Thalassemia patients in transfussion dependent period and after hematopoietic stem cell transplantation: how are the psychiatric status and life quality of these patients?

Although hematopoietic stem cell transplantation (HSCT) has been widely used to treat patients with beta-thalassemia major, evidence showing whether this treatment improves mental health, self esteem and health-related quality of life (HRQoL) is limited. We aimed to describe psychiatric problems, HRQoL and self-esteem scores of patients who have thalassemia and compared with patients who underwent HSCT in the current study. A total of 24 patients with thalassemia major and 13 patients who underwent HSCT at least 2 years ago aged between 7-37 years were included. We used The Children's Depression Inventory, The Spielberger State-Trait Anxiety Inventory, and Pediatric Quality of LifeTM (PedsQL™) for assesment of children and Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) for assessment of adults. We also used Piers Harris Self Concept Scale for children and adults. Psychopathologies are common in both groups (50% in Thalassemia group and 69.2% in HSCT group). Popularity scores in Piers Haris scale of patients in HSCT group were significantly higher compared to thalassemia group (p = 0.03). Additionally, HSCT group had higher scores in physical health subscales of HRQoL in both children and parents'(p = 0.02, p = 0.03 respectively). Our findings suggest improved HRQoL and self-esteem in thalassemia patients after HSCT. However, due to the high prevalence of mental disorders in both groups, we would like to emphasize that clinicians should examine not only the physical but also the psychological state of the patients with thalessemia during the their treatment and follow-up period after HSCT.

Turkish Adaptation Study of the Ask Suicide-Screening Questions in Adolescents.

Introduction: This study aimed to demonstrate the validity of the Ask Suicide-Screening Questions (ASQ) in a clinical sample consisting of adolescents admitted to child and adolescent psychiatry (CAP), and then to confirm its validation in those presenting to the pediatric emergency department (PED), which was the main target group for the study. Method: This cross-sectional study evaluated the compatibility of the ASQ with the suicide probability scale, which is a standardized measure, to identify cases with suicide risk in 248 adolescents aged 10-18 years. To demonstrate the clinical validity of the scale, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), Kappa, and area under the curve (AUC) performance metrics and 95% confidence interval (CI) values were calculated. Results: Positive screening rate, sensitivity, specificity, PPV and NPV for the CAP patients were calculated as 31.8%, 100% (95% CI: 100.0-100.0), 70.9% (95% CI: 63.4-78.4), 12.8% (95% CI: 3.2-22.3) and 100% (95% CI: 100.0-100.0), respectively. The PLR and AUC were calculated as 3.4% (95% CI: 2.7-4.5) and 0.855 (95% CI: 0.817-0.892), respectively. Positive screening rate, sensitivity, specificity, PPV and NPV for the PED patients were calculated as 28%, 100% (95% CI: 100.0-100.0), 75.3% (95% CI: 66.3-84.2), 21.4% (95% CI: 6.2-36.6) and 100% (95% CI: 100.0-100.0), respectively. The PLR, Kappa and AUC were 4.05% (95% CI: 2.82-5.81), 0.278 and 0.876 (95% CI: 0.832-0.921), respectively. Conclusion: This study showed the first evidence that Turkish adaptation of the ASQ is a valid screening tool for identifying those at risk of suicide among adolescents who applied to the CAP and PED.

Dynamic eye-tracking evaluation of responding joint attention abilities and face scanning patterns in children with attention deficit hyperactivity disorder.

There has been growing evidence that autistic traits are more represented in children with attention-deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate autistic traits associated with responding joint attention (RJA) abilities and face scanning patterns using eye-tracking in children with ADHD, and to compare with typically developing peers (TDs). All child participants viewed a series of videos related to male and female children under congruent and incongruent conditions during eye-tracking evaluation. The object and face regions of the models within the videos were determined as areas of interest (AOIs). Children with ADHD had significantly elevated ratings of autistic traits than TDs. Time course analysis of the proportion of fixations (PoF) on object region determined that children with ADHD tended to show more interest in the objects and had higher PoF on face interest area, including eyes and mouth compared to TD children in the videos when the male/female model shifts his/her gaze to the corner. Higher SRS scores were associated with higher PoF on the Face AOI in both groups. Given these findings, social skill interventions directly targeting the core deficits of RJA and problems in facial scanning appears to be beneficial in children with ADHD.

