Concurrent and Discriminant Validity of the Farsi Translation of the Social Responsiveness Scale-Second Edition (SRS-2) and Social Communication Questionnaire (SCQ).

Objective: Early detection of autism spectrum disorder (ASD) can lead to earlier intervention and greater improvement of children's quality of life and performance; hence, the use of screening tools is essential to facilitate the diagnosis process. The aim of the present study was to determine the clinical and differential validity of Social Responsiveness Scale-Second Edition (SRS-2) and Social Communication Questionnaire (SCQ) in a group of children and adolescents with autism spectrum disorder compared to a normal developmental group. Method : The study was conducted in Roozbeh Hospital involving 52 children with ASD and 53 typically developing (TD) children, aged between 4-12 years. Their parents completed the SRS-2 and SCQ. These children were also interviewed using the Childhood Autism Rating Scale, 2nd Edition (CARS-2) and Asperger Syndrome Diagnostic Scale (ASDS). After completion, the results were analyzed using the SPSS Version 18 software and a significant level of 0.05. Results: The average age of children in the autism group was 7.5 ± 2.7 years, while in the typically developing (TD) children group, it was 7.7 ± 2.3 years (P = 0.656). A positive correlation coefficient was observed between the CARS questionnaire score, the SRS questionnaire score, the SCQ questionnaire score, and the ASDS (P < 0.01). In the SRS questionnaire, the area under the ROC curve was 0.976, and in the SCQ questionnaire it was 0.953, both of which had a good and significant diagnostic value (P < 0.001). A sensitivity of 0.942 and specificity of 0.811 for the cut-off point of 62.5 were obtained in the SRS questionnaire. Additionally, a sensitivity of 0.865 and specificity of 0.925 for the cut-off point of 15.5 were achieved in the SCQ questionnaire. Conclusion: The SRS-2 and the SCQ are sensitive and specific tools for identifying and discriminating children with autism spectrum disorder.

Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: the National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP)

Objective: This was the first national epidemiological study on oppositional defiant disorder (ODD) in Iran, which provided new information about the prevalence, comorbidities, and sociodemographic predictors of ODD. Methods: Data from a face-to-face household survey of 30,532 children and adolescents aged 6-18 years were collected from across all 31 provinces of Iran using a multistage cluster sampling design. The Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) was used in this study. Results: The lifetime prevalence of ODD was found to be 3.9%. ODD was significantly more common in boys than girls and appeared in late adolescence more frequently than in childhood. A lower prevalence of ODD was found among participants who lived in rural areas. ODD is highly likely to co-occur with attention deficit hyperactivity disorder, separation anxiety disorder, generalized anxiety disorder, and depressive disorders. Conclusions: The findings of this national population-based study confirm and extend previous findings on the prevalence, comorbidities, and sociodemographic predictors of ODD.

Individualizing the dosage of Methylphenidate in children with attention deficit hyperactivity disorder.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood mental health disorders. Stimulant drugs as the most commonly used treatment and first-line therapy for ADHD have side effects. One of the newest approaches to select the best choices and optimize dosages of medications is personalized medicine. METHODS: This historical cohort study was carried out on the data taken from the period of 2008 to 2015. Eligible subjects were included in the study randomly. We used mixed-effects logistic regression models to personalize the dosage of Methylphenidate (MPH) in ADHD. The patients' heterogeneity was considered using subject-specific random effects, which are treated as the realizations of a stochastic process. To recommend a personalized dosage for a new patient, a two-step procedure was proposed. In the first step, we obtained estimates for population parameters. In the second step, the dosage of the drug for a new patient was updated at each follow-up. RESULTS: Of the 221 children enrolled in the study, 169 (76.5%) were male and 52 (23.5%) were females. The overall mean age at the beginning of the study is 82.5 (± 26.5) months. In multivariable mixed logit model, three variables (severity of ADHD, time duration receiving MPH, and dosage of MPH) had a significant relationship with improvement. Based on this model the personalized dosage of MPH was obtained. CONCLUSIONS: To determine the dosage of MPH for a new patient, the more the severity of baseline is, the more of an initial dose is required. To recommend the dose in the next times, first, the estimation of random coefficient should be updated. The optimum dose increased when the severity of ADHD increased. Also, the results show that the optimum dose of MPH as one proceeds through the period of treatment will decreased.

Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: the National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP).

OBJECTIVE: This was the first national epidemiological study on oppositional defiant disorder (ODD) in Iran, which provided new information about the prevalence, comorbidities, and sociodemographic predictors of ODD. METHODS: Data from a face-to-face household survey of 30,532 children and adolescents aged 6-18 years were collected from across all 31 provinces of Iran using a multistage cluster sampling design. The Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) was used in this study. RESULTS: The lifetime prevalence of ODD was found to be 3.9%. ODD was significantly more common in boys than girls and appeared in late adolescence more frequently than in childhood. A lower prevalence of ODD was found among participants who lived in rural areas. ODD is highly likely to co-occur with attention deficit hyperactivity disorder, separation anxiety disorder, generalized anxiety disorder, and depressive disorders. CONCLUSIONS: The findings of this national population-based study confirm and extend previous findings on the prevalence, comorbidities, and sociodemographic predictors of ODD.

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents.

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method : A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services.

Epidemiology of psychiatric disorders in children and adolescents; in Tehran, 2017.

OBJECTIVE: This survey was conducted to investigate the prevalence of various psychiatric disorders among children and adolescents aged 6-18 years in urban areas of Tehran. METHODS: In the study, which was done with random sampling method, 2095 children and adolescents in the range seniors aged 6-18 years, have been studied and based on Persian version of K-SADS-PL, we reviewed the psychiatric disorders related to them. RESULTS: The overall prevalence of psychiatric disorders in children and adolescents was 28.2%. The most commonly diagnosed disorders were anxiety disorders (21.9%), followed by behavioral disorders (9.6%). CONCLUSION: According to the results, 28.2% of the children and adolescents in Tehran province had psychiatric disorders, that is with increasing rate, compared with similar studies. Therefore, as a public health policy, the necessary tools for identifying, preventing and treating psychiatric disorders in children and adolescents should be considered in Tehran.

Attention-Deficit Hyperactivity Disorder in Adults Using Methamphetamine: Does It Affect Comorbidity, Quality of Life, and Global Functioning?

Objective: Attention-deficit hyperactivity disorder (ADHD) is common in adulthood, and it is associated with different high- risk behaviors, particularly substance use. Evidence suggests a high prevalence of ADHD in adults who take methamphetamine (METH). This study aimed at comparing functional level, quality of life, and psychiatric comorbidities in METH users with and without adult ADHD (A-ADHD). Method: In this cross-sectional study, 134 patients who had a history of METH use (at least once in lifetime) were selected from among inpatient and outpatient referrals to a psychiatric hospital. DIVA was performed for those who were positive on the Conners' Adult ADHD Rating Scales-Self-Report-Screening Version (CAARS-SR-SV). The Global Assessment of Functioning (GAF) and World Health Organization Quality of Life Scale-Brief (WHOQoL-BREF) were used to assess the participants' level of functioning and quality of life, respectively. Psychiatric comorbidities including substance use disorders were evaluated using the Structured Clinical Interview for DSM-IV-Axis I (SCID-I). Results: Among the METH users, 10.4% were diagnosed as having A-ADHD. A-ADHD was more prevalent among female METH users than males. The hyperactive-impulsive and combined types were more common than the inattentive type. Opiates and cannabis were the most commonly abused drugs by the 2 groups, while sedative-hypnotic use was significantly higher in the individuals with A-ADHD. Substance-induced mood disorder was the most prevalent comorbidity in the 2 groups and was higher in those with A-ADHD. quality of life and the GAF scores were significantly lower in those with A-ADHD and duration of METH use was higher Compared to the METH users without A-ADHD, (p>0.05). Conclusion: This study provided some preliminary findings supporting the prevalence of Adult ADHD among METH users and its negative impacts on their global functioning and quality of life. To provide more effective intervention for METH users, detection and treatment of those with A-ADHD can be of clinical value.

