The detect consensus report on Attention Deficit/Hyperactivity Disorder and its management among Turkish children and adolescents (Detect: consensus report on ADHD among Turkish youth)

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common and heritable neurodevelopmental disorders which may last through the life-span. A consensus report on diagnosis and management of ADHD among Turkish youth was prepared previously. However, the participants as well as the management options were rather limited and developments in the past decade necessitated a revision and update of the consensus. Therefore, this review aims to summarize the consensus among Child and Adolescent Psychiatrists from Türkiye on the nature and management of pediatric ADHD. For those aims, the etiology of ADHD, diagnostic and evaluation process, epidemiology, developmental presentations, differential diagnoses and comorbidities, course/outcome and pharmacological as well as non-pharmacological management options were reviewed and suggestions for clinical practice are presented. Since ADHD is a chronic disorder with wide-ranging effects on functionality that is frequently accompanied by other mental disorders, a multidimensional therapeutic approach is recommended. However, since the disorder has neurobiological basis, pharmacotherapy represents the mainstay of treatment. Additional therapies may include psychosocial therapy, behavioral therapy, school-based therapeutic approaches, and family education. This review provides recommendations for ADHD at the national and global levels. It contains information about ADHD that will contribute to and facilitate clinicians' decision-making processes. It is advisable to consider this guideline in clinical practice.

Psychometric properties of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in Turkish children

BACKGROUND

The nine item avoidant/restrictive food intake disorder screen (NIAS) is a short and practical assessment tool specific to ARFID with three ARFID phenotypes such as "Picky eating," "Fear," and "Appetite". This study aimed to evaluate the psychometric properties of the Turkish translation of the NIAS parent form and to investigate the relationship between ARFID symptoms and anxiety, depression symptoms, and eating behaviors in a sample of Turkish children.

METHOD

Parents were asked to provide their children's sociodemographic data and to complete the NIAS, Eating Disorder Examination Questionnaire-Short (EDE-QS), Children's Eating Behavior Questionnaire (CEBQ), and Revised Child Anxiety and Depression Scale (RCADS) scales.

RESULTS

The sample included 440 participants between 6 and 12 ages. Turkish NIAS demonstrated good internal consistency. The three-factor model of the Turkish NIAS was in an acceptable structure. The Turkish NIAS scale was shown to be valid and reliable. NIAS scores were shown to be higher in underweight participants. The NIAS-parent version subscales showed expected convergent and divergent validity with the CEBQ, EDEQ-S, and RCADS scales in children, except CEBQ emotional overeating and desire to drink subscales were correlated with NIAS.

CONCLUSION

The Turkish version of the NIAS is valid and reliable in evaluating ARFID symptoms in children.

Psychometric Properties of the Turkish version of the Child and Adolescent Behavior Inventory Sluggish Cognitive Tempo Scale (CABI-SCT) in Children and Adolescents

Sluggish cognitive tempo (SCT) (cognitive disengagement syndrome) (CDS) describes a cluster of symptoms including slowness, lethargy, and daydreaming. This study aims to evaluate the psychometric properties of the Turkish version of the Child and Adolescent Behavior Inventory (CABI-SCT) scale and its relationship to other psychological difficulties. A total of 328 children and adolescents aged between 6-18 years were included in the study. CABI-SCT, Revised Child Anxiety and Depression Scale (RCADS), Barkley Child Attention Scale (BCAS), ADHD Rating Scale-IV, and Strengths and Challenges Questionnaire (SDQ) were administered to parents of participants. Reliability analysis demonstrated good internal consistency and reliability. Confirmatory factor analysis indicated that the one-factor model of the Turkish version of CABI-SCT is an acceptable construct. This study supports the validity and reliability of the Turkish version of CABI-SCT for use in children and adolescents providing initial data concerning the psychometric properties and difficulties associated with the Turkish version of the CABI-SCT.

Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

OBJECTIVE

To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations.

METHOD

This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed.

RESULTS

Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58).

CONCLUSION

Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Sluggish cognitive tempo, eating habits, and daytime sleepiness in obese adolescents

OBJECTIVE

Rates of obesity have risen steeply in the western world in all age groups. Sluggish Cognitive Tempo (SCT) is characterized by a cluster of symptoms. Daytime sleepiness, commonly seen in obesity, may share a similar origin with sleepiness and daydreaming symptoms of SCT. This study aims to investigate the relationship between obesity, SCT, daytime sleepiness, and eating habits.

METHOD

Adolescents, aged between 10-17 years, with a BMI >95^th centile, were recruited to the study. Clinical interviews were supplemented with standardized questionnaires.

