The Presentation Of Childhood Obsessive–Compulsive Disorder Across Home and School Settings

This study aimed to determine the exact pattern of obsessive–compulsive disorder (OCD) symptoms in children displayed across school and home settings. Twenty-six school children (aged 7 through 17) with OCD were tested using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the Clinical Global Impression (CGI) – severity subscale and a questionnaire which consists of items serving to compare the symptoms between home and school settings. The mean obsession and compulsion subscores on the CY-BOCS were found to be 10.73 ± 3.14 and 10.88 ± 3.17, respectively, both summing up a Total score of 21.61 ± 5.52. The mean CGI-severity scores, rated for home and school settings were 4.42 ± 0.90 and 2.42 ± 1.13 respectively, indicating a strong difference in the presentation of OCD between those settings ( t= 7.02, df = 50, p< 0.0001). No gender, diagnosis (pure versus comorbid) and age effect (7 to = 12 years versus > 12 to 17 years) was found on the CY-BOCS and CGI-severity subscale (Mann–Whitney U test, all p> 0.05). The presentation difference we have noted in this study is a significant finding. Further studies are needed to delineate the characteristics of this phenomenon with possible implications for diagnosis, management and treatment.

Cognitive Flexibility and Social Responsiveness in Children and Adolescents with Tourette Syndrome

This study examined cognitive flexibility and social responsiveness in children and adolescents with Tourette Syndrome (TS). Thirty one subjects with TS were compared to 32 age-matched healthy controls. Assessments included semi-structured interviews to assess psychopathology, parent-rated Social Responsiveness Scale (SRS) and a brief neuropsychological battery selected as measures of cognitive flexibility. Completion time for both Trail Making Tests (TMT-A and TMT-B) were significantly longer for TS group than controls, however the difference in perseverative errors on Wisconsin Card Sorting Test (WCST) was not significant. SRS total score was significantly higher in the TS group compared to controls, indicating greater impairment in social responsiveness. Group difference for TMTs and SRS failed to reach significance after controlling for co-occurring conditions. Clinicians might consider social impairment in the evaluation plan of children and adolescents with Tourette syndrome.

The association of tattooing/body piercing and psychopathology in adolescents: a community based study from Istanbul

We aimed to investigate the association of psychopathology with tattooing and body piercing among adolescents in Istanbul by means of self-report questionnaires. Tenth, eleventh and twelfth grade students from 2 high schools in Istanbul with a total number of 607 participated in the study. The Youth Self Report, Children's Depression Inventory and a detailed semi-structured inquiry assessing tattooing, body piercing and some psychiatric and psychosocial variables were administered to the students. The prevalence of tattooing and body piercing were 4.8 and 7 %, respectively. The adolescents with tattooing and body piercing were found to have a higher frequency of alcohol and drug use, smoking, going to bars/night clubs and lower school grades when compared to those without tattooing and body piercing. Externalizing problems, mainly delinquent and aggressive behaviours were more prominent in the adolescents with tattooing and body piercing. Tattooing and body piercing in adolescents may be indicative of mental health risks.

The phenomenology of autistic regression: subtypes and associated factors

This study aimed to investigate the association of autistic regression (AR) and subtypes of AR with medical, developmental and psychiatric factors. Fifty-seven children with autistic spectrum disorders (ASD) were included in the study. Two types of AR are defined as regression after a normal social/language development (type 1) and regression as the worsening of previously reported autistic features (type 2). The frequency of history of AR was 56.1%. Male gender and sleep problems were found to be associated with a positive history of AR. The frequency of gastrointestinal complaints/diseases was higher in children with regression type 2 when compared to the children with regression type 1. Future studies with larger sample size and prospective design will contribute to clarifying the phenomenology and the associated factors of AR.

