Verhaltensauffälligkeiten bei Kindern und Jugendlichen

[Implementation of a novel form of care for the early detection and prevention of emotional and behavioral problems in children in the pediatric setting: Qualitative interviews with pediatricians, practice staff and parents]

AIM OF THE STUDY

Evaluation of the implementation of a standardized screening using the Strengths and Difficulties Questionnaire (SDQ) as part of the routine pediatric health check-ups in the Dresden area (Germany) in order to detect emotional and behavioral problems (EBPs) in children early and allocate them to indicated preventive programs and/or to further counselling and treatment services.

METHODS

1.) Semi-structured interviews were performed with participating pediatricians (n=4), practice staff (n=4) and custodians of screened children (n=17) and subjected to content analysis regarding feasibility, advantages and disadvantages of the screening and the targeted allocation, as well as barriers and facilitators of using the screening and the preventive programs and further services. 2.) A self-developed questionnaire survey (descriptive analysis: means and frequencies) was conducted among pediatricians (n=34/99) to inquire about the implementation of the SDQ screening regarding feasibility, advantages, disadvantages and necessary conditions for a potential adoption of the screening to standard health services.

RESULTS

In the interviews, the pediatricians and practice staff reported that the SDQ screening embedded in routine pediatric health check-ups was simple and could be carried out in a few minutes. The screening helped to identify and address possible EBPs in children and to recommend a targeted service. Apart from the expenditure of time, no disadvantages were mentioned. As expected, parent-related (e.g. fears, attitudes and trust in the pediatrician), child-related (does not want to reveal any information about him- or herself , attitude and motivation), service provider-related (presentation of services), organizational (necessary signatures, financing, waiting time) and service-related (duration, costs, venue, designation) factors influenced the families' use of the screening and further services. Interviewed custodians whose child participated in an indicated preventive program within the project (n=11) would recommend the SDQ screening and preventive program to other families. In the questionnaire survey 28/31 pediatricians "completely" or "rather" agreed on a 5-point Likert scale that the SDQ screening and targeted allocation should be included in standard pediatric care.

DISCUSSION

The use of the SDQ, which is one of the most widely used and, despite its brevity, most valid screening instruments for the early detection of EBPs, in routine pediatric health check-ups and the targeted allocation of further health services represent a feasible approach to the early identification and clarification of EBPs in children as well as their allocation to indicated preventive services.

CONCLUSION

An adoption of the novel form of care (SDQ screening and targeted allocation to indicated preventive programs and further services) to standard pediatric care unfolds its benefits if preventive and care services for EBPs in children are made available nationwide.

[Indicative prevention programs for mental health promotion in preschool and primary school age: Willingness of pediatricians and families to participate in an innovative care chain]

BACKGROUND

Mental health problems usually have their onset in childhood. Undiagnosed, they may progress into mental disorders. Despite their effectiveness, existing preventive programs have been rarely used. We aimed to examine to what extent the establishment of a care chain can identify children at high risk at an early stage and assign them to preventive interventions. In addition, prevention program participation was assessed.

METHODS

In a prospective implementation study, the Strengths and Difficulties Questionnaire was administered as a screening instrument to families during regular pediatric health examinations (U9-U11, child age 5-10 years). Families received feedback directly from the pediatrician, and in the case of borderline abnormal emotional or behavioral problems, a recommendation for an indicative prevention program. Program indication was additionally determined in an entry examination prior to program participation.

RESULTS

In the area of Dresden (Germany), n = 46 (38.7%) pediatricians participated in the project. In n = 28 pediatric practices, n = 3231 (86.4%) families participated in the screening and n = 864 (26.7%) children received a prevention recommendation. Of the families, n = 118/864 (13.7%) self-registered for the prevention programs, n = 215/624 (35.5%) showed interest after being contacted by the study teamn. Through other pathways, n = 139 families requested participation. Clinical evaluation interviews to assess prevention indication were conducted in n = 337 children (n = 461; via all entry pathways). Finally, n = 237 (n = 337) children participated in an indicated prevention program.

CONCLUSION

Expanding screening to mental health problems during regular health checkups is feasible, useful, and widely accepted. In order to implement a care chain, a supply structure should be established to enable referral to and uptake of preventive interventions.

Development and validation of a self-regulation scale within the German version of the Early Development Instrument

BACKGROUND

Early childhood self-regulation (SR) is key for many health- and education-related outcomes across the life span. Kindergarten age is a crucial period for SR development, and within this developmental window, potential SR difficulties can still be compensated for (e.g., through interventions). However, efficient measurement of SR through brief, comprehensive, and easy-to-use instruments that identify SR difficulties are scarce. To address this need, we used items of an internationally applied kindergarten teacher questionnaire-the Early Development Instrument (EDI) - to develop and validate a specific SR measurement scale.

METHODS

The psychometric evaluation and validation of the selected SR-items was performed in data collected with the German version of the EDI (GEDI), in two independent data sets - (a) the development dataset, with 191 children, and b) the validation dataset, with 184 children. Both included three- to six-year-old children and contained retest and interrater reliability data. First, three independent raters-based on theory-selected items eligible to form a SR scale from the two SR-relevant GEDI domains "social competence" and "emotional maturity". Second, exploratory and confirmatory factor analysis using structural equation modeling examined the item structure across both data sets. This resulted in a defined SR scale, of which internal consistency, test-retest and interrater reliability, cross-validation, and concurrent validity using correlation and descriptive agreements (Bland-Altman (BA) plots) with an existing validated SR-measuring instrument (the Kindergarten Behavioral Scales) were assessed.

RESULTS

Confirmatory factor analysis across both data sets yielded the best fit indices with 13 of the GEDI 20 items initially deemed eligible for SR measurement, and a three-factor structure: a) behavioral response inhibition, b) cognitive inhibition, c) selective or focused attention (RMSEA: 0.019, CFI: 0.998). Psychometric evaluation of the resulting 13-item-GEDI-SR scale revealed good internal consistency (0.92), test-retest and interrater reliability (0.85 and 0.71, respectively), validity testing yielded stability across populations and good concurrent validity with the Kindergarten Behavioral Scales (Pearson correlation coefficient: mean 0.72, range 0.61 to 0.84).

CONCLUSIONS

The GEDI contains 13 items suitable to assess SR, either as part of regular EDI developmental monitoring or as a valid stand-alone scale. This short 13-item (G)EDI-SR scale may allow early detection of children with SR difficulties in the kindergarten setting in future and could be the basis for public health intervention planning. To attain this goal, future research should establish appropriate reference values using a representative standardization sample.

