Neurocognitive Impairment in Patients With Ataxia Telangiectasia and Their Unaffected Parents: Is It Similar?

BACKGROUND: Ataxia telangiectasia (AT) is a genetic multisystemic disorder affecting the nervous system. Data on neurocognitive functioning in AT are limited and focused on patients at various stages of disease. Because of the genetic nature of the disorder, parents of patients may also display subtle neurological problems. This study aimed to evaluate neurocognitive functioning in patients with AT and their unaffected parents. METHODS: The study included 26 patients with AT and 41 parents among which 13 patients and 18 parents were evaluated with neurocognitive tests. Clinical and radiological data were reviewed retrospectively. Data were analyzed with descriptive statistics. RESULTS: The median ages of patients and parents were 12.5 years (interquartile range [IQR] = 9.5) and 38.0 years (IQR = 12.0), respectively. Median intelligence quotients were 62.0 (IQR = 21.3) and 82.5 (IQR = 16.8), respectively, for patients and parents. Rates of intellectual disability for patients and parents were 100.0% and 83.3%, respectively. Areas of impairment in patients in decreasing order of frequency were motor skills, visual perception/memory, visual-manual coordination, spontaneous/focused and sustained attention (100.0% for each), social judgment, as well as vocabulary and arithmetic skills (75.0% for each). Areas of impairment in unaffected parents in decreasing order of frequency were visual-manual coordination (77.8%), working memory (76.5%), and visual perception and motor skills (66.7% for each). CONCLUSION: Intellectual disabilities, visual-spatial disabilities, and reduced visual-motor coordination seem to be similar in patients with AT and their parents. These results should be replicated with larger samples from multiple centers and may form putative cognitive endophenotypes for the disorder.

The detect consensus report on Attention Deficit/Hyperactivity Disorder and its management among Turkish children and adolescents (Detect: consensus report on ADHD among Turkish youth).

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common and heritable neurodevelopmental disorders which may last through the life-span. A consensus report on diagnosis and management of ADHD among Turkish youth was prepared previously. However, the participants as well as the management options were rather limited and developments in the past decade necessitated a revision and update of the consensus. Therefore, this review aims to summarize the consensus among Child and Adolescent Psychiatrists from Türkiye on the nature and management of pediatric ADHD. For those aims, the etiology of ADHD, diagnostic and evaluation process, epidemiology, developmental presentations, differential diagnoses and comorbidities, course/outcome and pharmacological as well as non-pharmacological management options were reviewed and suggestions for clinical practice are presented. Since ADHD is a chronic disorder with wide-ranging effects on functionality that is frequently accompanied by other mental disorders, a multidimensional therapeutic approach is recommended. However, since the disorder has neurobiological basis, pharmacotherapy represents the mainstay of treatment. Additional therapies may include psychosocial therapy, behavioral therapy, school-based therapeutic approaches, and family education. This review provides recommendations for ADHD at the national and global levels. It contains information about ADHD that will contribute to and facilitate clinicians' decision-making processes. It is advisable to consider this guideline in clinical practice.

Autism spectrum disorder: Comorbidity and demographics in a clinical sample.

Objective: To determine the demographic and clinical characteristics of children followed up with the diagnosis of autism spectrum disorder (ASD) at a tertiary center in Southeeast Turkey. Methods: Children followed up with the diagnosis of ASD at a university hospital child psychiatry clinic between June 2016 and June 2021 were evaluated retrospectively for comorbidities, intellectual functioning and age at diagnosis. Results: In the preschool group, females displayed significantly more frequent cognitive developmental delay. Median age at diagnosis was 36 months (IQR= 22) regardless of gender. Approximately three-fourth (73.7%) of the cases had at least one psychiatric comorbid disorder while 22.8% had at least one medical diagnosis. Psychiatric comorbidity was found to be associated with later diagnosis. Conclusion: Although the age at first diagnosis in this study is relatively earlier than the studies in the literature, most of the children with ASD are still diagnosed very late. Psychiatric comorbidities may lead to later diagnosis due to overshadowing. Training of educational and primary healthcare workers on symptoms of ASD may enable earlier diagnosis.

