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Objective: Despite the increasing use of antipsychotic drugs in children and adolescents in many countries, little is known about the treatment duration in this vulnerable population. The present nationwide study investigated the duration of antipsychotic treatment and factors associated with treatment discontinuation in Finnish children and adolescents. Methods: All subjects aged 1-17 years who had started a second-generation antipsychotic (SGA) drug (risperidone, quetiapine, aripiprazole, or olanzapine) between January 2008 and December 2016 (n = 20,932) were extracted from the Finnish Prescription Registry and followed up until December 31, 2017. Treatment duration was calculated as the time between the initial purchase of medication and treatment discontinuation. Treatment was considered discontinued if the treatment-free gap was more than 270 days. The associations between explanatory factors and treatment discontinuation were analyzed with the Cox proportional hazards models. Results: The mean and median treatment durations were 509 days (95% confidence interval [95% CI]: 500-517 days) and 317 days (95% CI: 306-325 days), respectively. The duration was shorter in girls than in boys (p < 0.001). Of all SGA users, 35.1% used antipsychotics less than 50 days and 16.0% used more than 600 days. Shorter treatment duration was associated with age groups of 7-12 and 13-15 years compared with 1-6 years (hazard ratio [HR]:1.23 [95% CI: 1.11-1.36]; HR: 1.35 [95% CI: 1.21-1.51], respectively) and initiating treatment with quetiapine or olanzapine compared with risperidone (HR: 1.18 [95% CI: 1.12-1.25]; HR: 1.66 [95% CI 1.46-1.88], respectively). Switching of SGA drug during treatment was associated with longer treatment duration (HR: 0.40 [95% CI: 0.38-0.43]). Conclusions: In children and adolescents, the mean treatment duration of SGAs was relatively long given that the majority of SGA use was off-label. Older age and initiating treatment with quetiapine were associated with earlier treatment discontinuation, whereas switching of antipsychotic drug during therapy increased the possibility of longer SGA use. [ABSTRACT FROM AUTHOR]

We examined different forms of victimization experiences in relation to psychopathic features and whether these associations differed in boys and girls among 4855 Finnish school adolescents aged 15–16 years. Psychopathic features were measured with the Antisocial Process Screening Device- Self Report (APSD-SR). Victimization was assessed with questions about violent and abusive experiences across lifetime and within the last 12 months. Results from linear regression analysis showed that victimization was significantly associated with higher APSD-SR total scores, more strongly in girls than boys. Recent (12-month) victimization showed significance in the relationship between victimization and psychopathic features; especially recent sexual abuse and parental corporal punishment were strong determinants of higher APSD-SR total scores. The present study demonstrates novel findings on how severe victimization experiences relate to psychopathic features in community youth, especially in girls. The findings underscore the need for comprehensive evaluation of victimization experiences when psychopathic features are present in youth. [ABSTRACT FROM AUTHOR]

Background: Individuals with high psychopathy scores are capable of providing valid self-reports on their own personality traits, but there have been no empirical studies of the effect of psychopathic features on responding to sensitive survey questions about specific behaviours.Aims: The aim of this study is to investigate any relationship between facets of psychopathy and participants' willingness to report antisocial acts in youth delinquency surveys, controlling for demographic variables known to be associated with response integrity.Methods: In a nationally representative sample of 4,855 Finnish mainstream adolescents aged 15-16, honesty of responding was assessed through direct response integrity questions related to violence, property crime and drug use. Psychopathy was measured with the Antisocial Process Screening Device - Self Report (APSD-SR).Results: Callous-unemotional traits and, to a lesser degree, narcissistic features were associated with a dishonest response style, although the effect size was modest.Conclusions: Although psychopathy does not seem to influence the capability and willingness to report personality traits accurately, it may be associated with endorsing dishonest responses to questions about specific behaviours that have possible repercussions. Our findings suggest that previously observed associations between adolescents' self-reported delinquent behaviour and psychopathic traits may be underestimations of the strength of the effects. [ABSTRACT FROM AUTHOR]

