Parental attachment and childhood trauma in adolescents engaged in non-suicidal self-injury.

AIM: In this study, it was aimed to compare parental attachment and childhood traumas in adolescents with NSSI with healthy peers. METHODS: Fifty adolescents aged 14-18 years with lifetime NSSI and 56 healthy peers were included in the study. Inventory of Statements About Self-injury (ISAS), The Parental Bonding Instrument (PBI) and Child Trauma Questionnaire (CTQ-28) scales were used. RESULTS: Eighty-two percentage of the NSSI group and 70% of the control group were girls. The mean age was 15.6 ± 1.1 years in the NSSI group and 15.3 ± 0.9 years in the control group. There was no significant difference between the groups in terms of age and gender. The NSSI group had more negative scores than the control group in terms of childhood traumas and attachment characteristics to both mother and father. The analyses showed that mother PBI care/control and sexual abuse score had a relationship with both ISAS Autonomic Functions and ISAS Social Functions scores. CONCLUSIONS: These results suggest that secure attachment with the mother may be protective for both the autonomic and social functions of the NSSI. Therefore, interventions for dysfunctional parental attachment may prevent the development of NSSI.

Serum claudin-5, claudin-11, occludin, vinculin, paxillin, and beta-catenin levels in preschool children with autism spectrum disorder.

AIM: Increased intestinal and blood-brain barriers (BBB) permeability has been suggested to have a role in autism spectrum disorder (ASD). Claudin-5, claudin-11, occludin, ß-catenin, vinculin, and paxillin are crucial components of these barriers. This study assessed concentrations of these molecules in preschool children with ASD. METHODS: A total of 80 children with ASD and 40 controls aged 18-60 months were enrolled in this study. Serum levels of biochemical variables were determined using commercial enzyme-linked immunosorbent assay kits. RESULTS: Serum claudin-11, occludin, and ß-catenin levels were significantly higher in the ASD group than in the control group. However, no significant difference for serum claudin-5, vinculin, and paxillin levels was detected between the groups. CONCLUSION: These findings suggest that claudin-11, occludin, and ß-catenin may be involved in the pathogenesis of ASD. These proteins may affect the brain by causing dysregulation in intestinal or blood-brain barrier permeability or with other unknown mechanisms.

The Validity and Reliability of Borderline Personality Features Scale for Children-Short Form in Turkish Adolescents. / Borderline Kisilik Özellikleri Çocuk Ölçegi­Kisa Formunun Türk Ergenlerinde Geçerlik ve Güvenirlik Çalismasi.

OBJECTIVE: This study has aimed to investigate the validity and reliability of the Borderline Personality Features Scale for Children-Short Form (BPFSC-SF-TR) in Turkish adolescents. METHOD: The study was carried out with adolescents between the ages of 12-18 from clinical (N=168) and community (N=181) backgrounds. All participants were asked to complete the BPFSC-SF-TR, the Personality Belief Questionaire - Short Form (PBQ-SF), the Brief Symptom Inventory (BSI) and the Personality Inventory for DSM-5- Short Form (PID-5-SF) scales. Also, the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Version (K-SADS-PL-TR) was administered to the participants in the clinical group and their parents were asked to complete the Pediatric Quality of Life Inventory (PEDsQL). Test-retest correlations and the Cronbach's α coefficients were calculated. RESULTS: BPFSC-SF-TR scores of both groups of participants positively correlated with the PBQ-BF borderline subscale, the PID-5-SF borderline related facets and the BSI scores, and negatively correlated with the PedsQL in the clinical group. Furthermore, the clinical group had higher total BPFSC-SF-TR scores than the community group, and their scores positively correlated with the number of diagnoses and psychiatric symptoms determined by using the KSADS-PL-TR. Exploratory and multi-group confirmatory factor analyses of the data of both groups supported a single factor structure. The Cronbach's α of the scale was 0.84 in the clinical group, and 0.79 in the community group. The test-retest reliability correlation coefficient of the scale was 0.71. CONCLUSION: The BPFSC-SF-TR is a valid and reliable tool for Turkish adolescents.

Altered kynurenine pathway metabolite levels in toddlers and preschool children with autism spectrum disorder.

