1
|
Kodal A, Muirhead F, Reilly JJ, Wergeland GJ, Thorsen PJB, Bovim LP, Elgen IB. Feasibility of a physical activity intervention for children and adolescents with anxiety and depression. Pilot Feasibility Stud 2024; 10:49. [PMID: 38443992 PMCID: PMC10913538 DOI: 10.1186/s40814-024-01466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Physical activity is identified as a key modifiable factor towards good short- and long-term mental health and has shown positive effects on anxiety and depression in children and adolescents. However, physical activity-based interventions are not a part of standard mental health care and evidence on the effect of such interventions is still lacking. A transdiagnostic, physical activity-based intervention was developed as a supplement to routine clinical care for youth in specialized child and adolescent mental health services. METHODS /design. The feasibility of the physical activity intervention (Confident, Active, and Happy Youth) was evaluated in an open-label study by assessing the recruitment process, acceptability, intervention suitability, contentment, and preliminary intervention effects in the form of youth and parent-rated anxiety and depressive symptoms. Physical activity levels were objectively measured using Actigraph™ physical activity sensors, and progression to a definitive study was evaluated in accordance with a priori criteria. RESULTS In total 21 of 25 eligible youth consented to participate, two dropped out of the intervention and 19 completed (76% of eligible participants). The retention rate among consenting participants was 89% and mean attendance to sessions was 83%. The suitability of the intervention was rated as good by the youth and their parents, and intervention contentment was rated high. Changes in youth and parent-rated symptom measures following the intervention were negligible, except for parent-rated anxiety symptoms assessed at 10-month follow-up. Accelerometer data indicated lower levels of moderate to vigorous activity during sessions than intended. No adverse effects were noted. CONCLUSION This feasibility study met the pre-determined progression criteria to a definitive study. Thus, a larger trial with longer follow-up should be conducted to explore the effect of the intervention. TRIAL REGISTRATION ClnicalTrials.gov, NCT05049759. Retrospectively registered, 20.09.2021.
Collapse
Affiliation(s)
- Arne Kodal
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021, Bergen, Norway.
- Norce Research, RKBU Vest-Regional Centre for Child and Youth Mental Health and Child Welfare, Postboks 22, Nygårdstangen, Bergen, 5838, Norway.
| | - Fiona Muirhead
- School of Psychological Science and Health, University of Strathclyde, Glasgow, Scotland
| | - John J Reilly
- School of Psychological Science and Health, University of Strathclyde, Glasgow, Scotland
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, N-5020, Bergen, Norway
| | - Paul Joachim Bloch Thorsen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Lars Peder Bovim
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, N-5020, Bergen, Norway
| |
Collapse
|
2
|
Klyve GP, Rolvsjord R, Elgen IB. Polyphonic perspectives: a focus group study of interprofessional staff's perceptions of music therapy at an inpatient unit for children in mental health care. Int J Qual Stud Health Well-being 2023; 18:2197750. [PMID: 37014967 PMCID: PMC10075520 DOI: 10.1080/17482631.2023.2197750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
PURPOSE In an inpatient unit for children in mental health care, a variety of services are provided through interprofessional collaborations. Music therapy is a relatively recent proposition in this context, but there is increasing acceptance for music therapy as a therapeutic method. However, there is limited knowledge about music therapy in this field, and this study aims to address this research gap. METHOD Through focus group interviews with staff at an inpatient unit in mental health care for children, this article explores interprofessional perspectives of music therapy. A thematic analysis with an inductive approach informed by constructivist grounded theory was used in the analysis of the interviews. FINDINGS Several dimensions were involved in the findings, concerning the children and the interprofessional collaboration. The two main categories that emerged were: "What music therapy offers the children" and "What music therapy contributes to the interprofessional understanding of the children". CONCLUSION The interprofessional perspectives of music therapy revealed potentials for emotion regulation, and experience of identity and freedom for the children. As part of the integrated services, music therapy provided a new perspective of the child and enhanced relationship between the child and the health services.
Collapse
Affiliation(s)
- Guro Parr Klyve
- The Grieg Academy - Department of Music, University of Bergen, Bergen, Norway
| | | | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
3
|
Lygre RB, Gjestad R, Norekvål TM, Mercer SW, Elgen IB. An interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints: a feasibility study. BMC Health Serv Res 2023; 23:1241. [PMID: 37951903 PMCID: PMC10638682 DOI: 10.1186/s12913-023-10250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Children and adolescents with complex health complaints are often referred to several different healthcare specialists for assessments and treatment. This may result in fragmented care, higher risks of medical errors, and sub-optimal health outcomes. The aim of this non-controlled open label trial was to evaluate the feasibility of implementing a new interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints and to gather experiences from participating children, adolescents and parents. METHODS In all, 47 children and adolescents aged 6-16 years with multiple referrals at a tertiary hospital were invited to participate. The intervention was a half-day consultation based on a biopsychosocial model. The aim of the intervention was to clarify the child/adolescent's condition(s) and provide a joint understanding and treatment plan in collaboration with the family. A team consisting of a pediatrician, a physiotherapist and a psychologist delivered the intervention. Acceptance and completion rate was recorded, and child- and parent-experience measures were collected; the children and adolescents completed the Visual Consultation and Relational Empathy Scale (CARE) five questions and parents completed two de novo created measures about their experiences. RESULTS Almost all invited families consented to participate (96%) and ultimately received the interdisciplinary intervention (92%). Mean age of the children and adolescents was 12 years, and under half were boys (40%). Before the intervention, 39 (91%) parents completed a questionnaire about previous experiences with healthcare. After the consultation 39 children and adolescents (91%) and 40 (93%) parents completed the questionnaire regarding their experience with the interdisciplinary intervention. Of the children and adolescents, 18-30 (47-77%) rated relational empathy in the intervention as "Very good" or "Excellent". Of the parents, 35-39 (92-100%) rated their experience with the consultation using the more positive response options. The parents were significantly more content with the intervention compared to previously received healthcare (p < .001). CONCLUSIONS The present intervention was highly acceptable with positively reported experiences from parents of, and children and adolescents with, complex health complaints. A future randomized controlled trial is required to test the effectiveness of this intervention. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov NCT04652154 03.12.2020. Retrospectively registered.
