Mothers' alexithymia, depression and anxiety levels and their association with the quality of mother-infant relationship: a preliminary study.

OBJECTIVE: To evaluate the relationship between mothers and their developmentally normal infants in terms of maternal alexithymia, depression and anxiety, and marital satisfaction. METHODS: Fifty children between 18 and 48 months of age, and their mothers, were referred consecutively to the Infant Mental Health Unit of Ankara University School of Medicine, Department of Child and Adolescent Psychiatry. The sociodemographic features of the families and the depressive symptoms, anxiety, marital satisfaction and alexithymia levels of the mothers were assessed. The relationships between children in normal developmental stages and their mothers were evaluated and rated using a structured clinical procedure. RESULTS: There was a negative correlation between the mothers' alexithymia scores and the quality of the mother-infant relationship (p < 0.05). Mothers with high alexithymia showed higher depression and lower relationship qualities than mothers with low alexithymia, according to the correlation analysis. When depression and anxiety were controlled, high alexithymia levels were predictive of a low, impaired mother-infant relationship. CONCLUSION: Since alexithymia is a trait-like variable which has a negative correlation with impairment in a mother-infant relationship, it must be investigated in the assessment of mothers' interactions with their babies.

A nationwide study of social-emotional problems in young children in Turkey.

We aimed to assess the prevalence of social-emotional problems of Turkish children in early childhood and to understand their association with various bio-psycho-social risk factors, in order to establish guidelines in planning training programs for parents and professionals. Data from a representative sample of 1507 boys (54.3%) and 1268 girls (45.7%) aged 10-48 months were collected. The primary caregivers (mothers=91.4%) completed the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the Brief Symptom Inventory (BSI) and a form designed to gather information about various bio-psycho-social risk factors. Based on the caregiver terms, a total of 1626 children (60.1%) were reported to experience social-emotional problems. However, based on the BITSEA-problem clinical (1.5 SD) cut-off scores, 9.3% (9.1% of boys; 9.5% of girls) of all children were found to experience social-emotional problems. The variables, that showed a significant association with BITSEA-problem scores in pairwise comparisons, were entered in logistic regression analysis to determine the variables that predict the group with scores of above clinical cut-point. Higher total score of BSI of the primary caregiver, being separated from the mother for more than a month, and lower income of the family were found to be significant predictors of social-emotional problems. Caregiver reports highlight that maternal variables of mothers' psychological well-being, education and access to sources of support are closely related to the social-emotional wellbeing of their off-spring. The findings obtained from this study may be used for detection of prioritized domains in terms of management of preventive mental health services.

Underinvolved relationship disorder and related factors in a sample of young children.

BACKGROUND AND AIMS: The interaction between the infant and the caregiver is stated to be very important in the development of a child. When there is inadequacy of interaction, several emotional and developmental problems can emerge. We aimed to investigate the socio-demographic and clinical features of children diagnosed with Underinvolved Relationship Disorder according to the DC:0-3R classification system. STUDY DESIGN AND METHODS: Four hundred and fifty seven children aged between 1 and 59 months, who had been admitted to an infant mental health clinic were assessed using the DC:0-3R classification system and the whole sample was divided into two groups, the group in which Underinvolved Relationship Disorder between the child and the caregiver had been detected (URD), and the group in which this had not been detected (NURD). These two groups were compared with regard to socio-demographic features, reasons for referral, primary diagnoses, relational disorders, medical/developmental conditions, psychosocial stressors and the Parent-Infant Relationship Global Assessment Scale (PIRGAS) scores of children. RESULTS: Language delay, insufficient social interaction and aggression were found to be significantly more frequent reasons for referral in URD. Disorders of Relating and Communicating (equivalent to the Pervasive Developmental Disorders in DSM IV) and Deprivation/Maltreatment Disorder were more frequent primary diagnoses, Verbally or Physically Abusive Relationship Disorder was significantly more frequent relational disorder in URD. Mild and moderate mental retardation were significantly more frequent in URD, and social environment, educational/child care and health-care access challenges were found to be more frequent psychosocial stressors in the parents of URD. The Mean PIRGAS scores were significantly lower in URD connoting that the parent-infant relationship is poorer. CONCLUSIONS: The diagnosis of Underinvolved Relationship Disorder according to the DC:0-3R classification system is related to some developmental and psychosocial problems.

Lower urinary tract conditions in children with attention deficit hyperactivity disorder: correlation of symptoms based on validated scoring systems.