Use of Clonidine in Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder Comorbidity: Report of 3 Cases.

Clonidine has been widely used in child and adolescent psychiatry, especially in attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), which are recently categorized under neurodevelopmental disorders. However, it is not recommended as a first-line medication for treatment, and current data on the use of clonidine are limited. Herein, we present 3 cases with ADHD and ASD comorbidity, if any, as well as other neurodevelopmental disorders, including intellectual disability and Tourette's disorder, treated with clonidine. At the second-month follow-up, substantial improvements were observed in subscale scores of Conners's Parent Rating Scale-Revised Long Form, and Autism Behavior Checklist. Our case report indicated that clonidine is well tolerated, safe, and effective in improving both ADHD- and ASD-related symptoms as well as disruptive, aggressive behaviors and tics in children with multiple neurodevelopmental disorders.

Effects of psychiatric symptoms, age, and gender on fear of missing out (FoMO) and problematic smartphone use: A path analysis with clinical-based adolescent sample.

Background: Fear of missing out (FoMO) is a kind of anxiety that arises from FoMO on rewarding online social experiences that others might be having. Recent studies demonstrated that there is a strong relationship between FoMO and problematic smartphone use (PSU). In this study, we aimed to address the relationship between age, gender, psychiatric symptoms, PSU, and FoMO among a clinical-based adolescent sample. Methods: In total, 197 adolescents (136 boys, 12-18 years) who applied to psychiatry clinics were recruited in the study. Path analysis with observed variables was used to investigate the relationships of PSU and FoMO with each other and with psychiatric symptoms (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideation, and psychoticism), age, and gender. Results: Path analysis showed that age (B1 = 2.35, P < 0.001), somatization (B1 = 1.19, P < 0.001), hostility (B1 = 0.92, P = 0.001), and paranoid ideation (B1 = 0.93, P = 0.005) have significant positive effect on PSU, when interpersonal sensitivity has a significant negative effect (B1 = -1.47, P < 0.001). For FoMO, male gender (B0 = 0.35, P < 0.001), anxiety (B1 = 1.37, P < 0.001), and PSU have positive effects, whereas age (B1 = -1.60, P < 0.001), depression (B1 = -0.58, P = 0.004), and hostility (B1 = -0.49, P = 0.001) have a negative effect. Conclusions: Our study demonstrated that although PSU and FoMO are closely related to each other in previous studies, they have different associations with age, gender, and psychiatric symptoms among a clinical-based adolescent sample. The positive effects of PSU, anxiety on FoMO are predictable; however, the negative effect of age, hostility, and depression on FoMO was interesting. These relationships could be related to social exclusion-hostility and impulsivity-male gender/younger age associations in adolescence. In addition, we did not find a significant effect of FoMO on PSU, this could be related to the social and non-social use of smartphones, and should be reevaluated in clinical samples in the future.

How does adolescent motherhood affect mother-infant/toddler relationship and emotional availability.

BACKGROUND: The present study examined the different aspects of infant-mother relationships in adolescent mothers and compared them in adult mothers. METHODS: Children aged 18-40 months who were referred to our outpatient Infant Mental Health Department were analysed retrospectively. Sociodemographic data, Parent-Infant Relationship Global Assessment Scale (PIR-GAS) scores, and Emotional Availability (EA) Scales scores were analysed. Twenty-nine adolescent mothers being younger than 20 years at the beginning of pregnancy and thirty mothers who were aged at least 25 years were enrolled the same data as adult mother group. RESULTS: In the adolescent mothers group, the education years of the mothers, the ratio of mothers having professions were significantly lower (p < 0.001); the spousal age gap was significantly higher than among the adult mothers (p < 0.001). It was also found that an underinvolved relationship pattern was seen more frequently among the mother-infant dyads in the adolescent mothers' group than in the adult mothers group (p = 0.002). CONCLUSIONS: Although there were not found many problems in terms of the relationship of adolescent mothers with their infants/toddlers in the current study this may have been due to a small sample, we would like to emphasise that the problems should be detected and appropriate interventions should be made for adolescent mothers.Key pointsOur main aim for this study was assesment of the effect of adolescent motherhood in terms of infant\toddler-mother relationshipOur findings showed that lower education level and being unemployed were higher in adolescent mothers group.Higher age gap between spouses was found to be associated with adolescent motherhood. Underinvolved relationship was highly prevalent among adolescent mothersOur findings suggest that early motherhood is a risk factor for mother-infant\toddler-relationship and parenthood.Intervention and education programs during and after pregnancy for adolescent girls may help them to prepare for motherhood more consciously and form established relationships with their infants.