Internalizing and Externalizing Disorder Levels among Adolescents: Data from Poland

This article concerns internalizing and externalizing behaviors among Polish adolescents attending primary schools in a medium-sized city in Poland. The aim of the study was to examine the levels of select problem behaviors (i.e., depression, withdrawal, somatic complaints, aggressive behaviors, delinquent behaviors, thought problems, and internalizing and externalizing disorders) in early adolescence. Another important aim was to establish the ranges of the norm and deviation which would indicate the need for intervention aimed at internalizing and externalizing disorders in the sample. The relationships between variables such as age, gender, and school achievement (grade average) and the groups of problem behaviors and externalizing and internalizing disorders were also examined. To diagnose the occurrence of internalizing and externalizing behaviors, a sample of 550 students (55.3% girls, 46.7% boys) were measured using the Youth Self-Report (YSR) questionnaire. The results showed statistically significant differences in internalizing and externalizing behaviors between boys and girls. Girls achieved higher scores on most of the YSR scales, including internalizing and externalizing disorders, as well as on the total score. The student subgroup scores were also differentiated in terms of age and their average grades. The results also have practical implications; namely, the need for obligatory screening tests of students' emotional states; encouraging preventive measures in schools, including diagnosis and psychological support in the context of depression; monitoring aggressive behaviors and social problems, both in boys and girls; and implementing universal, selective, and indicated prevention through complex, empirically validated educational-therapeutic programs.

Cultural Bias in Parent Reports: The Role of Socialization Goals When Parents Report on Their Child's Problem Behavior

It has been called into question whether widely used screening instruments for child mental health can provide comparable results across countries and cultures. Socialization goals can influence whether and to what extent a parent considers a behavior to be problematic and thus might influence parental reports on their child's behavior. We tested comparability of parental reports between native German (N = 116) and Turkish origin (N = 77) parents in Germany in an online study using a vignette approach. Parents were asked to rate the perceived problem severity of the same behavior depicted in the vignettes. We expected and found that parents of Turkish origin in Germany rate the externalizing problem behaviour depicted in the vignettes as more problematic compared to native German parents. The effect was fully mediated by parental approval of the socialization goals obedience and collectivism. We also controlled for social desirability responding and an extreme response style.

[Practitioners in Psychotherapy can Improve their Competences in Assessing Attachment in Middle Childhood: Psychometric Quality of an Attachment Screening Tool Relevant forTherapy]

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.

Are we promoting boys and girls equally? An analysis of boys’ and girls’ participation in community prevention

Aim

Despite consensus that prevention and health promotion need to address gender aspects and differences, not much is known about how boys and girls in infancy (or their parents) make use of existing non-medical community programmes. The aim of the study was therefore to analyse the extent to which boys and girls or their parents in distinct social circumstances participate in respective programmes.

Subject and methods

We conducted secondary analyses for two study samples: The COLIPRE Study includes (n = 6.480) pre-schoolers from Duesseldorf; the SKILLS Study includes (n = 637) pre-schoolers and school children from Cologne. Social circumstances included parental education, employment status, family status, migration background, mother language and neighbourhood deprivation. Prevention participation included programmes for a healthy diet, physical activity, child education and language development. We used Poisson regressions to calculate prevalence ratios (PR) with 95% confidence interval (CI), adjusted for age, siblings and BMI, stratified for boys and girls.

Results

In both studies, we observed no gender differences in general participation. Taking a range of social circumstances into account, we found that boys and girls with specific disadvantages were underrepresented in programmes to promote a healthy diet, physical activity and child education. By contrast, boys and girls with a migration background participate in language promotion programmes more often than their German-native peers.

Conclusion

More effort should be put into developing programmes for boys and girls and their parents in difficult social circumstances.

Die klinische Validierung des diagnostischen Elterninterviews „Diagnostic Infant and Preschool Assessment“ (DIPA)

Zusammenfassung. Da Klein- und Vorschulkinder bereits unter psychischen Auffälligkeiten leiden können, ist ein valides Diagnoseinstrument erforderlich. Das Diagnostic Infant and Preschool Assessment (DIPA) ist ein Elterninterview zur klinischen Diagnostik im Kleinkind- und Vorschulalter. Die deutsche DIPA-Version wurde auf ihre psychometrischen Eigenschaften untersucht. Mit N = 109 Eltern klinisch vorgestellter Kinder (Alter: 0 bis 6 Jahre) wurde das DIPA durchgeführt und die Ergebnisse mit der CBCL / 1½-5 und der C-TRF / 1½-5 verglichen. Die Kinder erhielten durchschnittlich zwei DIPA-Diagnosen, wobei die Störung mit Oppositionellem Trotzverhalten am häufigsten vorkam. Es zeigten sich zufriedenstellende Beurteilerübereinstimmungen. Zwischen den nach Anzahl der DIPA-Diagnosen eingeteilten Gruppen zeigten sich signifikante Unterschiede in den CBCL-Ergebnissen. Erhöhte CBCL-Problemwerte konnten das Vorliegen von DIPA-Diagnosen vorhersagen. Die Ergebnisse sprechen für eine zufriedenstellende Konstruktvalidität des DIPA. Es kann im klinischen Alltag eingesetzt werden, da es die 15 wichtigsten DSM-5-Diagnosen des Vorschulalters umfasst und valide, benutzerfreundlich sowie effizient ist und auch für die Forschung vielfältige Möglichkeiten liefert.

Wie gelingt die Prävention psychischer Beschwerden?

Hintergrund

Emotionale und Verhaltensprobleme in der Kindheit haben oft weitreichende Folgen für die soziale, emotionale und kognitive Entwicklung, sodass ihrer Prävention ein hoher Stellenwert zukommt. Dennoch ist die Inanspruchnahme von Präventionsmaßnahmen im Kindesalter gering.

Ziel

In einer versorgungsepidemiologischen Implementationsstudie wird untersucht, inwiefern durch ein systematisches Screening eingebettet in U‑Untersuchungen die Identifikation von Risikokindern und die Zuweisung zu Präventionsprogrammen gelingt.

Methoden

Dazu ist ein Screening mittels „Strengths and Difficulties Questionnaire“ während der regulären Gesundheitsuntersuchungen (U9–U11) von ca. 3500 Kindern im Alter von 5 bis 10 Jahren in ca. 53 Arztpraxen in Dresden und 20 km Umkreis geplant. Die Eltern erhalten von der Fachkraft für Kinderheilkunde eine Rückmeldung zu den Ergebnissen und im Falle von grenzwertigen Werten auf den Subskalen „Emotionale Probleme“ und/oder „Verhaltensprobleme“ eine Empfehlung für ein indikatives Präventionsprogramm. Zu vier Messzeitpunkten werden Familien mittels standardisierter und projektspezifischer Fragebogen befragt. Zusätzlich erfolgen leitfadengestützte Interviews mit Leistungserbringern und Familien.

Ergebnisse und Schlussfolgerung

Es werden die Machbarkeit, Nützlichkeit und Akzeptanz eines Screenings für emotionale und Verhaltensauffälligkeiten bei Kindern und Präventionsempfehlungen in Kinderarztpraxen im Prä‑/Post-Vergleich und nach 12 Monaten evaluiert. Förderliche und hemmende Faktoren für die Inanspruchnahme werden bestimmt, um Empfehlungen für die Implementation von Präventionsangeboten in die Regelversorgung abzuleiten, um emotionale und Verhaltensauffälligkeiten frühzeitig zu erkennen und der Entwicklung psychischer Störungen vorzubeugen.

