The Effect of Combined Intervention on Improvement of Early Lexical Development in Minimally Verbal Children with Autism Spectrum Disorder.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by severe communication deficits and limited and repetitive behavioral tendencies. There are several treatment approaches and methods for minimally verbal children with ASD; nonetheless, there is inconclusive evidence about how early lexical development could be improved. The present study aimed to investigate the effect of combined intervention derived from the principles of different theories-including contemporary behaviorism, schemas, sociocultural, and event representation theories-to improve early lexical development in minimally verbal children with ASD. Methods: In this single-group pretest-posttest study, 10 children with ASD (mean age, 47.9 ± 8.3 months), including 7 boys and 3 girls, participated. Participants received 16 intervention sessions in 8 weeks. The combined intervention consisted of various methods derived from contemporary behaviorism, schemas, sociocultural, and event representation approaches. The MacArthur-Bates Communicative Development Inventory 1 (Infant form) assessed early lexical development before and after intervention and after a 2-month follow-up. The Friedman test was used to analyze the data, and pairwise comparisons were performed with the Will-Coxon test. Cohen's d was used to investigate the effect sizes. Results: Significant increases in expressive vocabulary (P < 0.001) and receptive language (P < 0.001) were seen after the end of the intervention and at the follow-up (P = 0.005). Large effect sizes were found for expressive vocabulary (d = 3.7) and receptive vocabulary (d = 2.17). Conclusion: This study suggests that the combination of intervention based contemporary behaviorism, schemas, sociocultural, and event representation approaches improved receptive and expressive vocabulary in minimally verbal children with ASD.

PERSIAN Traffic Safety and Health Cohort: a study protocol on postcrash mental and physical health consequences.

BACKGROUND: Cohort studies play essential roles in assessing causality, appropriate interventions. The study, Post-crash Prospective Epidemiological Research Studies in IrAN Traffic Safety and Health Cohort, aims to investigate the common health consequences of road traffic injuries (RTIs) postcrash through multiple follow-ups. METHODS: This protocol study was designed to analyse human, vehicle and environmental factors as exposures relating to postcrash outcomes (injury, disability, death, property damage, quality of life, etc). Population sources include registered injured people and followed up healthy people in precrash cohort experienced RTIs. It includes four first-year follow-ups, 1 month (phone-based), 3 months (in-person, video/phone call), 6 and 12 months (phone-based) after crash. Then, 24-month and 36-month follow-ups will be conducted triennially. Various questionnaires such as Post-traumatic Stress Disorder Questionnaire, Patient Health Questionnaire, WHO Disability Assessment Schedules, Cost-related Information, etc are completed. Counselling with a psychiatrist and a medical visit by a practitioner are provided accompanied by extra tools (simulator-based driving assessment, and psychophysiological tests). Through preliminary recruitment plan, 5807, 2905, 2247 and 1051 subjects have been enrolled, respectively at the baseline, first, second and third follow-ups by now. At baseline, cars and motorcycles accounted for over 30% and 25% of RTIs. At first follow-up, 27% of participants were pedestrians engaged mostly in car crashes. Around a fourth of injuries were single injuries. Car occupants were injured in 40% of collisions. DISCUSSION: The study provides an opportunity to investigate physical-psychosocial outcomes of RTIs, predictors and patterns at follow-up phases postinjury through longitudinal assessments, to provide advocates for evidence-based safety national policy-making.

Success in changing stuttering attitudes: A retrospective analysis of 29 intervention studies.

