Neurocognitive training enhances the outcomes of children with attention deficit hyperactivity disorder: A preliminary study.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by diverse clinical manifestations including inattention, hyperactivity and impulsivity. OBJECTIVE: The present study aims to investigate the effects of neurocognitive training (NT), a personalized and specialized exercise programme on symptoms, attention and dynamic balance in treatment-naïve children diagnosed with ADHD. METHODS: Fourteen treatment-naïve children aged 7-12 years diagnosed with ADHD were enrolled in the intervention group. The NT intervention was administered weekly for 10 consecutive weeks, supplemented by a structured home exercise programme for 6 days a week over the same 10-week period. ADHD-related symptoms, attention and dynamic balance were assessed in pre-treatment, post-treatment, 6 months, and 12 months. Fifteen typically developing (TD) children, matched for age, underwent evaluation only once to establish baseline normative values. RESULTS: Following the NT (post-treatment), significant improvements were observed in hyperactivity-impulsivity scores, oppositional-defiant behaviours and dynamic balance when compared to the TD children (p < 0.05). In the ADHD group, a significant difference was found in the long term (12-month follow-up) in hyperactivity-impulsivity, oppositional-defiant behaviours and dynamic balance (p < 0.05). CONCLUSION: The findings suggest that the NT yields favourable effects on hyperactivity-impulsivity, oppositional defiant behaviours and dynamic balance in children diagnosed with ADHD, with these improvements appearing to be sustained over the long term. CLINICAL TRIAL REGISTRATION NUMBER: NCT04707040.

Comparisons of clinical subtypes, symptom severity, global functioning, emotional and behavior problems, and CPT test profiles in children and adolescents with ADHD with and without co-occurring internet gaming disorder.

OBJECTIVES: This study aims to assess whether the presence of Internet Gaming Disorder (IGD) is associated with disease severity, Attention Deficit Hyperactivity Disorder(ADHD) presentation, emotional problems, behavioral problems, and CPT profile in patients with ADHD. METHOD: Forty children with IGD and sixty-four patients without IGD were included in the study, all of whom had a diagnosis of ADHD. Comorbid psychiatric disorders were determined using The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Conners's Parent Rating Scale-Revised Short form (CPRS-RS), The Strengths and Difficulties Questionnaire (SDQ), Internet Gaming Disorder Questionnaire (IGD-20), and MOXO Continuous Performance Test (MOXO d-CPT) were performed on the children, and Clinical Global Impression (CGI), Children's Global Assessment Scale (CGAS), comorbidities and ADHD presentations were evaluated. RESULTS: The IGD group was found to have the combined presentation of ADHD more commonly, and their CGI, CGAS, SDQ behavior problems subscale, cognitive problems, attention problems, and ADHD index in the CPRS-RS questionnaire were found to be higher (p < 0.05). No differences were found in attention, timing, impulsiveness, and hyperactivity scores in CPT between groups (p > 0.05). CONCLUSION: Our study has shown that children with both ADHD and IGD had more severe symptoms, more behavioral problems, and differences regarding the prevalence of the ADHD presentations when compared to children having ADHD without IGD. Longitudinal studies with higher sample sizes are required to investigate this possible connection in the context of a cause-effect relationship and draw a conclusion.

Hypernatremic Dehydration Risk Factors in Newborns: Prospective Case-Controlled Study.

BACKGROUND: The prevalence of hypernatremic dehydration (HND) has increased in recent years most likely due to insufficient intake of breast milk as the most important factor. This study aimed to investigate risk factors of HND. METHODS: In this study, 47 neonates whom were diagnosed to have HND were included in the study group and 96 healty neonates whom were included in the control group. While demographic data of the patients were recorded, mothers were asked to fill out the sociodemographic/ psychosocial data form, Edinburgh Postpartum Depression Scale(EPDS) and STAI I and II State and Trait Anxiety Scale. Breast milk sodium concentrations were studied from mothers of all infants. The relationship between the development of neonatal HND and risk factors affecting this condition were evaluated. RESULTS: Being the first-born baby of the family was found to be a significant risk factor for HND. Breast milk sodium concentration was 25.8±7.9 mmol/L in the HND group which was significantly higher than the control group. Median depression score was similar in both groups and there was no statistical difference in terms of groups. The anxiety score was higher in the control group compared to the study group. There was no difference in terms of other sociodemographic / psychosocial data of mothers. CONCLUSION: Primiparity or insufficient breastfeeding may result in elevated breast milk sodium levels and related neonatal HND. Breastfeeding support should principally target primiparous women to improve breastfeeding outcomes like as especially HND.

