The traits of Autism Spectrum Disorder and bullying victimization in an epidemiological population.

Autistic children (Autism Spectrum Disorder, ASD) show an increased risk of bullying victimization and often face challenges in communication and peer relationships. However, it is unclear to what extent the amount and quality of ASD traits are associated with bullying victimization. This study examined the association of bullying victimization and ASD traits in an epidemiological population of 8-year-old children (n = 4408) using parent and teacher completed Autism Spectrum Screening Questionnaires (ASSQs), both separately and combined. The ASSQ items relating to loneliness and social isolation, lack of co-operating skills, clumsiness and lack of common sense were associated with victimization in the study population. The higher the ASSQ scores, the more the children were victimized: the ASSQ scores increased in parallel with victimization from 0 (0% victimized) to 45 (64% victimized). The victimization rate was 46% in ASD sample, 2% in the total population sample and 2% in the non-ASD population sample. The results enable more targeted means for recognizing potential victimization.

Prevalence of Autism Spectrum Disorder in 7-9-Year-Old Children in Denmark, Finland, France and Iceland: A Population-Based Registries Approach Within the ASDEU Project.

We estimated autism spectrum disorder (ASD) prevalence in 7-9 year-old children in 2015 using data from three nationwide health registry systems (Denmark, Finland, Iceland) and two French population-based regional registries. Prevalence ranged from 0.48% in South-East France to 3.13% in Iceland (South-West France: 0.73%, Finland: 0.77%, Denmark: 1.26%). Male/female ratios ranged from 3.3 in Finland to 5.4 in South-West France. Between 12% (Denmark) and 39% (South-West France) of cases were diagnosed with intellectual disability. The variations in population-based ASD prevalence across four European countries with universal health care practices likely reflect variation in detection, referral and diagnosis practices and autism awareness across these areas. Using established population-based data systems is an efficient approach to monitor ASD prevalence trends over time.

Sensory Abnormality and Quantitative Autism Traits in Children With and Without Autism Spectrum Disorder in an Epidemiological Population.

Sensory abnormalities (SAs) are recognized features in Autism Spectrum Disorder (ASD), and a relationship between SAs and ASD traits is also suggested in general population. Our aims were to estimate the prevalence of SAs in three different settings, and to study the association between SAs and quantitative autism traits (QAT) using the Autism Spectrum Screening Questionnaire (ASSQ) and a parental questionnaire. In an epidemiological population of 8-year-old children (n = 4397), the prevalence of SAs was 8.3%, in an ASD sample (n = 28), 53.6%, and in a non-ASD sample (n = 4369), 8.0%, respectively. Tactile and auditory hypersensitivity predicted an ASD diagnosis. The ASSQ was able to differentiate children with and without SA. In conclusion, QAT level and SAs were associated in all study samples.

Mental health promotion in comprehensive schools.

The purpose of this paper is to describe a participatory action research process on the development of a professional practice model of mental health nurses in mental health promotion in a comprehensive school environment in the city of Oulu, Finland. The developed model is a new method of mental health promotion for mental health nurses working in comprehensive schools. The professional practice model has been developed in workshops together with school staff, interest groups, parents and students. Information gathered from the workshops was analysed using action research methods. Mental health promotion interventions are delivered at three levels: universal, which is an intervention that affects the whole school or community; selective, which is an intervention focusing on a certain group of students; and indicated, which is an individually focused intervention. All interventions are delivered within the school setting, which is a universal setting for all school-aged children. The interventions share the goal of promoting mental health. The purposes of the interventions are enhancing protective factors, reducing risk factors relating to mental health problems and early identification of mental health problems as well as rapid delivery of support or referral to specialized services. The common effect of the interventions on all levels is the increase in the experience of positive mental health.

Longitudinal associations between childhood and adulthood externalizing and internalizing psychopathology and adolescent substance use.

