Protection Team of the hospital (Haceteppe University Child Protection Unit [HU-CPU]). HU-CPU contributed to the early detection of this case and protected the child from a possible fatal outcome. The mother was confronted for MSBP and refused to take responsibility for her child's symptoms. As seen in this case, when MSBP is suspected, psychiatric evaluation of the mother, evaluation of the mother-child interaction and collection of a detailed family and social history can have a positive impact on the prognosis in these cases. This case report underlines the importance of multidisciplinary team work to share the responsibility and reduce the burden during the treatment process of these difficult and complicated cases.

Treatment of a severe conversion disorder in a 10-year-old boy: a case study and overview.

Conversion disorder (CD) in children remains a major challenge both in pediatric and mental health clinics and is still a prevalent psychiatric disorder in developing countries. The authors describe a 10-year-old boy with the complaints of inability to walk, speak or eat, excessive drooling, urinary and fecal incontinence, disturbance from light and sound, and expression of needs only by eye movements. The patient diagnosed with CD was followed by the Department of Child and Adolescent Psychiatry with play therapy, individual psychotherapy and family therapy. At the end of three months, the patient was discharged. This is one of the most challenging cases of CD in children. The most important aim of the treatment is to understand the need for conversion symptoms and to constitute a healthy psychological environment for the child rather than to remove the physical symptoms.

Relationship disorders and cognitive functioning in young children.

The aim of this study was to investigate the cognitive functioning of young children with or without relationship disorders with their mother. Mother-infant dyads were recruited during the first three postpartum days. Parent Infant Relationship Global Assessment Scale (PIRGAS) scores and mother-child relationship disorders were decided when children were 41-49 months of age by integrating the data obtained from psychiatric interview with mothers, Clinical Problem Solving Procedure (CPSP) and home observation. Cognitive functioning of young children was evaluated with Stanford-Binet Intelligence Scale. The young children without relationship problems/disorders had higher intelligence quotient (IQ) scores even after controlling for the effect of independent variables on cognitive functioning. These findings suggest that there is a link between the quality of the mother-child relationship and cognitive functioning in young children. Therefore, physicians should assess the interactions of children with their mothers even if they are brought for reasons other than relationship problems.

[Comparison of attachment-related social behaviors in autistic disorder and developmental disability]. / Otistik Bozukluk ve Gelisim Geriliginde Baglanmaya Yönelik Sosyal Davranislarin Karsilastirilmasi.

OBJECTIVE: This study examined social behaviors related to attachment in children with autistic disorder and the differences in these behaviors from those observed in developmentally disabled children. Additionally, we aimed to investigate the relationship between attachment behaviors and clinical variables, such as age, cognitive development, severity of autism, language development, and mothers' attachment styles. METHOD: The study group consisted of 19 children with autistic disorder (mean age: 37.9 +/- 6.8 months) and the control group consisted of 18 developmentally disabled children without autistic disorder that were matched with respect to age, gender, and cognitive development. The Childhood Autism Rating Scale (CARS) was administered to all the children by two child psychiatrists. Mothers completed the Relationships Scale Questionnaire (RSQ). Cognitive development of the children was assessed with the Stanford-Binet intelligence scale. Attachment behaviors of the children were evaluated with a modified Strange Situation Procedure (SSP). RESULTS: Attachment behaviors in the children with autistic disorder and in the children with developmental disabilities were similar. In contrast to the developmentally disabled group, the children with autistic disorder stayed closer toward their mothers compared with their responses to strangers. In the autistic disorder group, attachment behaviors were not associated with age, intelligence quotient, or mothers' attachment styles; however, a significant relationship between the severity of autism and the presence of speech was observed. CONCLUSION: Parents' understanding of the attachment needs and the attachment behaviors of their autistic children in the early stages of the disorder may lead to more secure attachment relationships and improved social development.

[Psychopathology in children of alcoholic fathers]. / Alkol Bagimliligi Olan Babalarin Cocuklarinda Psikopatoloji.

OBJECTIVE: In this study, we aimed to search cognitive, behavioral and psychopathological differences between children of fathers with alcohol dependency and children of fathers without alcohol dependency. METHOD: Forty-six children of 34 alcoholic fathers and 36 children of 34 non-alcoholic fathers, between the ages of 6 and 16 years were evaluated. Two groups were matched with each other on the basis of socioeconomic level of family, age and gender of children. All children were screened for psychiatric disorders according to DSM-IV criterias by using the Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version (K-SADS-PL). The mothers and teachers completed the Child Behavior Checklist, Teacher Report Form and Conners Parents/Teachers Rating Scales. Furthermore, Wecshler Inteligence Scale for Children-Revised (WISC-R) and Bender Gestalt Visual Motor Coordination test were applied to all children. The mothers completed Symptom Checklist-90-Revised (SCL-90-R). RESULTS: The findings of this research indicated that children of alcoholic fathers had a higher incidence of psychopathology. Teacher Report Form and Conners Teachers Rating Scale scores were higher in research group. It was also found that mothers in research group had higher level of psychiatric symptoms in SCL-90-R. CONCLUSION: Alcohol dependent patients are an easily available group for clinicians. It can be more realistic to treat alcohol dependency as a family disease because of associated psychiatric problems in children and mothers. In addition to alcohol dependent fathers, including mothers and children in the psychiatric assessment and treatment plans may become a preventive step for the child.