Parent-only Group Cognitive Behavioral Intervention for Children with Anxiety Disorders: A Control Group Study.

OBJECTIVE: Parents play an important role in development and continuation of anxiety disorders in children. Yet the evidence on parent contribution in cognitive behavioral therapy (CBT) for childhood anxiety is limited. This open randomized trial examined the effectiveness of a parent-directed group CBT to manage children with anxiety disorders. METHOD: Parents of 42 children aged 6-12 with primary anxiety disorders were allocated to a six, two-hour weekly intervention and a wait-list (WL) control. The Revised Children's Manifest Anxiety, Children's Depression Inventory, Strengths and Difficulties Questionnaire-Home Version, Depression-Anxiety-Stress Scale, Children Global Assessment Scale, and Global Relational Assessment of Functioning were used to assess children's and parents' functioning and emotional symptoms. Parents completed consumer satisfaction questionnaire. RESULTS: Parents in the CBT group reported significant improvement in their depressive symptoms (p=0.006) and the family functioning (p=0.04), as well as reduction in children's emotional symptoms (p=0.007). Clinician rating of children's functioning showed significant improvement in the CBT group(p=0.001). There was no significant difference in children rating of their anxiety within groups from pre- to post-intervention. Parents were satisfied mostly with the intervention. CONCLUSION: A brief parent-only CBT based intervention can be effective in the management of childhood anxiety.

OBJECTIF: Les parents jouent un rôle important dans le développement et la continuité des troubles anxieux chez les enfants. Et pourtant, les données probantes sur la contribution des parents à la thérapie cognitivo-comportementale (TCC) pour l'anxiété chez les enfants sont limitées. Cet essai randomisé ouvert a examiné l'efficacité d'un groupe de TCC dirigé par des parents pour prendre en charge des enfants souffrant de troubles anxieux. MÉTHODE: Les parents de 42 enfants de 6 à 12 ans souffrant de troubles anxieux primaires ont été affectés à 6 interventions hebdomadaires de 2 heures et à un groupe témoin en liste d'attente (LA). L'échelle révisée de l'anxiété manifeste des enfants, l'inventaire de dépression des enfants, la version maison du questionnaire des forces et difficultés, l'échelle de dépression-anxiété-stress, l'échelle d'évaluation globale des enfants, et l'évaluation relationnelle globale du fonctionnement ont servi à évaluer le fonctionnement et les symptômes émotionnels des enfants et des parents. Les parents ont répondu à un questionnaire sur la satisfaction du consommateur. RÉSULTATS: Les parents du groupe de TCC ont déclaré une amélioration significative de leurs symptômes dépressifs (p = 0,006) et du fonctionnement familial (p = 0,04), ainsi qu'une réduction des symptômes émotionnels des enfants (p = 0,007). L'évaluation du clinicien du fonctionnement des enfants a indiqué une amélioration significative dans le groupe de TCC (p = 0,001). Il n'y avait pas de différence significative de l'évaluation de l'anxiété des enfants au sein des groupes d'avant-après l'intervention. Les parents étaient plutôt satisfaits de l'intervention. CONCLUSION: Une brève intervention réservée aux parents basée sur la TCC peut être efficace pour la prise en charge de l'anxiété chez les enfants.

Intellectual and Developmental Status in Children With Hyperphenylalaninemia and PKU Who Were Screened in a National Program.

