Research review: A meta-analysis of the international prevalence and comorbidity of mental disorders in children between 1 and 7 years.

BACKGROUND: Children younger than 7 years can develop mental disorders that might manifest differently than in older children or adolescents. However, little is known about the prevalence of mental disorders at this early age. METHODS: We systematically searched the literature in the databases Web of Science, PsycINFO, PSYNDEX, MEDLINE, and Embase to identify epidemiological studies of community samples published between 2006 and 2020. A series of meta-analyses was conducted to estimate the pooled worldwide prevalence of mental disorders in general, specific mental disorders, and comorbidity in young children. RESULTS: A total of ten epidemiological studies reporting data on N = 18,282 children (12-83 months old) from eight countries met the inclusion criteria. The pooled prevalence of mental disorders in general was 20.1%, 95% CI [15.7, 25.4]. Most common disorders were oppositional defiant disorder (4.9%, 95% CI [2.5, 9.5]) and attention-deficit hyperactivity disorder (4.3%, 95% CI [2.5, 7.2]). The prevalence of any anxiety disorders was 8.5%, 95% CI [5.2, 13.5], and of any depressive disorders was 1.1%, 95% CI [0.8, 1.6]. Comorbidity was estimated at 6.4%, 95% CI [1.3, 54.0]. CONCLUSIONS: The literature search reveals that the epidemiology of mental disorders in children younger than 7 years is still a neglected area of research. The findings also indicate that there are a significant number of young children suffering from mental disorders who need appropriate age-adapted treatment.

Influence of executive functions on the self-reported health-related quality of life of children with ADHD.

PURPOSE: ADHD is regarded as a neurodevelopmental disorder associated with deficits in executive functions (EF). The presence of these deficits is associated with increased symptom severity. However, so far there is little knowledge, whether deficits in EFs relate to a reduced health-related quality of life (HRQoL) in children with ADHD. METHODS: Hence, n = 100 children with a confirmed ADHD diagnosis were compared with a non-cases group (n = 100) with regard to their HRQoL (6-12 years old). The clinical group was divided into ADHD-specific drug treatment intake (drug treatment: n = 42; no drug treatment: n = 58) or deficits in EF (n = 29; no deficits in EF: n = 71). RESULTS: Children with ADHD (without medication) reported a significantly worse HRQoL than healthy children (d = .72), when controlled for age and sex. Even if they were treated with drug treatment, they reported a lower HRQoL than the non-case group in the area Family (d = .53). Drug treatment of ADHD leads to a significant difference in HRQoL in school area (d = .39). Children with ADHD and EF problems reported impairments in the social context of HRQoL compared to healthy children (d = .51 to .70). In addition, a significant negative association between set-shifting and HRQoL in children with ADHD (without drug treatment) was demonstrated (r = - .27 to r = - .35). CONCLUSIONS: By assessing the HRQoL, an impairment in the functioning of children with ADHD can be detected, which is essential for the diagnosis. Furthermore, executive problems have an influence on the social sphere, which should be clarified and improved in therapy with the involvement of parents.

[Functional and dysfunctional emotion regulation strategies for depressive symptoms in adolescents]. / Zur Bedeutung funktionaler und dysfunktionaler Emotionsregulations- strategien für die depressive Symptomatik bei Jugendlichen.

Objective: Dysfunctional and functional emotion regulation strategies in adolescence have so far been examined separately, but not in interaction. Our aim is to analyze a possible compensation of dysfunctional regulation strategies through functional strategies in depressive symptoms. Method: The Regulation of Emotions Questionnaire (REQ) was used to examine the ability of emotion regulation in 247 adolescents between 12 to 17 years (M = 14.41, SD = 1.39). To measure depressive symptoms, Allgemeine Depressionsskala (ADS) was established. Results: Results speak for a compensation of internal-dysfunctional emotion regulation strategies with internal-functional emotion regulation strategies in girls. In boys, functional emotion regulation strategies strengthen the relationship between internal-dysfunctional emotion regulation strategies and depressive symptoms. Other strategies do not interact with each another. Conclusions: Results indicate a compensative effect in girls, while in boys functional emotion regulation seems to have an amplifying effect on depressive symptoms. Results suggest that boys use functional strategies in a dysfunctional way, while girls are able to use them appropriately. An exploration of the understanding of functional emotion regulation may enable approaches to treatment.