BACKGROUND: Emotional and behavioral problems are commonly associated with substance use in adolescence but it is unclear whether substance use precedes or follows mental health problems. The aim was to investigate longitudinal associations between externalizing and internalizing psychopathology and substance use in a prospective population study design. METHOD: The sample was the Northern Finland Birth Cohort 1986 Study (NFBC 1986; n = 6349; 3103 males). Externalizing and internalizing mental health problems were assessed at age 8 years (Rutter scales), substance use and externalizing and internalizing problems [Youth Self-Report (YSR)] at age 15-16 years, and hospital diagnoses for internalizing disorders (age 25) and criminal offences (age 20) from nationwide registers in adulthood. RESULTS: Externalizing problems at age 8 were associated with later substance use. After adjustment for sociodemographic factors, parental alcohol use and psychiatric disorders, and earlier externalizing and internalizing problems, substance use predicted criminality, especially among males, with the highest odds ratio (OR) for cannabis use [adjusted OR 6.2, 95% confidence interval (CI) 3.1-12.7]. Early internalizing problems were not a risk for later substance use. Female adolescent cannabis (OR 3.2, 95% CI 1.4-7.3) and alcohol (OR 2.1, 95% CI 1.1-4.2) use predicted internalizing disorders in adulthood. CONCLUSIONS: Externalizing problems precede adolescent substance use in both genders, whereas, among boys, substance use also precedes criminal offences. Internalizing problems may follow substance use in females. These associations were robust even when taking into account previous mental health problems.

Disruptive behaviour disorder with and without attention deficit hyperactivity disorder is a risk of psychiatric hospitalization.

AIM: To evaluate the psychiatric hospitalization among adolescents diagnosed with disruptive behaviour disorders (DBD) and/or attention deficit hyperactivity disorder (ADHD). METHODS: The sample (N = 457) was drawn from the Northern Finland Birth Cohort 1986. Four groups were formed, based on the K-SADS-PL diagnostic interview procedure: adolescents with DBD (n = 44), ADHD (n = 91), comorbid DBD and ADHD (n = 72) and without either DBD or ADHD (n = 250). Information from the Finnish Hospital Discharge Register (FHDR) was used to evaluate the psychiatric hospitalization among the study subjects. RESULTS: When compared with no diagnosis group, the adolescents with behavioural disorders had an increased risk (adjusted odds ratios: DBD = 4.4, ADHD = 2.2, comorbid DBD & ADHD = 5.6) of having also psychiatric disorder in the FHDR. The onset age of the psychiatric disorders in the FHDR (medians: DBD = 14.9, ADHD = 7.5 and DBD & ADHD = 15.3 years) and the combined length of hospitalization (medians: 25, 50 and 26 days, respectively) differed among adolescents with behavioural disorders compared with those with no diagnosis (median age 12.1 years and length of hospitalization 4 days). CONCLUSION: Adolescents diagnosed with DBD (with and without ADHD) are at high risk of undergoing psychiatric hospitalization during their life.

Physical activity, emotional and behavioural problems, maternal education and self-reported educational performance of adolescents.

This study examined whether physical activity, mental health and socio-economic position were associated with the overall academic performance and future educational plans of adolescents aged 15-16 years. We used a sample of 7002 boys and girls from the Northern Finland Birth Cohort 1986. Data were collected by a postal enquiry in 2001-02. Multivariable logistic regression models were estimated and adjusted for family structure and all variables in the models. In the fully adjusted models, higher levels of physical activity and high parental socio-economic position were associated with higher overall academic performance and future plans for higher education. High scoring on behavioural problems was related to lower overall academic performance and poorer future academic plans. In summary, a higher level of physical activity, fewer behavioural problems and higher socio-economic position were independently associated with high self-perceived overall academic performance and plans for higher education among adolescents. The interrelations of these factors and the positive relationship between physical activity, mental health and school outcomes provide a context of critical importance for future research, intervention programming and policy directed at improving the educational attainment of adolescents.

Is prenatal alcohol exposure related to inattention and hyperactivity symptoms in children? Disentangling the effects of social adversity.