BACKGROUND: Against the backdrop of hundreds of studies documenting negative stereotypes and stigma held by the public regarding people who stutter, a substantial number of investigations have attempted to improve public attitudes and measure their results with a standard instrument, the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S). Although the majority of interventions have been moderately to quite successful, a substantial minority have been unsuccessful. PURPOSE: This study sought to determine what properties of interventions and demographic variables were predictive of least to most successful interventions. Preliminary to that, however, it required the division of samples into clearly differentiated categories of success. METHOD: Twenty-nine different study samples containing 934 participants were categorized into four levels of success of interventions according to pre versus post POSHA-S summary mean ratings. Intervention properties and demographic characteristics and for each success category were analyzed for their predictive potential of successful attitude improvement. RESULTS: Interventions characterized by high interest or involvement, meaningful material, and content that respondents found to be relevant, but not excessive, tended to be associated with more successful interventions. In contrast, demographic variables were weak predictors of intervention success. CONCLUSION: The authors hypothesize that maximally effective interventions reflect optimal matches between participant characteristics and intervention features, although the critical variables in each are not yet apparent.

Attention deficit/hyperactivity disorder and risk of injuries: A systematic review and meta-analysis.

BACKGROUND: This study systematically reviewed the literature in order to determine the effect of Attention-Deficit Hyperactivity Disorder (ADHD) on injuries and assessed the magnitude of the potential association. METHODS: A systematic review of the studies examining the association of ADHD and injuries was carried out across multiple databases. Odds ratios and standardized mean differences were pooled. RESULTS: A total of 35 studies were selected for quantitative analysis. The association of ADHD and injuries was confirmed over the meta-analysis of eligible studies. The odds ratio pooled over all comparative studies was 1.96(95% CI: 1.6-2.4) using random effects model. Pooled odds ratio of 2.1 and 2.17 were calculated respectively when cohort and case-control studies or just cohort studies were included. The pooled odds ratio reduced to 1.8(CI:1.45-2.3) when studies on specific injuries were removed. For studies comparing scores of rating scales, the pooled standardized mean difference was 0.61(95% CI: 0.03-1.2). CONCLUSIONS: Those with ADHD are nearly two times more likely to be injured.

Comorbid Psychiatric Disorders in Children and Adolescents with Nocturnal Enuresis.

PURPOSE: The present study was conducted with the aim of identifying the frequency of comorbid psychiatricdisorders in children and adolescents with nocturnal enuresis (NE). MATERIALS AND METHODS: In this descriptive-analytical study, 183 children and adolescents aged 5-18 years withNE referred to psychiatric clinics at Tabriz University of Medical Sciences were selected in 2015. A structuredclinical diagnostic interview, the kiddie-schedule for affective disorders and schizophrenia (K-SADS), was employedbased on the diagnostic and statistical manual of mental disorders (DSM-IV-TR) for the diagnosis of NEand comorbid psychiatric disorders. RESULTS: In this study, 39 participants (21.3%) were female and 144 (78.7%) were male. The mean age of participantswas 8.69 ± 2.34 years. The lifelong incidence of mental disorders among enuretic children and adolescentswas 79.23%. The highest incidence belonged to attention deficit/hyperactivity disorder (ADHD) with 74.9%, oppositional-defiant disorder (ODD) with 53%, and tic disorders with 12% (motor tics together with a single caseof vocal tic). The lowest incidence was for conduct disorder, bipolar affective disorder, and post-traumatic stressdisorder (PTSD) with 5%. Based on the Fisher exact test, there was no significant difference between girls andboys in terms of psychiatric disorders incidence (P > .05). CONCLUSION: Comorbid psychiatric disorders with NE are common among children and adolescents. Therefore,in-depth examination of other psychiatric disorders needs to be carried out in enuretic children and adolescents,which will affect the treatment and prognosis of NE.

Knowledge and Attitude of Parents of Children With Attention Deficit Hyperactivity Disorder Towards the Illness.