Collapse
Affiliation(s)
- Ragnhild B Lygre
- Department of Clinical Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway.
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Centre on Patient-Reported Outcomes, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Irene Bircow Elgen
- Department of Clinical Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
4
|
Barone H, Elgen IB, Bliksrud YT, Vangsøy Hansen E, Skavhellen RR, Furevik MI, Haavik J. Case report: ADHD and prognosis in tyrosinemia type 1. Front Psychiatry 2023; 14:1213590. [PMID: 37533886 PMCID: PMC10392124 DOI: 10.3389/fpsyt.2023.1213590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Neurometabolic disorders such as tyrosinemia type 1 (TYRSN1) may interfere with brain metabolism and show symptoms of attention-deficit hyperactivity disorder (ADHD) in patients treated with the enzyme inhibitor nitisinone [2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione, NTBC]. It has been reported that ADHD treatment improves treatment compliance, which is imperative for the long-term prognosis of patients with TYRSN1. In this study, we report the case of a male patient who was diagnosed with TYRSN1 at 3 months of age and was subsequently treated with NTBC, restricted protein intake, and amino acids supplementation. At 7 years of age, he was referred for neuropsychiatric assessment, diagnosed with ADHD, and treated with methylphenidate. The effects of the treatment were monitored via parental interviews, questionnaires covering ADHD symptoms, and a continuous performance test. A reduction in ADHD symptoms, particularly inattentiveness, was observed across all measures. The early identification of ADHD and the treatment of neurometabolic disorders, such as TYRSN1, may be important from a lifetime perspective as this may improve the prognosis of the medical condition as well.
Collapse
Affiliation(s)
- Helene Barone
- Regional Resource Center for Autism, ADHD and Tourette Syndrome, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | | | - Rita Rigmor Skavhellen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Magne Ivar Furevik
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jan Haavik
- Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| |
Collapse
|
5
|
Heradstveit O, Askeland KG, Bøe T, Lundervold AJ, Elgen IB, Skogen JC, Pedersen MU, Hysing M. Substance-Related Problems in Adolescents with ADHD-Diagnoses: The Importance of Self-Reported Conduct Problems. J Atten Disord 2022; 26:1857-1869. [PMID: 35758182 PMCID: PMC9596946 DOI: 10.1177/10870547221105063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a known risk factor for substance-related problems (SRP) during adolescence, but the nature of this relationship and the importance of co-occurring conduct problems are not fully understood. METHODS Data stem from a linked dataset between a large population-based survey conducted in 2012 of Norwegian adolescents aged 16 to 19, and registry-based data from specialized child and adolescent mental health services (n = 9,411). RESULTS Adolescents with "ADHD + high conduct problems" had increased risk of SRP (odds ratios = 2.37-10.14). Adolescents with "ADHD only" had very similar risk of SRP as adolescents from the general population with low symptoms of conduct problems. Relative to boys, girls with "ADHD + high conduct problems" appeared to have somewhat higher risk for SRP. CONCLUSION The present study suggests that the risk for SRP among adolescent with ADHD is largely driven by co-existing conduct problems.
Collapse
Affiliation(s)
- Ove Heradstveit
- NORCE Norwegian Research Centre, Bergen, Norway,Stavanger University Hospital, Norway,Ove Heradstveit, NORCE Norwegian Research Centre, RKBU, Nygårdsgaten 112, Bergen 5008, Norway.