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.

Index depressive episode and antidepressant exposure were associated with illness characteristics of pediatric bipolar disorder.

OBJECTIVE: Pediatric bipolar disorder (PBD) is a serious, recurrent disorder leading to severe functional impairment. As a first mood episode, index episode could affect the long-term course of the illness. This study aimed to investigate the clinical characteristics of youth with PBD from our multicenter, nationwide, naturalistic follow-up samples and to identify (i) the effects of index mood episode and (ii) the effect of previous antidepressant treatments on the age at mania onset of PBD. METHOD: The study sample consisted of 271 youth with BD-I followed by the child and adolescent psychiatry clinics of seven different university hospitals and three research state hospitals, representing six geographic regions across Turkey. All diagnoses were made according to structured interviews, and all data were retrospectively obtained from clinical records by the clinicians. RESULTS: When patients with index depressive/mixed episodes (IDE, n=129) and patients with index (hypo)manic episodes (IME, n=142) were compared, the total number of mood episodes and rapid cycling feature were significantly higher in the IDE group than in the IME group. The Cox regression analysis adjusted for sociodemographic and illness characteristics revealed female adolescents in the IDE group treated with antidepressants were more likely to have an earlier onset of mania (hazard ratio=2.03, 95% confidence interval=1.31-3.12, p=0.001). CONCLUSION: This is the first large-scale nationwide follow-up study in Turkey that indicated prior antidepressant treatments were associated with an earlier onset of mania in youth, particularly in adolescent females. Larger prospective studies are needed to identify neurodevelopmental processes underlying PBD and initiate prevention approaches.

Motor functions, quality of life and maternal anxiety and depression in children with cerebral palsy of different intelligence levels.

BACKGROUND: Cerebral palsy (CP) is the most common motor disability in childhood. In addition to motor impairment, it is frequently accompanied by intellectual disability (ID). We aimed to investigate the associations between motor functions, quality of life (QoL) and maternal psychopathology in children with CP of different intelligence levels. METHODS: In total, 37 children and adolescents (16 females and 21 males) between 4 and 18 years of age diagnosed with CP were recruited from a Pediatric Neurology Outpatient Clinic. Gross Motor Function Classification System (GMFCS) and Bimanual Fine Motor Function (BFMF) were used for the children`s motor functions assessment. Quality of life was determined by the caregivers with Pediatric Quality Of Life Inventory-Parent version (PedsQL-P). Maternal anxiety and depression levels were assessed using Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). RESULTS: Moderate-severe ID (n=19)(13.5%, 37.8%) and normal IQ-mild ID (n=18) (32.4 %,16.2%) groups were evaluated in this study. GMFCS level 2 was more frequent in both groups. The majority of the severe-moderate ID group was at BFMF level 4, while the normal IQ-mild ID group was at BFMF level 2. PedsQL-P scores of children with CP, maternal BAI scores, and maternal BDI scores did not differ between the two groups (p > 0.05). Psychosocial PedsQL scores had a moderate negative correlation with the maternal BAI scores (r=- 0.41, p < 0.05). There was also a moderate positive correlations between the ages of children and maternal BDI scores (r=0.34, p < 0.05). CONCLUSIONS: Our results demonstrated that maternal anxiety was correlated with psychosocial QoL in children with CP. Maternal depression scores increasing with the ages of the children with CP may also indicate the social support needs for mothers with children of chronic diseases. Further studies may reveal the associations with other biopsychosocial factors in children with CP of different intelligence levels by using longitudinal study designs with larger sample sizes.

Managing precocious puberty: A necessity for psychiatric evaluation.