BACKGROUND: The knowledge and attitude of parents about attention deficit hyperactivity disorder (ADHD) is a public health issue in which management and rehabilitation approaches may be influenced. OBJECTIVES: The current study aimed to evaluate the knowledge and attitude of the parents of children with ADHD towards this disorder in Tabriz, Iran. MATERIALS AND METHODS: The current cross-sectional study evaluated 295 parents of children and adolescents with ADHD referred to psychiatric clinics of Tabriz University of Medical Sciences. The subjects were diagnosed based on Kiddie schedule for affective disorders and schizophrenia for school-aged children (K-SADS) and recruited according to a convenience sampling method in the first five months of 2014. The parents' knowledge and attitude towards ADHD was studied by a researcher-made questionnaire. RESULTS: The overall knowledge of parents was 66% in which 76.72% were aware of related signs and symptoms and 43.38% were able to identify the aberrations. Meanwhile, 44.62% of the parents knew the etiology and 54.75% had information about treatment strategies. In addition, 33.55%, 37.91%, 25.52% were aware of ADHD consequences, diagnosis and prevalence dimensions, respectively. Moreover, 82.72% of the parents had a positive attitude towards ADHD. A positive correlation was found between parents' attitude towards ADHD and their overall knowledge (identification, etiology, treatment, consequences and prevalence dimensions), ranging from 0.12 to 0.36 (P < 0.50). Age, gender, and place of residence did not have a correlation with parents' knowledge and attitude towards ADHD. Parent's education level only had a positive correlation with the knowledge of symptoms, with a value of 0.19 (P < 0.01). Parents with a higher overall knowledge, knowledge of ADHD symptoms, and prevalence rates accepted combination therapy (P < 0.05). CONCLUSIONS: While the overall knowledge of parents regarding ADHD was favorable, they were mostly unable to identify the aberrations in children with ADHD. These results may help practitioners address pitfalls in parent management training programs.

Preventive effect of liothyronine on electroconvulsive therapy-induced memory deficit in patients with major depressive disorder: a double-blind controlled clinical trial.

Introduction and Objective. Despite the effectiveness of electroconvulsive therapy (ECT) in treating major depressive disorder (MDD), its cognitive side effects make it less popular. This study investigated the impact of liothyronine on ECT-induced memory deficit in patients with MDD. Methodology. This is a double-blind clinical trial, in which 60 patients with MDD who were referred for ECT were selected. The diagnosis was based on the criteria of DSM-IV-TR. Patients were divided randomly into two groups to receive either liothyronine (50 mcg every morning) or placebo. After the assessment with Wechsler Memory Scale-Revised (WMS-R) before first session of ECT, posttests were repeated again, two months after the completion of ECT. Findings. By controlling the pretest scores, the mean scores of the experimental group were higher than the control group in delayed recall, verbal memory, visual memory, general memory, and attention/concentration scales (P < 0.05). Conclusion. Liothyronine may prevent ECT-induced memory impairment in patients with MDD. This study has been registered in IRCT under IRCT201401122660N2.

Personality profile of parents of children with attention deficit hyperactivity disorder.

OBJECTIVES: The present study was carried out aiming to identify the personality profile of parents of children with Attention Deficit Hyperactivity Disorder (ADHD). METHODS: This study is of a descriptive, analytic, cross-sectional type in which parents of 6-12-year-old children with ADHD who were referred to the Bozorgmehr Psychiatric Clinic, affiliated with Tabriz University of Medical Sciences, were enrolled. ADHD was diagnosed according to the criteria of DSM-IV-TR and a quasi-structured diagnostic interview (K-SADS-PL). The personality profile of the parents was assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). RESULTS: According to the findings of this study, the most common personality problems based on the assessment scales in the MCMI-III belonged to the clinical patterns of depressive personality in 43 persons (25.3%), histrionic personality in 34 persons (20%), and compulsive personality in 29 persons (17.1%). According to discriminant analysis, four scales of somatoform, sadistic, dependence, and though disorder were direct and antisocial scale was reverse significant predictors of membership in the women group. CONCLUSION: According to the findings of this pilot study, personality disorders are prevalent in parents of ADHD children and mothers suffer from personality disorders more than fathers.

Prevalence of Adult Attention Deficit Hyperactivity Disorder (Adult ADHD): Tabriz.