| | | | - Tormod Bøe
- NORCE Norwegian Research Centre, Bergen, Norway,University of Bergen, Norway
| | | | | | | | | | - Mari Hysing
- NORCE Norwegian Research Centre, Bergen, Norway,University of Bergen, Norway
| |
Collapse
|
6
|
Bjorgaas HM, Elgen IB, Hysing M. Mental Health in Pre-Adolescents with Cerebral Palsy: Exploring the Strengths and Difficulties Questionnaire as a Screening Tool in a Follow-Up Study including Multi-Informants. Children 2022; 9:children9071009. [PMID: 35883993 PMCID: PMC9318898 DOI: 10.3390/children9071009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
There is a high prevalence of mental health problems in children with Cerebral Palsy (CP). Still, knowledge regarding the trajectory of mental health problems throughout childhood and differences according to informants is lacking. There is also a need for more knowledge regarding the validity of mental health screening tools. In the present study, we assessed changes in parent-rated mental health problems in a cohort of 36 children with CP from school-starting age to pre-adolescence and differences in mental health problems according to informants. Further, we assessed the validity of the Strengths and Difficulties Questionnaire (SDQ) for psychiatric disorders. The study cohort was assessed using the SDQ and a child psychiatric diagnostic instrument at school-starting age and at pre-adolescence. Mean parental SDQ scores increased significantly for emotional, hyperactivity and total problems. Self-reported impact of mental health problems was significantly lower than parent-reported impact, and parents and pre-adolescents reported significantly higher mean scores than teachers for emotional problems, conduct problems and total problem scores. Validated against psychiatric disorders, the SDQ was satisfactory for screening children with CP for risk of psychiatric disorders at pre-adolescence. We recommend that mental health screening be integrated into the regular follow-up for children with CP.
Collapse
Affiliation(s)
- Hanne Marit Bjorgaas
- Department of Pediatric Neurology, Habu Stavanger, Stavanger University Hospital, Stavanger HF, 4068 Stavanger, Norway
- Correspondence: ; Tel.: +47-98895956
| | - Irene Bircow Elgen
- Department of Clinical Medicine, Bergen University Hospital, 5020 Bergen, Norway;
| | - Mari Hysing
- Department of Psychosocial Science, University of Bergen, 5020 Bergen, Norway;
| |
Collapse
|
7
|
Holgersen G, Nordgreen T, Ten Velden Hegelstad W, Bircow Elgen I. Views of young people with psychosis on using virtual reality assisted therapy. A qualitative study. Early Interv Psychiatry 2022; 17:361-367. [PMID: 35708166 DOI: 10.1111/eip.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/23/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
AIM Service disengagement is a challenge in young individuals struggling with psychosis. Combining cognitive behavioural therapy for psychosis (CBTp) with virtual reality (VR) has proven acceptable and potentially effective for symptoms and social functioning in adults with psychosis. However, studies focusing on young adolescents are lacking. The aim of the present study was to investigate the acceptability of VR-assisted CBTp among adolescents with psychosis. METHODS A qualitative study investigating the acceptability of VR during exposure-based social training among adolescents with early onset psychosis. Thematic analysis was used to identify, analyse, interpret and report patterns from the qualitative interviews. RESULTS A total of 27 adolescents with psychosis were invited to participate, 11 declined and 16 were enrolled (59%), and all completed the study. The participants were from 13 until 18 years old, mean age 16 years. None of them had previous experience with use of VR in therapy, but 10 out of 16 participants had prior experience with VR from playing video games. Regarding acceptability, 14 out of 16 had positive expectations towards using VR in CBTp, and they would prefer using VR during exposure-based social training to real-life training only. CONCLUSIONS VR-assisted CBTp can be an acceptable intervention for adolescents with psychosis, given their comfort with technology and the opportunity to confront their fears in less threatening virtual social settings with fewer social risks. The present study yields support to continue developing VR-assisted therapy for adolescents, and focusing on VR-interventions for early onset psychosis.
Collapse
Affiliation(s)
- Guri Holgersen
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Faculty of Social Science, Institute for Social Studies, University of Stavanger, Stavanger, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
8
|
Kleve L, Vårdal L, Elgen IB. The Nurse Role in the Management of ADHD in Children and Adolescent: A Literature Review. Front Psychiatry 2022; 13:676528. [PMID: 35273525 PMCID: PMC8902137 DOI: 10.3389/fpsyt.2022.676528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To review literature regarding existing and recommended roles for nurses in the management of children with ADHD. METHODS MEDLINE and CINAHL were searched from 2010 to the end of 2019 with the following keywords: ADHD, nurse, child, and inclusion criteria published in an English journal. RESULTS Forty-three records were found. However, only five articles scientifically evaluated the nurse role. The nurse role in ADHD management seemed to vary across countries with nurses working independently or as part of a team with delegated responsibility. CONCLUSION The literature review gave information to suggest that nurses can have a significant role in providing a range of medical and non-medical management.
Collapse
Affiliation(s)
- Liv Kleve
- Division of Mental Health, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lisa Vårdal
- Division of Mental Health, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Irene Bircow Elgen
- Division of Mental Health, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
9
|
Bjorgaas HM, Elgen IB, Hysing M. Illness perception in children with cerebral palsy, a longitudinal cohort study. Heliyon 2021; 7:e08558. [PMID: 34917821 PMCID: PMC8666649 DOI: 10.1016/j.heliyon.2021.e08558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/18/2021] [Accepted: 12/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background The perception of a disorder could be of importance both in problem solving behaviors, and in the emotional approach towards a disorder. Aims In this paper, we wanted to assess changes in illness perception in children with Cerebral Palsy (CP) over a four-year interval, to compare parental and self-ratings, and to assess illness perceptions according to co-occurring medical and psychiatric disorders. Methods Parents in a cohort of children with CP (N = 36), filled in the Illness Perception Questionnaire at age seven and again at age eleven, and self-reports were gathered at age eleven. Stability across time, informant differences and scores according to motor function, intellectual disability and the prevalence of psychiatric disorders were assessed. Results We found stable parental perceptions across a four –year interval. Parents reported significantly higher impact of CP on the child, than that reported by the child itself. In children with a more severe motor disability and/or co-occurring psychiatric disorders, parents reported significantly higher median scores for perceived impact of the CP condition on symptoms, duration of the condition, and impact on leisure activities, compared to those who had less severe motor disability and/or intellectual abilities within the normal range. Conclusions We propose that illness perception should be included in the follow-up of children with CP, as it may provide a mutual understanding between the child/family and professionals involved in follow-up services, with possible impact on treatment adherence and outcome of the condition. Parents reported significantly more negative impact of CP than their children. Parents reported stable perception of their child's CP across a four-year period. Parents and children reported significant impact of CP on leisure activities. Impact of CP was significant in children with co-occurring psychiatric disorders.