OBJECTIVE: Precocious puberty (PP) is one of the most common endocrine disorders in school-age girls. It has been reported that there is an increased tendency for psychiatric disorders for early maturing girls. The aim of this study was to determine the prevalence of psychiatric problems and to investigate depression and anxiety levels, and self-concept characteristics in girls with PP. METHODS: Girls with PP (n = 41) and controls (n = 45) aged 7-11 years participated in this study. Psychiatric evaluations were conducted with semi-structured interviews. Behavioral and emotional problems were assessed using Child Behavior Check List and Teacher Report Form. Children's Depression Inventory, State-Trait Anxiety Inventory for Children and Piers-Harris Children's Self Concept Scale were administered, respectively. RESULTS: Girls with PP had significantly more psychiatric diagnosis than controls (68.3 % vs 20 %, p < 0.001). PP group had significantly higher anxious-depressed, somatic complaints, social problems, aggresive behaviors and interestingly autistic traits. Increased symptom levels of depression and anxiety, and lower self-concept scores were also obtained from PP subjects. CONCLUSIONS: PP is an independent predictor of psychiatric disorders. It is also associated with poorer psychiatric status, lower self esteem characteristics, and autistic traits. A multidisciplinary approach combining endocrinologic and psychiatric evaluations seem to be beneficial for the management of girls with PP.

Ubiquinone Levels as a Marker of Antioxidant System in Children with Attention Deficit Hyperactivity Disorder.

The aims of this study are to compare serum ubiquinone levels in children with attention deficit hyperactivity disorder (ADHD) with healthy controls and to investigate the correlation between ubiquinone levels of children with ADHD and their ADHD symptoms. Twenty-seven children who are 6-12 years old age with attention deficit hyperactivity disorder having clinically normal intelligence and 23 children with clinically normal intelligence and no psychiatric disorder of similar age and sex who referred to Ankara University School of Medicine Department of Child and Adolescent Psychiatry were included in this study. All children were diagnosed by same researcher using the Semi-Structured Clinical Interview for DSM-IV Scale for Affective Disorders and Schizophrenia Interview for School Children-Now and for the Life-Long Version (K-SADS-PL). Parents and teachers of the children completed the Conners Parent Rating Scale Revised Long Form (CPRS-LF) and Conners Teacher Rating Scale Revised Long Form (CTRS-LF). There were no statistically significant differences regarding the age, gender, and sociodemographic data of the groups. Serum ubiquinone levels of the ADHD group were significantly lower than the control group. We did not find any correlation between ubiquinone levels and clinical values. Since ubiquinone levels are lower in children with ADHD compared with controls, we suggest that decreased antioxidant levels may play a role in ADHD pathogenesis by disrupting oxidative balance.

Family Functioning, Comorbidities, and Behavioral Profiles of Children With ADHD and Disruptive Mood Dysregulation Disorder.

Objective: Children with ADHD-combined type (ADHD-C), disruptive mood dysregulation disorder (DMDD), and healthy controls (HC) were compared with respect to the sociodemographic features, psychiatric comorbidities, behavioral patterns, and family functioning. Method: Research groups were identified using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). Conners' Rating Scale-Revised Long Form, Wechsler Intelligence Scale for Children-Revised (WISC-R) test, Sociodemographic Questionnaire, and Family Assessment Device (FAD) were administered to research groups. Results: DMDD group's rate of psychiatric comorbidity was higher than the ADHD-C group's rate. In most of the subscales of Conners, DMDD group's average scores were higher than the other groups' scores. In "Communication," "Affective Responsiveness" subscales of FAD, DMDD group's average scores were higher than the ADHD-C group's scores. In "Affective Involvement," "General Functioning" subscales of FAD, DMDD group's average scores were higher than the other groups' scores. Conclusion: Children with DMDD were distinguished from children with ADHD-C by their higher comorbidity rate, more impaired behavioral patterns, and family functioning.

The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T).