BACKGROUND: Hyperphenylalaninemia (HPA) and Phenylkeonuria (PKU) are metabolic errors caused by deficiency of phenylalanine hydroxylase enzyme, which results in increased level of phenylalanine. This increase is toxic to the growing brain. OBJECTIVES: The purpose of this study was to compare the intellectual and developmental status in HPA and PKU children with normal population in national screening program. PATIENTS AND METHODS: In a historical cohort study, 41 PKU patients who had the inclusion criteria and 41 healthy children were evaluated. Wechsler preschool and primary scale of intelligence-3rd edition (WPPI-3) was used in order to assess the intellectual status of children 4 years and older and Ages and stages questionnaire (ASQ) was used to assess the developmental status of children 5 years and younger. RESULTS: In intellectual test comparison, the two groups showed significant difference in Wechsler's performance intelligence score and some performance subscales (P-value < 0.01). In comparison of developmental status, no significant difference was observed between the two groups (P-value > 0.05). CONCLUSIONS: Even with early diagnosis and treatment of PKU patients, these children show some deficiencies intellectually compared to normal children. This study emphasizes on necessity for screening intellectual and developmental status of PKU patients so that effective medical or educational measures can taken in case of deficiencies.

Adverse reactions of Methylphenidate in children with attention deficit-hyperactivity disorder: Report from a referral center.

OBJECTIVE: The aim of the current study was to determine various aspects of methylphenidate adverse reactions in children with attention deficit-hyperactivity disorder (ADHD) in Iran. METHODS: During the 6 months period, all children under methylphenidate treatment alone or along with other agents attending a university-affiliated psychology clinic were screened regarding all subjective and objective adverse drug reactions (ADRs) of methylphenidate. Causality and seriousness of detected ADRs were assessed by relevant World Health Organization definitions. The Schumock and Thornton questionnaire was used to determine preventability of ADRs. FINDINGS: Seventy-one patients including 25 girls and 46 boys with ADHD under methylphenidate treatment were enrolled within the study period. All (100%) ADHD children under methylphenidate treatment developed at least one ADR. Anorexia (74.3%), irritability (57.1%), and insomnia (47.2%) were the most frequent methylphenidate-related adverse reactions. Except for one, all other detected ADRs were determined to be mild. In addition, no ADR was considered to be preventable and serious. CONCLUSION: Our data suggested that although methylphenidate related adverse reactions were common in children with ADHD, but they were mainly mild and nonserious.

Topiramate versus Valproate Sodium as Adjunctive Therapies to a Combination of Lithium and Risperidone for Adolescents with Bipolar I Disorder: Effects on Weight and Serum Lipid Profiles.

OBJECTIVE: To compare the effects of topiramate versus valproate sodium as an add-on therapy to a combination of lithium and risperidone (Li+Ris) on body weight and serum lipid profile in children and adolescents with bipolar disorder. METHODS: In a single-blind randomized clinical trial, thirty children and adolescents with bipolar disorder type I in the manic or mixed phase, treated with the combination of Li+Ris at therapeutic doses for at least 4 weeks who had the indication of add-on therapy due to a recurrent episode; a partial response or non response in the current episode or relapse were included. Participants were randomly assigned to receive either topiramate or sodium valproate as the third drug add-on therapy for a total of 6 weeks. Weight, height and serum lipid profiles were determined at baseline and at the end of week 6. RESULTS: Differences in the mean levels of lipid profiles at baseline and after week 6 evaluation were not significant in both treatment groups. BMI z-score increased in both treatment groups, being significant only in the Li+Ris/Valproate group, increasing from (mean±SD) 0.38±0.55 to 0.72±1.23 (p<0.05). Between group changes in BMI z-score was not significant.Among the BMI percentile categories, participants in the normal weight subgroup showed a significant increase in BMI z-score during the 6 week trial, compared to overweight/obese subgroup, in both Li+Ris/Valproate and Li+Ris/Topiramate treatment groups. Elevated mean serum level of triglyceride and a high proportion of participants with elevated total cholesterol (≥ 170 mg/dl), triglyceride (≥ 110 mg/dl), and BMI percentile 85-<95 at baseline (before randomization) and at the end of 6 week study were noted. CONCLUSION: When topiramate and valproate sodium are used for six weeks as adjunctive treatment to a combination of Li+Ris, they act alike on lipid milieu of children and adolescents with bipolar disorder. Both Li+Ris/Valproate and Li+Ris/Topiramate therapies can lead to an increase in BMI z-score. This increase is statistically significant with Li+Ris/Valproate therapy. This suggests that topiramate could attenuate the ongoing weight gain from lithium and risperidone. In this study, the majority of participants who gained weight were those with BMI less than 85th percentile. This suggests that normal weight patients may have greater weight gain potential than overweight/obese patients.High proportion of metabolic abnormalities among the patients at baseline, which remained elevated throughout the trial, warrants cardiometabolic monitoring in this population.

