Screening for affective dysregulation in school-aged children: relationship with comprehensive measures of affective dysregulation and related mental disorders.

Affective dysregulation (AD) is characterized by irritability, severe temper outbursts, anger, and unpredictable mood swings, and is typically classified as a transdiagnostic entity. A reliable and valid measure is needed to adequately identify children at risk of AD. This study sought to validate a parent-rated screening questionnaire, which is part of the comprehensive Diagnostic Tool for Affective Dysregulation in Children (DADYS-Screen), by analyzing relationships with comprehensive measures of AD and related mental disorders in a community sample of children with and without AD. The sample comprised 1114 children aged 8-12 years and their parents. We used clinical, parent, and child ratings for our analyses. Across all raters, the DADYS-Screen showed large correlations with comprehensive measures of AD. As expected, correlations were stronger for measures of externalizing symptoms than for measures of internalizing symptoms. Moreover, we found negative associations with emotion regulation strategies and health-related quality of life. In receiver operating characteristic (ROC) analyses, the DADYS-Screen adequately identified children with AD and provided an optimal cut-off. We conclude that the DADYS-Screen appears to be a reliable and valid measure to identify school-aged children at risk of AD.

Remote assessment of ADHD in children and adolescents: recommendations from the European ADHD Guidelines Group following the clinical experience during the COVID-19 pandemic.

The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some remote practices. The lack of clear evidence-based guidance about the most appropriate way to conduct remote assessments meant that these changes were typically implemented in a localised, ad hoc, and un-coordinated way. Here, the European ADHD Guidelines Group (EAGG) discusses the strengths and weaknesses of remote assessment methods of children and adolescents with ADHD in a narrative review based on available data and expert opinions to highlight key recommendations for future studies and clinical practice. We conclude that going forward, despite remote working in clinical services functioning adequately during the pandemic, all required components of ADHD assessment should still be completed following national/international guidelines; however, the process may need adaptation. Social restrictions, including changes in education provision, can either mask or exacerbate features associated with ADHD and therefore assessment should carefully chart symptom profile and impairment prior to, as well as during an ongoing pandemic. While remote assessments are valuable in allowing clinical services to continue despite restrictions and may have benefits for routine care in the post-pandemic world, particular attention must be paid to those who may be at high risk but not be able to use/access remote technologies and prioritize these groups for conventional face-to-face assessments.

Impact of the COVID-19 pandemic on children with and without affective dysregulation and their families.

Analyzing COVID-19-related stress in children with affective dysregulation (AD) seems especially interesting, as these children typically show heightened reactivity to potential stressors and an increased use of maladaptive emotion regulation strategies. Children in out-of-home care often show similar characteristics to those with AD. Since COVID-19 has led to interruptions in psychotherapy for children with mental health problems and to potentially reduced resources to implement treatment strategies in daily life in families or in out-of-home care, these children might show a particularly strong increase in stress levels. In this study, 512 families of children without AD and 269 families of children with AD reported on COVID-19-related stress. The sample comprised screened community, clinical, and out-of-home care samples. Sociodemographic factors, characteristics of child and caregiver before the pandemic, and perceived change in external conditions due to the pandemic were examined as potential risk or protective factors. Interestingly, only small differences emerged between families of children with and without AD or between subsamples: families of children with AD and families in out-of-home care were affected slightly more, but in few domains. Improvements and deteriorations in treatment-related effects balanced each other out. Overall, the most stable and strongest risk factor for COVID-19-related stress was perceived negative change in external conditions-particularly family conditions and leisure options. Additionally, caregiver characteristics emerged as risk factors across most models. Actions to support families during the pandemic should, therefore, facilitate external conditions and focus on caregiver characteristic to reduce familial COVID-19-related stress. Trial registration: German Clinical Trials Register (DRKS), ADOPT Online: DRKS00014963 registered 27 June 2018, ADOPT Treatment: DRKS00013317 registered 27 September 2018, ADOPT Institution: DRKS00014581 registered 04 July 2018.

Trust, but verify. The errors and misinterpretations in the Cochrane analysis by O. J. Storebo and colleagues on the efficacy and safety of methylphenidate for the treatment of children and adolescents with ADHD.