AIM: The aim of this study was to determine the prevalence of childhood psychopathologies in Turkey. METHOD: A nation-wide, randomly selected, representative population of 5830 children (6-13 years-old) enrolled as a 2nd,3rd or 4th grade student in 30 cities were evaluated for presence of a psychiatric or mental disorder by a Sociodemographic Form, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and DSM-IV-Based Screening Scale for Disruptive Behavior Disorders in Children and Adolescents scales. Impairment criterion was assessed via a 3 point-Likert scale by the parent and the teacher independently. RESULTS: Overall prevalence of any psychopathology was 37.6% without impairment criterion, and 17.1% with impairment criterion. Attention-deficit hyperactivity disorder was the most frequent diagnosis, followed by anxiety (19.5% and 16.7% without impairment, 12.4% and 5.3% with impairment, respectively). Lower education level and presence of a physical or psychiatric problem of the parents were independent predictors of any psychopathology of the offspring. CONCLUSION: This is the largest and most comprehensive epidemiological study to determine the prevalence of psychopathologies in children and adolescents in Turkey. Our results partly higher than, and partly comparable to previous national and international studies. It also contributes to the literature by determining the independent predictors of psychopathologies in this age group.

Factors Associated with Empathy Among Adolescents with Attention Deficit Hyperactivity Disorder. / Dikkat Eksikligi Hiperaktivite Bozuklugu Olan Ergenlerde Empati ve Iliskili Etmenler.

OBJECTIVE: The aim of this study is to investigate the effects of psychiatric comorbidities on the level of empathy in adolescents diagnosed with ADHD; to evaluate the relationship between adolescent behavioral problems and empathy; to acquire information on the role of having parents with psychiatric symptoms and the perceptions of the adolescents of parental acceptance and rejection in empathy development. METHOD: The study sample consisted of 101 adolescents of 12-16 years of ages diagnosed with ADHD and 50 adolescents as the control group. K-SADS-PL is used for the DSM-IV diagnoses and WISC-R is applied to the participants with ADHD. Both the ADHD and the control groups were evaluated with the Basic Empathy Scale, Parental Acceptance-Rejection/Control Questionnaire and the Young Self Report. The parents completed the Sociodemographic information form, Child Behavior Checklist and the Symptom Checklist-90- Revised; and the teachers completed the Teacher Report Form. RESULTS: There was no significant difference between ADHD and control group about basic empathy scale scores. The and emotional empathy scores were significantly lower in ADHD group with comorbid Oppositional Defiant Disorder (ODD) than ADHD group with no comorbidity. CONCLUSION: In our study having only ADHD had no effect on empathy levels, ODD comorbidity was related to lower basic and emotional empathy levels. In order to determine causal/temporal relations, prospective studies, studies with larger sample sizes and with more homogenous groups are needed.

The relationship between problematic smartphone use and psychiatric symptoms among adolescents who applied to psychiatry clinics.

Problematic mobile phone use is an important problem which has increasing prevalence among adolescents. We should address risk factors to create intervention frameworks related to this problem. In this study, we aimed to determine the prevalence of problematic smartphone use among adolescents who were referred to clinics, its relationship to sociodemographic characteristics, psychiatric symptoms and emotion regulation problems. We included 150 adolescents aged 12-18 years who own smartphones. All participants filled out the Sociodemographic Information Form, Brief Symptom Inventory (BSI), Difficulties in Emotion Regulation Scale (DERS) and Problematic Mobile Phone Use Scale (PMPUS). Problematic smart phone use was detected in 50.6% of the sample. Adolescents with problematic use were found to be older than the others, with lower levels of maternal education and self-achievement. Regression analysis revealed that the factors predicting the risk of problematic smartphone use are somatization, interpersonal sensitivity and hostility symptoms. According to our results, we suggest psychiatrists consider the high prevalence of problematic smartphone use, address the relationship between hostility, somatic symptoms and interpersonal sensitivity (susceptibility) and the effects of this current problem on social-academic functioning while evaluating and treating adolescents.

Prevalence of Childhood Affective disorders in Turkey: An epidemiological study.

