Online Behavioral Addictions Among Adolescents Before and After the COVID-19 Pandemic.

Background The COVID-19 pandemic changed people's lives and created a "new normal." It threatened individuals' mental health owing to reduced physical activity and social interaction, excessive indoor time, financial hardship, and insecurity. Moreover, the risk of online behavioral addiction increased in the general population, particularly among adolescents. The present study examined the differences between the pre-and post-pandemic periods regarding online behavioral addictions in adolescents. Methods The pre-pandemic data were obtained from 175 adolescents (August 2019 to February 2020) (T1). An online survey was sent to these participants to obtain the post-pandemic data (March to September 2022) (T2). Seventy participants completed the online survey (response rate: 40%). The participants completed the Smartphone Addiction Scale (SAS), the Internet Gaming Disorder Scale 9-Short Form (IGDS9-SF), and the Social Media Disorder Scale-Short Form (SMDS-SF) both before and after the pandemic. Results  Before the pandemic, females had significantly higher SMDS-SF scores compared to males (p = 0.005). On the other hand, males had higher IGDS9-SF scores than females before the pandemic (p<.001). Individuals with attention deficit hyperactivity disorder (ADHD) had higher IGDS9-SF scores before the pandemic than those with depressive disorders or other diagnoses (p = 0.004). However, the primary diagnosis was not related to pre-pandemic SAS and SMDS-SF scores. Lastly, there was no significant difference in IGDS9-SF (p = 0.151), SMDS-SF (p = 0.200), or SAS scores (p = 0.413) between pre-pandemic and post-pandemic scores. Conclusion Although the current study did not support this view, in emotionally challenging times, people may spend more time on online activities, which can lead to behavioral addiction. It is important for parents to monitor their children's online activities and provide guidance. More research is needed to compare online behavioral addictions before and after the pandemic.

Evaluation of long-term psychopathology and sleep quality in children and adolescents who presented to a university pandemic clinic with possible COVID-19 symptoms.

OBJECTIVE: The first articles about the impact of COVID-19 infection focused on the physical health and existing well-being of children and adolescents. However, little is known about the long-term effects of the disease itself, especially being infected with the virus and even the possibility of the infection on their mental health. Therefore, this study aimed to examine the long-term psychological effects of the disease. METHOD: The study was designed as cross-sectional quantitative research. For this, the medical records of all 8-18-year-old children who presented to a university pandemic clinic in 2020 with possible COVID-19 symptoms were scanned. One hundred 62 children, with the first presentation date of 6 months ago and earlier, were divided into three groups. Group 1 consisted of children with chronic diseases who were hospitalized at the time of admission and continued to be hospitalized in the follow-up after they were PCR( +; polymerase chain reaction +). Group 2 comprised children without chronic diseases and continued outpatient follow-up after they were PCR(+). Finally, Group 3 was constituted by children with chronic diseases who were hospitalized at the time of admission but were discharged after their test was negative. A control group was also included. RESULTS: It was found that presenting to a pandemic clinic with possible COVID-19 symptoms, being PCR-positive for COVID-19, and being hospitalized with a verified disease posed a significant risk to children for the development of mental disorders, including anxiety, depression, posttraumatic stress disorder (PTSD), and sleep disorders. CONCLUSION: Thus, prompt identification of at-risk populations, early intervention, and effective management of diagnosed disorders is necessary. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychiatric Disorders and Peer-Victimization in Children and Adolescents With Growth Hormone Deficiency.

In this study, we aimed to investigate psychiatric disorders, bullying/victimization, and quality of life in children and adolescents with idiopathic growth hormone deficiency (GHD). Sixty-one children and adolescents who were diagnosed as having idiopathic GHD were evaluated using a semistructured interview by a child and adolescent psychiatrist. Some 45.9% of the subjects with GHD were diagnosed with at least 1 psychiatric disorder. The most common psychiatric diagnosis was social anxiety disorder (18.3%). Twenty-eight percent of the subjects reported being bullied by their peers. Victimization rates were less frequent in those treated for more than 1 year. Children aged between 6 and 12 years had poorer quality of life and higher anxiety levels than adolescents aged between 13 and 18 years. Due to the higher rates of existing psychiatric disorders, the clinical management of patients with GHD should be conducted with a multidisciplinary approach, in which pediatric endocrinologists and mental health professionals work in coordination.

Psychological State of Parents of Children with Primary Immunodeficiencies During the COVID-19 Pandemic.

