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

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

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

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

Correction to: Translation and cross-cultural adaptation of eight pediatric PROMIS® item banks into Spanish and German.

In the original publication of the article, two of the author names "L. A. Schröder, F. Metzner" and email address of the authors "J. Devine, J. Moon, A. C. Haller" were missed out. The correct author group with affiliations are provided in this correction.

Translation and cross-cultural adaptation of eight pediatric PROMIS® item banks into Spanish and German.

PURPOSE: The Patient-Reported Outcome Measurement Information System (PROMIS®) is a National Institutes of Health (NIH)-funded initiative to develop reliable, valid, and normed item banks to measure health. We describe the first large-scale translation and cross-cultural adaptation effort to German and Spanish of eight pediatric PROMIS item banks: Physical activity (PAC), subjective well-being (SWB), experiences of stress (EOS), and family relations (FAM). METHODS: We utilized methods outlined in the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) PRO Translation Task Force recommendations. Ten professional translators performed a translatability assessment and generated forward translations. Forward Translations were compared within a country and cross-culturally to identify problems and to produce a consensus-derived version, which was then back translated, evaluated, and revised where necessary. Reconciled versions were evaluated in cognitive interviews with 126 children before finalization. RESULTS: Eight resulting pediatric PROMIS® item banks were translated: Two PAC banks (22 total items), three SWB banks (125 total items), two EOS banks (45 total items), and one FAM bank (47 total items). Up to 92% of all items raised no or only minor translation difficulties, 0-5.6% were difficult to translate. Up to 20% item revisions were necessary to ensure conceptual equivalence and comprehensibility. Cognitive interviews indicated that 91-94% of the final items were appropriate for children (8-17 years). CONCLUSIONS: German and Spanish translations of eight PROMIS Pediatric item banks were created for clinical trials and routine pediatric health care. Initial translatability assessment and rigorous translation methodology helped to ensure conceptual equivalence and comprehensibility. Next steps include cross-cultural validation and adaptation studies.

Predictors of health-related quality of life in chronically ill children and adolescents over time.

OBJECTIVE: This study aims at identifying predictors of generic health-related quality of life (HRQoL) in chronically ill children and adolescents over time. The newly developed computer-adaptive test Kids-CAT was used to assess five dimensions of HRQoL. METHODS: Longitudinal data from the Kids-CAT study on children and adolescents with asthma, diabetes and juvenile arthritis (n = 248; aged 7-17 years) were assessed at three measurement points over six months. Individual growth modeling served to investigate effects of sociodemographic, disease- and health-related as well as psychosocial factors on HRQoL dimensions Physical Well-Being (WB), Psychological WB, Parent Relations, Social Support & Peers, and School WB over time. RESULTS: Besides effects of sociodemographic variables on HRQoL dimensions Social Support & Peers as well as School WB, we found that a longer duration of the disease was associated with better Physical WB. Lower scores were found for patients with juvenile arthritis compared to those with diabetes in HRQoL dimensions Physical WB and Social Support & Peers. Disease control was positively related to Physical and Psychological WB over time. Mental health problems were negatively associated with four, and subjective health complaints with all five HRQoL dimensions over time. Parental mental health was positively related to the patients' HRQoL score in Parent Relations over time. CONCLUSIONS: HRQoL as a multidimensional construct is associated with a wide range of different factors. Pediatricians should consider potential mental health problems and subjective health complaints in their patients. Finally, parental HRQoL can affect HRQoL in chronically ill children and adolescents.

Predictive value of dysregulation profile trajectories in childhood for symptoms of ADHD, anxiety and depression in late adolescence.

We examined whether there are certain dysregulation profile trajectories in childhood that may predict an elevated risk for mental disorders in later adolescence. Participants (N = 554) were drawn from a representative community sample of German children, 7-11 years old, who were followed over four measurement points (baseline, 1, 2 and 6 years later). Dysregulation profile, derived from the parent report of the Strengths and Difficulties Questionnaire, was measured at the first three measurement points, while symptoms of attention deficit hyperactivity disorder (ADHD), anxiety and depression were assessed at the fourth measurement point. We used latent class growth analysis to investigate developmental trajectories in the development of the dysregulation profile. The predictive value of dysregulation profile trajectories for later ADHD, anxiety and depression was examined by linear regression. For descriptive comparison, the predictive value of a single measurement (baseline) was calculated. Dysregulation profile was a stable trait during childhood. Boys and girls had similar levels of dysregulation profile over time. Two developmental subgroups were identified, namely the low dysregulation profile and the high dysregulation profile trajectory. The group membership in the high dysregulation profile trajectory (n = 102) was best predictive of later ADHD, regardless of an individual's gender and age. It explained 11% of the behavioural variance. For anxiety this was 8.7% and for depression 5.6%, including some gender effects. The single-point measurement was less predictive. An enduring high dysregulation profile in childhood showed some predictive value for psychological functioning 4 years later. Hence, it might be helpful in the preventive monitoring of children at risk.