Sleep habits, parasomnias and associated behaviors in school children with attention deficit hyperactivity disorder (ADHD)

Considerable clinical data support an association between sleep problems and attention deficit hyperactivity disorder (ADHD). We aimed to investigate the sleep habits, associated parasomnias and behavioral symptoms in primary school children with ADHD. Forty primary school children with a clinical diagnosis of ADHD and 40 age-sex-matched healthy community controls were recruited. The Children's Sleep Habits Questionnaire providing information regarding sleep habits and nighttime and daytime symptoms was used. About 22% of children with ADHD (versus 2.9% of the controls) needed their parents to accompany them while going to sleep (p: 0.008). Transitional objects were needed by 8.1% of ADHD children in contrast to 2.9% of controls. Nightmares, overactivity during sleep, habitual snoring, and bed-wetting were significantly higher in the ADHD group. ADHD children needed significantly more time to go to sleep on school days (p < 0.02). Children undergoing evaluation for ADHD should be routinely screened for sleep disturbances.

Association of sleep duration with socio-economic status and behavioural problems among schoolchildren

AIM

In this population-based study, we aimed to determine the total sleep duration (TSD), its association with socio-economic status (SES) and behavioural symptoms among schoolchildren.

METHODS

A cross-sectional study was performed among schoolchildren in Istanbul. A structured questionnaire evaluating the sleep schedule variables was filled out by their parents. SES was determined according to the Turkish SES scale.

RESULTS

The mean age of 2669 children was 8.2 ± 2.4 years, and 51% of the students were girls. The mean TSD was 10.20 ± 1.04, and the mean bedtime was 21.57 ± 0.56 (both in hours, minutes ± SD). Boys tended to go bed later (p = 0.004) and slept less than girls (p = 0.02). The duration of sleep disruptions increased (p < 0.001), whereas TSD decreased with age (p < 0.001). Multiple linear regression revealed that waking time and TSD decreased significantly (p < 0.05) with higher SES among both girls and boys. Sleep fragmentation was associated with habitual snoring, parasomnias, daytime sleepiness and conduct symptoms.

CONCLUSION

Decreased total sleep duration is more prominent in boys, older children and children among higher socio-economic status. Insufficient sleep attributed to shortened total sleep duration by age and higher socio-economic status might have a negative effect on both sleep hygiene and psychological well-being in schoolchildren.

EEG abnormalities and epilepsy in autistic spectrum disorders: clinical and familial correlates

Our aim was to examine the characteristics of EEG findings and epilepsy in autistic spectrum disorders (ASD) and the associated clinical and familial risk factors. Fifty-seven children (86% male) with ASD, mean age 82+/-36.2 months, were included in the study. Thirty-nine (68.4%) children had the diagnosis of autism, 15 (26.3%) had Pervasive Developmental Disorder Not Otherwise Specified, and 3 (5.3%) had high-functioning autism. One hour of sleep and/or awake EEG recordings was obtained for each child. All patients were evaluated with respect to clinical and familial characteristics and with the Childhood Autism Rating Scale, the Autism Behavior Checklist, and the Aberrant Behavior Checklist. The frequency of interictal epileptiform EEG abnormalities (IIEAs) was 24.6% (n=14), and the frequency of epilepsy was 14.2% (n=8). IIEAs were associated with a diagnosis of epilepsy (P=0.0001), Childhood Autism Rating Scale Activity scores (P=0.047), and a history of asthma and allergy (P=0.044). Epilepsy was associated with a family history of epilepsy (P=0.049) and psychiatric problems in the mother during pregnancy (P=0.0026). Future studies with larger samples will help to clarify the possible associations of epilepsy/IIEAs with asthma/allergy, hyperactivity, and familial factors in ASD.

Depression and anxiety in children and adolescents with epilepsy: prevalence, risk factors, and treatment

Among the psychiatric comorbid conditions in children and adolescents with epilepsy, depression and anxiety disorders require further attention because they carry the risk of reduced quality of life and life-threatening complications (e.g., suicide). Research in recent years has shed light on both the prevalence of emotional problems in youth with epilepsy and the safety and efficacy of treatment options. A number of challenges exist in treating patients with epilepsy. This is particularly true when seizures are difficult to control and medication regimens are more complex. Some pharmaceutical options may provide assistance with both seizures and emotional distress, but care is needed when considering such treatment approaches. In addition, integration of mental health professionals into the care of patients is necessary when cases are complicated and risk factors are high. Thorough methods to accurately diagnose emotional conditions and regular monitoring of symptoms can help prevent serious problems that can negatively affect the success of children and adolescents in everyday life. Collaboration between disciplines offers the best hope for early identification and treatment of these conditions.