RESULTS

Of the 35 adolescents, more than one quarter (N = 10, 28.6%) had SCT. Emotional overeating and food enjoyment subscale scores showed moderate correlations with the SCT scores, though these associations were not significant when controlling for ADHD symptoms. Daytime sleepiness score in adolescents with SCT was found to be significantly higher than those without.

CONCLUSION

Sluggish Cognitive Tempo is frequently present in adolescents with obesity and associated with higher levels of emotional overeating, food enjoyment, and daytime sleepiness. Targeting aspects of SCT might offer additional avenues to assist in weight management programs for youth.

Mitochondrial Dysfunction in Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder is a neurodevelopmental disorder with primary symptoms of inattention, hyperactivity, and impulsivity, beginning in early childhood. Attention deficit hyperactivity disorder has a complex etiology based on neurobiological foundations, involving genetic, environmental, and biological factors in the early development process. The etiology of attention deficit hyperactivity disorder has not been completely clarified yet, but it has been suggested that increased oxidative stress is one of the possible common etiologies in attention deficit hyperactivity disorder. Oxidative stress can cause cellular damage, DNA repair system malfunction, and mitochondrial dysfunction. Mitochondrial dysfunction is thought to be a susceptibility factor in the development of psychiatric diseases. This article aims to review the research conducted to evaluate the possible relationship between attention deficit hyperactivity disorder and mitochondrial dysfunction and systematically examine the data obtained from these studies. Although studies considering the relationship between attention deficit hyperactivity disorder and mitochondrial dysfunction are less than those of autism spectrum disorder, schizophrenia, and mood disorders, studies on attention deficit hyperactivity disorder are increasing. A compensating system against mitochondrial dysfunction caused by hereditary and environmental factors may be generated by an increase in mitochondrial DNA copy number. Mitochondrial DNA copies may decrease with the reduction of attention deficit hyperactivity disorder severity and attention deficit in patients receiving treatment and may positively affect mitochondrial functions. The literature data of this review show that mitochondrial dysfunction could be a crucial factor in the pathophysiology of attention deficit hyperactivity disorder. Understanding mitochondrial contributions in the pathogenesis of attention deficit hyperactivity disorder may result in new diagnostic tools and the development of new therapeutic strategies for attention deficit hyperactivity disorder treatment.

Is common carotid artery intima-media thickness (cIMT) a risk assessment marker in children with attention deficit/hyperactivity disorder?

OBJECTIVE

Attention deficit/hyperactivity disorder (ADHD) is associated with impairment in social, academic and job-related functioning in both children and adults. The purpose of this study is to investigate the susceptibility to cardiovascular risk factors in children with ADHD diagnosis through common carotid artery intima-media thickness (cIMT) measurement, to compare cIMT in ADHD and control groups and to evaluate the association between cIMT and ADHD symptom severity.

METHODS

The mean cIMT of 42 children with ADHD, ADHD symptom scales and a semi-structured psychiatric interview, and 42 age and sex matched healthy controls were measured with B-mode Doppler neck ultrasonography.

RESULTS

The median cIMT was significantly higher for the ADHD group compared to the healthy controls. There was a statistically significant, negative, moderate correlation between cIMT and Conners ADHD index score, hyperactivity score, oppositional score and the presence of ODD comorbidity.

CONCLUSIONS

In this study, we found significantly higher cIMT in children with ADHD when compared to healthy controls. Considering that increased cIMT is a sign of atherosclerosis and it can be used as a marker of cardiovascular risk factors, our finding may indicate that children with ADHD are at increased risk for cardiovascular diseases.KeypointscIMT was significantly higher in children with ADHD when compared to healthy controls.Higher cIMT in children with ADHD may indicate that children with ADHD are at increased risk for cardiovascular diseases.cIMT measurement may be studied as a potential tool for risk assessment before a child with ADHD is started on psychostimulant medications.

Stress and Burnout in Psychiatrists in Turkey during COVID-19 Pandemic

BACKGROUND

Clinicians working in mental health (MH) services seem to be at increased risk of burnout. This study aimed to investigate the stress and burnout levels of psychiatrists working in MH services in Turkey and determine the relationship between stress, workload, and support during the COVID-19 pandemic.

SUBJECTS AND METHODS

An online questionnaire was sent to child and adult psychiatrists registered with Turkish professional mail groups. 217 psychiatrists replied, with equal numbers from child (n=108) and adult (n=109) MH services. The Copenhagen Burnout Inventory and study-specific questionnaire were used.

