Attachment and comorbid anxiety in ADHD.

Anxiety comorbidity is quite common in children with attention-deficit hyperactivity disorder (ADHD). What is known about the relationship between anxiety, attachment and emotion regulation in such children is still limited. We aimed to investigate the associations between attachment, emotion regulation and comorbid anxiety in children with ADHD. 100 children with ADHD and 100 children without any diagnosis aged 8-13 years were included. After the participants were clinically evaluated, Turgay ADHD Scale, Emotion Regulation Checklist, Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV) and Kerns' Security Scale were completed. According to the RCADS-CV scores, ADHD/ANX(+), ADHD/ANX(-), and control groups were formed. The emotional lability/negativity levels were higher in the ADHD groups compared to the non-ADHD controls. Paternal and maternal attachment security levels were lower in the ADHD/ANX(+) group compared to the controls. The regression analysis indicated that higher hyperactivity/impulsivity symptom levels and lower maternal attachment quality were associated with higher anxiety in children with ADHD. These results suggest that focusing on attachment quality and emotion regulation problems may be significant in management of core symptoms and comorbid anxiety problems in children with ADHD.

Impact of the Age at Distal Hypospadias Surgery on Behavioral Problems, Somatic Symptoms and Irritability Levels in Children.

BACKGROUND: To assess the effect of age at hypospadias surgery on emotional and behavioural problems, somatic symptoms, irritability, and penile perception. METHODS: We retrospectively identified the patients who underwent single distal hypospadias surgery and age-matched healthy controls were included. There were two further subgroups according to the age at the time of hypospadias repair (<2 vs. >2 years). The Strengths and Difficulties Questionnaire (SDQ), Revised Children's Anxiety and Depression Scale (RCADS), Affective Reactivity Index (ARI), Level 2 Somatic Symptom Scale, and Penile Perception Score (PPS) scale were used. The groups were compared using multivariate variance analysis (MANOVA). RESULTS: Both groups consisted of 70 patients (mean age 14.0 ± 0.2 years, for both), while there were 34 patients in the hypospadias groups who underwent surgery at <2 years of age. Depressive, panic, separation anxiety, social phobia, and somatic complaint symptom scores of the hypospadias group were lower than those of the control group. Obsessive-compulsive symptom levels were significantly higher in patients who underwent hypospadias surgery at >2 vs. <2 years of age. Additionally, PPSs rated by the surgeon were significantly higher in the former. A multivariate linear regression model indicated that panic disorder symptom scores predicted child PPS in the hypospadias group. Limitations include retrospective design. CONCLUSIONS: Single hypospadias surgery seems not to have a negative impact on emotional and behavioural status. Children who underwent distal hypospadias surgery after 2 years of age had higher levels of obsessive-compulsive symptoms. Following emotional status may help the early diagnosis of future psychopathologies. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: III.

The associations between reading mind in the eyes abilities, alexithymia, empathy, and bullying behavior in Turkish adolescents.

PROBLEM: The development of any program to reduce bullying is possible with a better understanding of the associated underlying factors with its emergence. This study, therefore, aimed to investigate three different social cognitive abilities: abilities to read minds in the eyes, alexithymic personality traits, and empathy, in association with bullying behaviors in adolescents. Although these factors have been studied separately, our data highlighted their effect, relationship, and interconnectivity. METHODS: The participants consisted of 351 adolescents (57.8% girls) aged 13-16 years (mean: 14.32 ± 0.73 for girls, 14.38 ± 0.86 for boys). The data used in this cross-sectional study were collected using self-reported questionnaires. Pearson's moment product correlation analysis and hierarchical linear regression analysis were performed to evaluate the associations between variables. FINDINGS: Bullying behavior levels were higher in male adolescents compared with females. The results indicated that bullying behavior was associated with low levels of reading minds in the eyes abilities, alexithymic personality traits, and low affective empathy levels. CONCLUSION: These findings highlight the critical impact of the poor comprehension of mental states and emotional statuses of other people and low emphatic thinking capacity in the emergence of bullying behaviors among adolescents. Therapeutic interventions focusing on improving these factors may therefore be useful in prevention and management programs for bullying behavior.