Physical Fitness and Dynamic Balance in Medication Naïve Turkish Children with ADHD.

This study investigated physical fitness levels and dynamic balance in medication-naïve children with Attention-Deficit/Hyperactivity Disorder (ADHD). Participants were 24 medication-naïve Turkish children with ADHD (4 girls, 20 boys) and 19 typically developing (TD) Turkish children (4 girls, 15 boys). We measured physical fitness levels with the Eurofit Test Battery, body composition with the Inbody 720 Body Composition Analyzer, cognitive attention with the Stroop Test, and dynamic balance with the Y-Balance Test. We found significantly poorer dynamic balance and both upper extremity and running fitness problems among the medication-naïve Turkish children with ADHD compared to the TD group (p = 0.002; p = 0.032; p = 0.002). It may be important to adress dynamic balance and physical fitness when treating children with ADHD.

Association of prenatal attachment and early childhood emotional, behavioral, and developmental characteristics: A longitudinal study.

This study examines the associations between prenatal attachment and child development, socioemotional behavioral problems, and competence at early childhood. It also inquires whether maternal depression and anxiety at the prenatal period and at early childhood are associated with child outcomes. The study consisted of 83 mothers and their children. Data regarding the prenatal attachment, depression, and anxiety were collected during Weeks 28 to 40 of gestation. When the children were 21 to 31 months old, the Brief Infant and Toddler Social Emotional Assessment (BITSEA) and the Ankara Developmental Screening Inventory (ADSI) were applied to children along with Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) administered to mothers. Results showed that prenatal attachment scores significantly correlated with BITSEA-Competency subscale scores and ADSI total scores at early childhood, r(83) = 0.246, P = .025, and r(82) = 0.316, P = .004, respectively. Prenatal attachment levels were found to be the predictors of both behavioral and emotional competence and development at early childhood, b = 0.081, t(83) = 2.273, P = .014, and b = 0.281, t(83) = 3.225, P = .002, respectively. In addition, prenatal attachment was shown to be even a stronger predictor of development than was worsening maternal depression at early childhood, b = -0.319, t(83) = 2.140, P = .035. Our results indicate that fostering prenatal attachment may be beneficial for better infant outcomes at early childhood.

Este estudio examina la asociación entre la afectividad prenatal y el desarrollo del niño, los problemas socio-emocionales de conducta y la competencia en la temprana niñez. También se pregunta si la depresión y ansiedad maternas en el período prenatal y en la temprana niñez están asociadas con los resultados en el niño. El estudio incluyó a 83 madres y sus niños. La información sobre la afectividad prenatal, la depresión y la ansiedad se recogió durante las semanas 28-40 de gestación. Cuando los niños tenían entre 21-31 meses de edad, se les aplicó la Evaluación Socio-Emocional Breve para el Infante y Niños Pequeñitos (BITSEA) y el Inventario Ankara de Examinación del Desarrollo (ADSI), y a las madres se les administró el Inventario Beck sobre la Depresión (BDI) y el Inventario Beck sobre la Ansiedad (BAI). Los resultados mostraron que los puntajes de la afectividad prenatal se correlacionaron significativamente con los puntajes de competencia de BITSEA y los puntajes totales de ADSI al nivel de la temprana niñez, r(83) = 0.246, p = 0.025; r(82) = 0.316, p = 0.004, respectivamente. Se encontró que los niveles de afectividad prenatal eran factores de predicción tanto de la competencia y desarrollo de conducta como emocional en la temprana niñez; b = 0.081, t(83) = 2.273, p = 0.014, b = 0.281, t(83) = 3.225, p = 0.002, respectivamente. Además, se mostró que la afectividad prenatal era un factor de predicción del desarrollo aún más fuerte que la depresión materna desmejorada en la temprana niñez, b = −0.319, t(83) = 2.140, p = 0.035. Nuestros resultados indican que fomentando la afectividad prenatal pudiera ser beneficioso para mejorar los resultados en el niño en la temprana niñez.