Collapse
Affiliation(s)
- Hanne Marit Bjorgaas
- Dept. of Pediatric Neurology, Habu Stavanger, Stavanger University Hospital, Stavanger HF, Pb. 8100, 4068, Stavanger, Norway
| | | | - Mari Hysing
- Dept. of Psychosocial Science, Pb. 7807, 5020, Bergen, Norway
| |
Collapse
|
10
|
Bjorgaas HM, Elgen IB, Hysing M. Trajectories of psychiatric disorders in a cohort of children with cerebral palsy across four years. Disabil Health J 2020; 14:100992. [PMID: 32943379 DOI: 10.1016/j.dhjo.2020.100992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Risk of psychiatric disorders has been reported for children and adolescents with cerebral palsy (CP) at different ages, however little is known regarding the long-term trajectories of these disorders. OBJECTIVE The aim of this study was to assess the trajectories of psychiatric disorders in children with CP, and to explore their association to risk factors. METHODS We assessed a cohort of children with CP at age seven and again at age eleven with a child psychiatric diagnostic instrument, and parents were informants. We assessed type of CP, Gross Motor Function Classification System (GMFCS) levels, and co-occurring medical conditions in a medical examination, through the medical records, and in an interview with the parents at the onset of the study. RESULTS We found a significant increase in the prevalence of emotional disorders from seven to eleven years of age (p 0.01), whereas the prevalence of behavioral disorders was stable. Half of the cohort met criteria for a psychiatric disorder at both assessment points. Type of CP, spastic bilateral or unilateral, dyskinetic or ataxic, and co-occurring medical conditions were non-significant predictors of psychiatric disorders. Subthreshold psychiatric disorders at age seven were predictive of psychiatric disorders at age eleven. CONCLUSIONS We found a persistently elevated prevalence of psychiatric disorders in children with CP. Prevalence of behavioral disorders was stable, whereas we found a significant four-fold increase in emotional disorders. Sub-threshold psychiatric disorders predicted later psychiatric disorders. Increased focus on early mental health symptoms as well as more knowledge regarding emotional disorders in children with CP seems warranted.
Collapse
Affiliation(s)
- Hanne Marit Bjorgaas
- Dep. of Pediatric Neurology, Habu Stavanger, Stavanger University Hospital, Stavanger HF, Pb 8100, 4068, Stavanger, Norway.
| | | | - Mari Hysing
- Dept. of Psychosocial Science, Pb 7807, 5020, Bergen, Norway.
| |
Collapse
|
11
|
Lygre RB, Thuen VM, Gjestad R, Norekvål TM, Greve G, Mildestvedt T, Elgen IB. How can we improve specialist health services for children with multi-referrals? Parent reported experience. BMC Health Serv Res 2020; 20:786. [PMID: 32831078 PMCID: PMC7446114 DOI: 10.1186/s12913-020-05666-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background Children with combined mental and somatic conditions pose a challenge to specialized health services. These cases are often characterized by multi-referrals, frequent use of health services, poor clinical and cost effectiveness, and a lack of coordination and consistency in the care. Reorganizing the health services offered to these children seems warranted. Patient reported experiences give important evidence for evaluating and developing health services. The aim of the present descriptive study was to explore how to improve specialist health services for children with multiple referrals for somatic and mental health conditions. Based on parent reported experiences of health services, we attempted to identify key areas of improvement. Methods As part of a larger, ongoing project; “Transitioning patients’ Trajectories”, we asked parents of children with multiple referrals to both somatic and mental health departments to provide their experiences with the services their children received. Parents/guardians of 250 children aged 6–12 years with multi-referrals to the Departments of Pediatrics and Child and Adolescent Mental Health at Haukeland University Hospital between 2013 and 2015 were invited. Their experience was collected through a 14 items questionnaire based on a generic questionnaire supplied with questions from parents and health personnel. Possible associations between overall experience and possible predictors were analyzed using bivariate regression. Results Of the 250 parents invited, 148 (59%) responded. Mean scores on single items ranged from 3.18 to 4.42 on a 1–5 scale, where five is the best possible experience. In the multiple regression model, perception of wait time (r = .56, CI = .44–.69 / β = 0.16, CI = .05–.28), accommodation of consultations (r = .71, CI = .62–.80 / β = 0.25, CI = .06–.45 / β = 0.27, CI = .09–.44), providing adequate information about the following treatment (r = .66, CI = .55–.77 / β = 0.26, CI = .09–.43), and collaboration between different departments at the hospital (r = .68, CI = .57–.78 / β = 0.20, CI = -.01–.40) were all statistically significantly associated with parents overall experience of care. Conclusions The study support tailored interdisciplinary innovations targeting wait time, accommodation of consultations, communication regarding the following treatment and collaboration within specialist health services for children with multi-referrals to somatic and mental specialist health care services.