AIM: There are increasing reports about the potential role of kynurenine pathway metabolites in autism spectrum disorder (ASD). Early childhood is a very crucial period of time for the etiopathogenesis of ASD and previous studies reported an age-dependent alteration in kynurenine metabolism. However, no study specifically examined kynurenine metabolites in very young children with ASD. This study aimed to investigate kynurenine pathway metabolite levels, kynurenine pathway enzyme activities and neuroprotective index (kynurenic acid/3-hydroxykynurenine ratio) in toddlers and preschool children with ASD. MATERIALS AND METHODS: A total of 68 children with ASD and 44 healthy controls aged between 18 and 60 months were included in this study. Serum levels of kynurenine pathway metabolites were determined by liquid chromatography-mass spectrometry/mass spectrometry system. RESULTS: Serum 3-hydroxykynurenine and kynurenic acid concentrations were significantly higher in the ASD group than in the control group, whereas serum 3-hydroxyanthranilic acid concentrations were significantly lower. CONCLUSIONS: These findings showed that the kynurenine pathway may play a role in the etiopathogenesis of ASD in early childhood.

The validity and reliability of the Stress and Anxiety to Viral Epidemics-9 items Scale in Turkish health care professionals.

There is a need for a valid and reliable measurement tool that will detect the psychological symptoms of health care workers in the epidemic and pandemic periods that have been effective worldwide in recent years. This study has aimed to investigate the validity and reliability of the Stress and Anxiety to Viral Epidemics-9 items Scale (SAVE-9) in Turkish health care professionals. The study was carried out with 150 health care professionals. All participants were asked to complete the SAVE-9, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Brief Resilience Scale (BRS). The Cronbach's α coefficient was calculated. Also, exploratory and confirmatory factor analyses were used to evaluate the factor structure. The SAVE-9 scores positively correlated with the PHQ-9, GAD-7, and negatively correlated with the BRS. The exploratory and confirmatory factor analyses supported two-factor structure similar to the original scale. The first factor consists of five items (1, 2, 3, 4, 5, 8), and the second factor consists of three items (6, 7, 9). The Cronbach's α coefficient was found as 0.77. The Turkish version of SAVE-9 is a valid and reliable tool for Turkish health care professionals.

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.

Increased serum brain-derived neurotrophic factor and adrenocorticotropic hormone levels are associated with obsessive compulsive disorder in medication­free children.

This study aimed to investigate serum levels of neurotrophins, including brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF) and neurotrophin-3 (NTF3), and hypothalamic-pituitary-adrenal axis (HPA) members including adrenocorticotropic hormone (ACTH) and cortisol in children with obsessive-compulsive disorder (OCD). The possible relationships between serum neurotrophins and HPA axis members were also addressed. A total of 60 medication-free children with OCD and 57 controls aged 8-18 years were enrolled in this study. The severity of OCD symptoms was determined by the Children's Yale-Brown Obsessive Compulsive Scale. The severity of anxiety and depression symptoms were assessed by self-report inventories. The serum levels of neurotrophins, ACTH, and cortisol were measured using enzyme-linked immunosorbent assay kits. Serum BDNF levels were significantly higher in the OCD group than in the control group for either sex and for the whole sample. Compared to controls, serum ACTH levels were significantly higher in the OCD group for the whole sample. An analysis of covariance was also conducted for the whole sample and indicated that, while controlling the potential confounders, including body-mass index percentile, age, sex, and the severity of depression and anxiety, the results did not change. Strong negative correlations between BDNF, NGF and NTF3, and HPA axis members were determined in the patient group for either sex and for the whole sample. These findings suggest that dysregulations of BDNF and ACTH may be associated with childhood OCD. Furthermore, there may be inverse relationships between certain neurotrophins and HPA axis members in these patients.

Turkish Adaptation and Validation of Behavioral Inhibition Questionnaire Parent Form.