Cette étude examine le lien entre l'attachement prénatal et le développement de l'enfant, les problèmes de comportement social et émotionnels et la compétence durant la petite enfance. Elle s'interroge aussi sur si la dépression maternelle et l'anxiété dans la période prénatale et durant la très petite enfance sont liés aux résultats de l'enfant. L'étude a consisté en 83 mères et enfants. Les données concernant l'attachement prénatal, la dépression et l'anxiété ont été recueillies à 28-40 mois de grossesse. Lorsque les enfants avaient 21-31 mois, l'Evaluation Emotionnelle Brève du Bébé et du Petit Enfants (en anglais Brief Infant and Toddler Social Emotional Assessment, BITSEA), l'Inventaire de Dépistage Développemental d'Ankara (en anglais Ankara Developmental Screening Inventory, ADSI) ont été appliqués aux enfants ainsi que l'Inventaire de Dépression de Beck (Beck Depression Inventory, BDI) et l'Inventaire d'Anxiété de Beck (Beck Anxiety Inventory, BAI) ont donnés aux mères. Les résultats montrent que les scores d'attachement prénatale étaient liés de manière importance aux scores de compétence BITSEA et aux Scores ADSI à la petite enfance, r(83) = 0.246, p = 0.025; r(82) = 0.316, p = 0.004, respectivement. Les niveaux d'attachement prénatal se sont révélé être des prédicteurs d'à la fois la compétence émotionnelle, la compétence comportementale et le développement à la petite enfance; b = 0.081, t(83) = 2.273, p = 0.014, b = 0.281, t(83) = 3.225, p = 0.002, respectivement. De plus, l'attachement prénatal s'est avéré être un prédicteur de développement encore plus fort que la dépression maternelle s'aggravant à la petite enfance, b = −0.319, t(83) = 2.140, p = 0.035. Nos résultats indiquent que le fait de cultiver l'attachement prénatal peut être bénéfique pour l'amélioration des résultats du bébé à la petite enfance.

Which parents dropout from an evidence-based parenting programme (Triple-P) at CAMHS? Comparison of programme-completing and dropout parents.

Evidence-based parenting programmes are beneficial for children's behavioural and emotional problems as well as parenting practices. Along with effectiveness, attendance affects the programme outcome and identification of risks associated with dropout may aid in development of special policy to increase engagement. In this study, we aimed to compare sociodemographics, parental attitudes, child behavioural and emotional problems of programme-completing and dropout parents from Level-4 Triple-P parenting programme applied at Child and Adolescent Mental Health Services (CAMHS). We also aimed to determine the attrition rate. In addition, we inquired whether there was a change in parenting styles and child behaviour and emotional problems before and after Level-4 Triple-P for the programme-completing parents at CAMHS. Results displayed that 52% ( n = 58) of the parents who were significantly less educated, used hostile rejecting attitudes, and reported more hyperactive/inattentive behaviour in their children compared to the parents who competed the programme ( p = 0.022, p = 0.016, p = 0.027, respectively) discontinued the programme. Parents who were able to complete the programme ( n = 54) reported a reduction in over-parenting and improvements in children's conduct problems along with overall stress levels before and after Triple-P ( p = 0.009, p = 0.040, p = 0.023). Parents at risk of discontinuing parenting programmes may require special policy to be engaged since these programmes may offer significant benefits for parenting practices and, in turn, children's well-being.

Cerebellar volume in early-onset schizophrenia and its association with severity of symptoms.