A recently developed virtual reality task, EPELI (Executive Performance in Everyday LIving), quantifies goal-directed behavior in naturalistic conditions. Participants navigate a virtual apartment, performing household chores given by a virtual character. EPELI aims to tap attention, executive function, and prospective memory. To ensure its applicability to further research and clinical work and to study its relationship to relevant background factors, we examined several key properties of EPELI in 77 typically developing 9–13-year-old children. These included EPELI's internal consistency, age and gender differences, sensitivity to gaming experience, head-mounted display (HMD) type, and verbal recall ability, as well as its relationships with parent-rated everyday executive problems. Of the eight EPELI measures, the following six showed acceptable internal consistency: task and navigation efficacy, number of correctly performed tasks and overall actions, time monitoring, and controller movement. Some measures were associated with age, gender, or verbal encoding ability. Moreover, EPELI performance was associated with parent-rated everyday executive problems. There were no significant associations of gaming background, task familiarity, or HMD type with the EPELI measures. These results attest to the reliability and ecological validity of this new virtual reality tool for the assessment of attention, executive functions, and prospective memory in children. [ABSTRACT FROM AUTHOR]

This study compared sleep in patients with Conduct Disorder/Oppositional Defiant Disorder (CD/ODD) and normative children and evaluated the associations between sleep and behavioral symptoms in patients. Participants were 30 patients, aged 7 to 12 years, with diagnoses of CD/ODD and their age and gender matched controls. Patients with CD/ODD and their parents reported significantly more sleep problems than did the control children and their parents (pvalues < 0.01). By actigraphy, CD/ODD children with comorbid ADHD slept significantly less than did the patients with CD/ODD alone and the controls. In patients, low sleep amount and efficiency associated with increased amount of parent-reported externalizing symptoms (r= −0.72, 0.66,pvalues < 0.001). Results highlight the need of evaluating sleep in children with CD/ODD. Improving their sleep may ease their symptoms. [ABSTRACT FROM PUBLISHER]

Aim To determine whether specific infant behavioural characteristics are present in children suspected of cow's milk allergy because of gastrointestinal symptoms. Methods We prospectively recruited 57 children (median age 8.7 months) with a suspicion of gastrointestinally manifested cow's milk protein allergy ( GI- CMPA). None had detectable cow's milk-specific Ig E. Mothers were asked to complete the Parenting Stress Index ( PSI) Child Domain, and those with children below 18 months of age (n = 49) also the Infant Temperament Questionnaire ( ITQ). GI- CMPA was diagnosed with the double-blind, placebo-controlled food challenge. Control group (n = 22) consisted of patients (age range 4-26 months), attending the Pediatric Allergy Unit, who did not have diagnosed or suspected food allergies. Results The scores were significantly higher for the PSI (n = 48) Child Domain (p < 0.0001) and for the ITQ (n = 44) subscale Difficultness (p = 0.0045) compared with the control patients without suspected/diagnosed food allergy. The difference between the challenge positive (n = 18) and negative (n = 39) patients remained statistically insignificant. After 6 months, in both groups, the scores ( PSI Child Domain p = 0.0004, ITQ Difficultness p = 0.0393) were lower, but the ITQ Difficultness score still remained higher than in the controls (p = 0.0453). Conclusion The mothers often perceive infants with unspecific symptoms suggestive of GI- CMPA as demanding and temperamentally difficult. [ABSTRACT FROM AUTHOR]

Abstract: Background: Motor retardation is a cardinal feature in adult depression. Limited information exists about motor activity in depressed children. The present study evaluated motor activity in depressed children compared to controls and investigated whether motor activity can be linked with the severity of symptoms in depressed children. Method: Motor activity during both day- and night time was recorded by actigraphy in twenty-two depressed children and their controls. A K-SADS-PL interview of the child and his/her mother was used to diagnose depression. The depressed children filled in the Child Depression Inventory (CDI) as a self-report of the severity of depression. Parents and teachers of both depressed children and controls filled in the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). Results: Motor activity was reduced during the daytime in depressed children compared to controls (p<0.001). Depressed children spent more time in total immobility during the night time than their peers (p<0.05). In depressed children motor activity was linked with the severity of self- (r=−0.45, p<0.05) and teacher-reported (r=−0.52, p<0.05) symptoms. Depressed children with suicidal ideation (n=10) differed significantly in motor activity compared to depressed children without suicidal ideation (n=12) and controls (n=22). Limitations: Sample size was only moderate. Conclusions: Reduced motor activity is an important feature of childhood depression. Objectively measured motor activity can distinguish depressed children from their peers. Motor retardation can be linked with the severity of depression, especially suicidal ideation and possibly subtype depressed children into groups with different etiology, treatment needs and course of illness. [Copyright &y& Elsevier]