The associations between metacognition problems, mindfulness, and internalizing symptoms in university students quarantined due to Covid-19 in Turkey.

PURPOSE: To investigate the associations between internalizing problems, metacognition problems, and mindfulness levels in university students during the COVID-19 pandemic. DESIGN AND METHODS: Depression, anxiety, and stress levels were compared between university students quarantined in dormitories and their homes under curfew conditions. The direct and indirect associations between internalizing problems, metacognition problems, and mindfulness levels of students under quarantine were evaluated. FINDINGS: Metacognition problems and low mindfulness levels were associated with higher depression, anxiety, and stress symptoms under quarantine conditions. PRACTICE IMPLICATIONS: Therapeutic interventions focusing on metacognition problems and mindfulness levels may reduce the negative psychological effects of quarantine.

The associations between metacognition problems, childhood trauma and internalizing symptoms in healthcare workers working directly with patients infected with COVID-19.

Healthcare workers (HCWs) providing medical support while facing one of the highest levels of adverse and potentially fatal outcomes due to COVID-19 are put in a vulnerable position leading to the development of mental health problems. The development of any prevention and intervention programs to reduce this risk is possible with better understanding and knowledge of possible vulnerability factors. The aim of the present study is to investigate psychological effect of working directly with patients infected with COVID-19 (WD) and possible individual vulnerability factors for the development of psychological problems in HCWs. The data used in this cross-sectional study were collected using online self-reported questionnaires from 290 HCWs aged 21-61 years old. The mean score of the scales of 145 HCWs-WD and 145 HCWs not WD (HCWs-NWD) were compared by independent sample t test. Associations between childhood traumas, metacognitive dysfunctional beliefs and internalizing symptoms were analyzed using structural equation modelling (SEM). The depression, anxiety, stress symptoms levels, somatization and sleep problem levels were found to be higher in HCWs-WD compared to HCWs-NWD. SEM revealed that childhood trauma levels was associated with the increased risk of internalizing problems, and metacognitive dysfunctional beliefs had a partial mediator role between childhood traumas and internalizing symptoms in HCWs-WD. Improving metacognitive abilities may hence need to be considered in prevention programs for the HCWs. The findings can also be used to set up further research on the specific interventions on the HCWs who are at a risk as their profession entails them being in such traumatic situations.

The Associations Between Attachment, Thought-Action Fusion, and Anxiety in Adolescents: Mediator Effect of Thought-Action Fusion.

Background: This study examined the relationship between attachment quality, thought-action fusion (TAF), and the anxiety levels and mediator effect of TAF-likelihood-self in this relationship in adolescents. Methods: The participants consisted of 637 adolescents aged 12-17 (61.3% female, n = 391; 38.7% male, n = 246) obtained from 2 secondary schools in Istanbul. TAF was screened with Thought-Action Fusion-Child Version (TAFIC), and anxiety was assessed with the Trait Anxiety subscale of the State-Trait Anxiety Inventory for Children (STAIC). The short form of The Inventory of Parent and Peer Attachment-short version (s-IPPA) was used to determine the attachment quality of adolescents. Results: Higher levels of TAF and lower levels of maternal attachment (MA) and paternal attachment (PA) quality were associated with higher levels of trait anxiety. In addition to this, TAF-likelihood-self had partial mediator role between attachment levels and anxiety symptoms. Conclusion: The results of the present study suggested that low attachment quality can be a risk factor in terms of higher anxiety levels, and TAF problems may have an increasing effect on this association. It can be suggested that, in the clinical or academic field, interventions focusing on the differentiation between the thought and action may be beneficial in anxious adolescents with attachment problems.

The evaluation of anxiety, depression and quality of life scores of children and adolescents with familial Mediterranean fever.