Are Communication Skills, Emotion Regulation and Theory of Mind Skills Impaired in Adolescents with Developmental Dyslexia?

This study investigates pragmatic language impairment, Theory of Mind (ToM), and emotion regulation in adolescents with Developmental Dyslexia(DD). The Social Responsiveness Scale-2(SRS) and Children's Communication Checklist-2(CCC-2) scores were found to be statistically significantly higher in the DD group than in healthy controls. DD group had lower performance in ToM skills and they have more difficulties in emotion regulation. We also found that CCC-2 and ToM scores were significantly correlated in adolescents with DD. These results may be important in understanding the difficulties experienced in social functioning and interpersonal relationships in adolescents with DD.

Editorial: Neuropsychological Correlates of Irritability Accompanying Symptoms of Attention-Deficit/Hyperactivity Disorder: Clues and Pitfalls.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders and is characterized by developmentally inappropriate, pervasive, and impairing symptoms of inattention and/or hyperactivity/impulsivity.1 Although not listed among the core symptoms, irritability, reduced tolerance to frustration, and labile mood are considered features associated with ADHD.1,2 Irritability refers to a tendency to get angry quickly and/or easily at a lower threshold of frustration and respond disproportionately to triggers.3 Almost two-thirds of youth with ADHD may display impairing irritability, while rates of ADHD may be elevated among youth with clinically significant irritability.2 Irritability and impulsivity are thought to share neurobiological mechanisms that may overlap with executive and self-regulatory functions such as inhibitory control.3-5 The nature and developmental stability of these associations are still debated. Areas of controversy include the role of emotion regulation problems in positive vs negative emotions for impairment6; relations between those problems and risk-taking behavior, hyperactive-impulsive symptoms, and disruptive behavior problems2-5; and the nature of emotion regulation problems (ie, as core symptoms, as a feature of a variant of ADHD, or as a characteristic of specific comorbidities such as depression).2.

Differential Effects of Disruptive Mood Dysregulation Disorder Comorbidity in Attention Deficit Hyperactivity Disorder on Social Cognition and Empathy.

OBJECTIVE: This study aimed to investigate social cognition and empathy properties in children among Disruptive Mood Dysregulation Disorder (DMDD) + Attention and Hyperactivity Disorder(ADHD); ADHD and healthy controls from Türkiye. METHODS: Twenty-two children with DMDD were compared to matched 30 children with ADHD and 60 healthy controls. We administered Affective Reactivity Index (ARI), KaSi Empathy Scale, Kiddie-SADS, and Reading Mind in the Eyes Test (RMET) to evaluate Theory of Mind skills to all study participants. RESULTS: DMDD + ADHD group had lower performance in ToM skills and empathy than in two groups. The ARI scores were found to be statistically significantly higher in the DMDD group than in two groups. It was also found that ARI, empathy, and ToM scores were significantly related in children with DMDD + ADHD. CONCLUSION: These results might be important to understand the difficulties in social functioning and interpersonal relationship in children with DMDD and ADHD. Children with DMDD may attend specific therapeutic programs which include specific techniques in social cognition, emotion regulation, and irritability.

functional outcome in late adolescence/early adulthood of patients with autism spectrum disorder and its relationships with parental burnout and depression: A preliminary multi-center, cross-sectional study.

The aim of this study is to determine the functioning of adults with autism spectrum disorders (ASDs) diagnosed in childhood and depression and burnout levels among their parents. A total of 261 adults with ASDs and their parents were recruited for the study. Both parents completed the Beck Depression and Maslach Burnout Inventories and reported the functioning of their adult offspring with ASDs. Only 5.4 % of our sample reported "good" or "very good" outcomes. The most common psychiatric comorbidities were intellectual disabilities and attention-deficit/hyperactivity disorder. Maternal burnout and depression scores were significantly elevated compared to those of fathers. There is an undeniable urgent need for more research to identify the needs of adults and families suffering from ASD. Modifications for those with ASD may have to be made for support in workplaces, achieving driving licenses, using public transportation and attendance at tertiary education.