Collapse
Affiliation(s)
- Ragnhild B Lygre
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.
| | | | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Centre on Patient-reported Outcomes Data, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gottfried Greve
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Thomas Mildestvedt
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
12
|
Fevang SKE, Hysing M, Sommerfelt K, Markestad T, Elgen IB. Development and predictors of childhood mental health problems in former extremely preterm infants. Early Hum Dev 2019; 135:44-49. [PMID: 31255959 DOI: 10.1016/j.earlhumdev.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate development and predictors of mental health problems from five to eleven years of age in children born extremely preterm (EP). METHOD In a national Norwegian cohort of children born before a gestational age of 28 weeks or with a birthweight <1000 g mental health was assessed by parents at five and eleven years of age using The Strengths and Difficulties Questionnaire. A Total Difficulties Score ≥ 90th percentile (TDS90) for a reference group was used as a measure of a mental health problem. Of 338 eligible EP children, 162 (48%) attended at both ages. RESULTS The rate of TDS90 was 52 (32%) at five and 37 (23%) at eleven years of age (p = 0.025). Of the 52 children with TDS90 at five years, 25 had TDS90 at eleven years of age, and of 37 children with TDS90 at eleven, 25 had TDS90 at five years of age. Mental health problems and an IQ of 70-84 at five years were independent predictors of TDS90 at eleven years of age. CONCLUSION The rate of mental health problems decreased from five to eleven years, but individual stability was moderate. Mental health problems and intellectual function in the lower normal range at preschool age were independent predictors of later mental health problems.
Collapse
Affiliation(s)
- Silje Katrine Elgen Fevang
- Department of Clinical Science, Faculty of Medicine and dentistry, University of Bergen, Bergen, Norway; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
| | - Mari Hysing
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway; Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway.
| | - Kristian Sommerfelt
- Department of Clinical Science, Faculty of Medicine and dentistry, University of Bergen, Bergen, Norway; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Trond Markestad
- Department of Clinical Science, Faculty of Medicine and dentistry, University of Bergen, Bergen, Norway; Department of Pediatrics, Hospital Innlandet Trust, Lillehammer, Norway.
| | - Irene Bircow Elgen
- Department of Clinical Science, Faculty of Medicine and dentistry, University of Bergen, Bergen, Norway; Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.
| |
Collapse
|
13
|
Stangenes KM, Hysing M, Elgen IB, Halvorsen T, Markestad T, Bjorvatn B. Sleep problems, behavioural problems and respiratory health in children born extremely preterm: a parental questionnaire study. BMJ Paediatr Open 2019; 3:e000534. [PMID: 31549000 PMCID: PMC6733321 DOI: 10.1136/bmjpo-2019-000534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/15/2019] [Accepted: 08/17/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To explore whether children born extremely preterm (EPT) with different types of sleep problems had more behavioural and respiratory health problems than EPT children without sleep problems. DESIGN Prospective, nationwide, questionnaire-based study. At 11 years of age, parents reported on four current sleep problems: difficulty falling asleep or frequent awakenings, snoring, daytime sleepiness and not recommended sleep duration (<9 hours). Behavioural problems were assessed by parents and teachers with the Strengths and Difficulties Questionnaire (SDQ). Parents assessed respiratory symptoms with the International Study of Asthma and Allergies in Childhood questionnaire and described use of asthma medication. SETTING Norway. PATIENTS EPT children. MAIN OUTCOME MEASURES Specified sleep problems, behavioural problems and respiratory health. RESULTS Data were obtained from 216 of 372 (58 %) of eligible children. All four specified sleep problems were associated with significantly higher parent-reported SDQ total-score (OR 1.1 for all), and except for not recommended sleep duration, also with higher teacher-reported SDQ total-score (OR 1.1 for all). Daytime sleepiness was strongly associated with wheezing last 12 months (OR 3.4), disturbed sleep due to wheezing (OR 3.9), wheeze during or after exercise (OR 2.9), use of inhaled corticosteroids or oral leukotriene modifiers (OR 3.4) and use of bronchodilators (OR 3.9). Snoring was associated with wheezing during or after exercise (OR 2.8) and current asthma (OR 4.2). CONCLUSION EPT children with different types of sleep problems had more behavioural and respiratory health problems than EPT children without sleep problems.