Associations Between Mental Health Problems in Adolescence and Educational Attainment in Early Adulthood: Results of the German Longitudinal BELLA Study

Mental health problems (MHP) in adolescence are a major public health concern of the 21st century. Global prevalence estimates range between 10 and 20%. Most MHP manifest by adolescence and persistence rates are high, often accumulating further impairment in early adulthood and beyond. We analyzed data of N = 433 participants from the German longitudinal BELLA study to examine whether MHP in adolescence negatively affect educational attainment in early adulthood. Externalizing and internalizing MHP among adolescents aged 11-17 years were assessed at baseline using the Strengths and Difficulties Questionnaire. Educational attainment was assessed at the 6-year follow-up based on level of education, failure to attain the expected level of education, and dropout from vocational or academic training. Findings from logistic regression analyses suggest that more pronounced externalizing MHP in adolescence predict a lower level of education in early adulthood. We did not find a corresponding effect for internalizing MHP. Adolescents with higher-educated parents were less likely to attain a lower level of education themselves and less likely to fail in attaining their expected level of education. Our findings support that educational attainment presents a central channel for intergenerational reproduction of education and forms an important pathway for upward, but also downward social mobility. The current study emphasizes school as a central setting to implement measures to prevent onset and persistence of MHP and to foster equal opportunities in education.

Associations between Parenting Style and Mental Health in Children and Adolescents Aged 11-17 Years: Results of the KiGGS Cohort Study (Second Follow-Up)

Few studies from Germany have investigated the associations between parenting style and children's and adolescents' health. Little attention has been directed to whether these associations vary with familial socioeconomic or migration status. The aim of this analysis was to investigate the association between parenting style and the mental health of children and adolescents aged 11-17 years using data from the KiGGS cohort study (second follow-up). We calculated mean Strengths and Difficulties Questionnaire (SDQ) total difficulties scores stratified by parenting style (authoritative, permissive, demanding-controlling, emotional distancing). Linear regression analyses adjusted for age, gender, socioeconomic status, migration status, and family status were performed. We also analyzed moderating effects of socioeconomic and migrations status on associations between parenting style and SDQ scores. There were only small differences between the permissive and the authoritative parenting styles. Significantly higher mean scores were observed for the demanding-controlling and emotional distancing styles for both the mother and father. These associations persisted after full adjustment and did not vary by socioeconomic or migration status. Parenting behavior is an important predictor of children's and adolescents' mental health. The promotion of good relationships within families and improving parenting skills offer promising approaches for health promotion in young people.

[Psychological Problems in Children and Adolescents for whom Children's Services Department was Utilized]

Psychological Problems in Children and Adolescents for whom Children's Services Department was Utilized Previous research proved a greater prevalence of mental health problems among children in residential youth care. In the present study, based on the KiGGS study, the prevalence of mental health problems is analyzed using the German version of the Strengths and Difficulties Questionnaire (SDQ) for those children and adolescents seeking youth welfare services, compared to those children not seeking youth welfare service. The possible differences between these two groups were tested using multivariate regression. The study covers two survey periods of KiGGS at intervals of six years. The result shows a significantly higher prevalence for mental health problems in adolescents seeking youth welfare services. The regression analysis shows that the association with mental health problems in these children persists even after adjusting for socioeconomic and demographic factors. There are hardly any changes in the results within the trend analysis. This indicates a high temporal stability of the association.

The association between thyroid function biomarkers and attention deficit hyperactivity disorder

The relation between thyroid function biomarkers and attention deficit hyperactivity disorder (ADHD) in children and adolescents is currently unclear. Cross-sectional data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Baseline) was analyzed to assess the association between thyroid function biomarkers and ADHD in a population-based, nationally representative sample. The study cohort included 11,588 children and adolescents with 572 and 559 having an ADHD diagnosis or symptoms, respectively. ADHD symptoms were assessed through the Inattention/Hyperactivity subscale of the Strength and Difficulties Questionnaire. ADHD diagnosis was determined by a physician or psychologist. Serum thyroid stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) concentrations were determined enzymatically. Adjusted regression models were used to relate serum TSH, fT3, and fT4 with risk for ADHD diagnosis or symptoms. In children, a 1 mIU/l higher TSH was related to a 10% lower risk (odds ratio [OR] 0.90; 95% confidence interval [CI] 0.81–1.00) of ADHD diagnosis. We found a significant positive association between fT3 and continuously assessed ADHD symptoms in children (β 0.08; 95% CI 0.03–0.14). Our results suggest that physical maturity may influence the association between thyroid function biomarkers and risk for ADHD.

Psychische Auffälligkeiten von Jugendlichen mit Adipositas in der stationären Rehabilitation

Zusammenfassung. Es wurden die Geschlechts- und Altersunterschiede in den selbst- und fremdbeurteilten psychischen Auffälligkeiten bei N = 142 Jugendlichen mit Adipositas in der stationären Rehabilitation untersucht. Mädchen wiesen im Selbsturteil höhere Ausprägungen in der Ängstlichkeit/Depressivität sowie den emotionalen und Verhaltensproblemen auf. Die Eltern gaben eine höhere Hyperaktivität ihrer Söhne an. Jüngere schätzten ihre Verhaltensprobleme höher ein als Ältere. Zudem wurde die klinische Stichprobe mit geschlechts- und altersgematchten Kontrollen aus der Normierungsstudie des Screenings psychischer Störungen im Jugendalter (SPS-J-II; Hampel & Petermann, 2012a ) verglichen ( N = 254). Es ergab sich ein 2.43-fach erhöhtes Risiko für auffällige Werte in der Ängstlichkeit/Depressivität bei den Jugendlichen mit Adipositas und ein signifikanter Mittelwertunterschied. Die Befunde sprechen für eine frühzeitige Diagnostik psychischer Auffälligkeiten und bedarfsgerechte Interventionen, um der Entwicklung komorbider psychischer Auffälligkeiten vorzubeugen.

Kinder- und jugendpsychiatrische stationsäquivalente Behandlung (StäB): Therapieoption – für alle oder für wenige?

Zusammenfassung. Fragestellung: Aufsuchende stationsäquivalente Behandlung (StäB) ist seit dem 01.01.2017 in Deutschland möglich und seit dem 01.01.2018 abrechenbar. Dennoch wird StäB unter Infragestellung der Machbarkeit der Rahmenbedingungen derzeit nur an wenigen Standorten der Kinder- und Jugendpsychiatrie und Psychotherapie in Deutschland regelhaft angeboten. Ziel war es, anhand der ersten 58 stationsäquivalent behandelten Kinder und Jugendlichen am ZfP Südwürttemberg (2018–2019) die Machbarkeit und Kosten von StäB zu evaluieren. Methodik: Es wurden alle seit dem 01.01.2018 konsekutiv stationsäquivalent behandelten Fälle eingeschlossen und anhand von rein deskriptiven Analysen in SPSS.25 evaluiert. Ergebnisse: Die durchschnittliche Behandlungsdauer betrug 37.95 Tage (SD 15.35), 86.2 % aller Familien beendeten die Behandlung regelgerecht, es kam nur bei drei Patientinnen und Patienten zu einem einvernehmlichen Behandlungsabbruch, fünf mussten in eine stationäre Behandlung verlegt werden. Es wurden primär internalisierende Störungen indiziert (70.7 %), während externalisierende Störungen nur ein Viertel der Behandlungsfälle ausmachten (27.8 %). Kosten einer StäB beliefen sich im Durchschnitt auf 8779,25 €. Schlussfolgerungen: StäB stellt eine neue Behandlungsform im familiären Umfeld dar, welche täglich stattfindet. Multiprofessionalität der Behandlung ist Voraussetzung. Eine Umsetzung in den gegebenen Rahmenbedingungen ist möglich. Eine Akzeptanz von den Familien ist gegeben, die durchschnittliche Behandlungsdauer liegt leicht über dem stationären Bundesdurchschnitt.