Gender associated developmental trajectories of SDQ-dysregulation profile and its predictors in children.

BACKGROUND: Severe mood dysregulation is common in childhood and can be highly impairing. The Dysregulation Profile (DP) can be considered as a broader phenotype of emotional dysregulation, including affect, cognition and behaviour. Since mood dysregulation may persist, but differently in boys and girls, the gender associated course needs to be considered longitudinally to gain a better insight in order to support the children more adequately. This study is focusing on gender associated subgroup trajectories of the Strengths and Difficulties Questionnaire-Dysregulation Profile (SDQ-DP) in middle childhood (9-13 years of age) and includes the potential impact of clinical and psychosocial characteristics. METHOD: The data set was available from the BELLA study on mental health and well-being in children and adolescents, which is the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A representative epidemiological sample of 564 children living in Germany was examined at three assessment points over 2 years (data collection 2003-2006). The SDQ-DP of children aged 9-13 years was evaluated using Latent Class Growth Analysis (LCGA). RESULTS: For both genders three trajectories with low (girls 67.0% and boys 59.5%), moderate (girls 28.0% and boys 31.7%) and high SDQ-DP (girls 5.0% and boys 8.8%) scores were detected. The courses of low and moderate subgroups were stable, while in the high SDQ-DP subgroup boys showed a decreasing and girls an increasing trend in symptom severity on a descriptive level. The results of the multinomial logistic regression analyses revealed a significant influence of mainly externalising but also internalising problems both increasing the risk of moderate and high SDQ-DP in both genders. Good quality of life was a protective factor for the SDQ-DP course in all subgroups. CONCLUSION: In addition to the known clinical and scientific value of the SDQ-DP, three distinguishable trajectories of SDQ-DP in boys and girls could be found. High externalising problems at the beginning of the trajectory were associated with an undesirable course of SDQ-DP. These findings might be helpful for better psychoeducation, counselling and monitoring in clinical cases and public health.

Mental Health Care Use in Children of Parents with Mental Health Problems: Results of the BELLA Study.

Whether parental mental health problems facilitate or hinder the use of mental health care of the parents´ children is still unclear. The present cross sectional study examined mental health care use and potential predictors in a population based sample. Children of parents with mental health problems (CPM) were nearly 5 times more likely to use mental health care compared to children of parents without mental health problems. A multiple regression analysis revealed that the most important predictors of mental health care use for CPM were active family life (OR = 2.67) and children´s own mental health problems (OR = 1.18 self-report, 1.17 parent-report). Additionally, parental strain showed a tendency to predict mental health care use (OR = 2.45). This study demonstrates that parental mental health problems are associated with mental health care use in their children and that improving certain family factors may support children´s mental health care use.

The validation of a computer-adaptive test (CAT) for assessing health-related quality of life in children and adolescents in a clinical sample: study design, methods and first results of the Kids-CAT study.

PURPOSE: Recently, we developed a computer-adaptive test (CAT) for assessing health-related quality of life (HRQoL) in children and adolescents: the Kids-CAT. It measures five generic HRQoL dimensions. The aims of this article were (1) to present the study design and (2) to investigate its psychometric properties in a clinical setting. METHODS: The Kids-CAT study is a longitudinal prospective study with eight measurements over one year at two University Medical Centers in Germany. For validating the Kids-CAT, 270 consecutive 7- to 17-year-old patients with asthma (n = 52), diabetes (n = 182) or juvenile arthritis (n = 36) answered well-established HRQoL instruments (Pediatric Quality of Life Inventory™ (PedsQL), KIDSCREEN-27) and scales measuring related constructs (e.g., social support, self-efficacy). Measurement precision, test-retest reliability, convergent and discriminant validity were investigated. RESULTS: The mean standard error of measurement ranged between .38 and .49 for the five dimensions, which equals a reliability between .86 and .76, respectively. The Kids-CAT measured most reliably in the lower HRQoL range. Convergent validity was supported by moderate to high correlations of the Kids-CAT dimensions with corresponding PedsQL dimensions ranging between .52 and .72. A lower correlation was found between the social dimensions of both instruments. Discriminant validity was confirmed by lower correlations with non-corresponding subscales of the PedsQL. CONCLUSIONS: The Kids-CAT measures pediatric HRQoL reliably, particularly in lower areas of HRQoL. Its test-retest reliability should be re-investigated in future studies. The validity of the instrument was demonstrated. Overall, results suggest that the Kids-CAT is a promising candidate for detecting psychosocial needs in chronically ill children.