Collapse
Affiliation(s)
- Kristine Marie Stangenes
- Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Mari Hysing
- Department of Pcychosocial Science, University of Bergen, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Trond Markestad
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
14
|
Sandtorv LB, Fevang SKE, Nilsen SA, Bøe T, Gjestad R, Haugland S, Elgen IB. Symptoms Associated With Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorders in School-Aged Children Prenatally Exposed to Substances. Subst Abuse 2018; 12:1178221818765773. [PMID: 29618930 PMCID: PMC5871041 DOI: 10.1177/1178221818765773] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/26/2018] [Indexed: 12/27/2022]
Abstract
Prenatal exposure to substances may influence a child's neurodevelopment and impact on subsequent mental health. In a hospital-based population of school-aged children prenatally exposed to opiates and a number of illicit substances (n = 57), we evaluated mental health symptoms associated with attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) using the Swanson, Nolan, and Pelham Questionnaire, revision IV (SNAP-IV) and the Autism Spectrum Screening Questionnaire (ASSQ) and compared the scores to a reference group which comprised children from the population-based Bergen Child Study (n = 171). Prenatally exposed children had significantly higher SNAP-IV scores associated with ADHD symptoms in both areas of inattention and hyperactivity/impulsivity and also reported a higher ASSQ score related to an increased number of symptoms associated with ASD, compared with the reference group. Of tested predictors of mental health outcomes in the exposed group, the intelligence quotient was a strong predictor of most mental health outcomes, and neonatal abstinence syndrome was a predictor of inattention. In conclusion, prenatally exposed children had more mental health symptoms associated with ADHD and ASD, compared with the reference group.
Collapse
Affiliation(s)
- Lisbeth Beate Sandtorv
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Rolf Gjestad
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Siren Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
15
|
Stangenes KM, Fevang SK, Grundt J, Donkor HM, Markestad T, Hysing M, Elgen IB, Bjorvatn B. Children born extremely preterm had different sleeping habits at 11 years of age and more childhood sleep problems than term-born children. Acta Paediatr 2017; 106:1966-1972. [PMID: 28714101 DOI: 10.1111/apa.13991] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/28/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022]
Abstract
AIM This study explored whether extremely preterm (EPT) children had different sleep characteristics in childhood than children born at term and how neurodevelopmental disabilities (NDD) affected sleep in children born EPT. METHODS A Norwegian national cohort of 231 children born EPT from 1999 to 2000 and separate study data on 556 children born at term in 2001 were compared. Parental questionnaires mapped the children's current sleep habits at 11 years of age, namely the prevalence of sleep problems throughout childhood until this age and five categories of sleep problems. In addition, the EPT children were clinically assessed at five years of age. RESULTS The EPT children had different sleep habits than the controls, for example they went to bed earlier. EPT children had a higher prevalence of sleep problems than the controls throughout childhood (26% versus 14%, p < 0.001) and this was also higher for the 93 EPT children with no NDD (20%) than for the controls (14%) and increased with increasing NDD to 67% (p = 0.015) for the six children with severe NDD. CONCLUSION EPT children had different sleep habits to term-born controls at 11 years of age, including those with no NDD. The prevalence of sleep problems increased with increasing NDD.
Collapse
Affiliation(s)
- Kristine Marie Stangenes
- Department of Clinical Science; University of Bergen; Bergen Norway
- Department of Pediatrics; Haukeland University Hospital of Bergen; Bergen Norway
| | | | - Jacob Grundt
- Department of Pediatrics; Innlandet Hospital Trust; Lillehammer Norway
| | | | - Trond Markestad
- Department of Clinical Science; University of Bergen; Bergen Norway
- Department of Pediatrics; Innlandet Hospital Trust; Lillehammer Norway
| | | | | | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Norwegian Competence Center for Sleep Disorders; Haukeland University Hospital; Bergen Norway
| |
Collapse
|
16
|
Sandtorv LB, Hysing M, Rognlid M, Nilsen SA, Elgen IB. Mental Health in School-Aged Children Prenatally Exposed to Alcohol and Other Substances. Subst Abuse 2017; 11:1178221817718160. [PMID: 29581703 PMCID: PMC5862371 DOI: 10.1177/1178221817718160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/26/2017] [Indexed: 11/17/2022]
Abstract
Prenatal exposure to substances can possibly influence a child's neurodevelopment and may impact on subsequent mental health. We investigated the mental health status of school-aged children referred to a pediatric hospital with a history of prenatal exposure to alcohol or other substances. Mental health was assessed using the Strengths and Difficulties Questionnaire and compared with a reference group. A total of 105 of 128 (82%) eligible children prenatally exposed to substances participated in the study, with 48 children exposed to alcohol and 57 to other substances. Strengths and Difficulties Questionnaire subscale mean scores, total difficulties scores, and total impact scores were statistically significantly higher in the group of exposed children, compared with the reference group. In this hospital-based population of school-aged children prenatally exposed to alcohol or other substances, the exposed group had an increased risk of mental health problems, compared with the reference group.
