Acute flaccid rhombencephalomyelitis with radiculitis in a child with an enterovirus A71 infection seen for the first time in Denmark: a case report.

BACKGROUND: Acute flaccid myelitis is a serious condition of the spinal cord. More than 80% of patients experience a mild respiratory illness or fever consistent with a viral infection prior to acute flaccid myelitis development. Enterovirus A71 is known to circulate in Denmark, and has previously been associated with severe neurological symptoms. In this case report we describe acute flaccid rhombencephalomyelitis with radiculitis in an infant with an enterovirus infection. CASE PRESENTATION: The 8-month-old male of Asian origin presented with fever and gastrointestinal symptoms, followed by severe neurological deficits such as flaccid paralysis of the neck and upper extremities. An initial magnetic resonance imaging scan of the brain was normal, and the boy was treated for encephalitis. A follow-up magnetic resonance imaging scan of the brain and spinal cord 1 week later showed the development of pathological symmetrical gray matter hyperintensity lesions on T2-weighted images in the brainstem and upper medulla spinalis, and nerve enhancement in the terminal thread of the spinal cord and the cervical roots; findings consistent with rhombencephalomyelitis with radiculitis causing flaccid paralysis. Enterovirus A71 was detected in both nasopharyngeal and fecal specimens. Other differential diagnostic etiologies of viral and bacterial encephalitis, including poliovirus, were excluded. CONCLUSIONS: This is the first case in Denmark of a patient diagnosed with acute flaccid rhombencephalomyelitis strongly linked to an enterovirus A71 infection. This case emphasizes the diagnostic importance of combining a history of respiratory and/or gastrointestinal illness, fever, and delayed onset of varying degrees of paralysis with progressive characteristic spinal and brain lesions. Analysis of respiratory, fecal, and cerebrospinal samples for the presence of enterovirus, and eliminating other differential pathogens, is essential to confirm the diagnosis.

The predictive validity of the Strengths and Difficulties Questionnaire in preschool age to identify mental disorders in preadolescence.

The Strengths and Difficulties Questionnaire (SDQ) is a brief, widely used instrument to screen for mental health problems in children and adolescents. The SDQ predictive algorithms developed for the SDQ, synthesize information from multiple informants regarding psychiatric symptoms and their impact on daily life. This study aimed to explore the validity of the SDQ predictive algorithms used in preschool age to predict mental disorders in preadolescence. The study population comprises 1176 children from the Copenhagen Child Cohort 2000 (CCC2000) assessed at age 5-7 years by the SDQ and reassessed at 11-12 years with the Development and Well Being Assessment (DAWBA) for evaluation of ICD-10 mental disorders. Odds Ratios (ORs), sensitivities, specificities, positive predictive values (PPVs) and negative predictive values (NPVs) were calculated for the SDQ predictive algorithms regarding ICD-10 diagnoses of hyperkinetic-inattentive-, behavioural- and emotional disorders. Significant ORs ranging from 2.3-36.5 were found for the SDQ predictive algorithms in relation to the corresponding diagnoses. The highest ORs were found for hyperkinetic and inattentive disorders, and the lowest for emotional disorders. Sensitivities ranging from 4.5-47.4, specificities ranging from 83.0-99.5, PPVs ranging from 5.0-45.5 and NPVs ranging from 90.6-99.0 were found for the SDQ predictive algorithms in relation to the diagnoses. The results support that the SDQ predictive algorithms are useful for screening at preschool-age to identify children at an increased risk of mental disorders in preadolescence. However, early screening with the SDQ predictive algorithms cannot stand alone, and repeated assessments of children are needed to identify, especially internalizing, mental health problems.

Concordance of child self-reported psychotic experiences with interview- and observer-based psychotic experiences.

AIM: Valid instruments for the early identification of psychotic experiences (PE) and symptoms in youths are urgently needed for large-scale preventive interventions. A new section of The-Development-and-Well-Being Assessment (DAWBA) measuring child self-reported PE has yet to be validated. The current study aimed to investigate the concurrent validity of DAWBA-based self-reported PE (PE-S) with regard to interview-based measures of PE (PE-I). METHODS: Participants were 1571 (47.8% male) children of age 11 to 12 years from the Copenhagen Child Cohort 2000 (CCC2000) with complete data from both the online PE-section of DAWBA and the following face-to-face interview and assessment of PE. The DAWBA-PE-section asks the child 10 questions covering auditory and visual hallucinations, delusional ideas and subjective thought disturbances ever in life; and attributions to sleep, fever, illness or drug intake. The interview-based assessment of PE was performed by trained professionals using 22 items from The Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (KSADS-PL). The two assessments were completed independently. RESULTS: The prevalence of PE-S was 28.1% (24.3% for PE-S with no frequent attributions), compared with 10.2% for PE-I. The predictive values of PE-S for any PE-I were: sensitivity = 73.8%, specificity = 77.1%, positive predictive value (PPV) = 26.8% and negative predictive value (NPV) = 96.3%. Self-reported visual hallucinations had the best overall predictive values with a sensitivity of 43.1%, specificity of 94.0%, PPV of 44.8% and a NPV of 93.6% for any PE-I. CONCLUSION: The DAWBA-section proved valuable as a screening tool for PE in the youth general population.