OBJECTIVE: Attention deficit hyperactivity disorder in adults (adult ADHD) is gaining more attention nowadays. Nevertheless, very few studies have addressed this issue in Iran. The present study was conducted to determine the prevalence of adult ADHD in Tabriz, North-West of Iran. METHODS: Four hundred urban inhabitants of Tabriz- with an age range of 18 to 45 years were selected through the probability proportional to size cluster sampling in 2009. The screening was performed by Conner's Adult ADHD Rating Scale, and the definite diagnosis of Adult ADHD was performed via clinical interview according to DSM-IV-TR and Wender Utah criteria. RESULTS: The prevalence of adult ADHD was estimated to be 3.8%. Men when compared with women were more likely to have ADHD (5.5 % in men versus 2 % in women). Marital status, birth order, educational level and occupational status showed no significant association with adult ADHD. History of psychiatric treatment, alcohol drinking and smoking had similar relative frequency in subjects with and without adult ADHD. CONCLUSION: The prevalence of adult ADHD in this region of Iran seems to be substantially higher than expected or treated. This would require more attention to be drawn by health sector managers in order to improve the knowledge of the general population and the knowledge of the health care professionals about the disorder.

Psychiatric comorbidities in ADHD children: an Iranian study among primary school students.

BACKGROUND: This study was performed to determine the lifetime prevalence of psychiatric disorders concomitant with attention deficit/hyperactivity disorder (ADHD) among primary school students. METHODS: One thousand six hundred fifty-eight primary school students (781 females and 877 males) were selected in a cluster random manner in 2010. The first screening was performed by the Conner's teacher rating scale revised and Teacher ADHD rating scale-IV and then the students, in whom the ADHD was diagnosed by a child and adolescent psychiatrist according to DSM-IV-TR, were evaluated by K-SADS-PL semi-structured interview to detect the psychiatric comorbidities. RESULTS: The prevalence of psychiatric comorbidities in ADHD subjects was 62.5%. Oppositional defiant disorder (29.4%), specific phobia (21.9%), and enuresis (17.5%) were the most common comorbidities. The most common comorbidities in ADHD-IA (inattentive type) (n = 29) were specific phobia (34.5%), oppositional defiant disorder (20.7%), chronic motor tic disorder (17.2%), and enuresis (17.2%). The most common comorbidities in ADHD-HI (hyperactive/impulsive type) (n = 15) were chronic motor tic disorder (33.3%), oppositional defiant disorder (26.7%), and specific phobia (26.7%). The most common comorbidities in ADHD-C (combined type) (n = 116) were oppositional defiant (31.9%), enuresis (19%), and specific phobia (18.1%). The frequency of chronic vocal tic disorder was higher in ADHD-HI compared with ADHD-C (P = 0.01). CONCLUSION: The results of this study indicated that the frequency of other psychiatric comorbidities in primary school students with ADHD is high that may affect disease course and treatment. Hence, evaluation for other comorbidities in ADHD patients should be considered. 

Associated factors with attention deficit hyperactivity disorder (ADHD): a case-control study.

BACKGROUND: The current study attempted to investigate factors associated with attention deficit hyperactivity disorder (ADHD) in children without co-morbidities. METHODS: In this case-control study, 164 ADHD children who attended the Child and Adolescent Psychiatric Clinics of Tabriz University of Medical Sciences, Iran were compared with 166 normal children selected in a random-cluster method from primary and secondary schools. Clinical interviews based on DSM-IV-TR using K-SADS were used to diagnose ADHD cases and to select the control group. Participants were matched for age. We used chi-square and binary logistic regression for data analysis. RESULTS: Among the associated factors with ADHD were gender and maternal employment. Boys (OR 0.54; 95% confidence interval: 0.34 - 0.86) and those children with working mothers (OR 0.16: 95% confidence interval: 0.06 - 0.86) suffered more from ADHD. The birth season, family size, birth order, and parental kinship were not among risk factors for ADHD. CONCLUSION: The results of the study show that maternal employment and male gender are among the associated risk factors for ADHD.

