Psychiatric comorbidities of children with elimination disorders.

Enuresis and encopresis can be stressful for children and parents. We investigated the comorbid psychiatric disorders and the emotional and behavioral symptoms associated with elimination disorders. A total of 97 children and adolescents (aged 4-17 years) with an elimination disorder participated in this study. The elimination disorder group consisted of three subgroups: 50 subjects with enuresis nocturna, 26 with encopresis, and 21 subjects with enuresis+encopresis. The control group with no elimination disorder comprised 50 healthy subjects. All children were interviewed by a child and adolescent psychiatrist. Comorbid psychiatric disorders were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). Parents completed the Strengths and Difficulties Questionnaire. The most common diagnosis was attention-deficit/hyperactivity disorder, followed by oppositional defiant disorder. The highest rate of psychiatric comorbidity was observed in the enuresis+encopresis subgroup, followed by the enuresis nocturna and encopresis subgroups. All the subgroups had higher total difficulties scores than the control group. Screening for psychiatric disorders should be performed for all children with incontinence.

Epidemiology of Psychiatric Disorders in Children and Adolescents in Chaharmahal and Bakhtiari Province, Iran, 2017.

BACKGROUND: This study aimed to investigate the epidemiology of psychiatric disorders in children and adolescents in Chaharmahal and Bakhtiari Province of Iran. METHODS: This community-based cross-sectional study included 1038 children and adolescents aged 6-18 years from Chaharmahal and Bakhtiari province selected by the multistage cluster sampling method. Samples were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Also, demographic data (gender, age, child education, parent education, and economic situation) were obtained. Binary logistic regression was used to analyze the data. RESULTS: A total of 16.1% of participants were diagnosed to have psychiatric disorders. Total psychiatric disorders were significantly more prevalent in boys than in girls (P=0.025). Unemployment of fathers was significantly related to increased prevalence of psychiatric disorders in children (P=0.016). Other demographic variables had no significant correlation with prevalence of psychiatric disorders in children. Anxiety disorders were highly comorbid with behavioral problems (16.4%). Behavioral disorders also had high comorbidity with elimination disorders (16.7%) and substance use disorders (10%). Enuresis was the most frequent psychiatric disorder (5.8%), followed by epilepsy (3.5%), tobacco use (3.4%), and attention deficit hyperactivity disorder (3%). Total anxiety disorders were the most prevalent group of psychiatric disorders in the sample (21.9%), followed by behavioral disorders (16.3%), elimination disorders (8.2%), and neurodevelopmental disorders (4.5%). CONCLUSION: Our findings suggest that psychiatric disorders affect a significant number of children and adolescents. Prevalence estimates and identification of sources of heterogeneity have important implications to service providers and modifications are needed in mental health services in the community.

Why good placements matter: Pre-placement and placement risk factors associated with mental health disorders in pre-school children in foster care.

Pre-school children placed in local authority care show elevated rates of mental health disorders when compared to the general population. This study investigated risk factors for mental health disorders relating to the period prior to entering care and while in care. A representative sample of 43 children in care aged 0-72 months in an inner London borough underwent comprehensive multidimensional assessments. Presence of emotional, behavioural, attachment and adaptive disorders was ascertained. Exposure to two pre-placement risk factors and six placement risk factors was compared between children with and without a disorder. A total of 26 children (60.5%) had at least one mental health disorder. The two pre-placement risk factors, multiple types of maltreatment and entry into care after the age of 6 months, were both significantly associated with mental health disorders. The three placement risk factors of sudden placement moves, multiple placement moves and child-carer alienation showed a significant association with mental health disorders. There was a strong correlation between the number of risk factors and the number of co-morbid mental health disorders per child (r = .67, p < .001). In conclusion, this study identified five modifiable risk factors related to the quality of safeguarding and fostering services which showed a significant association with pre-school mental health.

Elimination disorders and anxious-depressed symptoms in preschool children: a population-based study.

The prevalence rates of elimination disorders and anxious/depressed symptoms of a representative sample of young children and their associations were assessed. 2,079 children in a defined geographical area were examined at school-entry. A parental questionnaire with 4 questions referring to symptoms of incontinence and 14 items of the anxious/depressed scale of the Child Behavior Checklist (CBCL) was administered. 9.5 % of 6-year-old children wet at night, 2.7 % wet during day and 1.2 % had faecal incontinence. Significantly more boys wet at night (11.7 %) than girls (7.2 %; OR 0.58, 95 % CI 0.43-0.78). 12.7 % had clinically relevant anxious/depressed symptoms. Children with at least one elimination disorder had significantly higher T values of the 'anxious/depressed' CBCL than continent controls. Children with faecal incontinence had highest T values of the 'anxious/depressed' CBCL syndrome scale, significantly higher than those of children with other elimination disorders and controls. Elimination disorders, as well as anxious/depressed symptoms are common at a young age. Boys are more affected by elimination disorders than girls, but not by anxious/depressed symptoms. Children with faecal incontinence have the highest rate of anxious/depressed symptoms.