Parenting Self Efficacy in Mothers of Children with Attention Deficit Hyperactivity Disorder vs. Normal Children.

OBJECTIVES: The main purpose of this study was to compare parenting self efficacy between mothers of children with attention deficit-hyperactivity disorder (ADHD) and mothers of normal children. METHOD: One hundred twenty mothers including 60 mothers of children with ADHD and 62 mothers of normal children were selected. In each group the participants were allocated between three subgroups of preschool, first and second grade of primary school. The participants were evaluated for ADHD symptom severity and parenting self efficacy, using Conner's Parents Rating Scales-Revised Short (CPRS-R:S) and Berkeley Parenting Self-efficacy scale. Data were analyzed using independent sample T test, Chi square, Pearson and Spearman correlation and stepwise linear regression statistical analysis when appropriate. RESULTS: The results of this study did not show any significant difference between self efficiency in mothers of children with ADHD and mothers of normal children in preschool and first grade of primary school. However, between group differences were significant in mothers of children in second grade of primary school. The most associated factors with parenting self efficacy were Children's age, and education level. CONCLUSION: No difference was observed in self efficacy of parents of ADHD children and parents of normal children in pre-school and first grade of primary school. However, parenting self efficacy was significantly lower in parents of the second grade ADHD children compared to the normal group. Increment in age and education level of children with ADHD may be associated with lower level of parenting self efficacy.

Mental health problems of Iranian female adolescents and its association with pubertal development: a nationwide study.

Mental health problems including emotional and behavioral problems during puberty may be under influence of different risk factors including cultures, living in urban or rural areas and ethnic factors which may vary between different countries. The main aim of this study is to investigate the profile of emotional and behavioral problems and the role of factors such as age, stage of puberty, ethnicity, rurality and living in urban area, as risk factors in Iranian girls. As a part of a large national study we evaluated the emotional and behavioral problems in different stages of puberty in a community sample of Iranian adolescent girls from public schools that were selected by clustered random sampling method. In all subjects, demographic characteristics, and pubertal stages were measured. Emotional and behavioral problems were evaluated using Strength and Difficulties Questionnaire (SDQ). The associations of age, pubertal development indices, socioeconomic and demographic factors with the behavioral problems were assessed. A total number of 4576 students enrolled the study and responded to the questions. The mean age of participants was 13.83 ± 2.19 years. The mean total score of difficulties in participants was 14.34 ± 5.81. According to these results 813 (17.8%) adolescents had total problem scores higher than Goodman's cutoff points and the most frequent problem domain was conduct problems (20.5%). According to the results the most related variable with the total difficulty score of SDQ were ethnicity, residency in urban areas and development of menstrual cycle respectively. The results of this study showed that the most correlated factors with mental health problems in Iranian girls during puberty are ethnicity, urbanity and development of menstrual cycle.

Role of Omega-3 fatty acids in preventing metabolic disturbances in patients on olanzapine plus either sodium valproate or lithium: a randomized double-blind placebo-controlled trial.