Collapse
Affiliation(s)
- Lisbeth Beate Sandtorv
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Mari Hysing
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Malin Rognlid
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
17
|
Elgen SK, Leversen KT, Grundt JH, Hurum J, Sundby AB, Elgen IB, Markestad T. Mental health at 5 years among children born extremely preterm: a national population-based study. Eur Child Adolesc Psychiatry 2012; 21:583-9. [PMID: 22752364 DOI: 10.1007/s00787-012-0298-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 06/09/2012] [Indexed: 11/27/2022]
Abstract
The objective of this study was to compare mental health at 5 years in children born extremely preterm with a reference group, and assess associations between functional abilities and mental health within the preterm group. In a national Norwegian cohort with gestational age 22-27 weeks or birthweight 500-999 g, mental health was assessed with the Strengths and Difficulties Questionnaire (SDQ), cognitive function with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), motor function with the Movement Assessment Battery for children (ABC-test) and severity of cerebral palsy (CP) with the Gross Motor Function Classification for CP (GMFCS). Neurodevelopmental disabilities (NDD) were described as mild and moderate/severe. SDQ of the preterm children was compared with that of an unselected reference group. SDQ sub-scores ≥90th percentile of the reference group were defined as a mental health problem and a Total Difficulties Score ≥90th percentile (TDS90) as suggestive of psychiatric disorder. Of 361 eligible preterm children, parents completed SDQ for 255 (71%). 97 (38%) had TDS90 compared to 116 (11%) of the reference group (OR 5.1; 95% CI 3.7-7.1). For the preterms, the rate of TDS90 was higher for those with moderate/severe NDD (27/37 vs. 27/116, adjusted OR 8.0; 95% CI 3.2-19, and mild NDD 43/102 [adjusted OR 2.2 (1.2-4.1)]. For preterms with no NDD, TDS90 was more common than for the reference group (27/116 vs. 116/1,089, OR 2.5; 95% CI 1.6-4.1). Extreme prematurity was associated with increased risk of later mental health problems, particularly if they had other functional impairments.
Collapse
|
18
|
Elgen IB, Holsten F, Odberg MD. Psychiatric disorders in low birthweight young adults. Prevalence and association with assessments at 11 years. Eur Psychiatry 2012; 28:393-6. [PMID: 22999438 DOI: 10.1016/j.eurpsy.2012.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/22/2012] [Accepted: 06/08/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare mental health of 136 young adults without neurosensory handicaps born with low birthweight (LBW, birthweight less than 2,000 g) with 132 adults with normal birthweight (NBW). METHOD A cohort of moderate LBW and NBW young adults were assessed with the Mini-International Neuropsychiatric Interview (MINI) at 19 years and the Children Assessment Schedule (CAS) at 11 years of age. RESULTS At 19 years of age, 44 out of 136 (32%) LBW young adults were diagnosed with a psychiatric disorder compared to 10% NBW (OR: 2.8; 95% CI: 1.1, 4.5, P=0.02). Among the LBW young adults, affective-, anxiety-, ADHD- and antisocial personality disorders were most common, and nine subjects (20%) had more than one diagnosis. Of 97 LBW subjects examined both at 11 and 19 years of age, 54 (56%) were mentally healthy though out adolescence. This was half as many as for controls (OR: 0.6; 95% CI: 0.3 to 0.9). CONCLUSION Moderate LBW was associated with an increased risk of psychiatric disorders in young adulthood. Only half of LBW young adults stayed healthy throughout adolescence.
Collapse
Affiliation(s)
- I B Elgen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Norway; Department of Pediatric, Haukeland University Hospital, Norway.
| | | | | |
Collapse
|
19
|
Leversen KT, Sommerfelt K, Elgen IB, Eide GE, Irgens LM, Júlíusson PB, Markestad T. Prediction of outcome at 5 years from assessments at 2 years among extremely preterm children: a Norwegian national cohort study. Acta Paediatr 2012; 101:264-70. [PMID: 22026562 DOI: 10.1111/j.1651-2227.2011.02504.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To examine the predictive value of early assessments on developmental outcome at 5 years in children born extremely preterm. METHODS This is a prospective observational study of all infants born in Norway in 1999-2000 with gestational age (GA) <28 weeks or birth weight (BW) <1000 g. At 2 years of age, paediatricians assessed mental and motor development from milestones. At 5 years, parents completed questionnaires on development and professional support before cognitive function was assessed with Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) and motor function with the Movement Assessment Battery for children (ABC test). RESULTS Twenty-six of 373 (7%) children had cerebral palsy at 2 and 29 of 306 (9%) children at 5 years. Of children without major impairments, 51% (95% CI 35-67) of those with and 22% (95% CI 16-28) without mental delay at 2 years had IQ <85 at 5 years, and 36% (95% CI 20-53 with and 16% (95% CI 11-21) without motor delay at 2 years had an ABC score >95th percentile (poor function). Approximately half of those without major impairments but IQ <85 or ABC score >95th percentile had received support or follow-up beyond routine primary care. CONCLUSION Previous assessments had limited value in predicting cognitive and motor function at 5 years in these extremely preterm children without major impairments.
Collapse
|
20
|
Aukland SM, Westerhausen R, Plessen KJ, Odberg MD, Elgen IB, Peterson BS, Ersland L, Eide GE, Rosendahl K. Selectively reduced posterior corpus callosum size in a population-based sample of young adults born with low birth weight. AJNR Am J Neuroradiol 2011; 32:970-5. [PMID: 21493761 DOI: 10.3174/ajnr.a2594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Several studies suggest that VLBW is associated with a reduced CC size later in life. We aimed to clarify this in a prospective, controlled study of 19-year-olds, hypothesizing that those with LBWs had smaller subregions of CC than the age-matched controls, even after correcting for brain volume. MATERIALS AND METHODS One hundred thirteen survivors of LBW (BW <2000 grams) without major handicaps and 100 controls underwent a 3T MR examination of the brain. The cross-sectional area of the CC (total callosal area, and the callosal subregions of the genu, truncus, and posterior third) was measured. Callosal areas were adjusted for head size. RESULTS The posterior third subregion of the CC was significantly smaller in individuals born with a LBW compared with controls, even after adjusting for size of the forebrain. Individuals who were born with a LBW had a smaller CC (mean area, 553.4 mm(2)) than the controls (mean area, 584.1 mm(2)). Differences in total area, however, did not remain statistically significant after adjusting for FBV. CONCLUSIONS The uncorrected callosal size in 19-years-olds born with LBW was smaller than that of normal controls. However, after adjusting for FBV, the group difference was restricted to the posterior third. The clinical impact of a smaller posterior part needs further investigation.
