soulspace: Integrated youth mental health care in Berlin, Germany-An introduction to the program and a description of its users.

AIM: A substantial gap between young people's need for mental health care services and their actual access to such services led worldwide organizations (e.g., the WHO) to recommend the implementation of early intervention programs and youth mental health services. Some countries around the world have established structures to meet this recommendation. In this paper, we describe soulspace as the first integrated youth mental health service for young people aged between 15 and 35 years in Berlin, Germany. METHODS: We introduce soulspace as easily accessible mental health care for young people, and we characterize soulspace along the lines of the internationally established eight key principles of integrated youth mental health services (Killackey, et al., 2020, World Economic Forum). Soulspace is a cooperation between clinical outpatient units of psychiatric clinics for adolescents and young adults as well as a community-based counselling service. It provides initial contact, counselling, diagnostics, and treatment. RESULTS: Our analyses of the pathways to soulspace and the characteristics of the soulspace users suggest that the low threshold is a facilitator to help finding for young people in comparison to more conventional early intervention models. That is, having transferred the early intervention center in a youth-facing counselling service as was done in soulspace seems to have reduced the threshold to seek help for families and for young people in need for support. CONCLUSIONS: In summary, with soulspace, an easily accessible mental health care service was established that integrates counselling and specialized psychiatric treatment if needed.

Assessment and Diagnostic Classification Using DC:0-5 in Early Childhood Mental Health Clinics: The Protocol for the Developmental Psychiatry Diagnostic Challenges Study (DePsy).

Mental health problems in early childhood are common, but there is a lack of psychiatric research on this age group. DC:0-5 is a multiaxial classification system for mental disorders in early childhood, providing a framework for standardizing clinical practice and research. However, research on the validity of DC:0-5 is scarce. The Developmental Psychiatry Diagnostic Challenges Study (DePsy) is a multi-site, prospective clinical study including six German early childhood mental health (ECMH) clinics. The main objective of the study is to contribute to the validation of Axis I and Axis II of DC:0-5. A second aim of the study is to describe the population of the participating clinics regarding diagnoses, family context, and treatment outcomes. Additionally, the impact of environmental risk factors, including parental Adverse Childhood Experiences (ACEs) and media use, on child psychopathology and caregiver-child relationships will be examined. Over two years, patients aged 0.0-5.9 years old will be enrolled in the study. Assessments include ICD-10 and DC:0-5 diagnoses, developmental tests, video-based observations of caregiver-child interactions, and questionnaires on child psychopathology, media use, parental stress, and treatment satisfaction. Study results will promote the standardization of assessment and treatment in ECMH clinics aiming to improve the development of patients and their families.

[Case Conferences in Inpatient Child and Adolescent Psychotherapy - Single Case Presentation and General Recommendations]. / Die Fallbesprechung in der stationären Kinder- und Jugendpsychotherapie ­ Empfehlungen zum Vorgehen anhand einer Einzelfalldarstellung.

Case conference in a teamgroup in inpatient psychotherapy with children and adolescents are a tool to focus those aspects of treatment relations that can not (yet) be verbalized but present themselves in actions during the treatment. This paper gives a brief overview on the theory and methodology of case conferences and refers to an ongoing study. The presentation of a case conference leads to giving some general recommendations.

[Practitioners in Psychotherapy can Improve their Competences in Assessing Attachment in Middle Childhood: Psychometric Quality of an Attachment Screening Tool Relevant forTherapy]. / Stärkung bindungsdiagnostischer Kompetenz von Praktiker/innen in der Psychotherapie: Güte eines therapiebezogenen Bindungsinstrumentes für die mittlere Kindheit.

Attachment narratives are increasingly used as a diagnostic tool in the therapeutic work with children in middle childhood. This, however, demands extensive procedures to ensure its adequate analysis and reliability.Thus, a new diagnostic instrument has been developed. It is a short version of the coding procedure used in the German Attachment Story Completion Task (GASCT) andmakes use of the idea of traffic lights. It can be understood quite intuitively and can be applied time-economically in practice. Instead of a qualitative classification into four attachment groups it results in a five-graded clinical assessment of the child's attachment security towards his or her attachment figures. This can be compared to the attachment security score of the GASCT. Psychometric qualities of the "Attachment Story Completion Light" were analyzed in a sample of 50 patients of a child and adolescent psychiatric hospital aged between four and eight years. Reliability was high, validity of the new instrument was also satisfying, regarding it's association with the original GASCT. For applying the new attachment screening tool a supervised training is required.The tool will enable practitioners to better recognize strengths and difficulties in the attachment representations of children and to plan adequate individualized therapy. As a rating identifying developmental risks, the instrument can help to clarify therapeutic procedures as well as service delivery for child and family.