[Relationship between attachment style and depressive symptoms in postpartum women: findings from Turkey]

OBJECTIVE

The present study aimed to investigate the association between depressive symptoms and attachment style in postpartum women in a non-western setting.

METHOD

This study was carried out at the local health care centers in April 2004 among Turkish mothers within 2 to 18 months postpartum. A sociodemographic data sheet and the Turkish versions of Edinburgh Postnatal Depression Scale (EPDS) and Adult Attachment Style Questionnaire (AAQ) were administered to 80 mothers.

RESULTS

On the EPDS, 30 % of the sample (n=24) displayed symptoms of depression with a cut-off score of >/=11. Postpartum depressive symptoms (EPDS >/= 11) were found to be associated with insecure attachment style (X2=4.42, p=0.035; X2=10.81, p=0.001 for Part 1 and Part 2 of AAQ, respectively).

CONCLUSION

Maternal insecure attachment behavior, stimulated by the close relationship with the infant may contribute to the factors that may give rise to symptoms of depression. The present study, performed in a non-western country, confirms the results of the previous western studies suggesting a relationship between insecure attachment style and postpartum depression (PPD). Clinicians should pay particular attention to vulnerable women regarding their attachment style for early identification and treatment of PPD, either in western or non-western societies.

Symptoms of inattention and hyperactivity in children with habitual snoring: evidence from a community-based study in Istanbul

BACKGROUND

Neurobehavioural symptoms of inattention and hyperactivity are common in children with sleep-disordered breathing (SDB). Prevalence rates of habitual snoring and attention deficit hyperactivity disorder (ADHD) are very similar and both have a substantial negative effect on children's behavioural health.

OBJECTIVE

We examined the differences for subjective attentional and hyperactivity measures reported by parents and teachers among primary school children with habitual snoring and age- and sex-matched controls in a community-based case-control study in Istanbul. Methods In 2002, a survey was carried out to determine the prevalence of snoring in 2147 primary school children. After one year, in 2003, 151 children with habitual snoring and 302 controls from this survey were studied with parental SDB questionnaire, Conners' Parent (Conners-P) and Teacher Scales, and an inattention hyperactivity scale (IHS). Exclusion criteria included history of ADHD diagnosis, controls who started to snore and habitual snorers (HS) who no longer snored in this follow-up study.

RESULTS

Ninety-six HS and 190 control subjects (mean age: 9.4 +/- 1.3) were evaluated. HS had significantly more symptoms of hyperactivity (Conners-ADHD index) (P: 0.033), attentional (P: 0.019), and conduct and oppositional defiant in subscales (P: 0.001) of Conners-P and IHS-Parents. A pooled score of Conners-P ADHD Index > 60 and IHS-Parent score > 1.25 showed considerable difference in HS when compared with controls (5.1% vs. 1.4%) (P < 0.0001). Daytime hyperactivity and excessive daytime sleepiness reported by parents correlated with scores of Conners-P and IHS-P (P < 0.01). Teachers' observations showed significant correlations with learning disability and the level of academic performance in HS (P < 0.01). Other behavioural parameters related to SDB were not significantly correlated with teachers' ADHD ratings in HS.

CONCLUSION

Increased rates of moderate hyperactivity as well as conduct and oppositional defiant symptoms in HS reported by the parents might reflect a negative impact on overall neurobehavioural health. The teachers' scores yielded no significant results among HS and controls. This may be caused by the limitation due to shared method variance. The negative effect of crowded classes on teachers' evaluations must be also taken into consideration. After exclusion of a diagnosis of ADHD in children presenting with hyperactivity and inattention, children with habitual snoring with prominent scores of behavioural measures should be considered as candidates for further assessment by a sleep specialist.