BACKGROUND: Metabolic and cardiovascular side effects have been noted with the use of second generation antipsychotics (SGAs) and mood stabilizers. Since Omega-3 fatty acids have been known to prevent some cardiovascular risks, this preliminary study was designed to evaluate the cardiovascular benefits of omega-3 when added to the combinations of olanzapine with mood stabilizers. METHODS: This study was a randomized, double-blind, placebo-controlled, within-subject trial in adult psychiatric patients who were receiving olanzapine combined with lithium (Li) or valproate sodium (VPA). Omega-3 as fish oil with less than 1 g/day of EPA/DHA or its placebo was added to patients' olanzapine and mood stabilizer regimens for 6 weeks. Metabolic parameters including anthropometric variables, lipid profile, metabolic syndrome indices, C-reactive protein, fibrinogen and lipoprotein (a) [(Lp) (a)] were assessed for participants. RESULTS: Forty one participants completed this study; 20 patients received omega-3 and 21 patients received placebo, added to their regimen of SGA and mood stabilizer. Omega-3 addition did not modulate anthropometric, metabolic syndrome and lipid parameter changes in 6 weeks. However, fibrinogen levels significantly decreased, Lp (a) did not increase and non-high-density lipoprotein cholesterol (non-HDL-C) did not go beyond its target level after omega-3 supplementation. Additionally, a significant inter-group effect was noted for Lp(a). CONCLUSIONS: This study suggests that use of short-term omega-3 supplementation added to a combined regimen of olanzapine and mood stabilizer may have a small modulating effect on some cardiovascular risk factors. Trials in longer periods of time and with larger number of patients are needed to further evaluate the effects of omega-3 supplements on preventing cardiovascular risk factors.This trial is registered at irct.ir and its Identifier is as following: IRCT138712231764N1.

Duloxetine in the treatment of adolescents with attention deficit/hyperactivity disorder: an open-label study.

OBJECTIVE: The main aim of this study was to explore the efficacy and safety of duloxetine, a serotonin and norepinephrine reuptake inhibitor, in the treatment of adolescents with attention deficit/hyperactivity disorder (ADHD). METHODS: Seventeen adolescents aged 11-18 years, diagnosed with ADHD, participated in this 6-week open-label study. Duloxetine was given in doses of 30 mg/day in the first week and 60 mg/day from week 2 to the end of the study. Conners' Parent Rating Scale-Revised (CPRS-R) short form was used to assess the efficacy of the therapy. RESULTS: A significant reduction in ADHD symptoms measured by CPRS-R was observed. This reduction was evident from week 4 of the study. In addition, the decrease was significant in all four subscales of CPRS-R including inattention, oppositionality, hyperactivity and ADHD index. In terms of side effects, duloxetine was generally safe and well tolerated. CONCLUSIONS: The results of this open-label study suggest a promise of duloxetine in the treatment of youth with ADHD. Further controlled studies with larger samples are required to evaluate the efficacy of duloxetine in children and adolescents with ADHD.

Quality of Life and the Associated Psychological Factors in Caregivers of Children with PKU.

OBJECTIVES: The main objective of this study was to investigate the association of psychological factors and life stressors with quality of life in caregivers of children with PKU. METHODS: Participants were caregivers of children with PKU who were referred to a child and adolescent consultation-liaison psychiatry clinic for a clinical follow up. Their demographic characteristics were recorded at first. WHOQOL-BREF and Depression-Anxiety-Stress Scale (DASS) were used to assess quality of life, depression, anxiety and stress in participants. Data analysis was performed using SPSS-11.5 statistical software. RESULTS: A total number of 49 caregivers were enrolled for the study. The mean age of participants and their children were 35.63±8.82, and 9.84±6.62 respectively. Of the participants, 59.2% were mothers and 40.8% were fathers. Of the children, 51% were girls and 49% were boys. According to the results, 57.1, 50.1 and 57.1 percent of the participants had mild to severe levels of depression, anxiety and stress scores respectively. The most associated factors with quality of life were as follows: caregivers' occupation; anxiety; and depression mean scores. CONCLUSION: Results of the current study showed that caregivers of children with PKU have lower levels of quality of life in comparison with the general population; and the most correlated factors with quality of life were the caregivers' occupation (especially unemployment), and high levels of depression and anxiety.

Initial Orientation of Attention towards Emotional Faces in Children with Attention Deficit Hyperactivity Disorder.