[Child and adolescent development: common mental disorders according to age and gender]. / Desarrollo infantil y adolescente: trastornos mentales más frecuentesen función de la edad y el género.

Despite the increase in the incidence and prevalence rates of children and adolescents' mental disorders, there are few works performed with large and representative samples of children and adolescents with psychopathological symptoms. The present work analyses 588 participants referred by first care pediatricians to a specialized unit for children and adolescents' mental health. As a result of the study, a statistically significant relation was found between age and diagnosis: a larger incidence of behavioral disorders, communication disorders, elimination disorders, pervasive developmental disorders, impulse-control disorders from 0 to 5 years; behavioral disorders and attention deficit hyperactivity disorder (ADHD) were more common from 6 to 11 years, behavioral and anxiety disorders were more likely at 12 to 15 years; and, lastly, behavioral disorders were more prevalent from 16 to 18 years. With respect to gender, there was a significant relationship with diagnosis: boys had more behavioral disorders, whereas girl had more anxiety disorders. To conclude, a relationship between mental disorders and developmental achievements could be indicated in the younger group. Additionally, externalizing disorders in boys and internalizing ones n girls were more prevalent across all ages.

Diagnostic agreement predicts treatment process and outcomes in youth mental health clinics.

Several studies have documented low rates of agreement between clinician- and researcher-generated diagnoses. However, little is known about whether this lack of agreement has implications for the processes and outcomes of subsequent treatment. To study this possibility, the authors used diagnostic agreement to predict therapy engagement and outcomes for 197 youths treated in 5 community mental health clinics. Diagnostic agreement predicted better therapy engagement, with the agree group having fewer therapy no-shows and cancellations and a decreased likelihood of therapy dropout. Additionally, support for a link between agreement and treatment outcomes was found, as the agree group obtained larger reductions in parent-reported internalizing problems during treatment. These findings suggest that diagnostic accuracy may be an important precursor to successful treatment and highlight the importance of future research to find ways to incorporate standardized diagnostic procedures into clinical care settings.

Psychiatric comorbidity in Korean children and adolescents with attention-deficit hyperactivity disorder: psychopathology according to subtype.

It is well-known that more than 50% of attention-deficit hyperactivity disorder (ADHD) cases also have comorbid psychiatric disorders. We evaluated the comorbid psychopathology of Korean children and adolescents with ADHD using a standardized diagnostic instrument. The Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-K) was administered and completed in 105 patients who had been referred to the outpatient and inpatient clinics at the Samsung Medical Center from March 2004 to May 2005. All of the cases were diagnosed as ADHD according to DSM-IV criteria. We analyzed their clinical characteristics and psychiatric comorbidities, and assessed the correlation of any comorbidity with gender, age and ADHD subtype. Among our 105 participants, 70 (66.7%) subjects were diagnosed with combined-type ADHD, 22 (21.0%) were the predominantly inattentive type, only 1 (1.0%) was determined to have the predominantly hyperactive-impulsive type of ADHD, and 12 (11.4%) were classified as not otherwise specified (NOS) ADHD. Eighty (76.2%) subjects had at least one comorbid disorder such as oppositional defiant disorder (n = 53, 50.5%), anxiety disorders (n = 35, 33.3%) and affective disorders (n = 15, 14.3%). Our patients ranged in age from five to 16 years. Among the factors including gender, age, and ADHD subtype, ADHD subtype was the only one significant to comorbidity in our study. The results of this study suggest that psychiatric comorbidity in Korean children with ADHD is similar to the results of previous studies in western countries. Out of all the ADHD subtypes, the combined-type group had a significantly higher ratio of comorbid disorders and psychopathologies.