Emotion dysregulation and social communication problems but not ToM properties may predict obsessive-compulsive disorder symptom severity.

OBJECTIVE: Studies have shown that theory of mind, emotion regulation and pragmatic abilities are negatively affected in people with obsessive-compulsive disorder (OCD). We aimed to investigate theory of mind (ToM) abilities, social responsiveness, pragmatic language, and emotion regulation skills in children with OCD and to compare them to healthy controls. METHODS: This study was designed as a single-center, cross-sectional, case-control study. ToM abilities were evaluated via "Reading the Mind in the Eyes Test" (RMET), "Faces Test", "Faux-Pas Test", "Comprehension Test" and "Unexpected Outcomes Test". Social responsiveness, pragmatic language and emotion regulation were evaluated by Social Responsiveness Scale (SRS), Children's Communication Checklist- Second Edition (CCC-2), Difficulties in Emotion Regulation Scale (DERS) and Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Within the study period, we enrolled 85 adolescents (42 with OCD and 43 controls). RESULTS: The OCD group performed significantly lower than healthy controls in the Faux Pass and Comprehension tests (p = 0.003 for both). We found a statistically significant difference between groups in terms of the goal, strategy, non-acceptance subscales of the DERS (p < 0.001, p = 0.006, p = 0.008, respectively) as well as the total DERS score (p < 0.001). CY-BOCS total scores correlated significantly and negatively with Comprehension, Faux Pas and Unexpected Outcomes tests, and positively with CCC total, SRS total and DERS total scores. In regression analysis the DERS, SRS and CCC tests emerged as significant predictors of CY-BOCS total score. CONCLUSION: Addressing ToM, pragmatic, and ER difficulties when planning the treatment of young people with OCD may contribute to positive outcomes.

Early maladaptive schemas in episodic and chronic migraine in adolescents.

Introduction: Psychotherapies, such as schema therapy, are receiving increasing attention in the management of pediatric headaches. The purpose of this study was to investigate early maladaptive schemas (EMSs) in adolescents with episodic migraine (EM) and chronic migraine (CM). Methods: This clinic-based, cross-sectional study consisted of 167 adolescents, aged 12-18, who were diagnosed with EM (n = 140) and CM (n = 27). The clinical characteristics of migraine, its accompanying symptoms, EMSs, the interrelationship of EMSs, depression, and anxiety were evaluated. We specifically analyzed psychopathology and abuse history as covariates in this study. Results: Defectiveness/shame, mistrust/abuse, abandonment/instability, enmeshment/undeveloped self, self-sacrifice, and subjugation schemas were more prevalent in the CM group. In terms of schema domains, the CM group scored significantly higher in disconnection/rejection and other orientations. Psychopathology did not affect the EMS scores, but a history of sexual abuse did. In patients with EM, a relationship was found between the variables of anxiety, depression, and five of the EMS domains. On the other hand, the CM group showed a significant relationship with anxiety, hypervigilance/inhibition, disconnection/rejection, and other orientation domains. Discussion: This study highlights the value of EMSs, anxiety, and depression in young people with EM and CM. Schema therapy and schema-based therapeutic interventions should be researched, especially in pediatric migraine, as they may potentially prevent the progression to treatment-resistant migraine.

Parent rated bedtime resistance and comorbidity may predict levels of attention among Turkish children diagnosed with ADHD in on-line education classes during the COVID-19 outbreak.