This study aimed to evaluate the anxiety, depression and quality of life scores of children and adolescents diagnosed with familial Mediterranean fever (FMF) and compare these scores with the ones of healthy controls. The study group comprised of 130 children and adolescents diagnosed with FMF with a mean age of 12.6 ± 2.58 and control group comprised of 121 healthy controls with a mean age of 11.8 ± 2.84. Both groups were evaluated with child depression inventory (CDI), screen for child anxiety related emotional disorders (SCARED), pediatric quality of life inventory TM 4.0 (PedsQL™ 4.0) questionnaires. The severity of FMF was assessed by Pras scoring system as mild, moderate and severe disease. The comparisons of these three subgroups of FMF were made in terms of anxiety, depression and quality of life. Children and adolescents with FMF had significantly higher median scores of anxiety than healthy controls. The median scores of depression and quality of life were similar between both groups. Patients with a depression score of 19 or above had significantly higher scores of anxiety and longer duration of disease than the patients with a depression score below 19. While the patients with a severe course of FMF had higher median scores of depression and anxiety, they had significantly lower median scores of quality of life. According to our evaluation, patients with FMF had higher anxiety scores and as the disease become severe, not only anxiety scores but also features of depression become overt. An early apprehension of the mood changes of these patients may have a positive influence in the management of FMF. So, a close collaboration between child and adolescent psychiatrist and pediatric rheumatologist is essential for all over well-being of children and adolescents with FMF.

The relationships between attachment quality, metacognition, and somatization in adolescents: The mediator role of metacognition.

PROBLEM: To investigate the associations between attachment quality, metacognition problems, and somatization. METHODS: One thousand and seven adolescents between the ages of 14-17 were included in the study. They completed the DSM-V Level 2 Somatic Symptoms Scale, the Inventory of Parent and Peer Attachment (short version), the Metacognitions Questionnaire for Children (MCQ-C), and the Strengths and Difficulties Questionnaire. The Spearmen's rank-order correlation test and structural equation modeling were used to analyze the associations between the scales. FINDINGS: Correlation coefficients and structural equation modeling indicated that attachment quality is significantly associated with somatic symptom severity, and MCQ-C scores play a partial mediator role in the relationship between attachment quality and somatization. CONCLUSION: Improving metacognitive skills in adolescents with low attachment quality may increase therapeutic success when addressing somatization.

The relationships between nomophobia, alexithymia and metacognitive problems in an adolescent population.

Yavuz M, Altan B, Bayrak B, Gündüz M, Bolat N. The relationships between nomophobia, alexithymia and metacognitive problems in an adolescent population. Turk J Pediatr 2019; 61: 345-351. Nomophobia refers to an intense anxiety and stress caused by being out of contact with mobile phones (MPs). It is known that excessive engagement with MPs decreases adolescents` psychological well-being, social and academic functioning. The aim of this study was to investigate the associations of nomophobia with alexithymia which is characterized by difficulties in describing and expressing emotions and using empathy, and with the metacognition characteristics which have the function of controlling the cognitions in an adolescent population. The study was conducted on 1817 participants (n = 972, 54% female, n = 835, 46% male). The Nomophobia Questionnaire (NMP-Q), The Twenty-Item Toronto Alexithymia Scale (TAS-20) and The Metacognition Questionnaire for Children and Adolescents (MCQ-C) were administered to participants. A question form for socio-demographic data was also administered to participants and their families. Cathegorical variables were analyzed by chi-square test, and numerical variables were analyzed by independent sample t test. The relationships between the scales` scores were analyzed by the Pearson-product moments correlation test. The predictive effects of alexithymia, metacognition problems and gender were assessed by multiple linear regression analysis. Nomophobia, alexithymia and metacognition problem levels were significantly higher in females than males. There was a significant correlation between NMP-Q and TAS-20 scores and MCQ-C scores. TAS-20, MCQ-C scores and gender significantly predicted the nomophobia when NMP-Q score was a dependent variable. Therapeutic interventions for improving social skills like emphatic thinking and/or increasing emotional expression may be beneficial in the treatment of adolescents with alexithymic traits which experience nomophobia. Moreover, interventions that enhance metacognitive skills which can control negative thoughts triggered by the possibility of losing contact with MPs may increase treatment success.