Psychiatric Comorbidity in Korean Children and Adolescents with Attention-Deficit Hyperactivity Disorder: Psychopathology According to Subtype

It is well-known that more than 50% of attention-deficit hyperactivity disorder (ADHD) cases also have comorbid psychiatric disorders. We evaluated the comorbid psychopathology of Korean children and adolescents with ADHD using a standardized diagnostic instrument. The Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-K) was administered and completed in 105 patients who had been referred to the outpatient and inpatient clinics at the Samsung Medical Center from March 2004 to May 2005. All of the cases were diagnosed as ADHD according to DSM-IV criteria. We analyzed their clinical characteristics and psychiatric comorbidities, and assessed the correlation of any comorbidity with gender, age and ADHD subtype. Among our 105 participants, 70 (66.7%) subjects were diagnosed with combined-type ADHD, 22 (21.0%) were the predominantly inattentive type, only 1 (1.0%) was determined to have the predominantly hyperactive-impulsive type of ADHD, and 12 (11.4%) were classified as not otherwise specified (NOS) ADHD. Eighty (76.2%) subjects had at least one comorbid disorder such as oppositional defiant disorder (n = 53, 50.5%), anxiety disorders (n = 35, 33.3%) and affective disorders (n = 15, 14.3%). Our patients ranged in age from five to 16 years. Among the factors including gender, age, and ADHD subtype, ADHD subtype was the only one significant to comorbidity in our study. The results of this study suggest that psychiatric comorbidity in Korean children with ADHD is similar to the results of previous studies in western countries. Out of all the ADHD subtypes, the combined-type group had a significantly higher ratio of comorbid disorders and psychopathologies.

Dysfunctional elimination symptoms in childhood and adulthood.

PURPOSE: The dysfunctional elimination syndrome (DES) is rare in adulthood. We evaluate the natural history of DES to identify aspects of the disorder that may be carried into adulthood. MATERIALS AND METHODS: A 2-part questionnaire was devised and self-administered to 191 consecutive women attending a urogynecological clinic (UG) and to 251 normal women. The first section asked for recall of childhood symptoms known to be associated with DES, while the lat-ter section explored current bladder and bowel problems. Data sets from the normal cohort (55) reporting current bladder problems were excluded. Descriptive statistics, chi-square and Mann-Whitney-U tests were used to compare variables. RESULTS: UG patients had significantly higher childhood DES scores than normal women. Overall 41.7% of UG patients could be labeled as having dysfunctional elimination as an adult. Symptoms reported significantly more often in childhood by UG patients than by control women were frequent urinary tract infection, vesicoureteral reflux, frequency, urge incontinence, slow and intermittent urine flow, small volume high urge voids, hospitalization for constipation, frequent fecal soiling and nocturnal enuresis. Higher DES scores correlated significantly with current adult urgency, urge leak, stress incontinence, incomplete emptying, post-void leak, hesitancy, nocturia and nocturnal enuresis. Constipation and fecal incontinence in adulthood also showed a significant association with high DES scores. Logistic regression revealed childhood urgency to be associated with adult DES. CONCLUSIONS: Childhood lower urinary tract dysfunction may have a negative impact on bladder and bowel function later life.

Prevalencia de trastornos psicológicos en niños y adolescentes, su relación con la edad y el género / Prevalence of psichological disorders in children and adolescents and its relation with age and gender

Presentamos la segunda parte de un estudio sobre las características de los niños y adolescentes cuyos padres solicitan tratamiento psicológico en un Centro Comunitario de Salud. Se presentan las tasas de prevalencia diagnóstica y su relación con la edad y el género de los sujetos. La muestra se compone de 404 sujetos (265 varones y 139 mujeres) con edades comprendidas entre los 0 y los 18 años. Los trastornos más prevalentes fueron los de conducta (23,0 por ciento), seguidos de los depresivos (14,6 por ciento), de ansiedad (13,3 por ciento), del desarrollo (12,7 por ciento) y de eliminación (9,7 por ciento). Se encontró una correlación altamente significativa entre el tipo de trastorno y la edad de los sujetos ((c 2 = 76.33, g.l. = 30,p = 0.0001), mostrando así que la psicopatología infantil sigue una pauta evolutiva. También encontramos una correlación significativa entre el tipo de trastorno y el género (c 2 =33.92, g.l. = 10.p =0.0001) (AU)

We present the second part of our research about the characteristics of the children and adolescents whose parents asked for psychological treatment in a Community Health Center. We describe the diagnostic prevalence rates and its relation with the age and gender of the subjects. 404 subjects (265 males and 139 females), aged 0 to 18 years, constitute de sample. The behavioral disorders were the most prevalent (23.0 %), followed by depressive (14.6 %), anxiety (13.3 %), developmental (12.7 %) and elimination (9.7 %) disorders. A significant pattern of relationship between age and diagnostic categories was found (χ2 = 76.33, g.l. = 30, p = 0.0001), suggesting that psychopathology follows an evolutive pattern. We also found a significant pattern of relationship between the type of disorder and gender (χ2 = 33.92, g.l. = 10, p = 0.0001) (AU)