Psychotic experiences are associated with health anxiety and functional somatic symptoms in preadolescence.

BACKGROUND: Health anxiety (HA) is an increasing public health problem related to increased health service costs, and associated with functional somatic symptoms (FSS) and considerable personal suffering. Abnormal bodily experiences which may resemble HA and FSS are common in psychotic disorders, but a potential link between HA and psychosis vulnerability in childhood is largely unexplored. The current study estimates the association between subclinical psychotic experiences (PE) and HA and FSS in a general population cohort of preadolescents. METHODS: The study population consisted of 1,572 11-12-year-old children from the Copenhagen Child Cohort 2000. PE were comprehensibly assessed as either present or not present using the Kiddie Schedule of Affective Disorders and Schizophrenia psychosis section. HA and FSS were assessed by self-report on validated questionnaires. Additional variables on general psychopathology, puberty, and chronic somatic illness were also obtained. RESULTS: Psychotic experiences were associated with the top 10% high scores of HA (Odds Ratio (OR) 3.2; 95% CI: 2.1-4.8) and FSS (OR 4.6; 95% CI: 3.1-6.9) in univariate analyses. After mutual adjustment, the association was reduced to (HA: OR 2.3; 95% CI: 1.5-3.5; FSS: OR 3.7; 95% CI: 2.4-4.7), suggesting interdependence. Further adjustment for potential confounders and general psychopathology only reduced the associations slightly: HA OR 2.2 (95% CI: 1.4-3.4); FSS OR 3.3 (95% CI: 2.1-5.2). Secondary analyses of subdimensions of HA showed that PE were associated with fears (OR 3.0; 95% CI: 2.0-4.6) and daily impact of HA symptoms (OR 5.0; 95% CI: 3.4-7.5), but not help seeking (OR 1.2; 95% CI: 0.7-2.1). CONCLUSIONS: This is the first study to investigate the associations between PE and HA and FSS, respectively. PE were significantly associated with HA and FSS over and above general psychopathology in preadolescence. Individuals with PE expressed high levels of health-related fears and daily impact, but no corresponding help-seeking behavior.

Validation of the Eating Pattern Inventory for Children in a General Population Sample of 11- to 12-Year-Old Children.

Previous research suggests that the Eating Pattern Inventory for Children (EPI-C) is best conceptualized as comprising four factors: dietary restraint, emotional, external eating and parental pressure to eat. This study aims to examine the psychometric properties of the EPI-C and to test gender and weight group differences. The population-based study sample comprised 1,939 children aged 11 to 12 years from the Copenhagen Child Cohort (CCC2000). Psychometric properties were evaluated using multigroup categorical data in confirmatory factor analysis (CFA) and differential item functioning (DIF) tests. CFA supported the four-factor solution for the EPI-C. Reliability estimates were satisfactory for three of the four scales. DIF with regard to weight was found for an item on weight loss intention. Girls reported higher restrained and emotional eating; overweight children reported higher restrained, emotional and external eating, while underweight children reported higher parental pressure to eat. The results support the use of EPI-C for measuring eating behaviors in preadolescence.

Early Predictors of Eating Problems in Preadolescence-A Prospective Birth Cohort Study.