OBJECTIVE: Early recognition of negative emotions is considered to be of vital importance. It seems that children with attention deficit hyperactivity disorder have some difficulties recognizing facial emotional expressions, especially negative ones. This study investigated the preference of children with attention deficit hyperactivity disorder for negative (angry, sad) facial expressions compared to normal children. METHOD: Participants were 35 drug naive boys with ADHD, aged between 6-11 years,and 31 matched healthy children. Visual orientation data were recorded while participants viewed face pairs (negative-neutral pairs) shown for 3000ms. The number of first fixations made to each expression was considered as an index of initial orientation. RESULTS: Group comparisons revealed no difference between attention deficit hyperactivity disorder group and their matched healthy counterparts in initial orientation of attention. A tendency towards negative emotions was found within the normal group, while no difference was observed between initial allocation of attention toward negative and neutral expressions in children with ADHD. CONCLUSION: Children with attention deficit hyperactivity disorder do not have significant preference for negative facial expressions. In contrast, normal children have a significant preference for negative facial emotions rather than neutral faces.

The Effect of Parental Presence on the 5 year-Old Children's Anxiety and Cooperative Behavior in the First and Second Dental Visit.

OBJECTIVE: One of the most significant problems in pediatric dentistry is behavioral resistance of preschool children in the first visit. There is a debate on parental presence in operation room. The purpose of this study was to evaluate the Iranian 5-year-old children's behavior including anxiety and cooperation relative to parental presence in the first and second dental appointments. METHODS: The study was conducted on sixty seven 5-year-old children selected according to inclusion criteria and randomly divided into two subgroups. Children in group I were visited in parent's presence and in group II in parent's absence. Before the child's first dental visit, parents were interviewed. Forty eight of the children receiving the initial examination were recalled for a second visit. The children's responses during the Holst procedure of the first visit and restorative second visit were assessed using a combination of two measures including heart rate and clinical behavior. The dentist-patient interactions were regulated by standardized scripts and recorded on videotape. Then, the behavior of the child on the recording during each visit was quantified by two pediatric dentists independently according to Venham 6-point rating scale and Frankle 4-point rating scale. FINDINGS: There were no significant differences between the heart rate measures of children in group I and II in the first and second visit (0.67, 0.8 respectively). There were also no significant differences between the clinical anxiety scores of children in the two groups in the first and second visit (0.98, 0.42 respectively). Moreover, there were no significant differences between the clinical cooperation scores of children in group I and group II in the first and second visit (0.88, 0.40 respectively), neither were there any significant differences between response measures of each child between two visits (P>0.05). In addition, there were no significant differences related to sex, parental education and dental experiences (P>0.05). CONCLUSION: Parental presence or absence doesn't affect an Iranian 5-year-old child's anxiety on the first and second dental visit, as well as an Iranian 5-year-old child's cooperation on the first and second dental visit.

Behavior abnormality following intravenous immunoglobulin treatment in patients with primary antibody deficiencies.

OBJECTIVE: Treatment with intravenous immunoglobulin (IVIG) is considered a safe therapy for patients with primary antibody deficiencies (PADs), whilst adverse effects have been frequently reported. Meantime behavioral disorders reactions have not been reported yet. In this study, we describe for the first time a group of patients with PADs, who were under IVIG therapy and experienced some behavioral disorders. METHODS: Five patients, including two hyper IgM syndromes, one X-linked agammaglobulinemia, one common variable immunodeficiency, and one hypo IgM disease, were surveyed. Analysis of Conner's Parents Rating Scales-Revised Short (CPRS-R:S) and child behavior checklist (CBCL) was performed for the patients, suspected to hyperactivity. RESULTS: Analysis of CPRS-R:S showed an evidence of mild hyperactivity before IVIG administration in four patients, whereas another patient had evidence of severe hyperactivity. After IVIG administration, hyperactivity scores of three patients were changed from mild hyperactive behavior to markedly hyperactive behavior or attention deficit hyperactivity disorder range of hyperactivity. In the CBCL scores, there were abnormal externalization scores for three patients; while two remaining patients had abnormal internalization scores. CONCLUSIONS: Although predisposition to behavioral disorders can be due to a genetic background, further investigations are necessary to test the hypotheses about responsibility of either IVIG or underling disease in progression of behavioral abnormalities.