BACKGROUND: Studies concerning whether exposure to low levels of maternal alcohol consumption during fetal development is related to child inattention and hyperactivity symptoms have shown conflicting results. We examine the contribution of covariates related to social adversity to resolve some inconsistencies in the extant research by conducting parallel analyses of three cohorts with varying alcohol consumption and attitudes towards alcohol use. METHODS: We compare three population-based pregnancy-offspring cohorts within the Nordic Network on ADHD from Denmark and Finland. Prenatal data were gathered via self-report during pregnancy and birth outcomes were abstracted from medical charts. A total of 21,678 reports concerning inattention and hyperactivity symptoms in children were available from the Strengths and Difficulties Questionnaire or the Rutter Scale completed by parents and/or teachers. RESULTS: Drinking patterns differed cross-nationally. Women who had at least some social adversity (young, low education, or being single) were more likely to drink than those better off in the Finnish cohort, but the opposite was true for the Danish cohorts. Prenatal alcohol exposure was not related to risk for a high inattention-hyperactivity symptom score in children across cohorts after adjustment for covariates. In contrast, maternal smoking and social adversity during pregnancy were independently and consistently associated with an increase in risk of child symptoms. CONCLUSIONS: Low doses of alcohol consumption during pregnancy were not related to child inattention/hyperactivity symptoms once social adversity and smoking were taken into account.

Maternal adiposity prior to pregnancy is associated with ADHD symptoms in offspring: evidence from three prospective pregnancy cohorts.

OBJECTIVES: We examine whether pregnancy weight (pre-pregnancy body mass index (BMI) and/or weight gain) is related to core symptoms of attention deficit hyperactivity disorder (ADHD) in school-age offspring. DESIGN: Follow-up of prospective pregnancy cohorts from Sweden, Denmark and Finland within the Nordic Network on ADHD. METHODS: Maternal pregnancy and delivery data were collected prospectively. Teachers rated inattention and hyperactivity symptoms in offspring. High scores were defined as at least one core symptom rated as 'severe' and two as 'present' (approximately 10% of children scored in this range). Logistic regression and latent class analyses were used to examine maternal pregnancy weight in relation to children's ADHD core symptoms. RESULTS: Teacher rated 12 556 school-aged children. Gestational weight gain outside of the Institute of Medicine guidelines was not related to ADHD symptoms (below recommendations: odds ratio (OR): 0.96; 95% confidence interval (CI): 0.81, 1.14; above recommendations: OR: 0.98; 95% CI: 0.82, 1.16). To examine various patterns of pre-pregnancy BMI and weight gain, we used latent class analysis and found significant associations between classes that included pre-pregnancy overweight or obesity and a high ADHD symptom score in offspring, ORs ranged between 1.37 (95% CI: 1.07, 1.75) and 1.89 (95% CI: 1.13, 3.15) adjusted for gestational age, birth weight, weight gain, pregnancy smoking, maternal age, maternal education, child gender, family structure and cohort country of origin. Children of women who were both overweight and gained a large amount of weight during gestation had a 2-fold risk of ADHD symptoms (OR: 2.10, 95% CI: 1.19, 3.72) compared to normal-weight women. CONCLUSIONS: We show for the first time that pre-pregnancy BMI is associated with ADHD symptoms in children. Our results are of public health significance if the associations are causal and will then add ADHD symptoms in offspring to the list of deleterious outcomes related to overweight and obesity in the prenatal period.

Is a large family a protective factor against behavioural and emotional problems at the age of 8 years?

AIM: To study the prevalence of behavioural and emotional problems among children from different family types, sibship size and birth order. METHODS: A prospective birth cohort (n = 9357) study where parents filled in two questionnaires and teachers assessed children's behaviour using the Rutter scale (RB2). RESULTS: 14.3% scored above the cut-off point (RB2 > or = 9) indicating probable psychiatric disturbance, boys more often than girls (OR 2.6, 95% CI 2.3-3.0). Behavioural problems (9.2%) were more common than emotional ones (4.1%). Boys living in families other than two-parent families were at risk for probable psychiatric disturbance, and a corresponding risk was observed for girls living in single-parent or always one-parent families. Other than two-parent family was also a risk for behavioural problems; for boys adjusted odds ratios ranged significantly from 1.8 to 2.4 and for girls from 2.0 to 3.7. "Only children" had the highest prevalence of behavioural problems, while children in very large families had the lowest. Living in a very large family was a protective factor against behavioural problems among boys but not among girls. Eldest children were at lower risk of behavioural problems than the other children. The single-parent and always one-parent family was associated with higher risk of emotional problems among girls. CONCLUSION: Children's psychiatric problems are manifested at school mostly as behavioural problems. A two-parent family and being the oldest in the sibling series seem to be protective factors. Very large family size, if not connected to social disadvantages, does not seem to be a risk factor for children's behaviour.