Objective: A recent Cochrane review published by O. J. Storebo and colleagues (2015) raised substantial doubts about the benefit from stimulant medication with methylphenidate in the treatment of childhood ADHD due to the overall poor quality of studies. The systematic review thus contradicts all previous reviews and meta-analyses. Method: We here detail various examples of errors, inconsistencies, and misinterpretations in the review which led to false results and inadequate conclusions. Results: We demonstrate that the study selection is flawed and undertaken without sufficient scientific justification resulting in an underestimation of effect sizes, which, furthermore, are inadmissibly clinically interpreted. The methodology of the assessment of bias and quality is not objective and cannot be substantiated by the data. Conclusions: Cochrane reviews lay claim to a high scientific quality and substantial relevance for evidence-based clinical decisions. The systematic review by Storebo and colleagues (2015) illustrates that, despite adhering to strict standards and high-quality protocols, even Cochrane works should be critically read and verified, sometimes with surprising results.

[Early onset psychosis: rationale and concept of a cognitive-behavioral intervention]. / Jugendliche mit psychotischen Störungen: Rationale und Konzept einer kognitiv-verhaltenstherapeutischen Intervention.

Early onset psychoses (EOP, age of onset between age 14 and 18 years) are known to be associated with a poorer outcome than adult onset psychoses, both in terms of psychotic symptoms and social remission. For adult patients with psychosis, numerous cognitive-behavioral interventions have proven their effectiveness in recent years. This contrasts with a dearth of findings for EOP, even though it can be considered as a variant of adult onset psychosis. Thus, we have developed a cognitive-behavioral therapy intervention that was specifically adapted to the characteristics and needs of young people suffering from psychosis. The concept of the intervention is outlined in the present article. Acceptability and feasibility of the intervention are currently undergoing evaluation in a randomised, controlled pilot study.

European guidelines on managing adverse effects of medication for ADHD.

The safety of ADHD medications is not fully known. Concerns have arisen about both a lack of contemporary-standard information about medications first licensed several decades ago, and signals of possible harm arising from more recently developed medications. These relate to both relatively minor adverse effects and extremely serious issues such as sudden cardiac death and suicidality. A guidelines group of the European Network for Hyperkinetic Disorders (EUNETHYDIS) has therefore reviewed the literature, recruited renowned clinical subspecialists and consulted as a group to examine these concerns. Some of the effects examined appeared to be minimal in impact or difficult to distinguish from risk to untreated populations. However, several areas require further study to allow a more precise understanding of these risks.

Effectiveness of the prevention program for externalizing problem behaviour (PEP) in children with symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder--generalization to the real world.

The aim of the present study was to test the effectiveness of the Prevention Program for Externalizing Problem Behaviour (PEP). PEP has already been evaluated as an efficacy study, i.e., with high internal validity. The main concern of the current study was to test the effects of PEP under conditions of high external validity.58 child therapists of 37 local institutions of the public health system held PEP trainings. The intervention was evaluated by a within-subject control group design with three assessment points, two before (pre1 and pre2) and one immediately after (post) the PEP training. Depending on the type of analysis, 198 up to 277 families with children aged 3-10 years were included. Data were collected by questionnaires and comprised symptomatology of the child and the mother as well as parenting. For parenting and child behaviour problems, changes after treatment were greater than changes during the waiting period. PEP produced effect sizes in the small to moderate range. The results suggest that PEP can be delivered under routine care settings without loss of positive treatment effects. As worse results are often obtained in effectiveness trials, these findings have to be regarded as particularly promising.

[The effectiveness of atomoxetine in children, adolescents, and adults with ADHD. A systematic overview]. / Wirksamkeit von Atomoxetin bei Kindern, Jugendlichen und Erwachsenen mit ADHS. Eine systematische Ubersicht.

This paper gives an overview of the pharmacology, efficacy, duration, tolerance, and side effects of atomoxetine for children, adolescents, and adults. A systematic analysis of the published clinical studies and poster abstracts was conducted. Atomoxetine is the first selective inhibitor of the noradrenaline transporter that was approved by the FDA in the US as a nonstimulant for the treatment of ADHD in children, adolescents, and adults. In clinical studies, its efficacy was studied in 4,000 patients. Compared with placebo, atomoxetine proved to be superior with respect to reducing impulsiveness, hyperactivity, and inattention. There are indications that its efficacy is comparable to that of methylphenidate. In general, atomoxetine was well tolerated. The most frequently reported adverse events were decrease of appetite, abdominal problems, tiredness, and vertigo. These were classified as mild and found mostly at the beginning of treatment. The existing results indicate that atomoxetine is promising for the treatment of ADHD in children, adolescents, and adults.

[The psychopathy-concept and its psychometric evaluation in childhood, adolescence and adulthood]. / Das Psychopathy-Konzept und seine psychometrische Erfassung im Kindes-, Jugend- und Erwachsenenalter.