OBJECTIVE: This study aimed to compare the attention levels, of Turkish children and adolescents with Attention Deficit/ Hyperactivity Disorder (ADHD) in on-line education classes with healthy controls. METHODS: This study is a cross-sectional, internet-based, case-control study that recruited 6-18 years old patients diagnosed with ADHD and receving treatment and healthy controls from eight centers. The measurements used in the study were prepared in the google survey and delivered to the participants via Whatsapp application. RESULTS: Within the study period, 510 children with ADHD and 893 controls were enrolled. Parent- rated attention decreased significantly in both groups during on-line education classes due to COVID-19 outbreak (p<0.001; for each). Children and adolescents with ADHD had significantly elevated bedtime resistance, problems in family functioning difficulties than control children according to parental reports (p=0.003; p<0.001; p<0.001, respectively). Furthermore, bedtime resistance and comorbidity significantly predicted attention levels in on-line education. CONCLUSION: Our findings may underline the need to augment student engagement in on-line education both for children without attention problems and those with ADHD. Interventions shown to be effective in the management of sleep difficulties in children as well as parent management interventions should continue during on-line education.

Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study.

OBJECTIVE: To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. METHOD: This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. RESULTS: Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). CONCLUSION: Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. DIVERSITY & INCLUSION STATEMENT: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Body-focused repetitive behaviors in children and adolescents, clinical characteristics, and the effects of treatment choices on symptoms: a single-center retrospective cohort study.

INTRODUCTION: This study determines clinical features of body-focused repetitive behaviors (BFRBs) among a sample of Turkish children and adolescents, evaluates the naturalistic treatments selected in this sample, and determines the effects of those treatments during a 3-month follow-up. METHODS: The study included a cohort of 67 patients 9 to 17 years old attending a tertiary center between March and June 2013 with complaints of nail biting, skin picking, and/or hair pulling. The patients completed psychometric scales and were evaluated for symptom severity, improvement, and adverse effects after an initial interview and at control visits during the 4th and 8th weeks. RESULTS: The most common BFRB was nail biting. In nail-biting behavior, subjective awareness was higher, and urges prior to the behavior and release after the behavior were found to be higher. Although there was no significant difference between the choice of treatment and the course of psychiatric measures, significant improvement was found in functionality after treatment. CONCLUSIONS: Despite its limitations, the small number of studies on BFRBs increases the importance of studies in this area.

Impaired Affect Perception in Presence of Spared Electrodermal Activity with Affective Stimuli Among Children with Specific Learning Disorder: A Controlled Study.

Introduction: The aim of this study was to compare children with Specific Learning Disorders (SLD) and matched controls in terms of nonverbal communication skills, understanding of emotions, electrodermal activity (EDA) changes and response latencies measured with affective stimuli. Method: The study was designed as a single-center, cross-sectional, controlled study. KA-SI Empathic Tendency Scale-Child Form, Test of Perception of Affect-Via Nonverbal Cues (TPANC) were used for both groups. The TPANC test was performed in 4 different sessions (for picture, video, audio and textual stimuli), and during each session, the EDA was measured from the non-dominant hand. Stimuli were given at 15 second intervals in the tests and phasic changes within 3-8 seconds after the stimulus was accepted as skin conductance responses related to the stimulus in accordance with the literature. The responses and response latency during the TPANC test were recorded by the clinician. Results: 31 children with SLD and 31 healthy controls were included in the study. The mean ages for SLD and controls were 10 years 6 months and 10 years 1 month; respectively. In the SLD group, the number of correct responses in all subtests of TPANC was statistically significantly lower than controls (p<0.05). When TPANC subtests response latencies were compared, there was a significant increase in the SLD group compared to controls (p<0.05). The groups did not display a significant difference in EDA changes while providing responses in TPANC. Conclusion: Our results contribute to the literature on the affect recognition and its autonomic correlates among children with SLD. However, dependence on a single-modality for autonomic nervous system reactivity and limited sample size may affect our results and further studies with larger samples employing multiple domains of autonomic reactivity may be needed.

Elevated neurotensin levels among obese adolescents may be related to emotion dysregulation and impulsivity: a cross-sectional, case-control study.

