Patients' well-being during the transition period after psychiatric hospitalization to school: insights from an intensive longitudinal assessment of patient-parent-teacher triads.

BACKGROUND: The transition period after psychiatric hospitalization back to school is accompanied by various challenges, including a substantial risk for rehospitalization. Self-efficacy and self-control, as transdiagnostic variables and important predictors of coping with school demands, should be crucial factors for successful adaptation processes as well as an overall high well-being during school reentry. The present study therefore investigates how patients' well-being develops during this period, and how it is related to patients' self-control and academic self-efficacy, as well as parents' and teachers' self-efficacy in dealing with the patient. METHODS: In an intensive longitudinal design, daily ambulatory assessment measures via smartphone were collected with self-reports from the triadic perspective of 25 patients (Mage = 10.58 years), 24 parents, and 20 teachers on 50 consecutive school days, starting 2 weeks before discharge from a psychiatric day hospital (mean compliance rate: 71% for patients, 72% for parents and 43% for teachers). Patients answered daily questions between five and nine o'clock in the evening about their well-being, self-control, academic self-efficacy and about positive and negative events at school, as well as parents and teachers about their self-efficacy in dealing with the patient. RESULTS: Multilevel modeling revealed that on average, patients' well-being and self-control decreased during the transition period, with trends over time differing significantly between patients. While patients' academic self-efficacy did not systematically decrease over time, it did show considerable intra-individual fluctuation. Importantly, patients experienced higher well-being on days with higher self-control and academic self-efficacy as well as with higher parental self-efficacy. Daily teacher self-efficacy did not show a significant within-person relationship to daily patients' well-being. CONCLUSIONS: Well-being in the transition period is related to self-control and self-efficacy of patients and their parents. Thus, addressing patients' self-control and academic self-efficacy, as well as parental self-efficacy, seems promising to enhance and stabilize well-being of patients during transition after psychiatric hospitalization. Trial registration Not applicable, as no health care intervention was conducted.

E-Mental-Health aftercare for children and adolescents after partial or full inpatient psychiatric hospitalization: study protocol of the randomized controlled DigiPuR trial.

BACKGROUND: During reintegration to daily school life following psychiatric hospitalization, children and adolescents are confronted with various challenges and are at risk for rehospitalization. Tailored post-discharge services could support a successful readjustment and accompany the high-risk transition period after discharge. The study DigiPuR ("Digital gestützte Psychotherapie und Reintegration," digitally supported psychotherapy and reintegration) aims to establish and to evaluate an innovative digital aftercare program to alleviate challenges during reintegration and improve cross-sectoral care. METHODS: DigiPuR is a randomized controlled trial comparing a digital aftercare service with regular aftercare (TAU) (planned N = 150, 25 children/adolescents, 25 parents, and 25 teachers in each group). In the intervention group, direct communication via secure and regular video calls until 8 weeks after discharge and a secure messenger system between the hospital, family, and school, as well as, if needed, external support systems, are established. A longitudinal pre-post-follow-up assessment at admission, discharge, and 8, 24, and 36 weeks after discharge takes place supplemented by a daily smartphone-based ambulatory assessment from a triadic perspective of patients, parents, and teachers. Primary outcomes include whether participants in the intervention group have fewer readmissions and higher treatment satisfaction and health-related quality of life as well as lower symptom severity than participants in the control group. DISCUSSION: The present study is essential to address the cross-sectoral challenges associated with reintegration into daily (school) life following child and adolescent psychiatric hospitalization and to determine possible needed adaptations in partial or full inpatient settings. If applicability and efficacy of the aftercare service can be demonstrated, integration into regular care will be sought. TRIAL REGISTRATION: ClinicalTrials.gov NCT04986228 . Registered on August 2, 2021.

Disentangling symptoms of externalizing disorders in children using multiple measures and informants.