The relationship between acculturation and mental health of 1st generation immigrant youth in a representative school survey: does gender matter?

BACKGROUND

Although gender plays a pivotal role in the psychological adaptation of immigrant youth, its association with acculturation strategy and mental health among 1st generation immigrant adolescents are still scarce and inconsistent. Therefore, the purpose of the current study was to investigate gender-related differences in acculturation patterns and their association with mental health (internalizing and externalizing problems).

METHODS

Self-reported data of immigrant adolescents (N = 440) aged between 12 and 19 years (M = 16.2; SD = 1.6) was collected in a representative German school survey. Fifty-one percent of the sample were female (n = 224). Almost half of the sample was born in the Former Soviet Union, followed by Poland (9.3%). Sociodemographic variables, acculturation strategies, and internalizing as well as externalizing problems were assessed by questionnaires.

RESULTS

Confirmatory factor analysis supported the four- dimensional model of acculturation styles (assimilation, integration, separation and marginalization). Whereas girls more often showed an integration pattern, boys scored higher on the separation and marginalization scale. After adjusting for age and educational level, regression analyses revealed for both gender that marginalization was associated with more internalizing problems. Separation was related to more externalizing problems.

CONCLUSION

1st generation adolescents experiencing a lack of belongingness to German society, socio-economic and educational disadvantages might be particularly vulnerable to mental distress. Findings are discussed in terms of gender-related differential socialization processes in context of immigration.

Auswirkungen außerfamiliärer frühkindlicher Betreuung auf die Entwicklung psychischer Auffälligkeiten, Risikoverhaltens und schulischer Leistung im Jugendalter

Zusammenfassung. Internationale Studien zu den langfristigen Auswirkungen außerfamiliärer frühkindlicher Betreuung (AFB) auf die psychische Gesundheit zeigen differentielle Effekte in Abhängigkeit der Qualität der Betreuung, dem Eintrittsalter und dem Ausmaß sozialer Benachteiligung. Die Anzahl deutscher Studien dazu ist jedoch gering. In einer deutschen Längsschnittstudie an 249 Familien wird untersucht, welche Auswirkungen AFB auf die Entwicklung psychischer Auffälligkeiten, Risikoverhalten und die Schulleistung im Jugendalter ( M=14.4 Jahre) hat. AFB führt im Vergleich zu elterlicher Betreuung zu signifikant höheren Werten psychischer Auffälligkeiten im Jugendalter. Migrationshintergrund und der Erziehungsstatus sind relevante Moderatoren. Ein frühes Eintrittsalter in die institutionelle Betreuung korreliert mit mehr psychischen Auffälligkeiten. Bei der Entscheidung von Eltern für AFB sollten das Eintrittsalter, die Qualität der Betreuung und die eigene soziale Situation berücksichtigt werden.

Age-specific norms and validation of the German SDQ parent version based on a nationally representative sample (KiGGS)

The Strengths and Difficulties Questionnaire (SDQ) is the most widely used mental health screening instrument for children and adolescents. It is a short questionnaire including 25 items that can be answered by parents, teachers or children. There are two studies which report norms for the German SDQ parent version. They do not include children younger than 6 years. Moreover, whether the German SDQ parent version is measurement invariant across age has not yet been investigated. The absence of measurement invariance across age would support the use of age-specific norms that are not yet available for the German SDQ parent version. We used data of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a nationally representative survey including 14,835 children aged 3-17 years, to assess measurement invariance of the German SDQ parent version across the full age range. Multi-group confirmatory factor analysis revealed that the hyperactivity and emotional symptoms subscales are not comparable between children of different ages. This supports the use of age-specific norms for these two subscales and for the total SDQ. We used methods of centile estimation to smoothly model the centiles of the SDQ total score and the subscale scores in dependence on age. These age-specific centiles reflect the developmental course of SDQ problems in children (including preschoolers) and adolescents living in Germany. They can be used to identify children and adolescents with abnormal behaviour, while accounting for the developmental course of emotional and behaviour problems.

Significance of isolated borderline ventriculomegaly

PURPOSE

Foetal ventriculomegaly (VM) is one of the most commonly diagnosed brain abnormalities. The aims of this study were to assess cases with isolated VM, describe the prenatal course and assess short- and long-term follow-up at the age of 2 years.

METHODS

We performed a retrospective analysis from our prenatal data base and included all children that were prenatally diagnosed with VM in our unit between 2008 and 2013 (n = 250). Prenatal management, postnatal outcome and neurologic development at the age of 2 years were evaluated.

RESULTS

A total of 106 children were born at our institution and were diagnosed prenatally with isolated borderline VM. A total of 1.9% (n = 2/106) was transferred to the neonatal unit. A total of 0.9% (n = 1/106) showed abnormal findings in postnatal brain ultrasound. A total of 1.9% (n = 2/106) showed mild neurologic abnormalities after birth, but none had to be seen by a neuropediatrician. At the follow-up at 2 years, 2.5% (n = 1/40) had an insertion of a shunt.

CONCLUSION

Based on our analysis, the majority of isolated borderline VM do not show short- or long-term neurological abnormalities. However, all cases of VM should be referred to a detailed prenatal ultrasound exam by a specialist.

No Effect of Thyroid Dysfunction and Autoimmunity on Health-Related Quality of Life and Mental Health in Children and Adolescents: Results From a Nationwide Cross-Sectional Study

Background: In adults, a significant impact of thyroid dysfunction and autoimmunity on health-related quality of life (HRQoL) and mental health is described. However, studies in children and adolescents are sparse, underpowered, and findings are ambiguous. Methods: Data from 759 German children and adolescents affected by thyroid disease [subclinical hypothyroidism: 331; subclinical hyperthyroidism: 276; overt hypothyroidism: 20; overt hyperthyroidism: 28; Hashimoto's thyroiditis (HT): 68; thyroid-peroxidase antibody (TPO)-AB positivity without apparent thyroid dysfunction: 61] and 7,293 healthy controls from a nationwide cross-sectional study ("The German Health Interview and Examination Survey for Children and Adolescents") were available. Self-assessed HRQoL (KINDL-R) and mental health (SDQ) were compared for each subgroup with healthy controls by analysis of covariance considering questionnaire-specific confounding factors. Thyroid parameters (TSH, fT4, fT3, TPO-AB levels, thyroid volume as well as urinary iodine excretion) were correlated with KINDL-R and SDQ scores employing multiple regression, likewise accounting for confounding factors. Results: The subsample of participants affected by overt hypothyroidism evidenced impaired mental health in comparison to healthy controls, but SDQ scores were within the normal range of normative data. Moreover, in no other subgroup, HRQoL or mental health were affected by thyroid disorders. Also, there was neither a significant relationship between any single biochemical parameter of thyroid function and HRQoL or mental health, nor did the combined thyroid parameters account for a significant proportion of variance in either outcome measure. Importantly, the present study was sufficiently powered to identify even small effects in children and adolescents affected by HT, subclinical hypothyroidism, and hyperthyroidism. Conclusions: In contrast to findings in adults, and especially in HT, there was no significant impairment of HRQoL or mental health in children and adolescents from the general pediatric population affected by thyroid disease. Moreover, mechanisms proposed to explain impaired mental health in thyroid dysfunction in adults do not pertain to children and adolescents in the present study.