OBJECTIVES: This study aimed to investigate whether early-onset schizophrenia (EOS) cases differ from controls regarding volumes of the total cerebellum and the right and left cerebellar hemispheres, and volumetric asymmetry. Correlations of cerebellar volumes and asymmetry indices with severity of symptoms and general functioning in cases of EOS were also assessed. METHODS: Adolescents with EOS (n = 23) were compared with controls (n = 23). Sociodemographic and clinical data, and magnetic resonance imaging scans that were acquired for routine clinical purposes were collected retrospectively. Cerebellar volumes were evaluated using the stereological method. Asymmetry indices were subsequently calculated. Scores of the Positive and Negative Syndrome Scale and the Children's Global Assessment Scale were used to assess the severity of symptoms and general functionality. RESULTS: There were no significant differences in any of the cerebellar volumes and asymmetry indices between the two groups. Neither cerebellar volumes nor asymmetry indices were correlated with the severity of symptoms and general functionality in EOS. CONCLUSIONS: Our findings suggest that the early-onset form of schizophrenia does not show apparent volumetric changes of the cerebellum. Additionally, the neural circuits involved in formation of symptomatology may not reflect any correlation with cerebellar volumes at mid-adolescence.

Factors affecting improvement of children and adolescents who were treated in the child and adolescent psychiatry inpatient unit.

Objective This study aimed to assess the correlates and predictors of improvement in general functioning of children and adolescents who are treated in the child and adolescent psychiatry (CAMHS) inpatient unit. Methods Hospital records of 308 children and adolescents who were treated for at least 1 month in the CAMHS inpatient unit from 2005-2016 were included. Associations with individual, familial, and clinical variables and the difference in Children's Global Assessment Scale (ΔCGAS) scores at admission and discharge were evaluated. Results Positive predictors of ΔCGAS were older age and lower CGAS scores at admission, whereas high familial risk scores at admission and diagnosis of early-onset schizophrenia negatively predicted ΔCGAS (B = 0.698, p = 0002; B = -0.620, p < 0.001; B = -0.842, p = 0.002; B =-9.184, p = 0.000, respectively). Familial risk scores were significantly and negatively correlated with ΔCGAS (p = 0.004, Spearman's rho = -0.2). Conclusions This study indicates that improvement in general functioning during inpatient treatment in CAMHS is better at an older age and with lower general functioning at admission. However, high familial risks and diagnosis of early-onset schizophrenia weakens this improvement.

Do mothers with high sodium levels in their breast milk have high depression and anxiety scores?

Objective This study aimed to assess the possible association of high breast milk sodium levels with postpartum depression and anxiety. Methods A total of 150 mothers and their healthy, exclusively breastfed newborns aged 8 to 15 days were recruited. Mothers were asked to complete scales for evaluation of postnatal depression and anxiety following an interview for consent and sociodemographic data collection. Breast milk samples were obtained to measure sodium and potassium (K) levels. Results Forty-nine mothers had higher than expected breast milk Na concentrations and a high Na/K ratio. These mothers scored significantly higher on the scales of postnatal depression and state anxiety ( P = 0.018 and P = 0.048, respectively). Conclusions This study shows that compared to normal breast milk Na levels and Na/K ratio, high breast milk Na and high Na/K ratio, with possible serious consequences in infants, are associated with maternal depressive and anxious symptoms in the postpartum period.

Maternal psychosocial aspects in hypernatremic dehydration with high sodium concentrations in breast milk: a case-control study.