The trait impulsivity theory suggests that a single, highly heritable externalizing liability factor, expressed as temperamental trait impulsivity, represents the core vulnerability for externalizing disorders. The present study sought to test the application of latent factor models derived from this theory to a clinical sample of children. Participants were 474 German children (age 6-12 years, 81% male) with symptoms of attention-deficit/hyperactivity disorder and externalizing behavior problems participating in an ongoing multicenter intervention study. Using confirmatory factor analyses (CFA) and exploratory structural equation modeling (ESEM), we evaluated several factor models of externalizing spectrum disorders (unidimensional; first-order correlated factors; higher-order factor; fully symmetrical bifactor; bifactor S-1 model). Furthermore, we assessed our prevailing factor models for measurement invariance across raters (clinicians, parents, teachers) and assessment modes (interview, questionnaires). While both CFA and ESEM approaches provided valuable insights into the multidimensionality, ESEM solutions were generally superior since they showed a substantially better model fit and less biased factor loadings. Among the models tested, the bifactor S-1 CFA/ESEM models, with a general hyperactivity-impulsivity reference factor, displayed a statistically sound factor structure and allowed for straightforward interpretability. Furthermore, these models showed the same organization of factors and loading patterns, but not equivalent item thresholds across raters and assessment modes, highlighting cross-situational variability in child behavior. Our findings are consistent with the assumption of the trait impulsivity theory that a common trait, presented as hyperactivity-impulsivity symptoms, underlies all externalizing disorders. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Toward a Dimensional Assessment of Externalizing Disorders in Children: Reliability and Validity of a Semi-Structured Parent Interview.

OBJECTIVE: This study assesses the reliability and validity of the DSM-5-based, semi-structured Clinical Parent Interview for Externalizing Disorders in Children and Adolescents (ILF-EXTERNAL). METHOD: Participant data were drawn from the ongoing ESCAschool intervention study. The ILF-EXTERNAL was evaluated in a clinical sample of 474 children and adolescents (aged 6-12 years, 92 females) with symptoms of attention-deficit/hyperactivity disorder (ADHD). To obtain interrater reliability, the one-way random-effects, absolute agreement models of the intraclass correlation (ICC) for single ICC(1,1) and average measurements ICC(1,3) were computed between the interviewers and two independent raters for 45 randomly selected interviews involving ten interviewers. Overall agreement on DSM-5 diagnoses was assessed using Fleiss' kappa. Further analyses evaluated internal consistencies, item-total correlations as well as correlations between symptom severity and the degree of functional impairment. Additionally, parents completed the German version of the Child Behavior Checklist (CBCL) and two DSM-5-based parent questionnaires for the assessment of ADHD symptoms and symptoms of disruptive behavior disorders (FBB-ADHS; FBB-SSV), which were used to evaluate convergent and divergent validity. RESULTS: ICC coefficients demonstrated very good to excellent interrater reliability on the item and scale level of the ILF-EXTERNAL [scale level: ICC(1,1) = 0.83-0.95; ICC(1,3) = 0.94-0.98]. Overall kappa agreement on DSM-5 diagnoses was substantial to almost perfect for most disorders (0.38 ≤ κ ≤ 0.94). With some exceptions, internal consistencies (0.60 ≤ α ≤ 0.86) and item-total correlations (0.21 ≤ r it ≤ 0.71) were generally satisfactory to good. Furthermore, higher symptom severity was associated with a higher degree of functional impairment. The evaluation of convergent validity revealed positive results regarding clinical judgment and parent ratings (FBB-ADHS; FBB-SSV). Correlations between the ILF-EXTERNAL scales and the CBCL Externalizing Problems were moderate to high. Finally, the ILF-EXTERNAL scales were significantly more strongly associated with the CBCL Externalizing Problems than with the Internalizing Problems, indicating divergent validity. CONCLUSION: In clinically referred, school-age children, the ILF-EXTERNAL demonstrates sound psychometric properties. The ILF-EXTERNAL is a promising clinical interview and contributes to high-quality diagnostics of externalizing disorders in children and adolescents.

Word length and word frequency affect eye movements in dyslexic children reading in a regular (German) orthography.

We combined independently the word length and word frequency to examine if the difficulty of reading material affects eye movements in readers of German, which has high orthographic regularity, comparing the outcome with previous findings available in other languages. Sixteen carefully selected German-speaking dyslexic children (mean age, 9.5 years) and 16 age-matched controls read aloud four lists, each comprising ten unrelated words. The lists varied orthogonally in word length and word frequency: high-frequency, short; high-frequency, long; low-frequency, short; low-frequency, long. Eye movements were measured using a scanning laser ophthalmoscope (SLO). In dyslexic children, fixation durations and the number of saccades increased both with word length and word frequency. The percentage of regressions was only increased for low-frequency words. Most of these effects were qualitatively similar in the two groups, but stronger in dyslexic children, pointing to a deficient higher-level word processing, especially phonological deficit. The results indicate that reading eye movements in German children are modulated by the degree of difficulty, and orthographic regularity of the language can determine the nature of modulation. The findings suggest that, similar to Italian but unlike English readers, German children prefer indirect sub-lexical strategy of grapheme-phoneme conversion.

Eye movements in German-speaking children with and without dyslexia when reading aloud.