[On the Effectiveness of the Prevention Program JobFit: A Comparison of Different Class Levels]. / Zur Wirksamkeit des Präventionsprogramms JobFit: Ein Vergleich unterschiedlicher Klassenstufen.

The JobFit-Training for adolescents (Petermann u. Petermann, 2010) is a well documented behavioural psychological prevention program for students from the eighth grade and up. The present study examines the results of the evaluation of the practical implementation of the training over the course of two years. Data from 828 students could be collected in two measurements, before and after the intervention, out of which 323 were eighth-graders and 505 were ninth-graders. The analysis showed that eighth-graders profit more with regards to acquiring knowledge through the training than ninth-graders do. However, unlike male eighth-graders, female eighth-graders were unable to furthermore improve their social competences through the training. On the other hand the ninth-graders profit from the training in both groups with regards to their social competences.

[Cognitive Profiles of Preschool Children with Developmental Coordination Disorders and ADHD]. / Kognitive Leistungsprofile von Kindern mit motorischen Entwicklungsstörungen und ADHS im Vorschulalter.

Cognitive Profiles of Preschool Children with Developmental Coordination Disorders and ADHD Studies confirm that developmental coordination disorders (DCD) are often accompanied by ADHD. It is important to know why children with combined disorders show a special profile in a common intelligence test (WPPSI-III). For this purpose, the WPPSI-III results of a total of 125 children aged five to six years with diagnosed isolated DCD, isolated ADHD, combined disorders and a normative sample were compared. Children with isolated ADHD showed the best cognitive profile. Children of all three diagnosis subgroups presented significantly poorer abilities in all WPPSI-III scales than the normative sample. In comparison with preschoolers showing isolated ADHD, children with DCD and ADHD have a significant lower Processing Speed Quotient.

[Age-specific effects at the beginning of in-/out-/day patient welfare measures]. / Altersspezifische Effekte am Beginn teilstationärer Jugendhilfemassnahmen.

The study presented examines age-specific differences in emotional and behaviour problems as well as resources at the beginning of in-, out- and day-patient youth welfare measures. Additionally, parenting-skills were investigated. A sample of N = 126 was divided by the median (10.1 years) thus leading to two groups: ages six to ten (version for parents) versus eleven to sixteen (self-completion). Children and adolescents were evaluated with the SDQ, parenting skills with the DEAPQ-EL-GS. Values of both groups were compared cross-sectionally with multivariate, one-factorial variance analysis. Parents of younger children achieve significantly better results for parenting-skills. Compared to the older ones, younger children show significantly greater behaviour problems. Younger children belong to the group especially affected in youth welfare measures. Therefore, measures should be specifically adapted for this group to reduce symptoms.

Comorbidities in ADHD children treated with methylphenidate: a database study.

BACKGROUND: Methylphenidate (MPH) is the most common drug treatment of attention deficit / hyperactivity disorder (ADHD) in children. Treatment with MPH is contraindicated in the presence of certain psychiatric, cerebro- and cardiovascular conditions. We assessed MPH treatment prevalence and incidence and the frequency of comorbid conditions related to these contraindications in new MPH users compared to a control group without ADHD and ADHD medication. METHODS: We used health care data for the years 2004 to 2006 from the German Pharmacoepidemiological Research Database (GePaRD) which includes about 18% of the German population. MPH treatment prevalence and incidence was assessed based on at least one MPH prescription in the given year. In MPH users, the prevalence of psychiatric and other comorbidities was assessed in the quarter of the first MPH prescription and the three preceding quarters, whereas in controls it was assessed in the earliest four quarters of continuous insurance time starting at 01.01.2004 or the start of insurance if this was later. Differences in the presence of comorbid diagnoses between MPH users and controls were tested by logistic regression. RESULTS: In 2005, 1.5% of all children and adolescents aged 3 to 17 years (2.3% of males and 0.6% of females) received MPH in Germany. The proportion of children with a record of a psychiatric comorbidity in any of the nine ICD categories of diagnoses was substantially higher in new MPH users (83%) compared to controls (20%). Cerebro- and cardiovascular comorbidities were rare in general. Still, among new MPH users, 2% of males and females had a diagnosis of a pre-existing cardiovascular disorder but only 1.2% of controls. CONCLUSIONS: Besides MPH treatment prevalence we first publish age-specific incidence rates for Germany. A high proportion of children who were started on MPH had a record of a psychiatric comorbidity preceding the first prescription. Cerebro- and cardiovascular conditions were rare in the studied age range, but still higher among children who received MPH than in the control group. Results show that in a substantial subgroup of patients, comorbidities require a thorough weighting of possible risks of MPH medication against the risks of untreated ADHD.