PURPOSE: We investigated whether certain voiding problems have a higher incidence in patients with attention deficit disorder with hyperactivity compared to age matched controls. MATERIALS AND METHODS: We used the Conners Parent Rating Scale-revised for attention deficit disorder with hyperactivity and lower urinary tract symptom score to evaluate voiding problems. A total of 62 children with attention deficit disorder and 124 healthy controls were enrolled. We evaluated uroflowmetry patterns in both groups. Residual urine volumes and Bristol stool scale were noted. We examined the correlation between total Conners Parent Rating Scale-revised and lower urinary tract symptom score in patients with attention deficit disorder. Additionally we analyzed each index of the Conners Parent Rating Scale-revised separately in terms of correlation with symptom subgroups for lower urinary tract symptom scores. RESULTS: Mean ± SD total lower urinary tract symptom score was 11.1 ± 2.9 in patients with attention deficit disorder with hyperactivity and 3.2 ± 1.3 in controls, a difference that was statistically significantly (p <0.001). With the exception of constipation, mean scores of all lower urinary tract symptom subindices were significantly higher in patients with attention deficit disorder compared to controls. Symptoms evaluated in lower urinary tract symptom score were mostly correlated with attention deficit disorder index of the Conners Parent Rating Scale-revised. If a child with attention deficit disorder has a high index in the Conners Parent Rating Scale-revised, he or she is more likely to have urgency. Also, if a child with attention deficit disorder has a high hyperactivity subscale score, he or she is more likely to have enuresis. CONCLUSIONS: Voiding problems are more common in children with attention deficit disorder with hyperactivity than in age matched controls. Urgency and enuresis are the outstanding problems in children with attention deficit disorder. Simultaneous use of the Conners Parent Rating Scale-revised and lower urinary tract symptom score questionnaire should be encouraged in patients with attention deficit disorder to allow a structured and quantitative evaluation of these overlapping problems.

Sociodemographic characteristics of Turkish parents in relation to their recognition of emotional maltreatment.

OBJECTIVES: To develop an instrument which could assess the extent to which emotionally maltreating parental behavior was recognized by Turkish parents (Study 1) and to evaluate a group of parental and family characteristics that were related with their recognition of emotional maltreatment (Study 2). METHODS: Self-administered instruments were used in both studies. In Study 1, a representative sample consisting of a total of 498 parents of children attending public and private preschools, elementary, and high schools in Ankara, were recruited. A 21-item Recognition of Emotional Maltreatment Scale (REMS) was developed. In addition to exploratory and confirmatory factor analyses were performed and convergent validity was examined by utilizing the Child Abuse Potential Inventory (CAPI) and the Parental Acceptance Rejection Questionnaire (PARQ). Its test-retest reliability and internal consistency were also investigated. In Study 2, a total of 296 parents who were various public and private sector office workers and maintenance employees were recruited. Parents completed a socio-demographic form and the REMS. RESULTS: In Study 1, exploratory factor analyses revealed four factors. A confirmatory factor analysis indicated that the four-factor model met the criteria standards for adequacy of fit. A moderate correlation of the REMS with CAPI and PARQ (r=.40 and .44, respectively) supported its convergent validity. Its test-retest stability was .73 and internal consistency was .70. In Study 2, a three-way analysis of variance showed that gender of the parent, family income and parent education were significant. Correlation analyses showed that there were significant negative correlations of mean REMS scores with parental age (r=-.27; p<.0001) and positive correlations with number of children in the family (r=.20; p<.007). Mothers who were housewives had higher mean REMS scores than employed mothers. CONCLUSIONS: The REMS had acceptable validity and reliability properties. Fathers, parents with lower income and lower education levels showed lesser recognition of child emotional maltreatment. Maternal unemployment, younger parent age and more children in the family were related with lower levels of recognition. PRACTICE IMPLICATIONS: This is the initial effort in developing an instrument that may guide professionals in the selection and assessment of at-risk parent groups which need educational programs regarding child emotional maltreatment.

Depression, anxiety and obsessive-compulsive symptoms and quality of life in children with attention-deficit hyperactivity disorder (ADHD) during three-month methylphenidate treatment.