PURPOSE: The phonological difficulty and orthographic regularity of a language influence reading strategies. Only a few studies have been conducted in readers of German, which has a high grapheme-phoneme correspondence. The aim of this study was to investigate, firstly, the influence of different levels of phonological difficulty of reading material in German on reading in children and, secondly, to compare the reading strategies of German children with findings in English-speaking readers. METHODS: Eye movements in 16 German children with dyslexia and 16 age-matched control children (mean age 9.5±0.35years) in the third and fourth grades of school were recorded by scanning laser ophthalmoscope while they read aloud two texts of differing levels of difficulty. RESULTS: In the dyslexia group, reading speed was slowed, and the number of saccades and regressions was raised markedly, although the percentage of regressions only slightly. The number of eye movements increased in both groups with increasing text difficulty, although much more in the dyslexia group than in the control group, whereas fixation duration was not influenced. CONCLUSIONS: Phonological difficulty influences reading speed and eye movement pattern: children with dyslexia markedly increase their number of eye movements and analyse the text in smaller units per fixation, but keep fixation duration constant. This strategy reflects their favouring of the indirect, sublexical route of grapheme-phoneme conversion, whereas readers of English-language texts are more likely to prefer the whole-word approach, i.e. the direct, lexical route that is associated with orthographic memory.

Cortical activation during word reading and picture naming in dyslexic and non-reading-impaired children.

OBJECTIVE: In a recent study on picture naming and word reading in dyslexics and control children we found a combination of normal picture retrieval times and severe reading impairments in dyslexics. Therefore, we hypothesize that brain response patterns differ between patients and controls during word reading, but are similar in picture naming as a non-letter mediated task. METHODS: Time course of brain activation was investigated by magnetoencephalography during word reading and picture naming in 9 dyslexic children and 13 age-matched controls (aged 9-10 years). RESULTS: We found 5 consecutive activations spreading from occipito-parietal to temporo-frontal sites. Group differences occurred only during reading: a delayed response in temporal superior and angular gyri at 235-285 ms and absence of activation in anterior temporal and inferior frontal regions at 430-530 ms for dyslexics. CONCLUSIONS: Problems in phonological processing are reflected in delay of early activity and absence of late activity in language related brain regions. From the lack of group differences during picture naming, we conclude the presence of two pathways: a phonological/orthographic one for word reading, which is disturbed in dyslexics, and a visual one for picture naming, which can be unaffected in dyslexics. SIGNIFICANCE: Evidence is provided for different pathways for the processing of letter-mediated and visual-eidetic information. This knowledge may be important for dyslexics in the context of coping with everyday demands and for training of relevant skills.

Eye movement control during single-word reading in dyslexics.

We investigated whether dyslexics make instantaneous automatic adjustments of reading saccades depending on word length. We used a single-word reading paradigm on 10 dyslexic and 12 normally reading children aged 11-15 years. Eye movements were recorded by scanning laser ophthalmoscope (SLO) while subjects read single words of different length aloud. All subjects passed standardized prescreening tests, which included a reading test, to exclude those with discernible deficits of eyesight, oculomotor skill, or intellectual development. We measured number, direction, frequency, and amplitude of saccades, as well as the durations of inter-saccadic intervals, as functions of word length. The results show that word length influences the number and amplitude of reading saccades in both subject groups, but this relationship showed quantitatively significant group-specific differences: Both groups showed a gradual increase of the saccade amplitudes in either direction dependent on word length, but the gain of this function was significantly lower in the dyslexics. The durations of holding phases between saccades were significantly longer in the dyslexics, and accordingly, we found a lower rate of occurrence of saccades per unit time in the dyslexics. Forward saccade amplitudes showed no correlation with the duration of the preceding or following holding phases in either group. The data show that the mechanisms enabling dyslexics to make instantaneous adjustments of reading saccades depending on word length are present but quantitatively impaired. This supports the view that these adjustments may help dyslexics to increase reading speed, but that they cannot utilize them to the same extent as normal readers.

Pictogram naming in dyslexic and normal children assessed by SLO.

We measured pictogram naming (PN) and text reading in dyslexic and normally reading young teenagers. Eye movements were monitored by scanning laser ophthalmoscope, revealing positions of fovea, stimuli on the retina, and speech simultaneously. While text reading speed showed the expected difference between groups, PN speeds overlapped widely. PN was mainly controlled by retrieval time in both groups and correlated with age in dyslexics. During PN, only backward saccades occurred more frequently in dyslexics. We conclude that PN activates visual/eidetic mechanisms that are distinct from the phonemic/analytic pathway necessary for reading. This dual organization leads to a wide range of combinations of performances in PN and text reading.