RESULTS

60.8% of psychiatrists (n=132) experienced medium-or high-intensity work-related burnout, 49.8% (n=108) experienced patient-related burnout, and 31.8% (n=69) experienced medium-or high-intensity personal burnout. Patient-related burnout scores were significantly higher in the child psychiatry group than in the adult psychiatry group. The majority (n=126, 58.1%) reported either moderate or higher stress levels linked to the COVID-19 pandemic. Turnover intention, reluctance to retrain in psychiatry and sense of lack of value in the job are all associated with higher levels of burnout.

CONCLUSIONS

The current COVID-19 pandemic is likely to bring additional stressors to psychiatrists. This study shows that psychiatrists in Turkey already exhibit high levels of work-related stress. Organizational interventions to ameliorate psychiatrists' wellbeing and work conditions are required.

Psychometric Properties of the Turkish version of the Morningness - Eveningness Stability Scale improved (MESSi) in Adolescents

Morningness-Eveningness Stability Scale improved (MESSi) is an assessment tool that evaluates distinctness of daily changes as well as the person's propensity for morningness and eveningness. The aim of this study is to evaluate psychometric properties of the Turkish version of MESSi and associations of chronotypes and diurnal variations with personality, affect, sleep quality as well as validity of the scale in Turkish adolescents. The sample of this study consisted of 445 students between ages of 10-19. Participants filled in MESSi, Morningness/Eveningness Scale for Children, Composite Scale of Morningness, Personality Traits Scale (BIG-5), Positive and Negative Affect Scale (PANAS), Pittsburgh Sleep Quality Index (PSQI). Reliability analysis of the scale showed quite reliable internal consistency values. Confirmatory factor analysis (CFA) was used to test construct validity of three-factor model of MESSi. An acceptable model fit was demonstrated in CFA. There was a moderate and significant relationship between MA and DI subscale scores of MESSi. A moderate but negative correlation was found between MA and EV subscale scores of MESSi. MA and DI subscale scores of MESSi were found to be weakly correlated with conscientiousness, emotional stability, openness to experience and subscale scores of BIG-5, respectively. There was a positive correlation of positive affect subscale scores of PANAS with MA and DI subscale scores of MESSi. MA subscale scores of MESSi were found to be negatively correlated with scores of subjective sleep quality, latency, duration, disturbances, habitual sleep efficiency, daytime dysfunction, and global scores of PSQI. This study shows that Turkish version of MESSi is valid and reliable for use in adolescents. Three-factor MESSi provides an advantage over other chronotype scales in adolescence since it includes DI subscale as well as MA and EV subscales. Psychometric results were supported by other chronotype scales and clinical features such as sleep, affect, and personality.

Mitochondrial DNA copy number may be associated with attention deficit/hyperactivity disorder severity in treatment: a one-year follow-up study

OBJECTIVE

Studies on etiopathogenesis of attention deficit/hyperactivity disorder (ADHD) are increasingly focussing on mitochondrial dysfunction. Children diagnosed with ADHD who had significantly higher mitochondrial DNA (mtDNA) copy numbers than healthy children in our first study were re-examined in 1-year follow-up to investigate effects of severity and treatment of ADHD on mtDNA.

METHODS

Twenty-eight patients who participated in previous study were included in this follow-up study. Patients were equally divided into two groups according to whether they had been receiving treatment. Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, and Conners Parent Rating Scale (CPRS) were used. Polymerase chain reaction was performed.

RESULTS

Means of the first and second mtDNA copy were similar in all patients. mtDNA copy numbers did not change between two measurements in treated and non-treated groups. There was a correlation between CPRS ADHD index and inattention scores and mtDNA copy number in treated group. mtDNA copy number did not change in patients with ADHD over a period of 1 year regardless of treatment.

CONCLUSIONS

There may be a relationship between decreased ADHD severity with treatment and positive effects of mitochondrial functions. Mitochondrial dysfunction may play a role in pathophysiology of ADHD.KEY POINTSThis was the first study to follow up ADHD patients in order to investigate mitochondrial dysfunction by measuring mtDNA copy numbers 1 year after the initial measurements.mtDNA copy number, one of the best markers of mitochondrial dysfunction, did not change in ADHD patients over a period of 1 year regardless of treatment.Mitochondrial dysfunction may play a role in the pathophysiology of ADHD, where it may be involved with or without treatment.In the treated group, there was an association between decreased ADHD severity and reduced mtDNA copy numbers.There may be a relationship between decreased ADHD severity with treatment and the positive effects of mitochondrial functions.