Total plasma l-tryptophan, free l-tryptophan and competing amino acid levels in a homicidal male adolescent with conduct disorder.

OBJECTIVE: Several studies have shown abnormal findings in human serotonin metabolism, such as increased total plasma l-tryptophan and free l-tryptophan levels among habitually violent antisocial offenders. It is not clear if these increased l-tryptophan levels are associated with adult antisocial personality disorder (ASP) or history of substance abuse, or if these levels are already present in adolescent subjects with conduct disorder (CD). METHOD: Total plasma and free l-tryptophan and competing amino acids (CAAs) were measured in a 15-year-old adolescent offender, who was convicted for two homicides, and in 10 healthy male controls of similar age and body mass index (BMI). RESULTS: In the juvenile offender, plasma total l-tryptophan/CAA was 84% and free l-tryptophan/CAA 143% higher than average mean among controls. CONCLUSION: From this very aggressive boy with CD, findings of free l- and total l-tryptophan/CAA values were similar to those of habitually violent adult ASP offenders. As severe CDs in adolescence tend to develop into adults with ASP, increased l-tryptophan/CAA and free l-tryptophan/CAA values may serve as early indicators for the development of habitually violent adult offenders.

Somatically expressed psychological distress and alexithymia in adolescence--reflecting unbearable emotions?

The characteristics of five 11- to 15-year-old patients with somatic symptoms and alexithymia in conjunction with psychological distress are reported. The findings are compared with the existing literature. Preceding somatic disorders and difficulties at school and in peer relationships were found. Family violence was evident in two cases. We postulate that the developmental tasks of adolescence were complicated by the threat of disability, disease, and death. The parents were incapable of expressing their feelings either in general or because of their recent traumatic experiences. Our findings suggest that unbearable emotions often precede the combination of preadolescent and adolescent alexithymia and somatization in clinically relevant cases.

Elevated hypothalamic/midbrain serotonin (monoamine) transporter availability in depressive drug-naive children and adolescents.

Cumulative data suggest depression in adulthood being connected to reduced availability of brain serotonin while the role of dopamine remains less specific. Prospective studies have shown a continuity of depressive episodes from childhood to adulthood, combined with poor social function and excess mortality. The object of this study was to examine whether alterations in brain serotonin and/or dopamine transporter levels are already present in depressive children and adolescents. We examined 41 drug-naive patients (aged 7-17) by single photon emission tomography (SPET) using iodine-123-labelled 23-carbomethoxy-3P3(iodophenyl) tropane [123I]beta-CIT as a tracer for monoamine transporters. In addition to the ordinary clinical examination, the patients were given a structured interview and information was gathered from teachers and parents with questionnaires. The diagnoses were established by consensus evaluation between three child psychiatrists. To test the serotonin hypothesis and the dopamine hypothesis regarding depression in children and adolescents, the series was divided into groups with depression present (31) and no depression present (10). In this study, the depressive child and adolescent patients had significantly higher serotonin transporter availability (P < 0.02) in the hypothalamic/midbrain area. Age did not correlate to the hypothalamic/midbrain serotonin transporter binding ratio. No significant difference in dopamine transporter availability in striatum was found between the depressive and the nondepressive children and adolescents.

Smoking and drinking habits in adolescence--links with psychiatric disturbance at the age of 8 years.

Smoking and drinking habits were studied among 1098 14-15-year-old adolescents using a mailed questionnaire. The subjects were drawn from a representative population of 5813 randomly selected 8-year-old children previously studied in the National Epidemiological Child Psychiatry Study in Finland in 1989. The questionnaire included items on the adolescents' smoking habits and alcohol consumption. Regular smoking was more common among boys (and girls) who, in childhood, had been rated by their parents (Rutter Parent Questionnaire) (RA2) as disturbed, 14.6% (30.3%), than among the nondisturbed, 6.6% (8.4%). Similarly, more of the previously disturbed (according to the RA2) adolescent boys drank alcohol regularly, 19.7%, as compared to the nondisturbed boys, 9.3%. Among girls, regular alcohol consumption was more common among those who previously had behavioural or mixed type problems (according to the RA2), 70.7%, as compared to those who previously had emotional or no problems, 12.2%. More of the previously depressed girls smoked regularly, 45.1%, than those who had not been depressed, 7.9%. Behavioural and emotional problems in childhood seemed to predispose to smoking and drinking in adolescence. The parents were more sensitive than the teachers in recognising the long-lasting problems of their children.