Collapse
Affiliation(s)
- S M Aukland
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Leversen KT, Sommerfelt K, Rønnestad A, Kaaresen PI, Farstad T, Skranes J, Støen R, Bircow Elgen I, Rettedal S, Egil Eide G, Irgens LM, Markestad T. Prediction of neurodevelopmental and sensory outcome at 5 years in Norwegian children born extremely preterm. Pediatrics 2011; 127:e630-8. [PMID: 21321031 DOI: 10.1542/peds.2010-1001] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the prevalence of neurodevelopmental disability and the predictive value of pre-, peri-, and postnatal data on neurologic, sensory, cognitive, and motor function in children born extremely preterm. METHODS This was a prospective observational study of all infants born in Norway between 1999 and 2000 with gestational ages between 22 and 27 weeks or birth weights between 500 and 999 g. Cognitive function was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised, motor function with the Movement Assessment Battery for Children, and severity of cerebral palsy with the Gross Motor Function Classification for Cerebral Palsy. Disabilities were described as mild, moderate, or severe. RESULTS Of 371 eligible children, 306 (82%) were examined at a mean (SD) age of 5 years and 10 (4) months. For gestational age less than 28 weeks (n = 239), 26 (11%) children had cerebral palsy alone (n = 21) or in combination with blindness (n = 3) or deafness (n = 2); 1 was blind and 1 was deaf. Of the remaining children, the mean full-scale IQ was 94 ± 15, and significant predictors were (values given as the difference in IQ points [95% confidence intervals]) high maternal education (9.6 [5.7-13.4]), preeclampsia (-7.7 [-12.7 to -2.7]), and retinopathy of prematurity higher than grade 2 (-17.5 [-27.1 to -8.0]). Movement Assessment Battery for Children scores were positively associated with gestational age and prenatal steroids and negatively associated with being small for gestational age, male gender, and having retinopathy of prematurity. Moderate to severe neurodevelopmental disability was more common for gestational ages 25 weeks or less (28 of 87 children) than for 26 to 27 weeks (12 of 152 children; P < .001) and 28 weeks or more (7 of 67 children; P = .001). CONCLUSIONS The outcome was poorer for children with gestational ages of 25 weeks or less compared with those with gestational ages between 26 and 27 weeks. For those without cerebral palsy, blindness, or deafness, however, gestational age had a limited association with cognitive and motor function.
Collapse
|
22
|
Abstract
AIM To compare the quality of life (QOL), academic achievements and social functioning of 134 non-handicapped low birth weight (LBW, birth weight < 2000 g) and 135 normal birth weight (NBW, birth weight > 3000 g) young adults. STUDY DESIGN Population-based longitudinal follow-up study. METHODS The Norwegian version of the originally US child health questionnaire, child form 87 (CHQ-CF87), a generic health instrument was applied to measure different physical and psychosocial concepts of QOL. Questionnaires and semi-structured interviews were applied to the cohort to register different aspects of social functioning and academic performance. RESULTS The LBW group reported well-being in the different aspects of QOL. The LBW group was socially well functioning. The college attendance was similar in the two groups, but more LBW young adults had dropped out of school or attended individually adjusted classes. Performance in mathematics for the LBW women attending academic college was lower. With this exception, the academic performance was comparable in the two groups. CONCLUSION Except a somewhat higher rate of school dropouts, the overall outcome of school performance, QOL and social functioning in the LBW young adults was comparable to that of the NBW control group.
Collapse
|
23
|
Abstract
OBJECTIVE To compare trajectories for growth and somatic health characteristics until adulthood of non-handicapped low birthweight (LBW) and normal birthweight (NBW) children. STUDY DESIGN Population-based longitudinal follow-up study. PATIENTS LBW (<2 kg) and NBW (>3 kg) children were followed at 5, 11 and 19 years of age. At 19 years 134 of 173 subjects with LBW (77%), and 135 of the 170 with NBW (79%) participated. RESULTS Current health and body mass index (BMI) were similar for the groups. The LBW adults were shorter (5.9 cm), had higher systolic (4.5 mm Hg) and diastolic (2.0 mm Hg) blood pressures (BPs), higher heart rates (3.7 beats per min), lower forced expiratory flow at 50% of forced vital capacity (8.5%) and forced expiratory volume in 1 second/forced vital capacity ratios (0.03). All p values are <0.01 for the differences of means given above. Differences in height were mostly due to differences in parental height. From childhood, percentiles for height and systolic BP were maintained for both groups while diastolic BP increased more for the LBW children. The LBW young adults caught up in body proportions. CONCLUSION Difference in height and systolic BP between the LBW and NBW children tend to be maintained from childhood until young adulthood. The LBW young adults experience catch-up growth in body proportions. The LBW young adults have lower pulmonary function.
Collapse
|