The current study was designed to investigate the changes that occur in depression, anxiety, obsessive-compulsive symptoms and health-related quality of life during methylphenidate (MPH) treatment in children with attention-deficit hyperactivity disorder (ADHD). Forty-five treatment naive children with ADHD, aged 8-14, were assessed based on self, parent and teacher reports at the baseline and at the end of the first and third month of MPH treatment regarding changes in inattention, hyperactivity, impulsivity, depression, anxiety and obsessive-compulsive symptoms. Changes in the quality of life were also noted. Repeated measures of analysis of variance (ANOVA) tests with Bonferroni corrections were conducted in order to evaluate the data. Symptoms of inattention, hyperactivity and impulsivity were significantly reduced (p < 0.017) following a three-month MPH treatment. There were significant decreases in depression (p = 0.004), trait anxiety (p = 0.000) and checking compulsion symptom scores (p = 0.001). Moreover, parents reported significant improvements in psychosocial (p = 0.001) and total scores (p = 0.009) of quality of life, despite no change in physical health scores (p > 0.05). Children's ratings of quality of life measures showed no significant changes in physical health and psychosocial scores (p > 0.05), while total scores significantly improved (p = 0.001) after the treatment. Over a three-month MPH treatment, depression, trait anxiety and checking compulsion symptoms decreased and quality of life seemed to improve along with those of inattention, hyperactivity and impulsivity.

Psychometric properties and cut-off scores of the Beck Depression Inventory-II in Turkish adolescents.

The current study examined the psychometric properties and cut-off scores of the Beck Depression Inventory II in Turkish adolescents. A total of 503 non-clinical and 166 clinical adolescents participated in the study. Test-retest (r = .89) and internal consistency (alpha = .90) reliabilities, convergent validity (r = .81) and discriminant validities (r = .39, r = .49 and r = .42) were satisfactory. Exploratory factor analyses yielded two factors. The cut-off score for mild depression in Turkish adolescents was lower than that reported previously for adults. The findings are discussed in relation to those of previous studies conducted in other countries.

Extremity fracture characteristics in children with impulsive/hyperactive behavior.

INTRODUCTION: To investigate which fracture characteristics were associated with impulsive/hyperactive behavior in children with extremity fractures. MATERIALS AND METHODS: A clinical sample of 95 consecutive children with extremity fractures admitted to the Orthopaedics and Traumatology Outpatient Clinic of a university hospital were included in the study. The Conners Parent Rating Scale (CPRS) was used to assess children's symptoms. Fracture characteristics were grouped according to trauma type, fracture localization, hospitalization requirement, treatment type and history of previous fracture(s). Descriptive analyses were performed; t-tests and univariate ANOVAs were utilized to compare groups with respect to impulsivity/hyperactivity subscale scores on the CPRS. RESULTS: Mean CPRS impulsivity/hyperactivity subscale score for the whole group was 6.94 (SD = 2.69). Children with fractures which occurred during solitary activities presented with more impulsive/hyperactive behavior than those with fractures which occurred during group activities. Children with more severe fractures that required open reduction also presented with more impulsive/hyperactive behavior. Children with lower extremity fractures had showed more impulsive/hyperactive behavior than children with upper extremity fractures. CONCLUSION: Detecting behavior problems in children admitted with fractures and referring them for treatment, is critical in preventing future serious injuries.

Neurological soft signs in comorbid learning and attention deficit hyperactivity disorders.

The present study aimed to examine whether neurological soft signs identified in children with attention deficit hyperactivity disorder (ADHD), learning disorders (LD), comorbid ADHD-LD and children with no known disorders could be grouped and whether these groups of soft signs would differentiate between the clinical groups and the non-clinical group. A total of 148 children (114 boys, 34 girls) participated in the study, with a mean age of 8.84. The exploratory factor analysis for Neurological Examination for Subtle Signs (NESS) items revealed five factors, explaining 81.7% of the variation. Multivariate analysis of variance showed that these factors of NESS were significantly different between the clinical groups and the non-clinical group. The discriminant functional analysis also yielded significant canonical discriminant functions, correctly classifying 85% of the clinical and non-clinical groups of children. Certain factors of NESS such as speed of movement, dysrhythmia and overflow with timed movements, provide important information that may enhance our understanding of the neurobiological bases of ADHD and LD and the clinical implications of neurological soft signs.

Behavioral, interactional and developmental symptomatology in toddlers of depressed mothers: a preliminary clinical study within the DC:0-3 framework.

Relations between maternal depression and infant behavior, attachment and development were examined within a clinical diagnostic framework. The sample consisted of a study group of 15 infants and their mothers with depression compared to a group of 16 infants and their mothers with no diagnosable psychiatric disorders. The study group scored lower on expressive (p < .03), receptive (p < .05) and overall communication (p < .03) and coping skills (p < .03) of the Vineland and total scales (p < .05) of both developmental measures and higher on psychosocial stressor severity assessments (p < .01). More mother-infant dyads in the study group presented with relationship disorders (p < .01) with considerably lower PIR-GAS (global assessment scale for parent-infant relationship) scores (p < .001). Infants of depressed mothers were also significantly more likely to show problematic attachment behavior to their mothers (p < .01). As a factor leading to the increased risk of childhood developmental problems and psychopathology, maternal depression requires special attention during clinical assessment of infants and toddlers.