Are twins' behavioural/emotional problems different from singletons'?

We compared twins with singletons in the National Epidemiological Child Psychiatric Study, which included 122 twins and 5455 singletons, born in 1981 and selected at random. Behavioural and emotional symptoms were assessed in 1989 on the basis of questionnaires filled in by the parents (Rutter Parent Questionnaire) (RA2), teachers (Rutter Teacher Questionnaire) (RB2) and the children themselves (Children's Depression Inventory) (CDI). Parents' reported proportions of probable behavioural/emotional disorders did not differ between the twin and singleton girls, but among the twin boys there was a nonsignificant trend of being more often probably disturbed. Twins were reported to be less disturbed than singletons according to the teachers' assessments. No difference was found between twins and singletons in their self-reports. When analysing parents' reported values of various sum scores, the twin boys obtained slightly higher scores than singletons, while twin girls scored significantly lower on total and emotional disturbances. Twin boys obtained lower mean scores than singletons for probable disorder in the teachers' evaluations, the differences arising mostly in the emotional area. The same type of trend, however nonsignificant, was found among the teachers' evaluations of girls. No significant difference was found in the mean scores for hyperactivity. This large population-based sample suggests that twins may have a lower rate of behavioural problems in childhood than singletons, a finding that has to be taken into account in behavioural genetic studies.

Psychiatric symptoms in children with intellectual disability.

In a sample of almost 6000 8-year-old children, we found that 1.5% attended special schools for the educationally subnormal, or training schools. Psychiatric symptoms were studied by means of three screening instruments: the Rutter Parent Questionnaire (RA2) for the parents, the Rutter Teacher Questionnaire (RB2) for the teachers, and the Children's Depression Inventory (CDI) for the children. The prevalence rate of children identified as possibly suffering from a psychiatric disturbance was 32.2% according to the RA2. The corresponding prevalence rate for the RB2 was 34.2%. According to the CDI 11.0% had depressive disturbance. All types of disturbances were more frequent among the intellectually disabled children as compared to the nondisabled children. The differences were statistically significant for emotional and mixed types of disturbance on the RA2, and for emotional and conduct types of disturbance on the RB2.

To be born as a twin--risks and sequelae.

About 2.5% of infants born in Finland are twins. Twins have long been objects for genetic studies, which nowadays have large study groups, e.g. twin registers from a whole country. Twins can also be studied from another point of view: the special situation of being a twin, and its consequences on development and mental health. Perinatal mortality and morbidity are higher in twins than in singletons, and accordingly cumulative incidences of various handicaps are higher in twins. The human relationships of twins have their special features from the early beginning. Twins have to share the attention from the parents, and some parents resolve the situation by sharing the twins: "mother's child" and "father's child" may develop. Twins may be dependent on each other, and the inter-twin relationship can also be characterized by dominance-submissiveness. In adolescence, the time of getting independence from the parents, twins have also another task of development: they have to grow up from the co-twin dependence in order to become autonomous adults. In comparison to much bigger twin materials of genetic studies, follow-up studies in birth cohorts have their benefits, too. They give us a good opportunity to research the development of human relationships in twin families and their consequences on both somatic and mental health.

Long-term outcome of migration in childhood and adolescence.

The effect of migration on the family and on the individual can be divided into three groups: cultural, changes in social environment and changes in the interpersonal relations. When successful adaptation is not achieved, acculturative stress may arise and somatic or mental disorders may develop. The finding of individual differences in people's responses to environmental conditions has led to search for vulnerability factors that increase people's susceptibility to stressors and for buffering influences that serve a protecting function under the same circumstances. The studies on migration should focus on somatic and mental health of the migrants, on achievements at school and at work, on protecting factors at different ages of migration and on the role of language acquisition and of social network on the adaptational process. The focus on this review is in childhood, adolescence and young adulthood.