The Relationship of Temperament and Character, Parental Stress, and Mental Health Problems with Attachment Disorders among Children.

According to Cloninger's model, personality is conceptualized in temperament and character traits contributing to a child's psychosocial development. Additionally, parent-child interaction is important for the child's socio-emotional development. To date, the relationship between attachment and temperament and character for child mental health development and its effects on parents remains mostly unclear. The aim of the present study was thus to examine the relationship of attachment, temperament and character, parental stress, and mental health problems among 125 children (mean age = 7.14 years) in Switzerland. Temperament and character, attachment disorder (symptoms), parental stress, and mental health problems were assessed with psychometric questionnaires; attachment was assessed with an additional observational measure. Descriptive characters of the sample were presented, and group differences and correlations were computed. For temperament traits, results revealed significant group differences for novelty seeking and persistence and attachment disorder types. For character traits, the findings showed significant group differences for self-directedness and cooperativeness and attachment disorder types. Moderate effect sizes for groups differences were found. Further, the mixed-type (inhibited and disinhibited) and inhibited attachment disorder type were the most burdened groups. The present findings suggest that temperament and character traits, as well as parental stress and mental health problems are associated with the occurrence of attachment disorders among children. Future longitudinal studies with larger samples are needed to examine the causal relationships of temperament and character with attachment, including person-related and environmental factors among children.

German Version of the Relationship Problems Questionnaire: Effective Screening for Attachment Disorder.

INTRODUCTION: Attachment disorder (AD), including reactive AD and disinhibited social engagement disorder, is a prevalent, yet underdiagnosed disorder in severely maltreated children. Because the condition is associated with significant psychiatric morbidity over the entire lifespan, a valid and economic screening tool to identify children with clinical symptoms of AD is needed to avoid unspecific or ineffective treatment. The present study aimed to assess the effectiveness and efficiency of the German version of the Relationship Problems Questionnaire (RPQ). METHODS: With a total of 135 children (mean age = 7.17 years, SD = 1.40, 63% male) from both general (34 children) and high-risk populations (69 in- and outpatients, 32 foster children), we investigated the sensitivity and specificity of the RPQ. AD was diagnosed using a standardized clinical interview (K-DIPS). 35 out of 135 children fulfilled the criteria for AD. RESULTS: The RPQ identified 74% of the children who fulfilled the criteria for AD in the standardized clinical interview. The optimal cut-off score of the RPQ for identifying AD was 4.5 with a moderate sensitivity of 0.74 and specificity of 0.68. CONCLUSIONS: The German version of the RPQ proved useful as a diagnostic indicator of clinical symptoms of AD. The tool is economic and suitable for the screening of AD in the general population as well as high-risk populations. We recommend the use of the RPQ in clinical and research settings, adding multi-method approaches after a positive screening.

Attachment disorder and attachment theory - Two sides of one medal or two different coins?

INTRODUCTION: Currently, attachment quality and attachment disorder exist in parallel, but the mutual association is still insufficiently clarified. For policy makers and clinical experts, it can be difficult to differentiate between these constructs, but the distinction is crucial to develop mental-health services and effective treatment concepts. We aimed to investigate the association between attachment representations (AR) and attachment disorders (AD), including Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in children aged between 5 and 9. METHODS: A total of 135 children aged between 5 and 9 years (M=7.17 years, SD=1.40, 63% male) and their primary caregivers participated in the study. Children were interviewed with the story stem method to assess AR, and the primary caregiver completed diagnostic interviews and questionnaires on mental disorders, AD, emotional and behavioral problems, and intelligence and development. RESULTS: The prevalence of AR in children with AD was 28.6% for the 'secure' form of AR, 17.1% for the 'insecure-avoidant' form, 25.7% for the 'insecure-ambivalent' form, and 28.6% for the 'disorganized' form. Prevalences of the various AR forms did not differ statistically significantly, indicating that AR is conceptionally distinct from AD. Children with disorganized attachment scored significantly lower on language and intelligence skills than children with secure attachment. AD was significantly associated with a higher number of comorbidities, emotional and behavioral problems, and lower language skills. CONCLUSIONS: Longitudinal studies using standardized assessment instruments are needed to systematically provide comparable and reliable empirical findings to improve current understanding of AR and AD as well as their etiological models.