PURPOSE: The epidemiology of childhood eating problems is far from being fully described. The present study aims to explore early predictors of eating behavior problems in preadolescence. METHODS: The study sample comprised 1,939 children from the birth cohort study, the Copenhagen Child Cohort (CCC2000). Logistic regression models were used to investigate associations among infancy health, developmental and relational factors, maternal mental health problems, socioeconomic factors, parental reported eating behavior patterns in preschool age and eating behavior problems in preadolescence. RESULTS: A number of factors expressing socioeconomic disadvantage across childhood were associated with an increased risk of eating behavior problems at age 11-12 years. In addition, overeating patterns at age 5-7 years predicted restrained eating in preadolescence (odds ratio [OR] = 2.77; 95% confidence interval [CI] = 1.13-6.77; p = .03), with overweight at age 11-12 years and low annual household income as strong explanatory factors (OR = 4.79; 95% CI = 2.81-8.17; p < .0001 and OR = 2.06; 95% CI = 1.19-3.58; p = .02, respectively). No significant associations between perinatal, early child- and relational factors, or maternal mental disorder and eating behavior problems in preadolescence were found. CONCLUSIONS: Our results suggest that overeating at age 5-7 years is prospectively associated with restrained eating in preadolescence, with contemporaneous socioeconomic disadvantages and overweight as strong explanatory factors. Our findings might reflect successful public health interventions toward childhood obesity or might reflect a developmental course of problematic eating fluctuating between over- and undereating. Future studies should focus on the possible pathways from overeating to restrained eating and more severe eating pathology, including possible negative side effects of otherwise successful interventions aimed at reducing childhood obesity.

Eating behaviours in preadolescence are associated with body dissatisfaction and mental disorders - Results of the CCC2000 study.

Preadolescence is a key period in the early stages of eating disorder development. The aim of the present study was, firstly, to investigate restrained, emotional and external eating in a general population-based sample of 11-12 year olds. Secondly, we sought to explore how these eating behaviours are associated with possible predictors of eating disorders, such as body dissatisfaction, weight status and mental disorders. A subsample of 1567 children (47.7% boys; 52.3% girls) from the Copenhagen Child Cohort (CCC2000) completed web-based questionnaires on eating behaviours and body dissatisfaction using The Eating Pattern Inventory for Children (EPI-C) and The Children's Figure Rating Scale. Mental disorders were assessed using the online version of the Development and Well-Being Assessment (DAWBA) based on parental replies with final DSM-IV diagnoses determined by experienced child- and adolescent psychiatrists. Height and weight were measured at a face-to-face assessment. The results showed that restrained eating was significantly associated with overweight, body dissatisfaction and emotional disorders in both genders. Emotional eating showed similar associations with overweight and body dissatisfaction in both genders, but was only associated with mental disorders in girls. External eating was significantly associated with body dissatisfaction and neurodevelopmental disorders in both genders, but was only associated with overweight in girls. Our findings show that problematic eating behaviours can be identified in preadolescence, and co-exist with weight problems and mental disorders. Thus restrained, emotional and external eating was, in different ways, associated with overweight, body dissatisfaction and mental disorders. Our findings point to significant eating behaviours in preadolescence, which could constitute potential predictors of later eating disorder risk.

Health Anxiety in Preadolescence--Associated Health Problems, Healthcare Expenditure, and Continuity in Childhood.

Epidemiological data on the distribution, persistence, and clinical correlates of health anxiety (HA) in childhood are scarce. We investigated continuity of HA symptoms and associated health problems and medical costs in primary health services in a general population birth cohort. HA symptoms were assessed in 1886 Danish 11-12 year old children (48 % boys) from the Copenhagen Child Cohort using the Childhood Illness Attitude Scales (CIAS) together with information on socio-demographics and the child's somatic and mental status and healthcare expenditure. Non-parametric statistics and regression analysis were used to compare groups with low (n = 184), intermediate (n = 1539), and high (n = 161) HA symptom scores. The association between HA symptoms assessed at age 5-7 years and HA symptoms at ages 11-12 years was examined by Stuart-Maxwell test. HA symptoms were significantly associated with emotional disorders and unspecific somatic complaints, but not with chronic physical conditions. In regression analyses controlling for gender and physical comorbidity, healthcare expenditure peaked in children with the highest HA symptom score, that is these children used on average approximately 150 Euro more than children with the lowest score during the 2-year period preceding inclusion. HA symptoms at age 5-7 years were significantly associated with HA symptoms at age 11-12 years. We conclude that HA symptoms, including hypochondriacal fears and beliefs, were non-trivial in preadolescents; they showed continuity from early childhood and association with emotional disorders, unspecific somatic complaints, and increased healthcare expenditure. Further research in the clinical significance of childhood HA is required.

The CCC2000 Birth Cohort Study of Register-Based Family History of Mental Disorders and Psychotic Experiences in Offspring.