The psychopathy concept in accordance with Robert Hare was operationalized in 1985 when the revised form of the Psychopathy Checklist (PCL-R) was published. Since then, the PCL-R has been used internationally in prognosis and therapy research. In North America, personality traits of psychopathy have also been studied in children and juveniles for several years by now. On the basis of the PCL-R, a checklist for adolescents (PCL-YV) was developed that takes the special conditions of adolescents into account. In juveniles with a high score research with the PCL-YV demonstrated a lack of empathy, impulsivity and social adjustment disorder. Furthermore, researchers found associations between the number and severity of violent offences, early drug abuse and earlier recidivism, i. e. repeated criminality. The biological determinants of these dimensions are discussed as well as associated questions about recent specific therapy concepts and diagnostic aspects of psychopathy in juveniles.

[Disorder attribution in psychiatric problems of adolescents. A pilot study of inventory validation of disorder attribution of psychiatric problems in adolescents]. / Störungskonzepte für psychische Probleme bei Jugendlichen. Pilotstudie zur Validierung eines Fragebogens zu Störungskonzepten bei psychischen Problemen von Jugendlichen (SPPJ).

OBJECTIVES: The first Questionnaire on Disorder Concepts for Mental Problems in Adolescents (SPPJ) was developed on the basis of the attributional theory (health locus of control) and validated in a population of 54 adolescents with mental disorder hospitalized primarily as in-patients. METHODS: Analysis of consistency, correlation with the test for locus of control in health and illness (KKG-Test), scale intercorrelation, correlation with the Frankfurt Self-Concept Scales, therapy cooperation and prognosis. RESULTS: The SPPJ distinguishes between causal attributions and locus of control and proves to be a reliable measuring instrument that delivers satisfactory correlations to the statement of general measuring instruments (KKG-Test). Contrary to our expectations there is no significant positive correlation between internal locus of control and cooperation and prognosis. An external, powerful-others causal attribution has a negative effect upon cooperation, while an external powerful-others locus of control has a positive effect upon it. CONCLUSIONS: Adolescent self-assessment of mental problems is a defined research subject different from illness or health concept variables in adults or concerning bodily illness. Adolescents who are less inclined to blame others for their problem and who value professional competence are probably more accepting of interventions and more compliant. Further research in this area is necessary. On the basis of the attributional theory more attention must be paid to the substantial difference between locus of (treatment) control and causal attributions.

[Child is inattentive, cannot sit still, disturbs the classroom. Is it really a hyperkinetic disorder?]. / Kind ist unaufmerksam, kann nicht still sitzen, stört den Unterricht. Ist es wirklich eine hyperkinetische Störung?

The clarification of attention-deficit/hyperactivity disorder (ADHD) requires an unequivocal categorization of the diagnostic criteria and a differentiation of the condition from normal variations and other disorder patterns. The ICD-10 criteria comprise the main symptoms inattention, hyperactivity and impulsivity. In kindergarten and preschool children, hyperactivity predominates, while in schoolchildren poor attention and cognitive impulsivity tend to be to the fore. In adolescence, aggressiveness and dissocial behavior coupled with drug abuse become central. In adulthood, ADHD is associated in particular with a tendency towards a lower social status and more frequent delinquency. Establishment of the diagnosis of ADHD requires information from the person to whom the individual relates. In this connection, exploration schemas, check lists and questionnaires are often very helpful. With regard to the differential diagnosis, mental disturbances due to physical causes (e.g. hearing disorders, epilepsy, etc.) must be excluded. Consideration must also be given in particular to comorbidities--found in up to two-thirds of cases--in which disordered social behavior, affective disorders and anxiety disturbances dominate.

[Multimodal therapy concept in hyperkinetic disorder. Drugs alone are not enough]. / Multimodales Therapiekonzept bei hyperkinetischer Störung. Mit Medikamenten alleine ist es nicht getan.

For the treatment of attention deficit/hyperactivity disorder, both medical and behavioral therapeutic concepts have been shown to be effective. Somewhat problematical, however, is the fact that a large percentage of these children retain residual symptoms that need treating over a longer period of time. The value of a multimodal therapeutic approach (combination of medication and behavioral treatment including counseling of parents, teachers and the patient) remains controversial. Over the long-term, and account being taken of a number of indicators extending beyond the core symptoms, however, the multimodal treatment concept would appear superior to treatment solely with psychostimulants. For effective treatment accurate titration and the recording of the changes occurring under medication are important.

Discriminant validity of the child behaviour checklist CBCL-4/18 in German samples.