Implementation of the Kids-CAT in clinical settings: a newly developed computer-adaptive test to facilitate the assessment of patient-reported outcomes of children and adolescents in clinical practice in Germany.

PURPOSE: To describe the implementation process of a computer-adaptive test (CAT) for measuring health-related quality of life (HRQoL) of children and adolescents in two pediatric clinics in Germany. The study focuses on the feasibility and user experience with the Kids-CAT, particularly the patients' experience with the tool and the pediatricians' experience with the Kids-CAT Report. METHODS: The Kids-CAT was completed by 312 children and adolescents with asthma, diabetes or rheumatoid arthritis. The test was applied during four clinical visits over a 1-year period. A feedback report with the test results was made available to the pediatricians. To assess both feasibility and acceptability, a multimethod research design was used. To assess the patients' experience with the tool, the children and adolescents completed a questionnaire. To assess the clinicians' experience, two focus groups were conducted with eight pediatricians. RESULTS: The children and adolescents indicated that the Kids-CAT was easy to complete. All pediatricians reported that the Kids-CAT was straightforward and easy to understand and integrate into clinical practice; they also expressed that routine implementation of the tool would be desirable and that the report was a valuable source of information, facilitating the assessment of self-reported HRQoL of their patients. CONCLUSIONS: The Kids-CAT was considered an efficient and valuable tool for assessing HRQoL in children and adolescents. The Kids-CAT Report promises to be a useful adjunct to standard clinical care with the potential to improve patient-physician communication, enabling pediatricians to evaluate and monitor their young patients' self-reported HRQoL.

[Health Promotion and Child Protection in the Paediatric Practice - Paediatricians as Protagonists in an Invitation and Reporting System for Child Health Check-ups]. / Prävention und Kinderschutz in der pädiatrischen Praxis - Kinderärzte als Akteure im Einladungs- und Meldewesen für Kinderfrüherkennungsuntersuchungen.

INTRODUCTION: Since 1971 routine child health check-ups allow the routine identification of dis-eases in children and adolescents. Paediatricians play a central role in health prevention in childhood and adolescence and are - on account of their acceptance and admission requirements - important actors in child protection. Thus, paediatric practitioners were actively involved in the invitation and reporting system for the routine child health check-ups (U6 and U7), which was introduced to increase participation rates and improve child protection in Hamburg. METHOD: By means of a questionnaire survey, all paediatric practitioners practicing in Hamburg were asked a year after introduction of the invitation and reporting system to report on their practical experience, and to share their assessment and criticism of the system (response rate 73%). RESULTS: Out of 110 participating pediatricians (M=19.5 years practical experience), 81% evaluated the invitation and reporting system as very useful, useful or rather useful; 83% supported an expansion of the system for routine child health check-ups, and about 18% observed an increased utilisation of routine child health check-ups especially from families with a migrant background and by socially-disadvantaged families. Criticism was made concerning ineffective procedures. CONCLUSION: The invitation and reporting system for routine child health check-ups in Hamburg shows how pediatricians can be integrated into the network of prevention and child welfare. It also shows their support of this system. Paying more systematic attention and an interdisciplinary network connecting paediatricians may contribute to a more comprehensive prevention and child protection.

A new computerized adaptive test advancing the measurement of health-related quality of life (HRQoL) in children: the Kids-CAT.

PURPOSE: Assessing health-related quality of life (HRQoL) via Computerized Adaptive Tests (CAT) provides greater measurement precision coupled with a lower test burden compared to conventional tests. Currently, there are no European pediatric HRQoL CATs available. This manuscript aims at describing the development of a HRQoL CAT for children and adolescents: the Kids-CAT, which was developed based on the established KIDSCREEN-27 HRQoL domain structure. METHODS: The Kids-CAT was developed combining classical test theory and item response theory methods and using large archival data of European KIDSCREEN norm studies (n = 10,577-19,580). Methods were applied in line with the US PROMIS project. Item bank development included the investigation of unidimensionality, local independence, exploration of Differential Item Functioning (DIF), evaluation of Item Response Curves (IRCs), estimation and norming of item parameters as well as first CAT simulations. RESULTS: The Kids-CAT was successfully built covering five item banks (with 26-46 items each) to measure physical well-being, psychological well-being, parent relations, social support and peers, and school well-being. The Kids-CAT item banks proved excellent psychometric properties: high content validity, unidimensionality, local independence, low DIF, and model conform IRCs. In CAT simulations, seven items were needed to achieve a measurement precision between .8 and .9 (reliability). It has a child-friendly design, is easy accessible online and gives immediate feedback reports of scores. CONCLUSIONS: The Kids-CAT has the potential to advance pediatric HRQoL measurement by making it less burdensome and enhancing the patient-doctor communication.

