Vaccine refusal risk factors among parents of children with autism spectrum disorders

BACKGROUND

Vaccine refusal is a global trend and was announced as one of the top ten health threats in recent years. The rate of vaccine refusal (VR) among children with autism spectrum disorders (ASD) has also increased in parallel with the global trend but their vaccination behavior may differ from that of the normal population. This study aims to determine the VR rates among parents of children with ASD, to define the risk factors for developing VR, and to evaluate the parental concerns for childhood vaccinations in this susceptible population.

METHODS

We conducted a 4-part survey questionnaire among parents of children with ASD, evaluating the vaccination status for both the child with ASD and their younger sibling. The vaccination uptake of the first child was accepted as the `baseline` behavior, while the following sibling`s uptake was suggested as the `current` behavior. The risk factors of VR were determined with logistic regression analysis.

RESULTS

The study group included 110 parents of children with ASD (M/F:76/34) and their younger siblings (M/F:57/53). The rate of `baseline VR` was 12.7 % whereas the `current VR` was 40% (p=0.001). High socioeconomic status (relative risk [RR]: 4.4; 95% confidence interval [CI]: 1.01-16.6; p=0.04), using social media as the main source of information (RR: 7; 95% CI: 1.5-32; p= 0.01) and lack of regular well-child visits of the sibling (RR: 25; 95% CI 4.1-166; p=0.001) were determined as risk factors for VR.

CONCLUSIONS

The vaccination behavior of parents changed after having a child with ASD, and thus, the younger siblings may constitute a risk group for VR. In clinical practice, pediatricians should be aware of this risk and evaluate the vaccination uptake of the younger siblings of children with ASD more carefully. Regular well-child visits and improving media literacy may be the key points to prevent VR in this susceptible population.

Reliability and Validity of the Bipolar Prodrome Symptom Interview and Scale-Full Prospective in Its Turkish Translation

Editors' Note: The Editors would like to address issues related to the acceptance of this manuscript. The original manuscript referenced the study tool as the Bipolar Prodrome Symptom Interview Scale-Prospective (BPSS-P). After the manuscript's initial acceptance, the authors requested a revision of the tool name to Bipolar Prodrome Symptom Interview Scale-Full Perspective (BPSS-FP). When this request was made, the original acceptance was rescinded, and the authors were asked to formally revise and resubmit the manuscript with an explanation for the change. This revision and subsequent review led to the final acceptance of the manuscript. The authors have assured us that the tool used in the manuscript was the BPSS-FP (version 5) as opposed to abbreviated forms of this tool that are also used in research (e.g., Bipolar Prodrome Symptom Scale-Abbreviated Screen for Patients (BPSS-AS-P). Background: No scale exists to assess patients at-risk for bipolar disorder (BD) in Turkey. We aimed to assess the psychometric properties of the Turkish version of the Bipolar Prodrome Symptom Interview and Scale-Full Prospective (BPSS-FP). Method: Psychiatric service users aged 11-18 years old were interviewed using the BPSS-FP translated into Turkish and the Kiddie Schedule for Affective Disorders and Schizophrenia. Youth with major depressive disorder (MDD, n = 63), bipolar-spectrum disorder (n = 47), and healthy controls (n = 122) were included. Cronbach's alpha was calculated to assess internal consistency. The Young Mania Rating Scale (YMRS) and Children's Depression Rating Scale-Revised (CDRS-R) were administered to test convergent/discriminant validity. Discriminant validity was further tested using one-way ANOVA and "receiver operating characteristic" (ROC) curves. Inter-rater reliability was tested using correlation coefficients. Findings: Across 232 youth, Cronbach's alpha values were 0.932 for the BPSS-FP total score, 0.878 for the Mania Symptom Index, 0.887 for the Depression Symptom Index, and 0.797 for the General Symptom Index. Correlation coefficients for inter-rater reliability were high for the Mania Symptom Index (r = 0.989), Depression Symptom Index (r = 0.973), and General Symptom Index (r = 0.981). There were high correlations between the BPSS-FP Mania Symptom Index subscore and YMRS (r = 0.732), and the BPSS-FP Depression Symptom Index subscore and CDRS-R (r = 0.754), whereas cross-polarity correlations were non-significant. ROC analysis cut-off value was ≥21 for the BPSS-FP Mania Symptom Index between patients with BD and MDD (specificity = 85.7%, sensitivity = 78.7%). Conclusion: The Turkish version of the BPSS-FP has good psychometric properties and can be used in research. Longitudinal studies are needed to confirm the predictive value of the BPSS-FP.