This study examined the discriminant validity of the German version of CBCL in two large samples of referred and non-referred children and adolescents which were matched for age, sex and socio-economic status. The combined sample that was used for statistical analysis consists of 2,058 referred and 2,058 non-referred boys and girls between 4 and 18 years of age (mean age: referred boys= 10.9 years, non-referred boys = 10.9 years, referred girls=11.3 years, non-referred girls=11.1 years). Referral status was used as validity criterion. Statistical procedures included Odds Ratios, Total Predictive Values, ROC analyses and discriminant analyses. Results indicated that the discriminant validity of the German version of CBCL is comparable to the original English version. With the use of CBCL Total Problem Score as predictor (cut-off T > or = 60) 83.8% of children and adolescents could correctly be classified (sensitivity 83.6%, specificity 83.9%). Symptoms of the "Attention Problems Scale" show the highest discriminative power to distinguish between disturbed and undisturbed children and adolescents.

[Drug therapy of hyperkinetic diseases in adults]. / Pharmakotherapie hyperkinetischer Störungen im Erwachsenenalter.

Attention deficit hyperactivity disorder (ADHD) is often diagnosed in children. Some major studies proved that symptoms can persist until the patients are grown up and that the prevalence of adult ADHD is underestimated. The classification systems ICD-10 and DSM-IV allow a diagnosis for adults, they differ, however, from childhood regarding symptoms. The diagnostic procedure requires extensive exploration and information from parents and school. Diagnostic interview procedures and questionnaires for self and expert rating are available to date only for English speaking countries. Apart from counselling and psychotherapeutic intervention pharmacotherapy is a third option. Especially stimulants proved to be an efficient treatment. Alternatively tricyclic antidepressants can be considered, other agents play only a minor role. Clinical trials trying to evaluate the efficacy of different pharmacotherapeutic agents are lacking.

[Abbreviated Psychopathological Scale in basic documentation in child and adolescent psychiatry--results of a multicenter study]. / Die Kurzfassung des Psychopathologischen Befundsystems in der Basisdokumentation Kinder- und Jugendpsychiatrie--Ergebnisse aus einer multizentrischen Studie.

The short form of the Clinical Assessment Scale of Child and Adolescent Psychopathology (CASCAP) assesses psychopathological features only on the level of symptom domains and not on the level of single symptoms. The instrument is part of the basic documentation of child and adolescent psychiatry. Based on the multicenter study sample of CASCAP the ratings of the symptom domains in the different centers were analysed. Inpatients receive higher ratings than outpatients on nearly all symptom domains. Only minor differences could be found between the centres. Advantages and disadvantages of this short version are discussed.

[Incidence of psychiatric symptoms and somatic complaints in 4- to 10-year-old children in Germany as judged by parents--a comparison of norm-oriented and criteria-oriented models]. / Häufigkeit psychischer Auffälligkeiten und somatischer Beschwerden bei vier- bis zehnjährigen Kindern in Deutschland im Urteil der Eltern--ein Vergleich normorientierter und kriterienorientierter Modelle.

OBJECTIVES: To analyze the frequency of behavioral/emotional problems and somatic complaints of children aged four to ten as rated by their parents. METHOD: The analysis is based on the PAK-KID study on behavioural and emotional problems and psychosocial competencies of children and adolescents in Germany. In a nationally representative sample of N = 1030 children aged four to ten years the parents rated their child using the Child Behavior Checklist. RESULTS: The prevalence rates of the symptoms are presented. Additionally global prevalence rates based on three different models were calculated and compared. They range from 13.1% to 28.3%. The issues of defining cutoffs necessary for the calculation of prevalence rates are discussed.

[Comparison of 2 clinics with reference to axis 5 of the MAS: different patient populations or regional characteristics?]. / Klinikvergleich im Hinblick auf die Achse 5 des MAS: Unterschiedliche Inanspruchnahmepopulationen oder regionale Besonderheiten?

OBJECTIVE: The university departments of child psychiatry in Cologne and Berlin were compared to assess whether quantitative differences in reported abnormal psychosocial situations (Axis 5 MAS of ICD-10) are due to a difference in patient population or coding practices or to particular regional conditions. METHOD: Data were analyzed for 593 patients seen in Cologne in 1992/93 and for 685 patients seen in Berlin in the same period. The broader social situation was described by sociodemographic data from the respective city. RESULTS: Berlin showed about twice as many psychosocial stressors per patient as Cologne. Consistent relationships between axis 5 stress ratings and other parameters indicated the validity of the data. Only a few points of inconsistency in the data were found. The sociodemographic data for both cities revealed a greater number of single parents as well a a higher rate of suicide in Berlin. CONCLUSIONS: Indicators for the validity of the clinical data analyzed were found. Some special internal clinical and regional conditions were identified as contributing to the quantitative differences between the two university departments.