Psychotic experiences (PE) in individuals of the general population are hypothesized to mark the early expression of the pathology underlying psychosis. This notion of PE as an intermediate phenotype is based on the premise that PE share genetic liability with psychosis. We examined whether PE in childhood was predicted by a family history of mental disorder with psychosis rather than a family history of nonpsychotic mental disorder and whether this association differed by severity of PE. The study examined data on 1632 children from a general population birth cohort assessed at age 11-12 years by use of a semistructured interview covering 22 psychotic symptoms. The Danish national registers were linked to describe the complete family history of hospital-based psychiatric diagnoses. Uni- and multivariable logistic regressions were used to test whether a family history of any mental disorder with psychosis, or of nonpsychotic mental disorder, vs no diagnoses was associated with increased risk of PE in offspring (hierarchical exposure variable). The occurrence of PE in offspring was significantly associated with a history of psychosis among the first-degree relatives (adjusted relative risk [RR] = 3.29, 95% CI: 1.82-5.93). The risk increased for combined hallucinations and delusions (adjusted RR = 5.90, 95% CI: 2.64-13.16). A history of nonpsychotic mental disorders in first-degree relatives did not contribute to the risk of PE in offspring nor did any mental disorder among second-degree relatives. Our findings support the notion of PE as a vulnerability marker of transdiagnostic psychosis. The effect of psychosis in first-degree relatives may operate through shared genetic and environmental factors.

Psychotic experiences co-occur with sleep problems, negative affect and mental disorders in preadolescence.

BACKGROUND: Knowledge on the significance of childhood psychotic symptoms and experiences (PE) is still limited. This study aimed to investigate the prevalence and clinical significance of PE in preadolescent children from the general population by use of in-depth psychopathological interviews and comprehensive diagnostic assessments. METHODS: We investigated 1,632 children from the general population-based Copenhagen Child Cohort 2000. PE were measured by semistructured interviews using the K-SADS-PL-items on psychotic and affective symptoms, each symptom scored as not present versus likely or definitely present. The Development and Well-Being Assessment (DAWBA) was used independently to diagnose DSM-IV-mental disorders. Puberty development and sleep disturbance were self-reported. The associations between PE (any lifetime hallucination and/or delusion) and various mental problems and disorders were examined by multivariable binomial regression analyses, adjusting for gender and onset of puberty. RESULTS: The weighted life time prevalence of PE at age 11-12 years was 10.9% (CI 9.1-12.7). The majority of children with PE (n = 172) either had a diagnosable DSM-IV-mental disorder (31.4%) or self-reported mental health difficulties in absence of a diagnosis (31.4%). The risk of delusions increased with onset of puberty. The risk of PE increased with emotional and neurodevelopmental disorders, subthreshold depressive symptoms, sleep problems and lack of sleep, regardless of whether PE were expressed as hallucinations and/or delusions. The highest correlations were seen for emotional and multiple disorders. CONCLUSIONS: Psychotic experiences are particularly prevalent in the context of affective dysregulation and sleep disturbance, increase with onset of puberty and represent a trans-diagnostic marker of psychopathology.

Choroidal thickness in relation to birth parameters in 11- to 12-year-old children: the Copenhagen Child Cohort 2000 Eye Study.

PURPOSE: To examine choroidal thickness in a population-based child cohort in relation to birth parameters. METHODS: The Copenhagen Child Cohort 2000 Eye Study examined 1406 children aged 11 to 12 years using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT), ocular biometry and measurement of height, weight, refraction, and self-reported pubertal development status. Birth parameters were obtained from the Danish Medical Birth Registry. RESULTS: The subfoveal choroid in low birth weight children (<2500 g, n = 51, mean 324 ± 76 µm) was thinner than in normal birth weight children (2500-4500 g, n = 1194, mean 361 ± 78 µm), the difference being -37 (CI95 -60 to -15) µm, P = 0.001 after adjusting for age, sex, height, Tanner stage by sex, axial length, anterior chamber depth, and spherical equivalent refractive error. The subfoveal choroid in high birth weight children (>4500 g, n = 48, mean 351 ± 63 µm) was comparable with normal birth weight children, P = 0.44. The subfoveal choroid was thinner in preterm children, however the difference was not significant (-18 [-37 to 2] µm, P = 0.08). Small for gestation children had thinner subfoveal choroid (-19 [-37 to -1] µm, P = 0.04) compared with appropriate for gestation children. Longer birth length was associated with a thicker subfoveal choroid (2 [1-4] µm/cm, P = 0.005). Macular choroidal thickness at 16 extrafoveal locations was measured in a subset of children and found to have the same associations with birth weight as the subfoveal choroidal thickness. CONCLUSIONS: In 11- to 12-year-old children, thinner choroids were associated with lower birth weight, lower birth length, and being small for the gestational age.