AIM: To determine the prevalence of affective disorders in Turkey among a representative sample of Turkish population. METHODS: This study was conducted as a part of the "The Epidemiology of Childhood Psychopathology in Turkey" (EPICPAT-T) Study, which was designed by the Turkish Association of Child and Adolescent Mental Health. The inclusion criterion was being a student between the second and fourth grades in the schools assigned as study centers. The assessment tools used were the K-SADS-PL, and a sociodemographic form that was designed by the authors. Impairment was assessed via a 3 point-Likert type scale independently rated by a parent and a teacher. RESULTS: A total of 5842 participants were included in the analyses. The prevalence of affective disorders was 2.5 % without considering impairment and 1.6 % when impairment was taken into account. In our sample, the diagnosis of bipolar disorder was lacking, thus depressive disorders constituted all the cases. Among depressive disorders with impairment, major depressive disorder (MDD) (prevalence of 1.06%) was the most common, followed by dysthymia (prevalence of 0.2%), adjustment disorder with depressive features (prevalence of 0.17%), and depressive disorder-NOS (prevalence of 0.14%). There were no statistically significant gender differences for depression. Maternal psychopathology and paternal physical illness were predictors of affective disorders with pervasive impairment. CONCLUSION: MDD was the most common depressive disorder among Turkish children in this nationwide epidemiological study. This highlights the severe nature of depression and the importance of early interventions. Populations with maternal psychopathology and paternal physical illness may be the most appropriate targets for interventions to prevent and treat depression in children and adolescents.

Premenstrual syndrome health-related quality of life and psychiatric comorbidity in a clinical adolescent sample: a cross-sectional study.

OBJECTIVE: Adolescents who were admitted to the child and adolescent psychiatry clinic were compared with respect to the premenstrual symptom severity, psychiatric comorbidities and health related quality of life (HRQoL). METHODS: The research group was identified using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and Premenstrual Assessment Form. They completed the Pediatric Quality of Life Inventory (The PedsQL). RESULTS: There were 55 adolescents who were eligible for the study and 89% of participants were diagnosed with at least one psychiatric disorder. The most common psychiatric diagnoses among the diagnosed cases were anxiety and major depressive disorders. Of all of the cases, 78.2% were diagnosed with premenstrual syndrome (PMS) and among those cases, 46.5% had mild, 34.8% had moderate and 18.6% had severe PMS. Most common PMS symptom was anger/irritability. HRQoL in the group with PMS was significantly lower than that of the adolescents without PMS. Moreover, HRQoL of adolescents with PMS was found to deteriorate with the increasing severity of PMS. CONCLUSIONS: This study is of great importance since it demonstrated that PMS frequency is very high in a clinical adolescent population and negatively affects their HRQoL as similar to non-clinical adolescent population studies.

Relationship Between Sleep Problems and Quality of Life in Children With ADHD.

OBJECTIVE: The purpose of this study is to assess the sleep behaviors, sleep problems and frequency, and relationship with psychiatric comorbidities in ADHD Combined type and to evaluate the effect of sleep problems on quality of life. METHOD: Forty-six boys, aged 7 to 13 years, with ADHD-combined type and 31 healthy boys were included. ADHD children were never treated for sleep or psychiatric disorders. Intelligence quotient (IQ) test scores were minimum 80, body mass index were normal and did not have medical disorders. Parents completed Children's Sleep Habits Questionnaire, Conners' Parent Rating Scale and The Pediatric Quality of Life Inventory (PedsQL) and participants were asked about sleep behaviors and were administered PedsQL and Schedule for Affective Disorders and Schizophrenia. RESULTS: The frequency of sleep problems in ADHD is 84.8%, higher than the control group (p = .002). Evaluating PedsQL scores, the quality of life is worse in physical, psychosocial health, and total life quality (p < .05). ADHD group with sleep problems have more night wakings than control group with sleep problems (p = .02). The comorbidity do not increase sleep problems. The frequency of parasomnias is increased in group with learning disorders (p = .05). CONCLUSION: The results of this study, which controls for a number of possible confounders found in previous examinations of ADHD and sleep, support the results of a number of other studies that have found an increased overall prevalence of parent-reported sleep disturbances in children with ADHD compared with healthy control participants. As the ADHD group have more night wakings than the control group through the night, it is thought that night wakings that cause a partitioned sleep may be important signs seen in ADHD. That could be suggested by two hypotheses. First one is that, daytime sleepiness is more common in ADHD and those children present excessive hyperactivity during the day to stay awake and the second one is the improvement of ADHD signs when the drugs for sleepiness are used. Usage of standardized and valid diagnostic criteria, exclusion of adolescence, gender, socioeconomic level, primary sleep problems, medical disorders and low IQ level, making allowances for effect of comorbidities and having compared with the control group are the important methodological features of this study. The most important limitation of this study is small sample size that makes the findings less generalizable to other groups of children with ADHD, and another one is not having used objective measurements together with subjective measurements. In conclusion, these results underscore the importance of screening all children who have a symptom constellation suggestive of ADHD for sleep problems that may either play a causative role or exacerbate the clinical appearance of ADHD in a given child. Correct evaluation and treatment of sleep problems increase the life quality of family and child and also decrease the severity of ADHD symptoms.