Measuring children's emotional and behavioural problems: are SDQ parent reports from native and immigrant parents comparable?

BACKGROUND

The number of immigrants worldwide is growing and migration might be a risk factor for the mental health of children. A reliable instrument is needed to measure immigrants' childrens mental health. The aim of the study was to test the measurement invariance of the parent version of the Strengths and Difficulties Questionnaire (SDQ) between German native, Turkish origin and Russian origin immigrant parents in Germany. The SDQ is one of the most frequently used screening instruments for mental health disorders in children.

METHODS

Differential Item Functioning (DIF) was tested in samples matched by socio-economic status, age and gender of the child. A logistic regression/item response theory hybrid method and a multiple indicators- multiple causes model (MIMIC) was used to test for DIF. Multi Group Confirmatory Factor analysis (MGCFA) was used to test for configural invariance. Parent reports of 10610 German native, 534 Russian origin and 668 Turkish origin parents of children aged 3-17 years were analysed.

RESULTS

DIF items were found in both groups and with both methods. We did not find an adequate fit of the original five factor model of the SDQ for the Turkish origin group, but for the Russian origin group. An analysis of functional equivalence indicated that the SDQ is equally useful for the screening of mental health disorders in all three groups.

CONCLUSION

Using the SDQ in order to compare the parent reports of native and immigrant parents should be done cautiously. Thus, the use of the SDQ in epidemiological studies and for prevention planning is questionable. However, the SDQ turns out to be a valid instrument for screening purposes in parents of native and immigrant children.

[Intensive psychiatric care of children and adolescents in their natural environment : Alternatives to inpatient treatment]

Mental health disorders are one of the main diseases in children and adolescents, the persistence rate into adulthood being around 50%. Early intervention is therefore essential. However, present treatment options reach only 50% of children and adolescents with mental health problems.The objective of this article is to depict why legal deficits complicated the establishment of outreach treatment in the past and to illustrate recent legal changes that now allow innovative outreach treatment programs that meet the need of children and adolescents with mental health issues.This review is based on pertinent publications that were retrieved by a selective literature search in PubMed and Cochrane Library concerning types of home treatment in child and adolescent psychiatry, with due reference to the authors' own experience with intensive home treatment.The literature shows that outreach work has been effective in many other countries. In Germany however, clear separation in finances between outpatient and inpatient treatment did not allow the establishment of outreach teams in the past. On 01.01.2017 a new law, the PsychVVG, entered into force, and now provides a sound legal basis for outreach work. Home treatment in the form of, for example, intensive outreach work that equals the intensity and frequency of inpatient treatment (StäB) or continuum of care school (CCSchool), a project that joins school-based diagnostic elements with school-based treatment, can now be installed and evaluated.Intensive outreach work, especially in child and adolescent psychiatry, will now be a good alternative to inpatient treatment that integrates parents into the treatment approach.

[Headache, abdominal pain, and back pain in children and adolescents in Thuringia : Representative results of a regional module study in KiGGS wave 1]

Recurring pain in children and adolescents can have a negative impact on health and well-being. This study investigates recurring headache, abdominal pain, and back pain in children and adolescents in Thuringia. Data is based on a representative sub-sample from the federal state module Thuringia (2010-2012, n = 4096, 3-17 years), carried out in KiGGS wave 1 (first follow-up interview of the "German Health Interview and Examination Survey for Children and Adolescents"). The 3‑month prevalence of recurrent headache, abdominal pain, and back pain is reported according to socio-demographic factors and is compared with the prevalence for the whole of Germany. In addition, possible associated factors of recurring headache, abdominal pain, and back pain in the previous 3 months are analyzed. Results for Thuringia show that 3‑ to 10-year-old children were most frequently affected by recurrent abdominal pain (girls: 24.1%; boys: 16.7%), while 11- to 17-year-old adolescents were most frequently affected by recurrent headaches (girls: 36.8%; boys: 20.6%). There were isolated socio-economic differences in the 3‑month prevalences of recurrent headache and back pain to the detriment of the low status group. Compared to peers in the whole of Germany, girls and boys in Thuringia did not report headache, abdominal pain, and back pain in the previous 3 months more frequently. The investigated associated factors-fair to very poor self-rated health, emotional problems such as anxiety and depressive symptoms, chronic diseases and other health complaints, migraine, use of a general medical practice, as well as practices for orthopedics and neurology, and in-patient treatment at a hospital-were positively related to the 3‑month prevalence of recurrent headache, abdominal pain, and back pain. Overall, the results confirm that recurring pain is a common phenomenon in childhood and adolescents and, therefore, underline the public health relevance of pain in this young age group.

Health-related quality of life and mental health in children and adolescents with strabismus - results of the representative population-based survey KiGGS

Background

To estimate the effect of strabismus (squinting) on mental health and health-related quality of life aspects in children and adolescents.

Methods

Data from the German Health Interview and Examination Survey for Children and Adolescents KiGGS (2003–2006 baseline survey; N = 14,835, aged 3 to 17 years, 49% girls) were examined. The presence of strabismus was derived by parental questionnaire, and health-related quality of life and mental health were investigated with the KINDL-R and Strengths and Difficulties Questionnaire. Associations between strabismus and outcomes were analyzed using multivariable linear and logistic regression models.

Results

Of 12,989 children without missing data, 579 children (4.5% of the sample) were reported to have strabismus. Children with strabismus had lower scores in the parent-reported KINDL-R total scale (adjusted beta = − 1.02; 95%CI: -1.86 to − 0.18; p = 0.018) and sub-scale ‘friends’ (adjusted beta = − 2.18; 95%CI: -3.56 to -0.80; p = 0.002) compared to children without strabismus. The presence of strabismus was also associated with more mental health problems like ‘hyperactivity/inattention’ (adjusted OR = 1.50; 95%CI: 1.14 to 1.98; p = 0.005), and ‘peer problems’ (adjusted OR = 1.35; 95%-CI: 1.05 to 1.74; p = 0.018) as reported by parents.

Conclusions

Strabismus in children and adolescents is associated with lower health-related quality of life.

Electronic supplementary material

The online version of this article (10.1186/s12955-019-1144-7) contains supplementary material, which is available to authorized users.