[Effectiveness of School-Based Life Skills Programmes on Secondary Schoolchildren in a High Risk Sample]. / Überprüfung der Effektivität schulischer Gesundheitsprogramme bei Schülerinnen und Schülern der Sekundarstufe I mit besonderen sozialen Belastungen.

Based on a randomized controlled multicentre-design the effect of school-based life skills programmes was investigated in a sample of 102 classes of secondary schools (Hauptschulen) in northern Germany. Self-reports of 1,057 pupils showed positive effects of the programmes on the reduction of smoking. Pupils' life skills improved in the teachers' assessment. The social and the migration status did not moderate the results. Both pupils and teachers evaluated the programmes very positive.

Self-reported recurrent pain and medicine use behaviours among 15-year olds: results from the international study.

BACKGROUND: There is considerable variation in adolescent pain prevalence across epidemiological studies, with limited information on pain-related behaviours among adolescents, including medicine use. The aims of this study were (1) to examine the prevalence of recurrent pain among 15-year-old adolescents internationally; (2) to investigate the association between recurrent pain and medicine use behaviours among boys and girls; and (3) to evaluate the consistency of these associations across countries. METHODS: The World Health Organization (WHO) collaborative international Health Behaviour in School-aged Children 2009/2010 study collects data about self-reported aches and medicine use from 36,762 15-year-old adolescents from 22 countries/regions in Europe and the United States. Multi-level multivariate logistic regression, stratified by gender, was used to analyse the association between recurrent pain and medicine use for headache, stomachache, nervousness and difficulties in getting to sleep. RESULTS: More than 30% of adolescents reported recurrent headache, almost 30% recurrent backache and approximately 20% recurrent stomachache. Although pain prevalence and medicine use for aches were much higher for girls, the association between pain and medicine use was similarly strong for both genders. Adolescents with recurrent pain are more likely to use medicines also for non-corresponding pain, nervousness and difficulties in getting to sleep. The association between recurrent pain and medicine use was consistent across countries despite large-country differences in the prevalence of recurrent pain and medicine use. CONCLUSIONS: Recurrent pain in adolescence is common cross-nationally. Adolescents with recurrent pain are more likely to use medicine in general. Recurrent pain and medicine use should be addressed in adolescent health policies.

[Health-related quality of life in children and adolescents in Germany: results of the KiGGS study: first follow-up (KiGGS Wave 1)]. / Gesundheitsbezogene Lebensqualität bei Kindern und Jugendlichen in Deutschland : Ergebnisse der KiGGS-Studie - Erste Folgebefragung (KiGGS Welle 1).

In recent years, there has been a change in the health and disease spectrum among children and adolescents, with an increase in mental health problems and a shift from acute to chronic illness. In this phase, the health-related quality of life (HRQoL) has increased in importance as a dimension of subjective health. The aim of this study is to describe the HRQoL of children and adolescents measured with the internationally standardized screening instrument KIDSCREEN-10. In the follow-up of the KiGGS study in 2009-2012 (KiGGS Wave 1), 2,567 parents of children aged 7-10 years and 4,878 adolescents aged 11 years or older completed the KIDSCREEN-10 questionnaire. In all, 94% of parents of 7- to 10-year-old girls and boys estimate the HRQoL of their children to be "very good" or "good." Of the 11- to 17-year-old adolescents, 96% report their HRQoL as "very good" or "good." Somatic diseases and pain as well as mental health problems and a low social status are included in the HRQoL in only a limited way. Potential differences in HRQoL by social status were not confirmed in multivariate models. The HRQoL of the examined children and adolescents is predominantly very good or good. Interventions to improve the HRQoL of children and adolescents with diseases and psychopathological problems are necessary, regardless of their social status.

[Psychopathological problems and psychosocial impairment in children and adolescents aged 3-17 years in the German population: prevalence and time trends at two measurement points (2003-2006 and 2009-2012): results of the KiGGS study: first follow-up (KiGGS Wave 1)]. / Psychische Auffälligkeiten und psychosoziale Beeinträchtigungen bei Kindern und Jugendlichen im Alter von 3 bis 17 Jahren in Deutschland - Prävalenz und zeitliche Trends zu 2 Erhebungszeitpunkten (2003-2006 und 2009-2012) : Ergebnisse der KiGGS-Studie - Erste Folgebefragung (KiGGS Welle 1).