Thiols and ceruloplasmin levels in serum of children with attention deficit hyperactivity disorder: A cross-sectional study

Attention deficit hyperactivity disorder (ADHD) is a childhood onset disorder with well-known findings that include impulsivity, hyperactivity, and inattention. This study aims to explore the relationship between the levels of ceruloplasmin, native thiol, total thiol, and disulfide and ADHD by comparing case and control groups. The study case group comprised 50 children aged 6-16 years who had been diagnosed with ADHD. The control group included 47 healthy children. Clinical interviews were conducted and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version Turkish Adaptation and the Conners Parent Rating Scale were administered. Additionally, blood samples were taken and native thiol, total thiol, disulfide, and ceruloplasmin levels measured. In the ADHD group, the mean native thiol, total thiol, and disulfide levels were significantly lower than the control group. There was no significant difference between the ADHD and control groups in ceruloplasmin levels. Total thiol and native thiol levels were inversely correlated with scores on the Conners Inattention and Hyperactivity subscales; total thiol was negatively correlated with the ADHD index. Thiol-disulfide homeostasis was impaired in ADHD children and was related to symptom severity. Oxidative stress balance may play a role in ADHD.

Mitochondrial DNA Copy Number is Associated with Attention Deficit Hyperactivity Disorder

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children. Several hypotheses have been proposed to explain its etiology. Mitochondrial dysfunction (MD) is suggested to be one of the causes of Attention Deficit Hyperactivity Disorder. The objective of the study was to evaluate the relationship between MD and ADHD by investigating mitochondrial DNA (mtDNA) levels from peripheral blood leukocytes, one of the best biomarkers of mitochondrial dysfunction.

SUBJECTS AND METHODS

This study included 56 children aged 6-16 years who were diagnosed with ADHD for the first time and 56 age- and sex-matched children without ADHD. Real-time PCR was performed to determine the relative mtDNA copy number in each study participant.

RESULTS

The mean mtDNA copy number of the case group was 57.623±24.827 and that of the control group was 44.204±18.926 (p=0.002). The mtDNA copy number of the case group was higher than that of the control group. Results of ROC curve analysis provided a mtDNA cutoff value of 45.

CONCLUSION

Significantly higher mtDNA copy number in ADHD group may suggest mitochondrial dysfunction in the etiopathogenesis of ADHD.

Psychometric Properties of Turkish Version of the Strength and Difficulties Questionnaire for Age 2-4

Introduction

Strengths and Difficulties Questionnaire for 2-4 year olds (SDQ 2-4) is one of the best of these scales developed to screen children in early childhood for psychosocial problems. The aim of this study is to investigate the psychometric properties of SDQ 2-4 in Turkish for the age group of 2-4 years.

Methods

The study was conducted with 159 participants. SDQ 2-4 Parent and BITSEA scales were applied to parents. Patients whose scores were detected to be at risk were referred to the hospital and a clinical interview was performed.

Results

Chronbach alpha value for total difficulties scale was 0.80. Total difficulties score of the SDQ was positively correlated with the BITSEA/P score, and negatively correlated with the BITSEA/C score. Prosocial Behaviors score of SDQ was positively correlated with BITSEA/C while it was negatively correlated with BITSEA/P. In all scales of SDQ that identified the problem, the scores of the participants with clinical diagnosis were significantly higher than the scores of the participants not diagnosed. The cut-off value for total difficulties scale was calculated as 10 with 80% sensitivity and 88% specificity.

Conclusion

The SDQ 2-4 scale is valid and reliable in the Turkish language.

Unintentional Injuries in Preschool Age Children: Is There a Correlation With Parenting Style and Parental Attention Deficit and Hyperactivity Symptoms

Unintentional injuries are the leading cause of death among children. Previous research has shown that most of the injuries occur in and around the home. Therefore, parents have a key role in the occurrence and prevention of injuries. In this study, we examined the relationship among home injuries to children and parental attention deficit hyperactivity disorder (ADHD) symptoms, parental attitudes, and children's behavioral problems.Forty children who were admitted to the emergency department because of home injuries constitute the study group. The control group also consisted of 40 children, who were admitted for mild throat infections. The parents filled out questionnaires assessing parental ADHD, child behavioral problems, and parenting attitudes.Scores were significantly higher for both internalizing disorders and externalizing disorders in study groups. We also found that ADHD symptoms were significantly higher among fathers of injured children compared with fathers of control groups. Democratic parenting was also found to correlate with higher numbers of injuries.Parenting style, as well as the psychopathology of both the parents and children, is important factors in children's injuries. A child psychiatrist visit following an emergency procedure may help to prevent further unintentional injuries to the child.