Relationship between traumatic dental injuries and attention-deficit/hyperactivity disorder in children and adolescents: proposal of an explanatory model

The objective of the present study was to determine the association between attention-deficit/hyperactivity disorder (ADHD) and traumatic dental injuries in a child psychiatric clinical population in Istanbul. A total of 475 consecutive children aged 8-17 years were enrolled in the study. Children and their parents were interviewed about the presence of traumatic dental injury and if a positive response was obtained further questions were inquired regarding the time and cause of the injury, and whether treatment had been sought. Child psychiatric diagnosis was based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Of the 475 children, 32 reported a traumatic dental injury (6.7%) with statistically significant association with ADHD (chi(2) = 26.90, d.f. = 1, P = 0.0001; odds ratio = 17.41, 95% CI: 4.11-73.55). On the Conners Teacher Report Questionnaire, children with dental trauma group differed significantly from the non-ADHD group but not from the ADHD group (F = 17.02, d.f. = 2, P = 0.0001). Among children with ADHD and dental fracture, the most common subtype was combined ADHD (90%). This is the first study describing a significant association between dental fractures and ADHD which contributes to an explanatory model on dental traumas among children. According to us, awareness of this association is essential at child psychiatry and pediatric dentistry settings and we recommend preventive efforts to be directed at the treatment of ADHD.

Prevalence of snoring and symptoms of sleep-disordered breathing in primary school children in istanbul

STUDY OBJECTIVES

Snoring during sleep is an important manifestation of obstructive sleep apnea syndrome (OSAS). Although clinical history is not sufficiently sensitive and specific to distinguish primary snoring from OSAS, snoring is indicative of upper airway obstruction and may be associated with the presence of diurnal symptoms. Our study aims were to determine the prevalence of snoring in primary school children in Istanbul, and to evaluate the diurnal symptoms and conditions that may be associated with sleep problems.

DESIGN, SETTING, AND SUBJECTS

A parental questionnaire was used to assess the sleep and wake behavioral patterns in children. Eight representative schools in each of 9 school districts randomly selected from the 32 school districts in Istanbul were visited.

RESULTS

The response rate was 78.1%; 2,147 of 2,746 questionnaires were fully completed, returned, and analyzed. The prevalence of habitual snoring was 7.0%. Habitual snorers had significantly more nighttime symptoms, such as observed apneas (odds ratio [OR], 16.9; 95% confidence interval [CI], 10.0 to 28.8; p < 0.0001), difficulty breathing (OR, 17.8; CI, 10.9 to 29.2; p < 0.0001), restless sleep, parasomnias, and nocturnal enuresis, compared to occasional and nonsnorers. There were also increased prevalence of daytime symptoms, such as falling asleep while watching television (OR, 1.8; CI, 0.9 to 3.7; p = 0.01) and in public places (OR, 2.1; CI, 1.2 to 3.8; p = 0.03), and hyperactivity (OR, 2.7; CI, 1.8 to 3.9; p < 0.0001). Exposure to cigarette smoke and the presence of asthma and hay fever increased the likelihood of habitual snoring. Children with a higher risk for OSAS (habitual snoring, apnea, and difficulty breathing during sleep) were also compared to nonsnorers. Although nighttime symptoms were more likely in the high-risk group, the risk of daytime symptoms increased as well.

CONCLUSIONS

Habitual snoring is a significant problem for children and may be associated with diurnal symptoms. Exposure to cigarette smoke at home and the presence of asthma and hay fever increase the likelihood of habitual snoring.

Are sensory phenomena present in Sydenham's Chorea? Evaluation of 13 cases

Sydenham's Chorea (SC) is an early complication of rheumatic fever caused by group A beta-hemolytic streptococcal infection that manifests itself with adventitious choreatic movements and behavioral problems. Sensory phenomena are the premonitory sensory experiences that are described prior to tics. Tic disorders and SC share common underlying neurobiological substrates, yet sensory phenomena have not previously been examined in SC. We aimed to explore the presence of sensory phenomena associated with choreatic movements in children with SC. Thirteen SC patients are examined on measures of sensory phenomena using a semi-structured instrument. 10 out of 13 patients described sensory phenomena. Five of the SC patients described sensory phenomena as "between physical and mental". The patients described physical feelings of tension in joints, tingling and trembling sensations on skin. 69 % of them described movements as "completely involuntary". Sites of choreatic movements that were consistently preceded by sensory phenomena were upper and lower extremities, and trunk. Children may have difficulty in articulating sensory phenomena due to the subjective nature of premonitory feelings in SC. We recommend exploring the sensory experiences that might accompany the choreatic movements in children with SC.