Background: COVID-19 has affected humanity not only physically but also mentally. It was expected to have impact on high-risk groups such as the immunocompromised patients and parents/caregivers of them. Our study was aimed to investigate the COVID-19 related anxiety, post-traumatic stress levels, and sleep-related parameters of the parents of children with primary immunodeficiency. Methods: Parents of children with primary immunodeficiency and age and gender-matched control group completed questionnaires. Results: Anxiety and post-traumatic stress levels of the study group were found to be significantly higher than the control group. Furthermore, sleep time of the study group was significantly lower than the control group. The subjective sleep quality of the study group was also lower in the study group, but the difference did not reach a significant level. Conclusions: In the ongoing and other possible pandemic processes, professional support for the parents of these children is of great importance.

Elevated neutrophil-to-lymphocyte ratio in children and adolescents with attention-deficit/hyperactivity disorder.

OBJECTIVE: Inflammation is reported to play a substantial role in the pathophysiology of attention-deficit/hyperactivity disorder (ADHD). Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are inexpensive and potentially interesting biomarkers of inflammation. In this cross-sectional and retrospective study, we investigated the relationship between NLR, PLR and ADHD. METHODS: This study consisted of 100 children and adolescents with ADHD (85 of those receiving psychopharmacological treatment), and 99 physically and mentally healthy children. RESULTS: The mean NLR and PLR were significantly higher in patients than in controls. There was no significant difference between patients who received psychopharmacological treatment for ADHD and patient that did not with regard to NLR and PLR. No associations were found between NLR and PLR and ADHD symptom severity. The significance of NLR is not influenced by medication use, age and sex. CONCLUSIONS: Our findings suggest that NLR and PLR may be inflammation biomarkers in children and adolescents with ADHD. Moreover, the significance of NLR is not influenced by medication use, age and sex. Prospective studies that address alterations in NLR and PLR and other pro-inflammatory cytokines following ADHD treatment may provide additional information about the inflammatory mechanisms in ADHD.Key pointsThe mean NLR and PLR were significantly higher in patients than in controls.The significance of NLR is not influenced by medication use, age and sex.No associations were found between NLR and PLR and ADHD symptom severity.Prospective studies that address alterations in NLR and PLR and other pro-inflammatory cytokines following psychopharmacological treatment of ADHD may provide additional information about the inflammatory mechanisms in ADHD.

Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter Study.

BACKGROUND: Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons' illness, has not been studied previously in pediatric psoriasis patients. OBJECTIVE: We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients. METHODS: This multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study. RESULTS: The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores. CONCLUSION: Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.

Can gestation be considered as trauma in adolescent girls: post-traumatic stress disorder in teen pregnancy.

Although post-traumatic stress disorder (PTSD) in adolescent pregnancy has been reported at high rates in the limited research in this area, no studies have evaluated gestation as trauma in teens. This study, aimed to evaluate PTSD in this high risk group. All pregnant adolescents who presented to our obstetrics and gynaecology clinics in a one-year period were invited to participate in the study. Adolescents with a history of domestic or dating violence, rape, and sexual abuse were excluded. PTSD was rated using the Child Post-Traumatic Stress Disorder-Reaction Index. When the pregnant adolescents and control group were compared, various severities of PTSD were observed in nearly two-thirds of the study group. Although there was clinically significant PTSD among 23.3% of the controls, PTSD was more frequently seen in adolescents with pregnancy compared with their healthy peers. Educating adolescents about birth control methods and preventing child marriages will be protective in this respect.Impact statementWhat is already known on this subject? Teen pregnancy has significant psychosocial and economic impacts for adolescents, their offspring, and the community in terms of education and employment, increased risk of abuse and neglect, and the physical and emotional well-being of the offspring. Pregnancy and birth-related risks are also higher than in adults. In this context, pregnancy itself may be accepted as trauma for adolescents.What do the results of this study add? There has been limited research on PTSD in pregnant teens and is mainly associated with traumatic childhood events. This is the first study to examine pregnancy-related PTSD and related conditions in this group.What are the implications of these findings for clinical practice and/or further research? The prevalence of pregnancy related-PTSD in pregnant teens can be considered high and alarming, considering the fact that most of them had never been treated for it at all. Healthcare providers serving this population need to be trained to recognise the core symptoms of PTSD, and should direct adolescents for professional assistance if needed. Strategies such as higher quality sexual health education and greater access to reproductive health services to reduce adolescent pregnancy and marriage are also imperative.

Psychopathology, quality of life, and related factors in pediatric liver transplantation candidates and recipients.