OBJECTIVE: To investigate whether mothers, with no known biological reason to account for elevated breast milk sodium (BMS) and associated hypernatremic dehydration (HND) in their exclusively breastfed infants, have more adverse psychosocial characteristics compared with controls. METHODS: Design is prospective case-control. Mothers of 21 term infants diagnosed as HND with associated high BMS and mothers of 43 healthy, exclusively breastfed term infants, with expected milk sodium levels, were compared on rates of socio-demographic and relationship variables, pregnancy wantedness and planning, maternal attitudes towards breastfeeding, postnatal maternal depression and anxiety. A semi-structured interview, State and Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale were used. RESULTS: Reported maternal history of previous psychiatric morbidity (57.1% vs. 18.6%; P = 0.003), poor relationship with her own mother (36.8% vs. 9.6%; P = 0.026), not finding herself suitable to be a mother (28.6% vs. 4.6%; P = 0.012), unplanned pregnancy (52.4% vs. 20.9%; P = 0.020) and higher state anxiety scores (mean (SD) = 42.2 (11.1) vs. 35.5 (10.5); P = 0.038) in the post-partum period were significantly common in mothers with elevated BMS levels compared with the controls. Univariate analyses revealed that unplanned pregnancy and maternal perception of not being suitable to be mother constitute significant risks with odds ratios 4.2 and 8.2, respectively. CONCLUSION: The present study displays that mothers, with no known biological reason to account for elevated BMS, have more adverse psychosocial characteristics compared with controls; emphasising the importance of psychosocial and emotional factors during lactation and offering implications for the establishment of successful lactation through providing additional psychosocial support to vulnerable mothers.

Adjunctive olanzapine treatment in bipolar adolescents responding insufficiently to mood stabilizers. Four case reports.

This report was aimed to evaluate the efficacy of olanzapine treatment as an adjunct therapy to mood stabilizers in the treatment of four adolescents responding insufficiently to mood stabilizers. All patients were diagnosed with bipolar I disorder according to DSM IV criteria. YMRS (Young mania rating scale) and CGI (Clinical global impression, improvement and therapeutic effectiveness scales) were used to evaluate overall response of the episode to the drugs. All patients with no adequate response to mood stabilizers did respond to adjunctive olanzapine treatment (10-30 mg/per day). It has been suggested that antipsychotics may be useful as an adjunct to mood stabilisers in bipolar disorder. However, further research is warranted regarding the use of atypical antipsychotics in children and adolescents.

Suspected child abuse among victims of home accidents being admitted to the emergency department: a prospective survey from Turkey.

OBJECTIVES: Association between home injuries and child abuse has received interest in Western countries. Inasmuch as it is now known that cultural differences may have an impact on child-rearing practices and the definition of maltreatment, we aimed to assess the suspected physical abuse in children presenting to the emergency department with home injuries and determine the risk factors associated with suspected child maltreatment in our region. METHOD: The study is prospective in design. The sample was composed of 87 children younger than 72 months with presenting histories of home accidents. Data were collected by interview with the parents and by application of various questionnaires and inventories to both children and their parents. RESULTS: Suspected physical abuse was identified in 16.1% of cases presenting with home injuries. The significant factors associated with suspected abuse were child's age younger than 12 months, having developmental delays in the social and self-care domains, younger paternal age, paternal alcohol abuse, marital discordancy, repeated history of home injuries, and requirement for radiological examination. CONCLUSION: A missed diagnosis of child abuse can result in repeated injury, cause severe morbidity, and even result in death. This research indicates the features of "victims of accidents" who require special attention to recognize suspected abuse at the emergency department. Cultural factors might also provide additional indications that might aid in determining the cases of child maltreatment.

Development and behavior of non-handicapped preterm children from a developing country.

BACKGROUND: There are many studies, mainly conducted in industrialized countries, concerning developmental and behavioral outcomes of preterm children. However, little is known about the outcomes of preterm children from developing countries. METHOD: Forty-three non-handicapped Turkish preterm children, 15 with very low birth weight and 28 with low birth weight at preschool age, as well as 36 term controls were compared on rates of developmental, emotional and behavioral impairments. Data were collected by review of hospital records and application of various questionnaires and inventories to both children and their parents. RESULTS: Preterm children had significant delays in general development and significant rise in somatic complaints with unknown medical etiologies. The very low birth weight group also had significant delay in language and cognitive development. Parents of the preterm children displayed significantly higher rates of democratic attitudes. Developmental outcome was significantly associated with birth weight and authoritarian parental attitudes where behavioral outcome was significantly influenced by birth weight. CONCLUSION: Presence of developmental delay is in accordance with existing data on the outcomes of preterm children from industrialized countries. An isolated increase in somatic complaints is an uncommon finding which might also be related to cultural factors.