Sozio-emotionale Kompetenzen mehrsprachiger Kindergartenkinder und deren Wechselwirkungen mit den Sprachleistungen im Deutschen

Zusammenfassung. Gegenstand des vorliegenden Beitrags sind die bislang kaum betrachteten sozio-emotionalen Kompetenzen mehrsprachiger Kindergartenkinder und deren reziproke Beziehungen mit den sprachlichen Kompetenzen im Deutschen. Unter Heranziehung längsschnittlicher Daten ( N = 216) konnte in dieser Untersuchung gezeigt werden, dass die mehrsprachigen Kinder als Gruppe über altersangemessene sozio-emotionale Kompetenzen verfügen und diese im Zusammenhang mit den sprachlichen Leistungen der Kinder ( r = .18- .27, p ≤ .001) stehen. Eine Cross-lagged-panel-Analyse ergab ferner, dass frühe sozio-emotionale Kompetenzen den Zuwachs an Sprachkompetenzen nach einem Jahr prädizieren (ß = .08, p ≤ .05), allerdings der frühe Wortschatz nicht zur Vorhersage späterer sozio-emotionaler Kompetenzen beiträgt. Diese Befunde weisen auf einen unidirektionalen Zusammenhang in der frühen Kindheit hin. Abschließend werden Implikationen für zukünftige Forschung und pädagogische Praxis diskutiert.

[Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect]

Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect Abstract. Background: As part of a multicenter study evaluating measures to improve access to evidenced-based treatment for children and adolescents following child abuse and neglect, we introduced and evaluated migration-adapted services, including a one-day intercultural training. Key issues were the dissemination of information concerning migration and acculturation, trauma and mental health to immigrant families as well as the development of exercises on intercultural competence and culturally sensitive work. Method: Near the end of the research project we gathered experiences and opinions concerning the work with immigrant families using an online survey in a subgroup of case managers working in the project (professionals in child-welfare services). This article presents two case report illustrating the practical relevance of the training's content. Results: Overall, the training was rated positively. In the opinion of the case managers, especially language barriers and cultural diversity should be considered while working with immigrant families. The case reports show that the training sensitized and supported the case managers supported the case managers when dealing with differing illness concepts, differing illness concepts, culture-sensitive assessment, or work with language mediators. Conclusions: The case management work also demonstrated the limitations of the psychosocial care system; the further dissemination of intercultural knowledge is important.

Mental health problems in children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Mental health problems in children and adolescents are associated with individual and family-related constraints as well as social costs. 20.0% of children and adolescents showed mental health problems at the KiGGS baseline study (2003-2006). This study investigates the current prevalence for KiGGS Wave 2 (2014-2017) as well as time trends in comparison with the KiGGS baseline study. Mental health problems were assessed for 3- to 17-year-old children and adolescents by using the parent-based version of the Strengths and Difficulties Questionnaire (SDQ). For KiGGS Wave 2, the prevalence of mental health problems was 16.9%. A decreasing trend is pronounced particularly among boys between 9 and 17 years of age. Mental health problems are displayed more frequently by girls and boys from families with a low socioeconomic status compared to their peers from families with a medium or high socioeconomic status. These findings are discussed in the light of various measures and actions in health promotion and health care.

Native-born German and immigrant children's development of emotion knowledge: A latent growth curve analysis

Young children in immigrant families tend to face more challenges and can often call upon fewer resources than their native-born peers. This situation adversely affects their social-emotional development. In this study, the development of emotion knowledge of 576 immigrant and native-born German children, aged 3-6 years, was compared at three time points over a 12-month period by means of a latent growth curve analysis. Language abilities and behavioural self-regulation were examined as mediators of the relation between immigration background and emotion knowledge. The immigrant children showed less emotion knowledge than did their native-born peers at each point of measurement. These effects were partially mediated by their behavioural self-regulation and their language abilities. How behavioural self-regulation and language abilities affect the development of emotion knowledge and what this effect means for interventions are discussed. Statement of contribution What is already known on this subject? Emotion knowledge develops rapidly between the ages of three and six. Emotion knowledge develops similarly in different cultures. What does this study adds? This study compares the development of emotion knowledge between immigrant children and native-born children. It includes language skills as mediator on the development of emotion knowledge. It also includes behavioural self-regulation as mediator on the development of emotion knowledge.

Messinvarianz zwischen Eltern- und Jugendversion des Strengths and Difficulties Questionnaire (SDQ)?

Zusammenfassung. Die interne Struktur des Strengths and Difficulties Questionnaire (SDQ) ist kontrovers diskutiert worden. Das erste Ziel der vorliegenden Studie bestand daher in der Überprüfung der internen Struktur der SDQ Jugend- und Elternversion. Auf Basis der Daten der ersten Wiederholungsbefragung der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS-Studie) wurde mittels konfirmatorischer Faktorenanalysen gezeigt, dass das Fünf-Faktoren-Modell eine gute Anpassungsgüte besitzt, wenn korrelierte Fehlervarianzen zwischen Items mit ähnlichem Inhalt zugelassen werden. Da Skalenmittelwerte aus der SDQ Jugend- und Elternversion häufig miteinander verglichen werden, wurde im zweiten Teil der Analyse geprüft, ob skalare Messinvarianz zwischen beiden SDQ-Versionen besteht. Die Ergebnisse der konfirmatorischen Multi-Gruppen-Faktorenanalysen zeigen, dass der SDQ bei Eltern und Jugendlichen die gleichen Konstrukte erfasst (konfigurale Messinvarianz). Skalare Messinvarianz liegt hingegen nur für 19 der 25 Items vor. Unterschiede in den latenten Skalenmittelwerten zwischen Jugendlichen und Eltern können daher entweder das Ergebnis von tatsächlichen Bewertungsunterschieden darstellen oder sie sind das Resultat der fehlenden skalaren Messinvarianz zwischen beiden SDQ-Versionen. Folglich sollten Unterschiede in den latenten Mittelwerten aus Eltern- und Selbstbeurteilungsversion für Jugendliche mit Vorsicht interpretiert werden.

[Subjective, physical and mental health of children and adolescents in Thuringia : Representative results of the Thuringia state module in KiGGS wave 1]

Children and adolescents from Thuringia have higher health care needs compared with peers in Germany overall. It was investigated whether this is due to a higher disease process. The data basis was the Thuringia state module (2010-2012; n = 4884; 0-17 years), which was conducted in KiGGS wave 1 (2009-2012). The health situation of children and adolescents is described in terms of various indicators of subjective, physical, and mental health. Prevalences with 95% confidence intervals were reported, and with logistic regressions, the significance of the group differences was examined. Whether children and adolescents in Thuringia and Germany overall differ in the examined health indicators, was tested with chi-square tests and the p values are corrected according to Bonferroni. With 93.8%, the majority of children and adolescents in Thuringia had very good or good subjective health. One-fifth of children and adolescents (20.4%) had a chronic illness or a long-standing health condition. Hay fever (13.6%) and atopic dermatitis (17.6%) were the most common medically diagnosed chronic diseases. In addition, one-fifth of children and adolescents (20.6%) had symptoms of mental health problems; a medical ADHD diagnosis was found in 5.6% of children and adolescents in Thuringia. Compared with peers from Germany overall, there were only a few differences in the incidence of disease. According to these results, the higher degree of care provided to Thuringian girls and boys cannot be attributed to a higher incidence of disease. Other factors such as greater parental willingness of utilization or a better supply structure must be taken into account.