[Biopsychosocial variables associated with gender of rearing in children with male pseudohermaphroditism]. / Erkek Yalanci Hermafrodit Olgularin Yetistirildikleri Cinsiyetle Iliskili Biyopsikososyal Degiskenler.

OBJECTIVE: The effect of parental rearing on gender identity development in children with ambiguous genitalia remains controversial. The present study aimed to address this issue by investigating the factors that may be associated with sex of rearing in children with male pseudohermaphroditism. METHOD: The study included 56 children with male pseudohermaphroditism that were consecutively referred to a child psychiatry outpatient clinic. At the time of referral the age range of the sample was 6 months-14 years; 28 children had been raised as boys and 28 as girls. Demographic and biological information was obtained from patient charts. An intersex history interview was administered to the children and parents, whereas The Gender Identity Interview and the Draw-A-Person Test were administered only to the children. The children were observed during free play. Comparisons of biological, psychological and social variables were made with respect to gender of rearing. RESULTS: More children reared as boys were younger at time of referral, belonged to extended families, and had higher Prader scores. Although children's gender roles were appropriate for their gender of rearing, findings of the Gender Identity Interview and the Draw-A-Person Test suggested that some of the girls presented with a male or neutral gender self-perception. CONCLUSION: The relationships between age at the time of problem identification, age at the time of diagnosis, and gender of rearing indicate the importance of taking measures to ensure that the intersex condition is identified at birth and children are referred for early diagnosis, gender assignment, and treatment.

Children with fractures show higher levels of impulsive-hyperactive behavior.

Children with fractures have been reported to have impulsive-hyperactive behavior problems although whether they exhibited such behavior more often than children with other orthopaedic conditions is unknown. We investigated whether impulsivity-hyperactivity was more prominent in children with extremity fractures than in children with orthopaedic conditions not involving a fracture. From outpatient clinical intakes, we recruited 39 consecutive children with extremity fractures and 33 children with orthopaedic conditions not involving a fracture. We used the Conners' Parent Rating Scale to detect behavioral symptoms in children with and without extremity fractures. Children who were treated for extremity fractures had higher mean scores for impulsivity-hyperactivity than those treated for nontrauma-related reasons. Additionally, more children in the fracture group reached impulsive-hyperactive behavior scores high enough to warrant additional psychiatric evaluation. In terms of injury prevention, the orthopaedic surgeon should be familiar with problem behaviors of children, particularly impulsivity and hyperactivity, to be able to make appropriate referrals for psychiatric evaluation and treatment.

Psychoeducation and expressed emotion by parents of children with learning disorders.

The present study assessed use of a psychoeducation group program on expressed emotion, family functioning, and child behavior by parents of children with learning disorders. 81 parents of children with learning disorders were randomly assigned to a psychoeducation group program (n=46) or to a regular treatment group (n=35). A semistructured interview for parental expressed emotion, self-reports of family functioning, and child behavior were utilized at baseline and after an 8-session psychoeducation group program. Parents who attended the program differed significantly from parents in the regular treatment group on measures of criticism, warmth, and positive remarks, and overall expressed emotion, but not on measures of perceived family functioning and child behavior. Findings indicate a psychoeducation group program could be effective in helping parents to establish a more positive emotional climate in their relationships with their children who have learning disorders.

[Development of grade level norms for reading speed and writing errors of Turkish elementary school children]. / Ilkögretim okullarina devam eden türk cocuklarinin sinif düzeylerine göre okuma hizi ve yazim hatalari normlarinin gelistirilmesi.

INTRODUCTION: Despite being in the normal intelligence range, children with learning disorders fail to reach expected academic performance levels. Clinical diagnosis and decisions for therapeutic management for these children require the use of academic achievement tests. The lack of reliable achievement tests and age appropriate reading speed and writing norms hinder clinical studies with Turkish children. OBJECTIVE: To develop and establish Turkish norms of an assessment tool which will aid in the objective evaluation and diagnosis of learning disorders. METHOD: A total of 2572 children attending the 1st-5th grades of randomly selected elementary schools belonging to different socioeconomic levels constituted the sample of the study. The number of words read from grade-level appropriate scripts in 1 minute indicated reading speed. A three-sentence script containing repeating consonants p-b-t-d-m-n-v-f was dictated to determine writing errors. RESULTS AND DISCUSSION: Grade levels of reading speed increase and writing errors decrease as the child grows. Mean, standard deviation and standard error scores indicate that objective academic achievement criteria were reached. Achievement differences according to gender and sociocultural status, which were not the subject of this study, also seem to be important variables.