[Educational competence of parents with children participating in youth welfare measures]. / Erziehungskompetenz von eltern mit kindern in jugendhilfe-maßnahmen.

OBJECTIVE: The study examines the influence of specific risks on parenting at the beginning of youth welfare measures. METHOD: Family risk factors as well as parental behaviour styles of N = 74 parents were assessed with standardized questionnaires. RESULTS: The results were evaluated cross-sectionally with one-way factor analysis. Three groups were formed according to degree of risk factors. Families with special risks, i.e., material needs, physically ill parents, or single parents, show a significantly lower level of parenting competence. Differences in negative parenting features are not found to be under the influence of specific risks. CONCLUSIONS: Parents of children in youth welfare measures who are specifically stressed may need special training to increase their parenting skills, especially when pre-post comparisons show lower parenting quality in the group with specific risk factors at the end of an intervention.

[Cognitive, linguistic, motoric, and social deficits in schoolstarters with behavioral disorders]. / Kognitive, sprachliche, motorische und sozial-emotionale Defizite bei verhaltensauffälligen Schulanfängern.

Studies show that ADHD, conduct disorders, and anxiety disorders are clinical disorders mostly diagnosed in schoolstarters. The preschool medical examination in Bremen was therefore extended by behavioral screenings. Based on their screening results from the SEU (health examination for school entry) 2011 in Bremen, 67 preschoolers were tested for behavioral disorders. Subsequently, children with behavioral or emotional symptoms (N = 56) were compared to symptomfree controls (N = 52) for their cognitive, motoric, linguistic, and social-emotional development. Psychosocial health was obtained through external assessment by the parents and kindergarten teachers. Results of the WPPSI-III, M-ABC-2, and ET 6-6 were included in the analysis. 32 children met the criteria for behavioral disorders. Children with behavioral or emotional symptoms showed significant lower scores on tests measuring cognitive, motoric, linguistic and emotional development compared to controls. Results suggest that there is necessity to screen all preschoolers for behavioral disorders before entering school. Because children with clinical or subclinical behavioral disorders showed major developmental deficits compared to children without behavioral symptoms, it is essential to conduct a multiple assessment on children with suspected behavioral disorders to ensure early developmental support and adequate interventional programs.

[Diagnostic of ADHD in childhood and adolescence with the K-SADS-PL]. / Diagnostik der ADHS im Kindes- und Jugendalter mit dem K-SADS-PL.

Attention Deficit-/Hyperactivity Disorder (ADHD) is one of the most prevalent psychiatric disorders in childhood and adolescence, often accompanied by comorbid disorders. A high standard of diagnostic assessment combined with a demand for valid diagnostic instruments is necessary. The K-SADS-PL is an established semi-structured interview, focusing on the categorical assessment of psychiatric disorders. The aim of the following study was to examine specific characteristics of ADHD symptomatology including functional and behavioral assessment. Therefore correlations between the result in a diagnostic interview (K-SADS-PL) and different ADHD-specific instruments were performed. Groups were formed (exposed vs. unexposed), based on the diagnostic finding in the K-SADS-PL. Group-specific test score differences were calculated and compared by multivariate analyses of covariance. Children with ADHD showed a significantly higher impact of conduct and emotional problems than the unexposed group. Health related quality of life was more impaired in children and families suffering from ADHD which refers to the relevance of family-oriented psychotherapy.