The associations between day length and activity, rest-activity rhythm, and psychiatric symptoms were studied. Sixty-six healthy children participated in the study during one year. They were monitored for 72 consecutive hours with belt-worn activity monitors (actigraphs) to obtain objective data on their activity levels during the day and night. In addition, the parents filled out the Child Behavior Checklists. It was found, that the mean total and day and night time activity levels were increased and the relative circadian amplitude blunted with the longer day length. It was concluded that day length was associated with activity level and rest-activity rhythm and this association may reflect the seasonal changes in these parameters. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the predictive value of childhood depressive symptoms for psychiatric symptoms, adaptive functioning, and self-performance in young adults.Method: The study sample consisted of 111 young adults born during 1975-1976 in the Helsinki region. The young adults were assessed in childhood (10 to 11 years of age) using the Children's Depression Inventory (CDI) and at the age of 20 to 21 years using Achenbach's Young Adult Self Report (YASR), the Beck Depression Inventory (BDI), and the Wallston Self-Performance Survey.Results: Self-reported depressive symptoms in childhood predicted psychiatric symptoms (especially aggression), poor adaptive functioning, and low self-esteem in young adulthood.Conclusions: Depressive symptoms in children should be addressed to prevent later psychiatric problems. The CDI may be a measure of nonspecific psychopathology rather than of pure depression--thus, it may be a good screening tool for child populations. [ABSTRACT FROM AUTHOR]

Effects of early risk and intervention on the psychiatric symptoms of young adults were studied. By means of a weighted risk index, 160 families with a baby born in 1975-1976 were classified as being at low or high risk. Half of the families attended a five-year family counseling program, the other half served as a control group. At age 20-21 years, the young adults from the counseled families had significantly fewer psychiatric symptoms than did those from the control families. A significant interaction between family risk and counseling was found. Implications for preventive intervention efforts are discussed. [ABSTRACT FROM AUTHOR]

Presents information on a study which evaluates the correlation between the quantity and quality of children's sleep and parent- and teacher--reported psychiatric symptoms in the United States. Methodology of the study; Discussion of the results; Conclusions.

This study evaluated the continuity of psychiatric symptoms from adolescence into young adulthood. The study sample consisted of 121 young adults born in 1975-76 in the region of Helsinki. The young adults were assessed in adolescence (age 14 to 15 years) with the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) and at the age of 20 to 21 years with the Symptom Checklist-90 (SCL-90). The results showed that the self-reported psychiatric symptoms in adolescence significantly predicted the psychiatric symptoms of young adulthood. The internalizing symptoms were stronger predictors than the externalizing symptoms. The associations between the symptoms in adolescence and young adulthood were stronger for girls than for boys; the self-reported symptoms were stronger predictors than the parent-reported symptoms. It was concluded that especially the internalizing symptoms reported by adolescents themselves should not be regarded as normative but should be addressed and treated. [ABSTRACT FROM AUTHOR]

Presents the findings of a study which examined psychiatric symptoms in adolescents, with emphasis on infant temperament and early home-based intervention. Methods used to conduct the study; How a fussy/demanding temperament was found to predict psychiatric symptoms in adolescence; Effects of the introduction of a family counseling program.

In this longitudinal study the effects of early risk factors, early intervention, and present family factors on the competence of 14- to 15-year-old adolescents were evaluated. The competence was assessed by using Achenbach's parent and youth reports' competence parts describing social behaviour and academic achievement. The material consisted of 160 families, which were classified with a risk index into low- and high-risk groups during the child's first 6 months. Half of the families attended a 5-year family counselling program. The results of this study showed that the early risk factors made the strongest contribution to the social competence of 14- to 15-year-old adolescents. These results imply that good interactions in the family during early development foster social competence in adolescence. [ABSTRACT FROM AUTHOR]

Presents a study which aims to determine whether there is an association between motor activity levels and severity and nature of depressive symptoms in selected hospitalized prepubertal children. Prevalence of mood disorders in hospitalized children and adolescent; Correlation of measures of reduced daytime activity with scores on the Children's Depression Rating Scale.

Evaluates the effects of an early home-based intervention on the psychiatric symptoms in adolescents. Report of scores in counseling families; Benefits from counseling; Factors affecting risk index; Attrition rates.