BACKGROUND: In this study, we aimed to evaluate the serum neurotensin (NT) levels and their relationships with self-reported anxiety, emotion regulation skills and impulsivity in healthy and obese adolescents. METHODS: Adolescents who gained weight between 12- 17 years of age and who were above the 95th percentile (p) for body mass index (BMI) > 95p were compared with age- and gender-matched healthy adolescents with a BMI of 3-85 p. Anthropometric measurements were performed, and serum NT levels were analyzed with ELISA method in all participants. Barrat Impulsivity Scale-11 (BIS-11), Screen for Child Anxiety Related Disorders (SCARED) and Difficulties in Emotion Regulation Scale (DERS) were used for evaluating self-reported impulsivity, anxiety and emotion regulation. MANOVA with follow-up univariate ANOVAs (Bonferroni corrected) were used for group comparisons. P was set at 0.05 (two-tailed). RESULTS: Sixty-five obese and 65 healthy adolescents were included in the study. In the obese group, NT levels were significantly elevated compared to the control group. Self-reported emotion-regulation difficulties, anxiety and impulsivity were significantly elevated among obese adolescents. Serum NT levels among the obese group were positively correlated with emotion dysregulation and impulsivity scores. CONCLUSIONS: In this study, we found emotional dysregulation, anxiety, impulsivity, and serum NT levels were significantly elevated among obese adolescents compared to controls. NT levels in the obese group correlated with impulsivity and emotion dysregulation. Further studies should evaluate the potential role of NT in the etiology of psychopathology among adolescents who are obese.

Early maladaptive schemas differing according to sex may contribute to migraine among the youth.

OBJECTIVE: Despite many diverse findings from studies about the comorbidity of psychiatric disorders and migraine, there are still unknown points. Schemas, which are the basic structures of cognition, are understudied. This study examined the effects of sex on early maladaptive schemas (EMSs) and the clinical characteristics of migraine in adolescents with migraine. METHODS: The sample comprised 171 adolescents (67.3% females, n = 115) aged 12-18 years. The clinical characteristics of migraine (duration, severity, frequency of headaches, etc.), accompanying symptoms (nausea, vomiting, photophobia, etc.) and EMSs were evaluated depending on sex. Psychopathology and abuse history were analyzed as covariates in this study. RESULTS: The mean age was 15.4 ± 1.9 among the females and 15.2 ± 2.0 among the males (p = 0.65). There was no difference in terms of migraine characteristics, and except for dizziness and pain relief by massage, all other symptoms were similar between the sexes. Female adolescent migraineurs significantly elevated scores for EMS of emotional deprivation, abandonment/instability, defectiveness/shame (disconnection/rejection domain), dependence/incompetence, vulnerability to harm/illness, failure (in impaired autonomy/performance domain) and negativity/pessimism (in hypervigilance/inhibition domain). On the other hand, male migraineurs had significantly elevated scores only in insufficient self-control/self-discipline (in impaired limits domain). Type of migraine and current psychopathology had no significant effect on the EMS domains, while sexual abuse history significantly affected some EMS. CONCLUSION: Our study highlights the importance of screening for EMSs among adolescent patients with migraine. Schema therapy and similar therapeutic interventions may be used in the management of migraine in adolescents. Gender may also be important factor the schema therapy in adolescent migraine patients.

CYP450 2D6 and 2C19 genotypes in ADHD: not related with treatment resistance but with over-representation of 2C19 ultra-metabolizers.

OBJECTIVES: Cytochrome P450 (CYP450) is a major enzyme system involved in drug metabolism as well as regulation of brain function. Although individual variability in CYP enzymes have been studied in terms of personality traits and treatment effects, no study up to now evaluated CYP polymorphisms in children with attention deficit/hyperactivity disorder (ADHD). We aimed to define the genetic profiles of CYP2D6 and CYP2C19 relevant alleles in children with ADHD according to treatment status and compare the frequencies according to past results. METHODS: Three hundred and seventeen patients with ADHD-Combined Presentation were enrolled; symptom severity was evaluated by parents and clinicians while adverse effects of previous treatments were evaluated with parent and child reports. Reverse blotting on strip assays was used for genotyping and descriptive and bivariate analyses were conducted. A p-value was set at 0.05 (two-tailed). RESULTS: Children were divided into treatment-naïve (n=194, 61.2%) and treatment-resistant (n=123, 38.8%) groups. Within the whole sample PM, EM and UM status according to 2D6 were 3.8% (n=12), 94.3% (n=299) and 21.9% (n=6); respectively. PM, IM, EM and UM status according to 2C19 were 2.5% (n=8), 19.8% (n=63), 48.6% (n=154) and 29.0% (n=92), respectively. No relationship with treatment resistance, comorbidity or gender could be found. Importantly, CYP2C19 UMs were significantly more frequent in ADHD patients compared to previous studies in the general population. CONCLUSIONS: CYPs may be a rewarding avenue of research to elucidate the etiology and treatment of patients with ADHD.