[Short- and long-term effects of parent training programmes of children with developmental disabilities]. / Kurz- und langfristige Effekte von Elterntrainings bei entwicklungsverzögerten Kindern.

Due to the higher care needs of their children, parents of children with developmental disabilities are often burdened. An increased degree of stress correlates with dysfunctional parenting behaviour and a low sense of competence. Parent involvement in treatment implementation is essential so that parents can support the development of their children long-ranging and positively. Parenting training programmes are an appropriate method to reduce child behaviou problems. The effectiveness of two parenting training programmes is presented: Intervention A involves weekly training courses containing information about a normative child development. Furthermore all parents are given the possibility to take part in therapy sessions. Intervention B is modular and high structured. Parents are taught in small groups and receive information about the different areas of development and how to increase their parentin behaviour. The outcomes of a randomized clinical trial of the two intervention concepts are presented. 34 parents with children (between 54 and 77 months) with developmental dis abilities participated per group. Particularly, intervention B was associated with a reduction of dysfunctional parenting behaviour and fewer child behaviour problems; a decreased parental stress level was observed for both interventions similarly.

[Follow-up support measures as parameters for the effectiveness of day-care measures in youth welfare - a comparative study]. / Anschlusshilfen als Parameter für die Wirksamkeit teilstationärer Jugendhilfe-Massnahmen. Eine Vergleichsstudie.

OBJECTIVE: Educational support measures aim at reducing strain on families in precarious life situations. In children and adolescents, measures usually focus on reducing conduct problems and promoting competencies; parents are supported in order to improve their parenting competencies. But youth welfare measures have different effects on children, adolescents, and their parents, and a national comparison reveals that most families require follow-up support measures afterwards. This study compares different courses of youth assistance measures in families with or without follow-up support measures. METHODS: A total of 89 families received day-care educational support for an average period of 2 years. Subsequently, 26 families required further support. In order to identify predictors for follow-up support measures, we systematically assessed problem areas indicating a need for further support prior to and after youth help measures, and contrasted them in a pre-post-design. RESULTS: Children in need of further support displayed significantly more symptoms of strain and less improvement in their competencies after the end of youth help measures. However, the most distinctive differences resulted for ineffective parenting. These groups differed significantly. CONCLUSIONS: The effectiveness of youth welfare measures strongly depends on an improvement of parenting competencies. A lack thereof points toward further need for support, even after intensive educational support measures.

[The training of social skills in children with ADHD - results of a pilot study]. / Training sozialer Fertigkeiten für Kinder mit ADHS.

OBJECTIVE: Insufficient social competence belongs to the most frequent concomitants of ADHD. This is the first therapeutic concept for the training of social skills adapted to the specific deficits of children with ADHD and developed in the German-speaking region. METHOD: In a two-group, pre-posttest design with untreated waiting control group, 40 children between 7 and 13 years with the diagnoses F90.0, F90.1, and F98.8 were examined; 15 % were female, 85 % male. In groups of three they took part in the newly developed 10-h training TEAM. The record sheet of social skills for parents (ESF-E) was used to measure social competence. In addition, we recorded attention performances (FBB ADHS) and concomitant psychic factors. RESULTS: Significant effects of the training were demonstrated for almost all social skills (MANOVA/GLM). The outcomes on the different components of attention and the psychosocial concomitant factors are without uniformity. The strongest effects appeared in the areas of conflict management, regulation of emotions, and the capacity for empathy. CONCLUSIONS: Training of social skills is a sensible and effective supplement in the therapy of ADHD. An examination of long-term effects still needs to be done.

[Youth welfare and therapy: effects of youth welfare alone and youth welfare combined with additional therapy]. / Jugendhilfe und Therapie: Effekte aus kombinierten Massnahmen in der Gegenüberstellung mit Hilfen ohne Therapieangebot.