[Impact of Socioeconomic Risk Exposure on Maternal Sensitivity, Stress and Family Functionality]

Impact of Socioeconomic Risk Exposure on Maternal Sensitivity, Stress and Family Functionality Parental stress exposure can influence the parent-child relationship, child development and child wellbeing in negative ways. The aim of this study was to investigate the impact of socio-economic risk exposure on the quality of the mother-child-interaction and family functionality. A sample of 294 mother-infant dyads at psychosocial risk was compared with a lower-risk, middle-class sample of 125 mother-infant-dyads in regard to maternal sensitivity/child's cooperation (CARE-Index), maternal stress (PSI-SF) and family functionality (FB-K). Lower levels of maternal sensitivity/child's cooperation and by trend also of the family functionality were found among the mothers from the at-risk sample in comparison to the low-risk sample. The level of maternal stress was similar in both samples. The results underpin the negative effects of a socio-economic risk exposure on the mother-child relationship. An early, sensitivity-focused family support could be encouraged to counteract the negative effects of early socioeconomic stress.

Die Eltern-Kurzversion des Fragebogens zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen (FEEL-KJ)

Zusammenfassung. Theoretischer Hintergrund: Das Konzept der Emotionsregulation (ER) hat große Bedeutung für die Klinische Psychologie und Psychotherapie. Gleichzeitig liegen besonders im Kindes- und Jugendalter kaum zuverlässig evaluierte und normierte Verfahren zur Messung von ER vor. Fragestellung: Es soll geprüft werden, ob eine Eltern-Kurzversion des Fragebogens zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen (FEEL-KJ) über ausreichende psychometrische Qualität verfügt, um diese Lücke zumindest teilweise zu schließen. Außerdem sollen erste Hinweise auf die Validität der Testwerte und deren Abhängigkeit von soziodemographischen Variablen untersucht werden. Es wurde insbesondere eine mit dem Alter zunehmend häufige Verwendung von ER-Strategien erwartet. Ebenso wurden positive Zusammenhänge maladaptiver und negative Zusammenhänge adaptiver ER mit psychischen Beschwerden angenommen. Methode: Die Eltern-Kurzversion des FEEL-KJ und weitere Fragebogenverfahren wurden bei einer Elternstichprobe von 1638 Kindern im Alter von 2 – 10 Jahren eingesetzt (958 Datensätze von beiden Elternteilen, 605 nur Mütter und 75 nur Väter). Ergebnisse: Die Ergebnisse für Mütter und Väter stimmten weitgehend überein und die internen Konsistenzen der Testwerte lagen im guten bis sehr guten Bereich. Mit zunehmendem Alter wurden adaptive wie maladaptive ER-Strategien häufiger angewandt und die Zusammenhänge der Testwerte mit internalisierender wie externalisierender Psychopathologie waren deutlich. Es zeigten sich kaum bedeutsame Unterschiede in Abhängigkeit vom Geschlecht des Kindes und weiteren soziodemographischen Variablen. Schlussfolgerung: Die Eltern-Kurzversion des FEEL-KJ scheint zumindest als Ergänzung der bestehenden Diagnostik in Forschung und Praxis gut geeignet. Auf Basis der vorhandenen großen Stichprobe werden Normwerte bereitgestellt. Dennoch werden multimethodal angelegte Validierungsstudien notwendig sein, um die Validität der Testwerte weiter abzuklären. Normierung: Die ermittelten T-Wert- sowie Prozentrangnormen sind unter https://doi.org/10.24355/dbbs.084-201803050916 ( Greuel, Briegel & Heinrichs, 2018 ) oder über eine Anfrage bei den Autoren kostenfrei erhältlich. 1

Evaluation eines migrationsspezifischen Angebots im Case Management von Kindern und Jugendlichen mit Therapiebedarf nach Misshandlung, Missbrauch oder Vernachlässigung

Zusammenfassung. Für Kinder und Jugendliche aus Familien mit Migrationshintergrund (MHG) ist der Zugang zu evidenzbasierter Psychotherapie möglicherweise erschwert. Im Rahmen einer randomisierten und kontrollierten Multicenter-Studie zur Evaluation eines Case Management-Ansatzes für Kinder und Jugendliche, die nach Misshandlung, sexuellem Missbrauch oder Vernachlässigung eine psychische Störung entwickelt haben, wurden zur Projektmitte die beteiligten Case Manager zusätzlich hinsichtlich kultur- und migrationsspezifischer Aspekte geschult und in ihrer Arbeit mit Migrantenfamilien durch übersetzte Materialen und die Finanzierung von Dolmetschern unterstützt. Obwohl mit einem Anteil von 30 % Fällen mit MHG in der Interventionsstudie die anvisierte Zielgruppe erreicht wurde, waren die Fallzahlen im Case Management-Arm mit n = 7 vor der migrationsspezifischen Schulung und n = 8 danach zu gering, um einen klinischen Nutzen der Maßnahmen im Sinne einer besseren Versorgung nachzuweisen.

Risikoepidemiologie und Kinderschutzstatistik in der frühen Kindheit: Eine Pilotuntersuchung mit dem „Wahrnehmungsbogen für den Kinderschutz“

Zusammenfassung. Fragestellung: Bislang liegen in Deutschland weder empirisch ausreichend abgesicherte Prävalenzdaten bezüglich Kindesvernachlässigung und -misshandlung noch in Bezug auf Risikoindikatoren für potenzielle Vernachlässigung oder Misshandlung vor. Methodik: Ziel der Studie war es, ein Verfahren zur systematischen Datenerhebung von Anhaltspunkten für Kindesvernachlässigung und -misshandlung in Kindergärten zu erproben und erste Prävalenzdaten zu generieren. Dazu wurde in 35 Kindergärten eines baden-württembergischen Flächenlandkreises der eigens entwickelte Wahrnehmungsbogen für den Kinderschutz (ESM1 und ESM2) zur Erfassung von Anhaltspunkten für Kindesvernachlässigung und -misshandlung und Risikoindikatoren eingesetzt. Erzieherinnen und Erzieher beurteilten 1122 Kinder zwischen 4 und unter 7 Jahren mithilfe des Wahrnehmungsbogens und des Stärken- und Schwächen-Fragebogens (SDQ). Ergebnisse: Anhaltspunkte für eine Kindesvernachlässigung bzw. -misshandlung wurden bei 13.2 %, Risikoindikatoren bei 38.4 % der Kinder angegeben. Schlussfolgerungen: Systematische Datenerhebungen für den Kinderschutz sind in deutschen Kindergärten machbar und können zur Erhellung des Dunkelfelds beitragen. Künftig sollten lokale Kinderschutznetzwerke auf Grundlage solcher empirischer Untersuchungen adaptiert werden.

[Parental Social Status and other determinants of quality of life and behavioral problems: An analysis of German preterm births between 1987-2004]

BACKGROUND

Knowledge of the factors affecting the development of preterm children in Germany is limited. We analysed the prevalence of preterm birth in Germany using the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 and assessed factors associated with quality of life (QOL) and behavioural development in preterm children (< 37 weeks' gestational age).

METHODS

Data were weighted and preterm prevalence was calculated by socioeconomic status (SES) and year of birth for  1,106 preterm children. Using linear regression models, the relationship between sociodemographic, pre- and perinatal, lifestyle, and contextual determinants on the one hand, and the QOL (KINDL® parent questionnaire) and behavioural problems (the total problem behaviour scale, the Strengths and Difficulties Questionnaire [SDQ]) on the other was calculated.