Evaluation of peripheral inflammatory markers, serum B12, folate, ferritin levels and clinical correlations in children with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD).

AIM: The aim of the current study is to compare serum B12, folate, and ferritin levels and peripheral inflammatory indicators between children with Autism Spectrum Disorders (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and healthy controls (HC) and to evaluate the correlation of those with symptoms. MATERIALS AND METHODS: A total of 203 children were evaluated (ASD = 72; ADHD = 61; HC = 70). Diagnoses of ASD and ADHD were ascertained according to Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL). Control group was chosen among the healthy children who applied to general pediatrics outpatient clinic. Gilliam Autism Rating Scale-2 is used to assess autistic symptoms and Atilla Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale is used for ADHD symptoms. RESULTS: Neutrophil levels (p = 0.014) and neutrophil/lymphocyte ratio (NLR) (p = 0.016) were higher in the ADHD and ASD groups compared to HC. Neutrophil values explained 70.1% of the variance across groups while NLR explained a further 29.9% of the variance. NLR significantly correlated with social interaction problems in ASD (r = 0.26, p = 0.04). There were no significant differences between groups in terms of vitamin B12, folate and ferritin levels. CONCLUSION: Our results may support involvement of inflammation in the underlying pathophysiology of neurodevelopmental disorders. However, these parameters should be analyzed in a wider population to clarify the effect on the etiology and symptomatology of neurodevelopmental disorders.

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.

Correlates and predictors of re-incarceration among Turkish adolescent male offenders: A single-center, cross-sectional study.

BACKGROUND: Adolescents involved in the legal system are known to be under elevated risk for repeat offending. There may be many reasons for recidivism. Specifically, we aim to investigate the clinical, socio-demographic, and familial factors and psychopathology among adolescents in a penal institution and to determine risk factors for re-incarceration. METHODS: This single-center cross-sectional survey was conducted at Tarsus Closed Penal Institution for Children and Youth. This institution is for males only, and all male adolescents detained at the center within the study period were evaluated with semi-structured interviews (K-SADS-PL). The adolescents completed Meaning and Purpose of Life Scale, The EPOCH measure of Adolescent Well-being, Family Sense of Belonging Scale, Children's Alexithymia Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory for themselves. Descriptive and inferential analyses were used. P was set at 0.05. RESULTS: Ninety adolescent offenders with a mean age of 16.6 years (S·D = 0.7) were enrolled. Mean age at first offense was 14.6 years (S·D = 2.1). The most common reason for offenses was reported as as being with peers who were offenders, too (57.8%). Most common diagnoses were substance use (36.7%), attention deficit/hyperactivity disorder (33.3%), and conduct disorder (26.7%). Rates of offending and conviction in first-degree relatives were 62.2% and 60.0%, respectively, and most of the adolescents had at least one peer with a criminal record (n = 71, 78.9%). Re-incarcerated adolescents had lower education, committed more violent crimes, and reported elevated use of substances, suicide attempts, and psychopathology. However, in regression analysis, age of onset was the sole predictor of re-incarceration. CONCLUSION: Turkish male adolescents in forensic settings may be screened for externalizing disorders and referred for treatment. Re-incarcerated Turkish youth may be more susceptible to peer influence, substance use and externalizing disorders. It may be prudent to systematically screen offending youth for psychiatric disorders regardless of the individual's request for treatment and refer identified cases to treatment. Integration of child and adolescent psychiatrists with penal institutions serving youth may help in this regard.