Presents information on a study which examined the long-term effects of an early home-based intervention,in relation to its quality and quantity of psychiatric symptoms found in adolescents. Discussion on the positive effect of the home-base early intervention; Methodology used to conduct the study; Findings of the study.

Aim: We assessed psychosocial burdens in children who developed narcolepsy after receiving the Pandemrix H1N1 vaccine during the 2009-2010 pandemic. Parental quality of life was also assessed.Methods: This multicentre study covered four of the five Finnish University Hospital Districts, which dealt with about 90% of the paediatric narcolepsy cases after the Pandemrix vaccination. The medical records of children diagnosed from 2010 to 2014 were reviewed. The questionnaires included the Youth Self-Report (YSR), Children's Depression Inventory (CDI), the Child Behaviour Checklist (CBCL) and questions on parental resources, stress and quality of life.Results: We obtained the medical records of 94 children who were aged 5-17 years at the time of their narcolepsy diagnosis and questionnaire data for 73 of those children. Most children had strong narcolepsy symptoms, and 25% had CDI scores that suggested depression. In addition, 41% had total CBCL problem scores above the clinically significant limit and 48% were anxious, withdrawn and had somatic complaints. Sleep latency was weakly associated with the CBCL total problem score. Half of the children needed psychiatric interventions and parental stress was common.Conclusion: Depression and behavioural problems were common in children with narcolepsy after the Pandemrix vaccination and their parents frequently reported feeling stressed. [ABSTRACT FROM AUTHOR]

Objective: The youngest children in a classroom have a higher risk of attention-deficit/hyperactivity disorders (ADHDs) and depression than their relatively older peers. However, there has been a lack of research on how relative age is related to second-generation antipsychotic (SGA) medication use. Methods: This study used the Finnish National Prescription Register data and comprised all 669,726 Finnish children and adolescents aged 7-17 in 2018. We extracted data for those who were dispensed SGAs (risperidone, quetiapine, aripiprazole, and olanzapine) and ADHD medication (methylphenidate, atomoxetine, dexamphetamine, and lisdexamfetamine). Odds ratios (OR) and 95% confidence intervals (CI) were calculated for medication dispensed to schoolchildren born from January to April (the relatively oldest), May to August, and September to December (the relatively youngest). Dispensed prescriptions were a proxy for medication use. Results: SGAs were dispensed to 9146 (1.4%) individuals in 2018. Their use was lower among girls aged 12-17 years born from September to December than January to April (OR 0.89; 95% CI 0.83-0.97), with no association between SGA use and birth month among boys. However, younger relative age was associated with combined SGA and ADHD medication, which was used by 2556 (0.4%) of the cohort: 2074 (0.6%) boys and 482 (0.1%) girls. The OR was 1.27 for boys aged 12-17 born from September to December (95% CI 1.10-1.46), compared with January to April. The OR for girls born from May to August was 1.35 (95% CI 1.04-1.76) and from September to December it was 1.33 (95% CI 1.02-1.74), compared with January to April. Conclusions: A novel discovery of this study was that using both SGA and ADHD medication at the age of 12-17 years was more common among the youngest subjects in a school year than their relatively older peers. [ABSTRACT FROM AUTHOR]

We examined several parent-reported prenatal and postnatal factors as potential risk factors for attention-deficit and hyperactivity disorder (ADHD) symptomatology in 5-year-old children. Our study is based on the CHILD-SLEEP birth cohort. Several parental questionnaires were collected prenatally (32nd pregnancy week) and postnatally (i.e. child aged 3, 8, and 24 months and at 5 years). At 5 years of age, ADHD symptoms were assessed using questionnaires. Our main results showed that being a boy, parental depressive symptoms, more negative family atmosphere or a child's shorter sleep duration, and maternal authoritarian parenting style predicted inattentive/hyperactive symptoms. Maternal and paternal authoritative parenting style predicted less inattentive/hyperactive symptoms. Children with several risk factors together had the highest risk for inattentive/hyperactive symptoms. Our findings emphasise the need for early screening and treatment of parental mental health, and early evidence-based targeted parental support, to enable early intervention in those children at a risk of developing ADHD. [ABSTRACT FROM AUTHOR]