BACKGROUND: Liver transplantation (LT) has been accepted as a standard treatment of pediatric liver diseases that can progress to end-stage liver disease or lead to acute liver failure. However, there is a lack of studies clarifying quality of life (QoL) and the characteristics and the prevalence of common psychiatric disorders in children before and/or after LT. Thus, this study aimed to investigate QoL and the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in children and adolescents before and after LT and to compare them with healthy controls. METHODS: The study included 30 children aged 5-18 years who were waiting for LT (pTx group) or had undergone LT (Tx group) as the study groups and 20 children for the control group. The PedsQL was used to evaluate QoL, and SCARED, CDI, and the CPTSD-RI were used to evaluate psychopathology. RESULTS: The QoL scores were higher in the control group compared with the study groups in all or most of the dimensions, depending on the reporter. The mean scores of anxiety, depression, and PTSD of the control group were significantly lower than those of the Tx and pTx groups. A significant positive correlation was found between depression, anxiety, and PTSD scores, and a negative correlation was observed between depression, anxiety, and PTSD scores and QoL. CONCLUSION: Waiting for LT and the transplantation process itself seem to be psychologically traumatic for children. Healthcare providers need to be trained to recognize the symptoms of the main psychiatric disorders.

Psychopathology, health-related quality-of-life and parental attitudes in pediatric asthma.

Objective: Considering that unknown psychopathology might play a role in the management of pediatric asthma, this study examines how self-esteem and psychosocial family environment (child-raising attitudes and parental coping strategies) influence the physical and psychosocial well-being of these children. Hence, this paper aims to predict psychosocial factors influencing health-related quality-of-life (HRQL) in children with asthma without a documented history of mental illness. Methods: 32 patients with asthma and 32 controls aged 8-18 years were included in the study. All participants were largely middle-income, Caucasian school-aged children. The child-raising attitudes examined were: dependency, egalitarianism/democratic attitude, rejection of the homemaking role, marital conflict, and strictness/authoritarianism. The parental coping strategies were; social support seeking, problem-solving attitude and avoidance. Results: Psychiatric comorbidity was present in 72% of asthma patients and 22% of the controls. The most common mental illness identified was generalized anxiety disorder; 32% vs 13%, respectively. Dependency was the only parental child-raising attitude that differed significantly between groups (47 ± 8 vs 41 ± 11, respectively. p = 0.035). There was a negative correlation between the PARI dependency subscale and the total HRQL score according to the parents (rp= -0.39, p = 0.027). The most influential factors connected with the total HRQL score in asthma were Rosenberg self-esteem scale score, presence of psychopathology and dependency according to the child. Conclusions: Simple ways to overcome emotional dependency and fortify self-esteem (exercises promoting self-awareness, opportunities cultivating decision-making, and a considerable freedom-of-choice to experience consequences) worth recommending to parents of children with asthma. Patients with suspected mental illness must be referred for psychiatric evaluations.

Evaluation of psychological characteristics of Turkish children with type 1 diabetes mellitus from two demographically and geographically distinct regions.

Baran RT, Sürer-Adanir A, Karakurt MN, Dündar M, Aydin M, Özbek MN, Demirbilek H. Evaluation of psychological characteristics of Turkish children with type 1 diabetes mellitus from two demographically and geographically distinct regions. Turk J Pediatr 2018; 60: 554-561. Type 1 diabetes mellitus (T1DM), patients have an increased risk of psychiatric morbidity compared to their healthy counterparts. The aim of the present study is to evaluate the demographic and laboratory data and psychological characteristics of children with T1DM from two geographical regions of Turkey. The study included 98 pediatric T1DM patients followed in pediatric endocrinology clinics from Diyarbakir (n=50), an eastern city and Antalya (n=48) a western city, and 43 healthy subjects from Diyarbakir (n=20) and Antalya (n=23). The sociodemographic data, duration of diabetes and the glycated hemoglobin levels (HbA1c) were also noted. For the evaluation of emotional and behavioral problems in children, Turkish version of The Child Behavior Checklist (CBCL) 6-18, and for depression, Child depression inventory (CDI) was used. Patients from the Diyarbakir Diabetes Mellitus (DDM) group had a longer duration of diabetes compared to those of the Antalya Diabetes Mellitus (ADM) group, while HbA1c levels were not statistically different. Children with T1DM from Diyarbakir reported higher problem scores in CBCL in majority of domains and both internalizing and externalizing subscores compared to the controls and in all domains compared to the patients from Antalya. The CDI scores of the DDM group were also significantly higher than those of the ADM group. In conclusion, diabetic children from Diyarbakir had more problems in emotional, social and behavioral domains compared to the healthy peers and patients from Antalya, indicating that T1DM brought more psychosocial burden to these patients independently from the metabolic control. Pediatric specialists working in the eastern region should be more precautious with diabetic patients in terms of comorbid psychiatric conditions and psychiatric referral when needed.

Increased Hyperacusis with Risperidone in an Autistic Child.