[Agreement of clinical diagnosis, structured interviews, and self-report questionnaires for depression in children and adolescents]. / Übereinstimmung von klinischer Diagnose, strukturierten Interviews und Selbstbeurteilungsfragebögen bei Depression im Kindes- und Jugendalter.

OBJECTIVE: The present study examines the agreement of structured child and parent interviews as well as clinical diagnosis for depressive episodes in children and adolescents. Moreover, it compares the accuracy and optimal cutoff scores of self-report questionnaires with reference to each of these diagnostic assessments. METHOD: 81 children (9-12 years) and 88 adolescents (13-16 years) in psychiatric care and their parents completed the structured diagnostic interview Kinder-DIPS. The children answered the German Children's Depression Inventory (CDI), and the adolescents answered the German Center for Epidemiologic Studies Depression Scale (CES-D). Kappa coefficients quantified the agreement. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff scores, sensitivity, specificity, as well as positive and negative predictive values. RESULTS: The agreement between the child and parent interviews as well as between the interviews and clinical diagnosis was low to moderate. Clinicians diagnosed depressive episodes more frequently than the interviews. Cutoff scores and measures of accuracy varied between the reference standards, with less favorable results for clinical diagnosis. CONCLUSIONS: Clinicians may profit from conducting structured interviews. Strategies for dealing with conflicting information from children and parents should be tested empirically and described in detail.

The Beck depression inventory-II in adolescent mental health patients: cut-off scores for detecting depression and rating severity.

The Beck Depression Inventory-Second Edition (BDI-II) was developed as an indicator of the presence and severity of depression in psychiatric patients from age 13. Its cut-off scores were derived from an adult sample and differentiate four categories of severity but contain no screening cut-off score for classifying patients as depressed vs. nondepressed. We aimed to determine this screening cut-off score and to examine the utility of the severity cut-off scores for adolescents in mental health care. 88 adolescent psychiatric patients (13-16 years, 58% female) completed the German BDI-II. A structured diagnostic interview served as the reference standard for computing receiver operating characteristic (ROC) curves and identified 24 adolescents (27%) as depressed. ROC analysis of depressed vs. nondepressed patients yielded an area under the curve (AUC) value of 0.93. The optimal screening cut-off score according to Youden's Index was ≥23, where sensitivity was 0.88 and specificity was 0.92. The severity cut-off scores yielded satisfying sensitivity (≥0.89) and specificity (≥0.72) for mild and moderate but not for severe depression. Our findings indicate that the BDI-II can be recommended for screening for depressive disorders in adolescent mental health patients. However, the currently used severity cut-off scores may be suboptimal for this population.

Cognitive development of singletons conceived by intracytoplasmic sperm injection or in vitro fertilization at age 5 and 10 years.

OBJECTIVE: To investigate the cognitive functioning of low-risk singletons born after intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF) at the age of 5 or 10 years. METHODS: Sixty-nine children (35 ICSI, 34 IVF) participated voluntarily in the study that had been approved by the local IRB. Their intellectual functioning was examined by the Kaufmann Assessment Battery for Children. RESULTS: The IQ of the study group fell in the normal range (mean = 98.2; SD = 12.2). ICSI children (IQ = 94.1, SD = 13.8) had statistically lower intellectual abilities compared to IVF children (IQ = 102.0, SD = 9.1; t = -2.81, p = .005), especially in simultaneous mental processing. 23.5% ICSI children, but only 2.9% IVF children (p = .011) had at least borderline delayed cognitive development. CONCLUSIONS: Most artificially conceived singletons show a normal cognitive development, however the method of fertilization seems to have an impact on their IQ. ICSI might be associated with the risk for a slightly delayed cognitive development compared to IVF.

[The development of children from assisted reproduction--a review of the literature]. / Die Entwicklung von Kindern aus assistierten Befruchtungen Eine Ubersicht der Studienlage.

Based on a systematic review of the recent literature (2000-2006) we describe the results of 22 empirical studies of the development of children born after assisted reproduction. We considered the somatic, functional and psychosocial development and found some consistent outcomes. With regard to the somatic health, higher incidences of perinatal complications, major birth defects and chromosomal aberrations are repeatedly described. In most cases the studies of the functional and psychosocial development found no statistically differences to naturally conceived children. However some preliminary results demonstrate tendencies to emotional symptoms. The findings suggest the well-being and well-functioning of these children, but further empirical data especially to assess the psychosocial development are needed, especially for schoolage children and adolescents.