Background: This randomized controlled trial (RCT) evaluated the long-term effectiveness of the Incredible Years® (IY) Parenting Program in modifying children's externalizing problems among families in Child Protection Services (CPS) and using other special support services. We also examined whether parent-reported effects of the IY® generalize to the daycare/school setting as reported by teachers. Methods: Participants in the study were 3–7-year-old children with behavioural problems (N = 102 at baseline, N = 89 at one-year follow-up). Participants were randomized to intervention (N = 50) and control groups (N = 52) after the baseline assessment. The intervention group received 19-week IY® Parenting Program. The effectiveness of the intervention was analyzed using linear mixed model. Results: Our previously reported pre-post intervention effects on CBCL (Child Behavior Checklist) and ECBI (Eyberg Child Behavior Inventory) were not sustained to the one-year follow-up. Child conduct problems decreased from baseline to follow-up in both intervention and control groups. The positive changes were not observed at daycare/school from baseline to post-intervention or to the one-year follow-up, and there were no significant differences in changes between the groups. Conclusions: Evidence-based parenting program IY® seems to be an effective intervention for child conduct problems in the short term in families in the CPS context, but sustaining the positive effects and generalizing them to the daycare/school context are challenging. Trial registration: The trial is registered in the ClinicalTrials.gov registry (NCT03239990), Registered August 4th, 2017; https://clinicaltrials.gov/ct2/results?cond=&term=NCT03239990&cntry=&state=&city=&dist= [ABSTRACT FROM AUTHOR]

Potentially traumatizing events are common in adolescence, and these experiences have an impact on psychopathology. Furthermore, these events cumulate for certain individuals. More knowledge about the relationship between well-being and victimization experiences' amount, type, and timing in adolescents is needed to understand the phenomenon of adolescent victimization. In this cross-sectional study, we investigated in a population-based sample of Finnish adolescents, whether victimization experiences associate with psychosocial well-being. The study sample comprised 5743 adolescents aged 15–16 years who filled in a questionnaire about 12 victimization experiences and psychosocial well-being. General Linear Model regression analyses were used for statistical analysis. A greater number of victimization experiences and recent timing, as well as type of victimization such as cyberbullying, were linked to problems related to psychosocial well-being. It is important to recognize current forms of youth victimization to identify the adolescents at risk for psychosocial distress and investigate on specific types of victimization. [ABSTRACT FROM AUTHOR]

Background: Knowledge of the continuity of sleep problems and the associations between sleep and psychiatric symptoms in child psychiatric patients is scarce. Objectives: To investigate the persistency of sleep problems and how sleep at preschool age predicts sleep problems and psychiatric symptoms at school age in child psychiatric patients. Methods: Participants (n = 68) were child psychiatry outpatients at Helsinki University Hospital in 2015–2017. Caregivers evaluated sleep with the Sleep Disturbance Scale for Children (SDSC) and psychiatric symptoms with the Child Behavior Checklist (CBCL) at baseline (age 4–7 years) and again at follow-up (age 8–13 years). Family background information was collected at both time points. Results: Sleep problems at preschool age predicted sleep problems at school age (R2Adjusted =.48, p <.001). Persistent sleep problems associated strongly with the intensity of psychiatric symptoms (p =.001). Internalizing symptoms were predicted by sleep problems (p =.038) even after controlling for age, sex, and psychiatric symptoms at preschool age. Conclusion: Sleep problems are prevalent and persistent and relate to psychiatric symptoms in children treated at child psychiatry clinics. These results emphasize the need for identification and treatment of sleep problems in these children. [ABSTRACT FROM AUTHOR]

Abstract This randomized controlled trial (RCT) evaluated the effectiveness of the Incredible Years® (IY) Parenting Program in modifying children's behavioral problems, parenting practices and parents' psychological well-being among families under child protection and using other special support services. Participants in the study were 3–7-year-old children with behavioral problems (n = 102, intervention group n = 50, control group n = 52) and their parents (n = 122). The results show that parent reported child problem behavior as well as clinical levels of behavioral problems decreased to a greater extent in the intervention group than in the control group. The intervention also increased positive parenting practices. Changes in parental stress or parents' psychological well-being in the intervention did not differ from those in the control group over time. The results suggest some promising evidence that the IY parenting intervention may be effective in the context of child protection and other family support services in real-life conditions. Highlights • A structured parenting program in child protection services was evaluated. • Child problem behavior decreased. • Positive parenting practices increased. • No effect in parental stress or parents' psychological well-being was found. • Structured parenting program is effective in child protection services in real-life. [ABSTRACT FROM AUTHOR]