Around 17% of children and adolescents suffer from some form of psychological disorder. Compared to this rate, the prevalence among families seeking youth welfare assistance is substantially higher: 60 to 80% of children in day care and residential educational settings meet the criteria of an ICD-10-diagnosis. While effective psychotherapeutic interventions are available, only a fraction of those children affected receive such help. This study assesses whether the effectiveness of educational day care support can be increased by offering additional treatment. To this end, 89 families were assessed who received an average of two years of day care assistance. One group (n = 23) received additional therapeutic treatment. In order to assess the effectiveness of combined youth welfare and therapeutic intervention, indicative problem areas were evaluated using a pre-post-design. Effect measures indicate small advantages of the combined treatment. The group receiving additional therapeutic treatment suffered from fewer risk factors. They also showed some long term effects and fewer families needed follow-up support. Overall, combined treatment was more effective. However, differences between the two groups were less pronounced than expected, due to the effectiveness of day care groups.

[Ambulant and outpatient youth welfare: long-term effectiveness]. / Ambulante und teilstationäre Jugendhilfe-Maßnahmen.

OBJECTIVE: This study concerns the long-term effects of ambulant and outpatient youth provisions. Progress was examined regarding the impact of stress, extensive conduct problems, emotional problems, as well as available resources. In addition, we included data on adolescents' educational status, legal problems, and substance use in the analysis. METHOD: Using quantitative data from three surveys, we analysed the development in children and adolescents and their families, all of whom were engaged in youth welfare services (N = 59). RESULTS: At the onset of youth welfare services involvement, there were three groups that different significantly regarding the stress impact (low, moderate, high). It was hypothesized that children with low stress impact would benefit most from youth welfare services. Even 3 years after the welfare service had come to an end children and adolescents with a high level of problems at service onset still showed significantly higher impact levels and more familial problems. However, there were no significant differences between the groups regarding behavioral problems. CONCLUSIONS: The study indicates the long-term effects of youth welfare services, independent of the initial extent of general impact.

[Differential effectiveness of youth welfare measures: a comparative study on the effectiveness of day care measures]. / Differenzielle Wirksamkeit der Jugendhilfe: Traditionelle und zerbrochene Familien im Vergleich.

Single parent families not only differ from traditional families regarding socioeconomic problems and missing a parent, but also concerning the duration of using youth welfare measures, psychological problems in single parents, and the way youth welfare measures are ended. Due to different basic parameters in these two family settings, this study investigates the differential effectiveness of youth day care measures. In total, 55 children and adolescents (aged 6 to 14 years) and their parents were involved. Using axis I, II and V, ICD-10 multiaxial presentation, data on the general burden of problems, externalizing problems, emotional problems, and parenting skills were recorded before care measures began and again after they had ended. Although day care measures were very effective in both family settings, traditional families showed a significantly stronger decline of externalizing problems than single parent families, exceptions being emotional problems and burdens.

[Effectiveness of day care youth welfare measures]. / Zur Wirksamkeit ambulanter und teilstationärer Jugendhilfemassnahmen.

OBJECTIVE: In order to provide optimal support to families living in precarious circumstances, empirically sound findings on the adequacy of the educational-therapeutic concepts that are being implemented in the context of these measures are required. Our study investigates to what extent service-users benefit from youth welfare measures between the measures between start and finish. METHOD: Altogether, 50 adolescents have participated in educational measures for a period of two years on average. Problem areas constituting an indication for an educational measure were assessed systematically at the beginning and after termination of the measure (pre-post-comparison). RESULTS: The primary goals of day care in particular were clearly reached. Compared to their level at the beginning of the measure, problems concerning social behaviour had clearly improved at the measure's termination. Further, school achievement problems were clearly reduced during the educational measure. In cooperation with the parents it was possible to significantly reduce deficits in parenting skills inherent in the family system. CONCLUSIONS: Results underscore the high effectiveness of educational measures in reducing strain and problem behaviour.

[Behaviour therapy and child welfare - results of an approach to improve mental health care of aggressive children]. / Verhaltenstherapie und Jugendhilfe: Ergebnisse zur Optimierung der Versorgung aggressiver Kinder.