Protective and Supportive Injunctions for Children Exposed to Sexual Abuse: The First Data from Turkey

Child sexual abuse (CSA) requires multidisciplinary approach by forensic, social, and medical services, thus Child Advocacy Centers (CACs) have been established to evaluate CSA cases in Turkey. At CACs the social needs of children are assessed by social workers. Protective and supportive injunctions (PSIs) are considered at each step of evaluation and are proposed to child courts. This study aimed to evaluate PSIs at a local CAC, which is one of the leading CACs in Turkey. The study group consisted of children and adolescents exposed to CSA admitted to Izmir CAC between April 2014 and April 2015. Socio-demographic characteristics, social investigation reports, psychiatric reports, and proposed PSIs were evaluated. The rate of social investigation necessity was 28.3% (n = 113), and the rate of being proposed for at least one PSI was 24.3% (n = 97). The most common proposed injunctions were maintenance care injunctions (n = 47; 48%) and counseling injunctions (n = 46; 47%). The rate of proposed PSIs was significantly higher in adolescents, incest cases and abuse types including penetration than in the other groups. This is the first study to evaluate PSIs in the child protection system. Our results provide data about the risk groups that need PSIs among the victims of CSA cases.

How Do Childhood and Parental Anxiety Features Affect the Consequences of Child Sexual Abuse?

The purpose of the study was to investigate the anxiety features of children who experience child sexual abuse (CSA) and their parents, along with the features and consequences of sexual abuse in the environment of Child Advocacy Centers (CAC). The sample of this study comprised 150 children affected by CSA and one of their parents who were admitted to İzmir CAC between June 2016 and November 2016.The children-age range 9 to 13 years-and one of their parents were asked to complete the State-Trait Anxiety Inventory separately. The children also completed the Childhood Anxiety Sensitivity Index (CASI). During psychiatric evaluations of the children, sociodemographic characteristics and features of sexual abuse were noted and all psychiatric conditions were examined. The statistical analyses yielded significant correlations between the STAI scores of the parents and STAI-C and CASI scores of the children. There were statistically significant differences between the CASI scores, STAI-C subscale scores, and STAI subscale scores according to some variables of CSA along with their psychiatric diagnosis. Our findings showed that having higher anxiety sensitivity and trait anxiety levels and having parents with higher trait anxiety might be considered as risk factors for being diagnosed as having a psychiatric disorder due to CSA.

Neutrophil-lymphocyte and platelet-lymphocyte ratios among adolescents with bipolar disorder: A preliminary study

We aimed to evaluate the neutrophil lymphocyte and platelet lymphocyte ratios among euthymic adolescents with bipolar disorder (BD) type I. Thirty-six adolescents with BD and 30 healthy controls were included in the study. The diagnosis was made by experienced physicians using the Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version and the affective module of Washington University in St. Louis Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia-Present State and Lifetime. Blood samples were taken during euthymia, which was defined as Young Mania Rating Scale and Hamilton Depression Rating Scale scores below 7. There was no significant difference in neutrophil lymphocyte ratio and platelet lymphocyte ratio between the patient and control group. Considering the literature, we may speculate that in the early stages, euthymia is associated with a lower inflammatory response, and prolongation of BD causes increased inflammatory processes predominant even in euthymia. In pediatric BD, further studies that assess neutrophil lymphocyte ratio and platelet lymphocyte ratio during different mood episodes and that identify neutrophil lymphocyte ratio and platelet lymphocyte ratio changes during the course of the disease will clarify the role of inflammation in the etiology of pediatric BD.

Genetic imaging study with [Tc-99m] TRODAT-1 SPECT in adolescents with ADHD using OROS-methylphenidate

AIM

To examine theeffects on the brain of 2-month treatment withamethylphenidate extended-release formulation (OROS-MPH) using [Tc-^99m] TRODAT-1SPECT in a sample of treatment-naïve adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). In addition, to assess whether risk alleles (homozygosity for 10-repeat allele at the DAT1 gene were associated with alterations in striatal DAT availability.