Background: Behavioral inhibition has been proposed as a temperamental risk factor for the development of childhood anxiety disorders universally; however, there is no validated instrument for, especially, its evaluation in Turkish children. This study aimed to examine reliability and validity of the Turkish version of Behavioral Inhibition Questionnaire parent form for children aged 3-7 years. Methods: Around 250 mothers or fathers of 3-7 years old children were recruited from non-clinical population to collect responses to the questionnaires. The sample was created by reaching 3 schools at preschool or elementary grade for the purpose of providing the questionnaires filled about the student and/or his/her little sisters and brothers by their parents; questionnaires were sent out to parents and then gathered. Parents were asked to fill sociodemographic data form, Behavioral Inhibition Questionnaire parent form, Children Behavior Questionnaire, and Strengths and Difficulties Questionaire parent form in order to perform convergent and divergent validity analyses. Results: As a result of reliability analysis, total Cronbach alpha coefficient for Behavioral Inhibition Questionnaire was determined as 0.92 with strong reliability. The internal consistency coefficients for Behavioral Inhibition Questionnaire subscales also showed strong reliability with alphas ranging between 0.81 and 0.87 except for the performance (α = 0.69) and physical challenges (α = 0.19) subscales of which some items were excluded due to item-total correlations and confirmatory factor analysis results. In the validity assessment analyses, confirmatory factor analysis demonstrated that Behavioral Inhibition Questionnaire has a construct validity with 5 factors loaded on the 2-second order main factors and one third-order final factor (root mean square error = 0.032, root mean square residual = 0.153, Comparative Fit Index = 0.978, Goodness of Fit Index = 0.915, and Turker-Lewis Index = 0.970). While the strongest correlations with the overall Behavioral Inhibition Questionnaire score were found for 2 main subscales, inhibition to social novelties (r = 0.926, P < .001) and situational novelties (r = 0.928, P < .001), similarly peers (r = 0.848, P < .001) and new situations (r = 0.898, P < .001) subscales, had strong correlations with the overall Behavioral Inhibition Questionnaire score. The weakest correlation with overall Behavioral Inhibition Questionnaire score was observed for physical challenges subscale even though this subscale displayed moderate association (r = 0.454, P < .001). A good convergent validity was determined accompanied by significant moderate positive correlations with Children Behavior Questionnaire shyness and Strengths and Difficulties Questionnaire internalizing scales. An adequate divergent validity was also demonstrated based on significant positive mild to moderate correlations with Children Behavior Questionnaire impulsivity, Children Behavior Questionnaire smiling/laugh, Strengths and Difficulties Questionnaire prosocial scales, and non-significant correlation with Strengths and Difficulties Questionnaire externalizing scale. Conclusion: The study demonstrated that the Turkish version of the Behavioral Inhibition Questionnaire parent form is an effective tool with good reliability and validity among 3-7 years old children.

Caregiver burden and related factors in caregivers of patients with childhood-onset systemic lupus erythematosus.

OBJECTIVE: Having a child with a chronic illness is a source of stress for the whole family, especially the primary caregiver. The aim of this study was to evaluate the associations between caregiver burden and both the caregiver's and child's psychological symptoms in a cohort of children with systemic lupus erythematosus (SLE). METHODS: Thirty-four patients (aged 9-18 years) with childhood-onset SLE and their caregivers participated in this study. The control group was composed of healthy children and their caregivers. Questionnaires were used to evaluate caregiver burden and the psychological status of parents and children and adolescents with and without SLE. RESULTS: No significant difference was found between the study and control groups for caregiver burden, anxiety and depression in parents, and psychological status in children. Caregiver burden was positively correlated with parent's depression, anxiety, and behavioral and peer problems of the children, and it was negatively correlated with the children's prosocial behaviors. According to regression analyses, the parents' depression and children's peer relationship had a positive effect on caregiver burden scores. CONCLUSION: Physicians should be aware of the presence of psychological symptoms in patients with childhood-onset SLE and their caregivers because it can affect caregiver burden and the caregiver's psychological state. Key points •Caregiver burden was positively correlated with parent's depression and anxiety. •Caregiver burden was positively correlated with children's behavioral and peer problems. •Caregiver burden was negatively correlated with child's prosocial behaviors.

Serum Brain-Derived Neurotrophic Factor, Glial-Derived Neurotrophic Factor, Nerve Growth Factor and Neurotrophin-3 Levels in Preschool Children with Language Disorder.

INTRODUCTION: Accumulating studies demonstrate that neurotrophins may play a crucial role in a variety of neurodevelopmental disorders. However, little data are available regarding the potential role of neurotrophins in language disorder (LD). This study aimed to investigate serum brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF) and neurotrophin-3 (NTF3) levels in preschool children with LD. METHODS: A total of 43 cases with LD and 43 healthy controls aged 18 to 60 months were enrolled in the study. The development levels and psychiatric symptoms of the children were determined by the Ankara Developmental Screening Inventory and Child Behavior Checklist 1.5-5, respectively. Serum neurotrophin levels were assessed by enzyme-linked immunosorbent assay kits. RESULTS: Serum GDNF and NGF levels were significantly higher, serum BDNF and NTF3 levels were significantly lower in the LD group than in the control group. However, with logistic regression analyses, only negative relationship of BDNF and NTF3 levels with the presence of LD remained significant after accounting for the confounders including development level and coexisting psychiatric symptoms. CONCLUSIONS: These results suggest that low BDNF and NTF3 levels have independent negative relationships with LD, which could be contribute to etiopathogenesis of the disorder.