Pregnancy-related maternal risk factors of attention-deficit hyperactivity disorder: a case-control study.

Background. The etiology of attention-deficit hyperactivity disorder (ADHD) is complex.This study was conducted to evaluate the pregnancy-related maternal risk factors of ADHD. Methods. 164 ADHD children attending to Child and Adolescent Psychiatric Clinics compared with 166 normal children selected in a random-cluster method from primary schools. ADHD rating scale and clinical interview based on Schedule for Affective disorders and Schizophrenia for School-Aged Children (K-SADS) were used to diagnose ADHD cases and to select the control group. Results. The mean maternal age at pregnancy, duration of pregnancy, and the mean paternal age were alike in two groups. The ADHD children's mothers compared with those of control group had higher frequencies of somatic diseases, psychiatric disorders, and alcohol and cigarette exposure during the pregnancies (P < 0.01). Also birth by cesarean section was more common among mothers of ADHD children (P < 0.001). These factors plus trauma to the abdomen during pregnancy were significantly predictors of ADHD in children. Conclusions. Some pregnancy-related maternal factors may be considered as environmental risk factors for ADHD. Each of these factors considered in our study as a risk factor needs to be tested and confirmed through next methodologically appropriate researches in this field.

Tourette's syndrome, chronic tics, and comorbid attention deficit/hyperactivity disorder in elementary students.

BACKGROUND: This study estimated the true prevalence of chronic motor and vocal tic disorders, and Tourette's syndrome in students as well as its comorbidity with attention deficit/hyperactivity disorder (ADHD). METHODS: A random clustered sample of elementary students was selected from schools in Tabriz, Iran. Students were screened by Conner's teacher rating scale for ADHD and a detailed history from parents and teachers for the presence of any type of tic was obtained. Next, a clinical interview based on the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL), and an interview with parents lead to the definitive diagnosis. RESULTS: A total of 1658 children were evaluated. Vocal tic was observed in 3.2% (±SD = 0.02) students, and was more prevalent in boys. ADHD was diagnosed in 45.5% of these students. Motor tic was observed in 7.3% (±SD = 0.02) of students. Almost half (48.1%) of these students had ADHD. Tourette's syndrome was observed in 1.3% (±SD = 0.01), with a male/female ratio of 3.5:1. CONCLUSION: This is the first study to provide the prevalence of chronic tics in elementary school students in Iran. ADHD is more common among students with chronic tics and Tourette's syndrome.

Factors related to marital satisfaction in women with major depressive disorder.

OBJECTIVE: Major depressive disorder (MDD) is one of the most common psychiatric disorders which affects married couples frequently.The present study aims to explain the role of family processes, social support and demographic factors in marital satisfaction of women with Major Depressive Disorder (MDD). METHOD: In this cross-sectional study, 188 women with MDD were randomly selected among the patients who visited Bozorgmehr Clinic of Tabriz University of Medical Sciences. The sample selection was carried out through structured psychiatric interviews based on DSM-TV-TR criteria. Data were collected using Index of Marital Satisfaction (IMS), Family Process Scale (FPS) and Norbeck Social Support Questionnaire (NSSQ).The Mann Whitney U, Multivariate and ANOVA tests were used to analyze the data. RESULTS: No relationship was observed between age, educational level, age difference of couples and number of children with family processes and marital satisfaction (p ≥ 0.05). The patients with low educational level reported less social support (p ≥ 0.05).Marital satisfaction and family coherence were lower when the husband had a psychiatric disorder (P ≤ 0.01). The family processes (family coherence, problem-solving skills, communication skills and religious beliefs) and social support positively predicted marital satisfaction, while the husband's psychiatric disorders negatively predicted marital satisfaction. CONCLUSION: The findings highlight the significance of family processes, social support and husband's psychiatric disorders in marital satisfaction of women with MDD.