Examining the factors that are correlated with mindfulness with a focus on attention deficit hyperactivity symptoms.

PURPOSE: We hypothesized that attention deficit hyperactivity symptoms would negatively correlate with the level of mindfulness. DESIGN AND METHOD: Seventy-six subjects referred to the outpatient psychiatry unit and 32 healthy control subjects filled out the Mindful Attention Awareness Scale (MAAS), the Depression Anxiety Stress Scale (DASS), the Adult ADHD Self-Report Scale (ASRS), and the Wender Utah Rating Scale (WURS). FINDINGS: Patients scored higher on ADH symptoms compared to controls (p ≤ .001). Higher scores on the ASRS and WURS revealed lower mindfulness in the study group (p ≤ .001). WURS, DASS depression, ASRS attention subscale-based scores (p < .05) were significant predictors on MAAS scores. PRACTICE IMPLICATIONS: Besides emotional symptoms ADH symptoms had a significant predictive value on mindfulness.

The relationships between problematic internet use, alexithymia levels and attachment characteristics in a sample of adolescents in a high school, Turkey.

The aim of this study is to investigate the relationships between attachment characteristics, alexithymia and problematic internet use (PIU) in adolescents. The study was performed on 444 high school students (66% female and 34% male). Internet Addiction Test (IAT), Toronto Alexithymia Scale (TAS-20) and Short Form of the Inventory of Parent and Peer Attachment (s-IPPA) scales were used. The adolescents who scored ≥50 on IAT were considered as the PIU group and <50 were considered as control group. There was a moderate positive relationship between TAS-20 and IAT scores (r = .441), and a moderate negative relationship between TAS-20 and s-IPPA scores (r = -.392), and a negative weak relationship between IAT and s-IPPA scores (r = -.208). S-IPPA scores were significantly lower in the PIU group compared to the controls (p < .001). TAS-20 scores of the PIU group were significantly higher compared to the controls (p < .05). Logistic regression analysis indicated that s-IPPA scores and TAS-20 significantly predict the PIU development (p < .05). The results indicate that alexithymia increases the risk of PIU and higher attachment quality is a protective factor for both alexithymia and PIU. These results suggest that it is important to focus on the insecure attachment patterns and alexithymic characteristics when studying adolescents with PIU.

Recognition of emotional facial expressions and broad autism phenotype in parents of children diagnosed with autistic spectrum disorder.

OBJECTIVE: Research findings debate about features of broad autism phenotype. In this study, we tested whether parents of children with autism have problems recognizing emotional facial expression and the contribution of such an impairment to the broad phenotype of autism. METHOD: Seventy-two parents of children with autistic spectrum disorder and 38 parents of control group participated in the study. Broad autism features was measured with Autism Quotient (AQ). Recognition of Emotional Face Expression Test was assessed with the Emotion Recognition Test, consisting a set of photographs from Ekman & Friesen's. RESULTS: In a two-tailed analysis of variance of AQ, there was a significant difference for social skills (F(1, 106)=6.095; p<.05). Analyses of variance revealed significant difference in the recognition of happy, surprised and neutral expressions (F(1, 106)=4.068, p=.046; F(1, 106)=4.068, p=.046; F(1, 106)=6.064, p=.016). CONCLUSION: According to our findings, social impairment could be considered a characteristic feature of BAP. ASD parents had difficulty recognizing neutral expressions, suggesting that ASD parents may have impaired recognition of ambiguous expressions as do autistic children.

Attachment Characteristics and Behavioral Problems in Children and Adolescents with Congenital Blindness.