Background: Not much is known about low mood and its associates in child psychiatric patients. In this study, we examined the prevalence of low mood, how it associates with disruptive behaviour, and affects clinician-rated global functioning in child psychiatric outpatients. Methods: The study population consisted of 862 5-12 year-old child psychiatric patients. The study sample was a subsample of all 1251 patients attending a child psychiatric outpatient clinic at Helsinki University Hospital in 20132015 formed by excluding 4 year-old and 13 year-old patients and those with missing or incomplete data. The parentrated Strengths and Difficulties Questionnaire, collected as part of the routine clinical baseline measure, was used as a measure of psychiatric symptoms. The diagnoses were set according to ICD-10 by the clinician in charge after an initial evaluation period. The Children's Global Assessment Scale (CGAS) score set by clinicians provided the measure of the patients' global functioning. All information for the study was collected from hospital registers. Associations between emotional symptoms and conduct problems/hyperactivity scores were examined using ordinal regression in univariate and multivariate models, controlling for age and sex. The independent samples T test was used to compare the CGAS values of patient groups with low/normal mood. Results: In our sample, 512 children (59.4%) showed low mood. In multivariate ordinal regression analysis, low mood associated with conduct problems (OR 1.93, 95% CI 1.39-2.67), but no association was found between low mood and hyperactivity. Low mood was prevalent among children with oppositional defiant disorder or conduct disorder (51.8%). The global functioning score CGAS was lower among children with parent-reported low mood (52.21) than among children with normal mood (54.62, p < 0.001). The same was true in the subgroup of patients with no depression diagnosis (54.85 vs. 52.82, p = 0.001). Conclusions: Low mood is prevalent in child psychiatric outpatients regardless of depression diagnosis and it has a negative effect on global functioning. Low mood and behavioural problems are often associated. It is important to pay attention to low mood in all child psychiatric patients. We recommend prevention measures and low-threshold services for children with low mood. [ABSTRACT FROM AUTHOR]

The use of antipsychotics in children and adolescents has increased rapidly. Little is known about psychotropic polypharmacy in children and adolescent initiating an antipsychotic drug. Thus, we investigated the frequency and predictors of polypharmacy during the first year of antipsychotic use in Finnish children and adolescents. Between 2008 and 2016, 14 848 individuals aged 1–17 years initiating risperidone, quetiapine, aripiprazole, or olanzapine treatment were identified from Finnish Prescription Registry. Data on psychotropic drug prescriptions prior to and during antipsychotic treatment were collected. Associations between predictors and polypharmacy were analyzed with regression models. During the study period polypharmacy occurred in 44.9% of the new antipsychotic users, being more frequent in girls (55.5%) than in boys (44.5%, p < 0.001). The two most frequent concomitant psychotropic drug classes were antidepressants (66.2%) and psychostimulants/atomoxetine (30.8%). Adolescents aged 13–15 and 16–17 years, and girls showed an increased risk of polypharmacy during antipsychotic treatment (OR 2.37 [95% CI 1.91–2.92], OR 2.39 [95% CI 1.92–2.98], and OR 1.64 [95% CI 1.51–1.78], respectively). The use of psychostimulants/atomoxetine or antidepressants prior to initiation of antipsychotic treatment was strongly associated with polypharmacy during antipsychotic treatment (OR 8.39 [95% CI 7.49–9.41], OR 3.02 [95% CI 2.75–3.31]). Polypharmacy was common in children and adolescents initiating antipsychotic treatment. Prior use of psychostimulants/atomoxetine and antidepressants increased the risk of polypharmacy. The use of antipsychotics was mainly off-label, thus, the risks of concomitant use of antipsychotics with other psychotropic drugs should be carefully weighed. [ABSTRACT FROM AUTHOR]