Cognitive and behavioral characteristics of children with caustic ingestion.

BACKGROUND/AIM: Children with attention-deficit/hyperactivity disorder (AD/HD) have risk taking behavior and are more prone to sustaining injury. It is aimed to evaluate the cognitive and behavioral characteristics of children with caustic ingestion. PATIENTS AND METHODS: Ninety two children with a history of nonsuicidal caustic ingestion (CI, n=46) and healthy subjects (HS, n=46) admitted to pediatric surgery department were enrolled into the study. Patients in groups were evaluated for age, sex, number of siblings and educational status of the parents. Before filling the questionnaires, the children were undergone flexible endoscopy and treated accordingly. Conners Parents Rating Scale-revised long form (CPRS-R:L), validated for Turkish Children, was used to evaluate the cognitive and behavioral characteristics of children. Parents rate their child's behavior with a four-point Likert scale. Subscales of CPRS-R:L including cognitive problems/inattention (CG/I), hyperactivity (H), attention deficit hyperactivity disorder index (AD/HD-I), Conners' Global Index-discomfort-impulsivity (CGI-DI), DSM-IV-symptom subscale-inattention (DSMIV, SS-I), DSM-IV-symptom subscale-hyperactivity-impulsivity (DSM-IV, SS-HI), DSMIV-symptom subscale-total score (DSM-IV SS-T) were used to determine the severity of the AD/HD symptom. Demographic features and cognitive/behavioral characteristics of children with caustic ingestion were compared with healthy subjects. RESULTS: The median age of the patients was 4 (2-14 years) in both CI and HS groups. Female male ratio was 13:33 in CI and 12:34 in HS. Sixty seven percent of patients were preschool children (younger than 5 years of age) in both CI and HS groups. There was no difference between groups for number of siblings (p>0.05). Parents of HS group had higher educational status than parents in CI (p<0.05). When subscale scores of CPRS-R:L compared between CI and HS groups, CI group had higher CGI-DI scores than HS (p<0.05). Children younger than five years of age had higher scores of H, emotional instability and total CG/I in CI than HS group (p<0.05). CONCLUSION: Children with caustic ingestion had impulsiveness behavior when compared to healthy children. In addition to impulsivity, hyperactivity can be also assessed as a risk factor for caustic ingestion in children younger than 5years of age. We suggest that association between AD/HD behavior and risk of sustaining injuries was also confirmed for caustic ingestion in children.

Clinical review of 95 patients with 46,XX disorders of sex development based on the new Chicago classification.

STUDY OBJECTIVE: The aim of our study was to determine the etiologic distribution of 46,XX disorder of sexual development (DSD) according to the new DSD classification system and to evaluate the clinical features of this DSD subgroup in our patient cohort. PARTICIPANTS: The evaluation criteria and clinical findings of 95 46,XX patients were described by clinical presentation, gonadal morphology, genital anatomy, associated dysmorphic features, presence during prenatal period with/without postnatal virilization, hormonal characteristics, and presence or absence of steroidogenic defects among 319 patients with DSD. RESULTS: Types and ratios of each presentation of our 95 patients with 46,XX DSD were as follows: 82 had androgen excess (86.3%): (74 had classical congenital adrenal hyperplasia, 2 had CAH variant possibility of P450-oxidoreductase gene defect), 6 had disorders of ovarian development (6.3%): (1 patient had gonadal dysgenesis with virilization at birth with bilateral streak gonad, 4 patients had complete gonadal dysgenesis, and 1 patient had ovotesticular DSD) and 7 had other 46,XX DSD. Two sisters, who had 46,XX complete gonadal dysgenesis,were diagnosed with Perrault Syndrome with ovarian failure due to streak gonads and associated with sensorineural deafness. CONCLUSION: 46,XX DSD are usually derived from intrauterine virilization and CAH is the most common cause of 46,XX DSD due to fetal androgen exposure.