INTRODUCTION: This study aimed to assess the behavioral problems and the attachment characteristics of children and adolescents with congenital blindness (CB). METHOD: Forty children and adolescents aged 11-14 years with CB were included as the case group. Forty healthy children and adolescents who were matched for age, gender, and socioeconomic status with the case group served as the comparison group. Behavioral problems were assessed by the Child Behavior Checklist for ages 4-18 (CBCL 4/18). Attachment characteristics were assessed via the Short Form of Inventory of Parent and Peer Attachment (s-IPPA). RESULTS: The case group had lower CBCL total problems scores as well as anxiety/depression, withdrawal/depression, and attention problems subscales scores with respect to the comparison group. There were no significant differences between the two groups in s-IPPA scores. CONCLUSION: Children and adolescents with CB did not differ from the comparison group in terms of attachment, whereas, they had lower scores on behavioral problems than the comparison group. Although previous studies indicate that children and adolescents with CB may be at the risk of insecure attachment, our study suggested that adaptive mechanisms of their families together with professional help from specialized teachers and services provided by schools for children and adolescents with CB may play compensatory roles.

[The effect of circumcision on the mental health of children: a review]. / Sünnetin Çocuk Ruh Sagligi Üzerine Etkisi: Gözden Geçirme Çalismasi.

Circumcision is one of the oldest and most frequently performed surgical procedures in the world. It is thought that the beginning of the male circumcision dates back to the earliest times of history. Approximately 13.3 million boys and 2 million girls undergo circumcision each year. In western societies, circumcision is usually performed in infancy while in other parts of the world, it is performed at different developmental stages. Each year in Turkey, especially during the summer months, thousands of children undergo circumcision. The motivations for circumcision include medical-therapeutic, preventive-hygienic and cultural reasons. Numerous publications have suggested that circumcision has serious traumatic effects on children's mental health. Studies conducted in Turkey draw attention to the positive meanings attributed to the circumcision in the community and emphasize that social effects limit the negative effects of circumcision. Although there are many publications in foreign literature about the mental effects of the circumcision on children's mental health, there are only a few studies in Turkey about the mental effects of the one of the most frequently performed surgical procedures in our country. The aim of this study is to review this issue. The articles related to circumcision were searched by keywords in Pubmed, Medline, EBSCHOHost, PsycINFO, Turkish Medline, Cukurova Index Database and in Google Scholar and those appropriate for this review were used by authors.

Depression and anxiety levels and self-concept characteristics of adolescents with congenital complete visual impairment.

OBJECTIVE: Previous studies have reported that visual impairment can affect the mental health of children and adolescents. The aim of this study is to investigate the depression and anxiety levels and the self-concept characteristics of adolescents with congenital complete visual impairment. METHOD: This is a cross-sectional study. 40 adolescents with congenital complete visual impairment studying in a specialized primary school for visual impairment, and 40 sighted adolescents were included in the study. Both groups were matched in terms of age, gender and socio-economic status. The mean age of the adolescents in both groups was 12.82±1.17. The Children's Depression Inventory, Piers-Harris Children's Self-Concept Scale, Spielberger Trait Anxiety Inventory for Children and sociodemographic form were used in the study. The mean scores of the scales obtained from both groups were compared using the Mann-Whitney U test. RESULTS: The difference between the two groups was not statistically significant either in terms of depression scores or in terms of total scores; the happiness, physical appearance, popularity, behavior and adjustment subscales scores of the Piers-Harris Children's Self-Concept Scale. The intellectual and school-status subscale scores of the adolescents with visual impairment were significantly higher than those of the controls. Anxiety levels of the adolescents with visual impairment were significantly higher when compared with sighted adolescents. CONCLUSION: These results indicate that the depression levels and self-concept characteristics of adolescents with visual impairment are similar to those of sighted adolescents, whereas the anxiety levels of the adolescents with visual impairment are significantly higher than those of the sighted ones.