Excessive Masturbation Successfully Treated With Methylphenidate in a 6-Year-Old Child With Autism Spectrum Disorder Accompanied by Attention Deficit Hyperactivity Disorder.

ABSTRACT: Children with autism spectrum disorder frequently exhibit inappropriate sexual behaviors, such as excessive masturbation. However, research on the control and management of excessive masturbation in these children is very limited. In this presentation, excessive masturbation that responded to treatment with methylphenidate is described in a young boy diagnosed with autism spectrum disorder and comorbid attention deficit hyperactivity disorder.

The role of tryptophan metabolic pathway in children with attention deficit hyperactivity disorder with and without comorbid oppositional defiant disorder and conduct disorder.

Accumulating data presented that tryptophan metabolic pathway (TMP) may play a role in attention-deficit/hyperactivity disorder (ADHD). However, no study have investigated potential role of TMP in disruptive behavior disorders coexisting with ADHD. This study compared serum levels of tryptophan, kynurenine, kynurenic acid, 3-hydroxykynurenine and 3-hydroxyantranilic acid in medication-free children with ADHD combined presentation (ADHD-C), with ADHD-C and oppositional defiant disorder (ODD), and with ADHD-C and conduct disorder (CD) versus healthy controls. The study also compared several ratios that are previously suggested to reflect the activities of the KP enzymes (kynurenine/tryptophan, kynurenic acid/kynurenine, 3-hydroxykynurenine/kynurenine) or neuroprotective activity (kynurenic acid/3-hydroxykynurenine) among groups. A total of 122 patients were enrolled: 46 children with ADHD-C alone, 43 children with ADHD-C+ODD, 33 children with ADHD-C+CD and 50 healthy controls. Targeted biochemical molecules were assessed by liquid chromatography-mass spectrometry/mass spectrometry. Compared to control group, serum kynurenine levels were significantly higher in the ADHD-C group, serum 3-hydroxykynurenine levels were significantly lower in the ADHD-C and ADHD-C+ODD groups, the serum kynurenic acid/kynurenine ratio was significantly higher in the ADHD-C, ADHD-C+ODD and ADHD-C+CD groups, and the serum 3-hydroxykynurenine/kynurenine ratio was significantly lower in the ADHD-C group. These findings suggest that TMP may play a role in the pathophysiology of ADHD-C.

Evaluation of Appetite-Regulating Hormones in Young Children with Autism Spectrum Disorder.

This study aimed to investigate the role of leptin, ghrelin, neuropeptide Y, and nesfatin-1 in young children with autism spectrum disorder (ASD). A total of 44 children with ASD and 44 healthy controls aged 18-60 months were included. Plasma levels of hormones were measured using commercial enzyme-linked immunosorbent assay kits. Plasma leptin and ghrelin levels were significantly higher in the ASD group than in the control group. However, no significant difference for plasma neuropeptide Y and nesfatin-1 levels was detected between the groups. No relation was found between the severity of ASD symptoms, severity of eating problems, and plasma levels of hormones. Leptin and ghrelin may play a potential role in the pathogenesis of ASD.

Exploring the association between depression, suicidality and serum neurotrophin levels in adolescents.

Objective: The aim of this study was to identify potential differences in serum brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF) and neurotrophin-3 (NTF3) levels in adolescents with major depressive disorder (MDD) compared to healthy controls. The possible relationship between serum neurotrophin levels and suicidality in adolescents with MDD was also addressed.Methods: A total of 70 treatment-free adolescents with MDD and 40 healthy controls aged 11 to 19 years were enrolled. The severity of suicidality was determined using the Columbia-Suicide Severity Rating Scale, and the severity of depression and anxiety symptoms were evaluated by self-report inventories. Serum levels of neurotrophins were measured using an enzyme-linked immunosorbent assay.Results: The mean serum BDNF levels were significantly higher in adolescents with MDD than in control subjects; no significant difference was found between the groups for serum GDNF, NGF and NTF3 levels. No correlations were found between the levels of serum neurotrophins and the severity of depression or suicidality.Conclusions: The study results suggest that elevated serum BDNF levels may be related to MDD in adolescents. However, our findings did not support a role for neurotrophins in suicidality.Key pointsSerum BDNF levels were higher in adolescents with MDD than in controls.No significant alterations of serum levels of GDNF, NGF and NTF3 were evident in adolescents with MDD.Neurotrophin levels were not associated with suicidal ideation and behaviours.

Effect of adenotonsillectomy on sleep problems, attention deficit hyperactivity disorder symptoms, and quality of life of children with adenotonsillar hypertrophy and sleep-disordered breathing.