OBJECTIVE: The Training with Aggressive Children (Petermann & Petermann, 2008) was integrated into the setting of a child welfare service. This study examined, if mental health care of aggressive children in child welfare settings can be improved, compared the effectiveness of a combination of the training and child welfare intervention after six months with effects of the TAK. METHOD: 25 Children with conduct problems (24 boys, one girl) aged 7;6 to 13;0 years participated in the study. RESULTS: A pretest-follow up comparison of parent ratings on the Child Behavior Checklist (CBCL) documented a large reduction of aggressive-delinquent behaviour and social problems in the training and child welfare group. Furthermore, conduct and peer relationship problems decreased essentially on the Strengths and Difficulties Questionnaire (SDQ). By reducing conduct, attention and social problems, and delinquent behaviour, the therapeutic outcome of the training and child welfare group was clearly superior to training group. CONCLUSIONS: In comparison to the training, the combination of child welfare and training seemed to reduce a wider range of behavioural problems more effectively. This indicates that combined intervention programs can optimize mental health care of aggressive children.

Drug treatment patterns of attention-deficit/hyperactivity disorder in children and adolescents in Germany: results from a large population-based cohort study.

OBJECTIVE: Despite a substantial increase in total methylphenidate (MPH) prescriptions in Germany over the last 20 years, and the introduction of modified release MPH (MR MPH) and atomoxetine (ATX), remarkably little is known about treatment patterns of attention- deficit/hyperactivity disorder (ADHD) in individual patients. METHODS: Usage patterns of ADHD drugs in children and adolescents in Germany were analyzed using data from one large German health insurance including >7,200,000 members. Of those, 6210 ADHD patients newly diagnosed in 2005 were followed for a maximum of 4 years. Kaplan-Meier estimates were calculated for onset and discontinuation of ADHD drug treatment. Predictors of time until drug treatment initiation were assessed by Cox regression. RESULTS: During follow-up, 52.0% of ADHD subjects (53.4% of boys, 47.5% of girls) received ADHD drug treatment. The majority of them (91.6%) were started on MPH, with immediate release MPH (IR MPH) being the initial treatment choice in 75.3%. In these subjects, change to drug treatment with MR MPH in the first year occurred in 48% by switch or addition. Significant predictors of drug treatment were behavioral and emotional disorders (HR=1.13; 95% CI 1.03-1.24) and a diagnosis of ADHD with conduct disorder (HR=1.21, 95% CI 1.12-1.32), whereas young age showed a protective effect. After 6, 12, and 24 months of treatment initiation, 22.4%, 43.4%, and 66.3% of treated girls, and 17.8%, 36.1%, and 54.1% of treated boys had discontinued ADHD treatment. CONCLUSION: Drug treatment of ADHD was relatively common in Germany and more frequent in boys than in girls. IR MPH was the predominant treatment choice at treatment initiation. Approximately 20% of treated subjects discontinued drug treatment within the first 6 months, with girls stopping drug treatment earlier than boys. The reasons for early drug discontinuation need to be further explored.

The impact of a multimodal Summer Camp Training on neuropsychological functioning in children and adolescents with ADHD: an exploratory study.

This study examined the combined effects of methylphenidate (MPD) and response cost and token strategy (RCT), administered in an intensive ADHD Summer Camp Training (ASCT) format, on neuropsychological functions. Forty children with ADHD were randomly assigned to either the ASCT treatment (MPD plus RCT) or a control group (MPD plus a 1-hour session of standardized parental education/counselling [SPC]). This latter group was structured to be similar to the more typical current treatment. The ASCT treatment was administered for 2½ weeks and included RCT, consisting of elements of social skill training, attention training, and sports participation. RCT was systematically applied in all daily situations and activities. Executive functions and state of regulation using the Test for Attention Performance (TAP) and the Trail-Making Test (TMT) were assessed before training and at a 6-month follow-up. Participants receiving the ASCT improved specific neuropsychological functions in attention regulation and inhibitory control tasks at the 6-month follow-up. No changes occurred for participants assigned to the control condition. The data suggest that an intensive multimodal summer camp treatment program including strategies of instrumental learning can lead to substantial and enduring improvements in neuropsychological functioning of children and adolescents with ADHD.