Child and adolescent mental health problems burden not only the individual, but also their families and their social environment and may, therefore, be regarded as a highly relevant public health issue. The data on mental health problems of children and adolescents from the KiGGS Wave 1 study (sample period 2009-2012) make it possible to report on both current prevalence rates and time trends over the 6-year period beginning with the KiGGS baseline survey (2003-2006). The assessment of emotional and behavioral problems in KiGGS Wave 1 was carried out with the symptoms questionnaire of the Strengths and Difficulties Questionnaire (SDQ) in a telephone interview with 10,353 guardians of children and adolescents aged 3-17 years. Moreover, using the SDQ impact supplement, the KIGGS Wave 1 data provide information on psychosocial impairment following child and adolescent mental health problems. Subjects with a borderline or abnormal SDQ score, according to German normative data, were considered at risk. A total of 20.2% (95% CI: 18.9-21.6%) of the study subjects were identified as being at risk for a mental health disorder, compared with 20.0% (19.1-20.9%) during the KiGGS baseline study (age-standardized based on population from 12 December 2010). Thus, no significant changes over time in the prevalence of mental health problems were detected. Also, there were no statistically significant differences in prevalence by sex, age group, or socioeconomic status between the KiGGS baseline survey and KiGGS Wave 1. The statistical comparison of the subscale mean values for both girls and boys showed higher values with respect to the subscales for emotional problems, behavioral problems, and prosocial behavior and lower mean values for the peer problems subscale in KiGGS Wave 1. These partly small temporal trends, however, may be due to possible mode effects (written questionnaire in the KiGGS baseline study versus telephone interview in KiGGS Wave 1). The hyperactivity subscale remained stable across the two sample periods. Regarding impairments following mental health problems at the second sample period, boys were more affected in the areas of chronicity, family burden, and impact score. The high and stable prevalence rates and magnitude of emotional and behavioral problems should prompt increased preventive efforts.

The impact on family scale: psychometric analysis of long and short forms in parents of children with epilepsy.

Epilepsy in a child or adolescent can have severe psychosocial impact on the whole family and burdens them, especially the parents. As the familial background is essential for the child's coping and the progression of the epilepsy, parental burden should be considered within a comprehensive treatment approach. This study validated the applicability of the Impact on Family Scale (IOFS), a well-established instrument that assesses the strains of families with chronically ill or disabled children, in parents of children with epilepsy. In a sample of 219 parents, the psychometric properties of the original IOFS version (33 items) and two short forms (15 and 11 items, respectively) were examined. Both short forms revealed good reliability (Cronbach's alpha, test-retest reliability), and construct validity was verified by correlations with epilepsy- and burden-related variables. However, exploratory and confirmatory factor analyses indicated superior characteristics of the short form with 11 items (IOFS-11). In conclusion, the IOFS-11 as well as the IOFS-15 proved to be practicable, reliable, and valid tools to assess the impact of childhood epilepsy on family life in research and clinical practice.

[Trends in subjective health and well-being of children and adolescents in Germany: results of the Health Behaviour in School-aged Children (HBSC) Study 2002 to 2010]. / Trends in der subjektiven Gesundheit und des gesundheitlichen Wohlbefindens von Kindern und Jugendlichen in Deutschland: Ergebnisse der Health Behaviour in School-aged Children (HBSC) Studie 2002 bis 2010.

The monitoring of health through the analysis of trends provides important information on the long-term development of key outcome parameters for health. Currently, Germany does not have any reliable data on trends in the health situation of young people.The presented results are based on the German trend data from the Health Behaviour in School-aged Children (HBSC) Study. Data were analysed for a representative sample of 11-, 13- and 15-year-old school children from 2002 (N=5 650), 2006 (N=7 274) and 2010 (N=5 005). First, a comparison between German and international HBSC trend data was conducted for subjective health, life satisfaction and health complaints in 2002, 2006 and 2010. Next, a logistic regression was calculated to further describe the trends for these outcomes in the German data set.Overall, children and adolescents in Germany report good health. The comparison with the international data further supports this finding. Detailed analyses of trends showed that the health level generally improved between 2002 and 2010 for German children. In particular, better subjective health and lower rates of multiple recurrent health complaints were reported. Irrespective of the survey year, girls and older adolescents reported the highest level of health impairment.Trend analyses contribute towards health politics not only by providing information on the health situation across time, but also by pointing out the long-term effects of measures at the macro level (such as national health programmes, interventions) on children's health.