OBJECTIVE: Chronic adenotonsillar hypertrophy is the most common etiologic reason for upper airway obstruction in childhood and has been found to be associated with a variety of psychiatric disorders and poor quality of life. In the present study, we investigated the impact of adenotonsillectomy on attention deficit hyperactivity disorder symptoms, sleep problems, and quality of life in children with chronic adenotonsillar hypertrophy. METHODS: The parents of children with chronic adenotonsillar hypertrophy filled out the Conners's Parent Rating Scale-Revised Short form (CPRS-RS), Children's Sleep Habits Questionnaire (CSHQ), and Pediatric Quality of Life Inventory, Parent version (PedsQL-P) before and six months after adenotonsillectomy. RESULTS: A total of 64 children were included in the study (mean age = 6.8 ± 2.4 years; boy:girl ratio= 1). The mean attention deficit hyperactivity disorder index and oppositionality subdomain scores of the CPRS-RS and all of the CSHQ subdomain scores (bedtime resistance, sleep-onset delay, sleep anxiety, night waking, parasomnias, sleep-disordered breathing, and daytime sleepiness) except for sleep duration significantly decreased after adenotonsillectomy ( p < 0.05). The PedsQL-P total score and both PedsQL-P physical health and psychosocial health subdomain scores were significantly higher at six months after adenotonsillectomy ( p < 0.001). CONCLUSIONS: Child and adolescent psychiatrists should check the symptoms of chronic adenotonsillar hypertrophy to identify children with chronic adenotonsillar hypertrophy who suffer from sleep disturbance, attention deficit hyperactivity disorder symptoms, and oppositionality. Adenotonsillectomy seems to be beneficial for coexisting attention deficit hyperactivity disorder and sleep disorder symptoms and quality of life in these children.

Possible Sertraline-Induced Hiccups in a Boy With Obsessive-Compulsive Disorder and Attention-Deficit/Hyperactivity Disorder.

Hiccup is a sudden-onset repeated involuntary and spasmodic contraction of the diaphragm and intercostal muscle accompanied by laryngeal closure, generating the characteristic inspiratory sound and discomfort. Various factors including drugs may trigger the hiccups. There are some reports regarding the possible links between psychotropic agents that can affect the dopaminergic system and the triggering of hiccup; however, to our knowledge, there are no data regarding sertraline-induced hiccup. We present the case of a boy with obsessive-compulsive disorder and attention-deficit/hyperactivity disorder who displayed hiccup after sertraline therapy.

The relationship between prenatal testosterone and developmental stuttering in boys.

Dönmez YE, Özcan Ö, Bilgiç A, Miniksar DY. The relationship between prenatal testosterone and developmental stuttering in boys. Turk J Pediatr 2019; 61: 193-199. Stuttering is a multi-factorial speech disorder characterized by various dysfluencies in the beginning and/or smooth flow of speech. Its incidence is about 1% in the general population, with 80% of stuttering cases seen in children aged three to eight years. The etiology of developmental stuttering has not been precisely explained. Several researchers report that neurological factors, especially atypical lateralization of the speech and language processes, play an important role in the etiology of stuttering. Various hypotheses suggest that prenatal testosterone causes atypical hemispheric lateralization. The aim of this study was to investigate the role of prenatal testosterone in the etiology of developmental stuttering by the use of the ratio of secondand fourth-digit lengths (2D:4D). Totally 133 boys (49 boys who stutter and 84 boys who do not stutter) were included in the study. The age range of children participating in the study was determined as 2-12 years. In the comparative evaluation conducted between the stuttering group and the control group in terms of their right 2D:4D and left 2D:4D ratios, it was found that the left 2D:4D ratio of the patients was significantly higher than that of the control group. We are of the opinion that prenatal testosterone may play a role in the etiology of developmental stuttering. The present study is the first study in the literature to reveal a relationship between prenatal testosterone and developmental stuttering.

Fluoxetine-Induced Skin Picking and Compulsive Behaviors in a Preschool Girl.

Skin-picking disorder is regarded as a type of obsessive-compulsive and related disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Selective serotonin reuptake inhibitors (SSRIs) are reported to be effective in the treatment of skin-picking disorder. However, these agents can cause opposite effects in some cases. There is a report on SSRI-induced skin-picking disorder in adults. However, to our knowledge, there are no data regarding SSRI-induced skin picking in children. We present the case of a preschool girl with separation anxiety disorder who displayed skin-picking and compulsive-asking behaviors after fluoxetine therapy.