METHODS

Twenty adolescents with ADHD underwent brain single-photon emission computed tomography (SPECT) scans with [Tc-^99m] TRODAT-1 at baseline and two months after starting OROS-MPH treatment with dosages up to 1 mg/kg/day. Severity of illness was estimated using the Clinical Global Impression Scale (CGI-S) and DuPaul ADHD Rating Scale-Clinician version (ARS) before treatment,1 month and 2 months after initiating OROS-MPH treatment.

RESULTS

Decreased DAT availability was found in both the right caudate (pretreatment DAT binding: 224.76 ± 33.77, post-treatment DAT binding: 208.86 ± 28.75, p = 0.02) and right putamen (pre-treatment DAT binding: 314.41 ± 55.24, post-treatment DAT binding: 285.66 ± 39.20, p = 0.05) in adolescents with ADHD receiving OROS-MPH treatment. Adolescents with ADHD who showed a robust response to OROS-MPH (n = 7) had significantly greater reduction of DAT density in the right putamen than adolescents who showed less robust response to OROS-MPH (n = 13) (p = 0.02). However, between-group differences by treatment responses were not related with DAT density in the right caudate. Risk alleles (homozygosity for the 10-repeat allele of DAT1 gene) in the DAT1 gene were not associated with alterations in striatal DAT availability.

CONCLUSION

Two months of OROS-MPH treatment decreased DAT availability in both the right caudate and putamen. Adolescents with ADHD who showed a robust response to OROS-MPH had greater reduction of DAT density in the right putamen. However,our findings did not support an association between homozygosity for a 10-repeat allele in the DAT1 gene and DAT density, assessedusing[Tc-^99m] TRODAT-1SPECT.

An Overview of a Hospital-Based Child Advocacy Center's Experience from Turkey

The purpose of the present study was to investigate sociodemographic variables, features of sexual abuse (SA), and first psychiatric evaluation results of abused children, and to analyze the relation of the psychiatric evaluation results to the children's age and gender, type and duration of abuse, abuser-child relationship, and marital status of the children's parents, at one of the most experienced Child Advocacy Centers (CACs) in Turkey. All data were obtained from reports prepared by child and adolescent psychiatrists. The sample of this study consists of 436 child sexual abuse (CSA) cases who admitted İzmir CAC between April 2014 and November 2015. The statistical analyses yielded significant relations between psychiatric symptoms and chronic abuse, the gender of the children, and type of abuse. Suicidal ideation and behaviors due to sexual abuse (SA) were also examined. According to our results, it is fair to say that children exposed to SA benefit from immediate psychiatric help because of their vulnerability for psychiatric disorders due to abuse. In this context, CACs are very important multidisciplinary establishments to determine children's multiple needs to ease their trauma with collaborative teamwork. Psychiatric evaluation should be part of this multidisciplinary context.

Infant colic or early symptom of autism spectrum disorder?

BACKGROUND

Gastrointestinal (GI) disorders are common in autism spectrum disorder (ASD). Infant colic (IC), the functional GI disorder of infancy, has not been evaluated in this patient group. The aim of this study was therefore to determine the rate of IC in ASD and investigate a possible association between ASD and IC.

METHODS

The subjects consisted of 100 ASD patients (mean age, 6.6 ± 3.5 years) and 100 healthy controls (mean age, 5.3 ± 2.8 years). The parents were questioned using the diagnostic criteria for infant colic for clinical research purposes defined in Rome IV to diagnose IC, retrospectively. The sample size was estimated using a maximum type I error probability of 5% (alpha) and a type II error of 20%.

RESULTS

The rate of IC was 16% and 17% in the ASD group and control group, respectively (P ˃ 0.05). Excessive crying with late onset and long duration in infants was defined as persistent crying. The rate of persistent crying was significantly higher in the ASD group than in the control group (32% vs 9%, P < 0.001). The relative risk of persistent crying was 4.40 in ASD. The likelihood of being misdiagnosed with IC in this group was 78%.

CONCLUSION

The rate of IC is not increased in patients with ASD, but infants with excessive crying should be very thoroughly evaluated before being diagnosed with IC. In particular, persistent crying in infants (i.e. excessive crying with late onset and long duration) may be an early symptom of ASD.