RESULTS

Prevalence of preterm birth (mean 7.5 %) was higher in families with low compared with high SES (8.4 versus 7.0 %). In the final regression models, preterm children with high SES had higher QOL scores (+ 3.3 KINDL points, p = 0.024) compared with children with low SES, and adolescents (aged 14-17 years) had a higher QOL than children aged 7-13 years. All other variables (contextual, pre- and perinatal) were not related to QOL. In contrast, there were many determinants of behavioural development in preterms: the SDQ total score was lower in girls, children with older mothers, those from high SES and those with a high level of physical activity. However, both very low birth weight (< 1,500 g) and birth at > 34 weeks' gestation were associated with a higher SDQ total score.

CONCLUSION

Given its high prevalence, preterm birth is a relevant public health issue in Germany. While SES may be the most important determinant of QOL in preterms, determinants of behavioural problems are the same as those in term children and also encompass perinatal factors.

The Specificity Principle in Acculturation Science

The specificity principle in acculturation science asserts that specific setting conditions of specific people at specific times moderate specific domains in acculturation by specific processes. Our understanding of acculturation depends critically on what is studied where, in whom, how, and when. This article defines, explains, and illustrates the specificity principle in acculturation science. Research hypotheses about acculturation can be more adequately tested, inconsistencies and discrepancies in the acculturation literature can be satisfactorily resolved, acculturation interventions can be tailored to be more successful, and acculturation policies can be brought to new levels of effectiveness if the specificity principle that governs acculturation science is more widely recognized.

The Relationship between Emotion Comprehension and Internalizing and Externalizing Behavior in 7- to 10-Year-Old Children

The influence of internalizing and externalizing problems on children’s understanding of others’ emotions has mainly been investigated on basic levels of emotion comprehension. So far, studies assessing more sophisticated levels of emotion comprehension reported deficits in the ability to understand others’ emotions in children with severe internalizing or externalizing symptoms. The aim of this study was to investigate the relation between emotion comprehension and interindividual differences, with a focus on internalizing and externalizing behavior in children aged 7–10 years from the general population. A sample of 135 children was tested for emotion understanding using the Test of Emotion Comprehension. Information on internalizing and externalizing behavior was assessed with the Child Behavior Checklist 4/18. Age, bilingual upbringing, and amount of paternal working hours were significant control variables for emotion comprehension. In contrast to prior research, overall level of emotion understanding was not related to externalizing symptoms and correlated positively with elevated levels of somatic complaints and anxious/depressed symptoms. In addition, and in line with previous work, higher levels of social withdrawal were associated with worse performance in understanding emotions elicited by reminders. The present results implicate not only an altered understanding of emotions among more specific internalizing symptoms, but also that these alterations occur already on a low symptom level in a community based sample.

The Child Health Care System of Germany

We describe the strengths and challenges of the child health care system in Germany and also provide an outlook on future health plans, focusing on making idiosyncrasies of national health care services in Europe understandable to those pediatricians working in other countries. The aim should be to avoid those unnecessary processes in child care which, unless abandoned, may be responsible for a poor outcome of child health. Larger countries, such as Germany, have many distinct regional differences. When it comes to problem-solving strategies, pediatricians must be aware of unavoidable cultural and historic differences that may influence the outcome of care. Even when assuming unlimited financial resources, different regional priorities might result in diverging goals.

Mobile phone use, behavioural problems and concentration capacity in adolescents: A prospective study

The aim of this study is to prospectively investigate whether exposure to radiofrequency electromagnetic fields (RF-EMF) emitted by mobile phones and other wireless communication devices is related to behavioural problems or concentration capacity in adolescents. The HERMES (Health Effects Related to Mobile phonE use in adolescentS) study sample consisted of 439 Swiss adolescents aged 12-17 years. Behavioural problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), concentration capacity of the adolescents was measured by means of a standardized computerized cognitive test named FAKT. Cross-sectional and longitudinal (1year of follow-up) analyses were performed to investigate possible associations between behavioural problems and concentration capacity and different exposure measures: self-reported and operator-recorded wireless communication device use, cumulative RF-EMF brain and whole body dose and measured personal RF-EMF exposure. In the cross-sectional analyses behavioural problems were associated with several self-reported wireless device use measures but not operator-recorded mobile phone use measures, concentration capacity was associated with several self-reported and operator-recorded exposures. The longitudinal analyses point towards absence of associations. The lack of consistent exposure-response patterns in the longitudinal analyses suggests that behavioural problems and concentration capacity are not affected by the use of wireless communication devices or RF-EMF exposure. Information bias and reverse causality are likely explanations for the observed cross-sectional findings.

Determinants of organised sports participation patterns during the transition from childhood to adolescence in Germany: results of a nationwide cohort study

BACKGROUND

Organised sports (OS) participation is an important health behaviour but it seems to decline from childhood to adolescence. The aim of this study was to investigate OS participation patterns from childhood to adolescence and potential determinants for those patterns.

METHODS

Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) cohort study with a 6 year follow-up period were used (KiGGS0: 2003-06, KiGGS1: 2009-12). Participants aged 6-10 years at KiGGS0, who were aged 12-16 at KiGGS1, were included (n = 3790). The outcome variable was 'OS participation' between KiGGS0 and KiGGS1 with the categories 'maintenance' (reference), 'dropout', 'commencement' and 'nonparticipation'. Relative risk ratios (RRRs) were calculated using multinomial logistic regression to identify potential predictors for OS patterns. Socio-demographic, family-related, health-related, behavioural and environmental factors were considered as independent variables.

RESULTS

48.5 % maintained OS, 20.5 % dropped out, 12.3 % commenced OS between KiGGS0 and KiGGS1 and 18.7 % did not participate at both times. The RRRs for dropout rather than maintenance were 0.6 (95 % Cl 0.5-0.7) for boys versus girls, 1.5 (1.3-1.9) for the age group 8-10 versus 6-7 years, 0.7 (0.5-0.9) for high versus intermediate parental education, 1.4 (1.1-1.8) for low versus middle household income, 1.4 (1.0-1.8) for below-average versus average motor fitness. The RRRs for commencement rather than maintenance were 0.6 (0.5-0.8) for boys versus girls, 0.6 (0.5-0.8) for the age group 8-10 versus 6-7 years, 1.5 (1.1-2.1) for low versus intermediate parental education, 1.5 (1.1-2.0) for low versus middle household income, 0.7 (0.5-1.0) for no single-parent versus single parent family, 1.8 (1.3-2.5) for below-average and 0.6 (0.4-0.8) for above-average versus average motor fitness, and 1.4 (1.1-1.9) for high versus middle screen-based media use. The RRRs for abstinence rather than maintenance were 0.6 (0.4-0.7) for boys versus girls, 1.5 (1.1-2.0) for low versus intermediate parental education, 2.2 (1.7-2.8) for low and 0.6 (0.5-0.8) for high versus middle household income, 1.6 (1.2-2.1) for psychopathological problems versus no problems, 1.7 (1.3-2.2) for below-average and 0.4 (0.3-0.6) for above-average versus average motor fitness, and 1.6 (1.0-2.6) for rural versus metropolitan residential area.

CONCLUSIONS

OS participation rates among all children living in Germany need to be improved. More tailored offerings are needed which consider the preferences and interests of adolescents as well as a cooperation between public health actors to reduce barriers to OS.