Autistic spectrum disorder is a neurodevelopmental disorder characterized by qualitative impairment in social interactions and communication skills. In addition to these core features, sensory processing abnormalities such as auditory hypersensitivity have been frequently reported. Although the cause of auditory hypersensitivity remains unknown, it is thought to be associated with decreased inhibitory processing, possibly resulting from an abnormal sensory gating system or dysfunction of inhibitory interneurons. Its relation to drugs has not been well documented to date. In the literature, there is only one case on hyperacusis that worsened with risperidone in a 5-year-old girl with autism. Here we represent the case of an 11-year-old boy with autism, in whom hyperacusis worsened with risperidone, decreased after the discontinuation of the medication, and re-occurred after the prescription of the drug again. Although auditory hypersensitivity tends to affect the child's daily life negatively and is found to be correlated with behavioral problems in autistic patients, we still know very little about its etiology, treatment, and conditions related to it. There is a great need for conducting further studies in this regard.

Post-traumatic stress disorder and health-related quality of life in the siblings of the pediatric bone marrow transplantation survivors and post-traumatic stress disorder in their mothers.

Although BMT is lifesaving in many childhood diseases, it was found to be related to anxiety, depression, and PTSD in parents, and PTSD, anxiety and overall low self-esteem in siblings. Research on siblings' HRQoL is limited. The aim of this study was to investigate PTSD and HRQoL in siblings (donor and non-donor) of pediatric BMT survivors and PTSD in their mothers, compared to the healthy controls. Thirty-five siblings and their mothers and 35 healthy peers and their mothers were recruited as the study group and as the comparison group, respectively. In children, Child PTSD-Reaction Index for PTSD and PedsQL for HRQoL were used. PTSD Checklist-Civilian Version was used for PTSD in mothers. The study group, both children and mothers, obtained significantly higher PTSD rates than the control group. Children in the study group also reported significantly poorer HRQoL than the control group in all scales. As a novel finding, there was a significant negative correlation between siblings' and mothers' PTSD scores and siblings' PedsQL scores, indicating that PTSD symptoms in siblings and mothers significantly led to impairment in siblings' HRQoL or vice versa. Thus, the identification and treatment of siblings and mothers with PTSD seems imperative.

Psychopathology in pediatric bone marrow transplantation survivors and their mothers.

BACKGROUND: Bone marrow transplantation (BMT) is used to treat various hematologic, oncologic and metabolic diseases. While the treatment is lifesaving, it is also associated with anxiety, post-traumatic stress disorder, depression and psychosocial problems both in children and parents. METHODS: The aim of this study was to investigate the psychopathology in pediatric BMT survivors and their mothers compared with healthy controls. All children were interviewed using Kiddie Schedule for Affective Disorders and Schizophrenia to assess lifelong psychopathology. For the mothers, the Symptom Checklist-90-Revised (SCL-90-R) was used. RESULTS: In the BMT group, 17 children (63%) had at least one psychiatric disorder, while 15 (53.6%) did in the control group. Although lifelong prevalence of psychopathology in the BMT group did not differ significantly from the control group generally, anxiety disorders were significantly higher in the BMT group. When the SCL-90-R scores of the mothers were compared, Anxiety, Obsessive-Compulsive, Interpersonal Sensitivity and Phobic Anxiety were significantly higher in the mothers in the BMT group, indicating more difficulty in these areas. CONCLUSIONS: Bone marrow transplantation is a significant stressor, especially for mothers. Clinicians should address the child and family as a whole in assessments and be aware of psychiatric symptoms in mothers and children who have had such a life-threatening condition.

Living with the unknown: Posttraumatic stress disorder in pediatric bone marrow transplantation survivors and their mothers.

Bone marrow transplantation (BMT) is used to treat children with various hematologic, oncologic, and metabolic diseases. Although the treatment can be lifesaving, it is also physically and psychologically demanding for both the child and caregivers. In previous studies, BMT is found to be related with anxiety, posttraumatic stress disorder (PTSD), depression, and psychosocial problems both in children and parents. The aim of this study was to investigate PTSD in pediatric BMT survivors and their mothers compared with the healthy controls. Twenty-seven BMT survivors and their mothers and 28 healthy peers and their mothers were recruited as the study group and as the comparison group, respectively. All children were interviewed using Child Posttraumatic Stress Disorder-Reaction Index (CPTSD-RI) for assessing posttraumatic stress responses. As for mothers, Clinician-Administered PTSD Scale (CAPS) was used. In healthy children and mothers, instead of BMT, the most important traumatic event reported by them was included. All data were analyzed by a neutral statistician from the Department of Biostatistics of the university. The BMT group, both children and mothers, obtained significantly higher PTSD rates than the control group (66.5% and 17.8%, respectively, in children; 57.6% and 7%, respectively, in mothers). However, there was a weak correlation between survivors' and mothers' posttraumatic stress responses. These findings suggest that BMT is a significant stressor for both children and mothers. Clinicians should be aware of psychiatric symptoms of children who underwent such a life-threatening condition. Combination of medical treatment with psychosocial support is imperative.