Brain imaging studies have identified two cortical areas, the parahippocampal place area (PPA) and the retrosplenial complex (RSC), that respond preferentially to the viewing of scenes. Contrary to the PPA, little is known about the functional maturation and cognitive control of the RSC. Here we used functional magnetic resonance imaging and tasks that required attention to scene (or face) images and suppression of face (or scene) images, respectively, to investigate task-dependent modulation of activity in the RSC and whole-brain functional connectivity (FC) of this area in 7-11-year-old children and young adults. We compared responsiveness of the RSC with that of the PPA. The RSC was selectively activated by scene images in both groups, albeit less than the PPA. Children modulated activity between the tasks similarly in the RSC and PPA, and to the same extent as adults in PPA, whereas adults modulated activity in the RSC less than in PPA. In children, the whole brain FC of the RSC was stronger in the Sf than Fs task between the left RSC and right fusiform gyrus. The between groups comparison suggested stronger FC in children than adults in the Sf task between the right RSC and the left inferior parietal lobule and intraparietal sulcus. Together the results suggest that the function of the RSC and the related networks undergo dynamic changes over the development from 7-11-year-old children to adulthood. [ABSTRACT FROM AUTHOR]

salmela m., salanterä s. & aronen e.t. (2010) Coping with hospital-related fears: experiences of pre-school-aged children. Journal of Advanced Nursing 66(6), 1222–1231. Title. Coping with hospital-related fears: experiences of pre-school-aged children. Aim. This paper is a report of a study of how 4- to 6-year-old children cope with their fears associated with hospitalization and how they explain their experiences. Background. Pre-school-aged children are particularly vulnerable to the effects of stress and fear during hospitalization. Children cope with their fears through problem-oriented, emotion-oriented, and function-oriented coping strategies. Even pre-school-aged children can express their emotions and expectations quite well orally. However, little is known about the coping strategies of 4- to 6-year-old children related to hospital fears and the meaning of coping for children. Method. A qualitative method was chosen using a purposive sample of 89 children. The data were gathered using semi-structured interviews from 2004 to 2006. The data were analysed using Colaizzi’s method for phenomenological analysis. Findings. The children’s experiences of coping with hospital fears consisted of ten main clusters: pleasure, positive images, security, confidence, care, understanding the meaning of the situation, participating, asking for help, readjustment and protecting oneself. The coping strategies during hospitalization described by the children were familiar to them and part of their everyday lives. Conclusion. It is important to observe and support the child’s individual coping strategies. Pre-school-aged children need information and guidance to orientate themselves in unknown situations and to participate in decisions concerning their everyday life. Most of all, they need opportunities to play and experience pleasure. Children can also be taught coping strategies that give them an active, positive role. [ABSTRACT FROM AUTHOR]

Abstract: Using functional magnetic resonance imaging (fMRI) and n-back tasks we investigated whether, in 11–13-year-old children, spatial (location) and nonspatial (color) information is differentially processed during visual attention (0-back) and working memory (WM) (2-back) tasks and whether such cognitive task performance, compared to a resting state, results in regional deactivation. The location 0-back task, compared to the color 0-back task, activated segregated areas in the frontal, parietal and occipital cortices whereas no differentially activated voxels were obtained when location and color 2-back tasks were directly contrasted. Several midline cortical areas were less active during 0- and 2-back task performance than resting state. The task-induced deactivation increased with task difficulty as demonstrated by larger deactivation during 2-back than 0-back tasks. The results suggest that, in 11–13-year-old children, the visual attentional network is differently recruited by spatial and nonspatial information processing, but the functional organization of cortical activation in WM in this age group is not based on the type of information processed. Furthermore, 11–13-year-old children exhibited a similar pattern of cortical deactivation that has been reported in adults during cognitive task performance compared to a resting state. [Copyright &y& Elsevier]

Summary: Objective: To determine the prevalence of snoring in young children and to assess age, growth, previous surgery therapy, respiratory problems and sleep-related symptoms in relation to child''s snoring, and to evaluate the relationship between child''s snoring and parents’ snoring and smoking. Children and methods: A cross-sectional study evaluated 2100 children 1–6 years of age in Helsinki, Finland. Child''s frequency of snoring on a five-point scale (never to every night) and age, height, weight and body mass index, previous adenotonsillectomies, tympanostomies, allergic rhinitis and respiratory infections were determined as was frequency of parental snoring and smoking. Sleep problems were determined based on Finnish or Swedish modified version of the sleep disturbance scale for Children. Results: Of the 2100 eligible children, 1471 (71%) returned questionnaires. Children always or often snoring numbered 92 (6.3%), sometimes snoring, 183 (12.4%), and never or occasionally snoring, 1196 (81.3%). No difference in age (p =0.06) or gender (p =0.39) existed between snorers and non-snorers. History of previous adenotonsillectomies (p <0.001), allergic rhinitis (p <0.001), recurrent respiratory infections (p <0.001), and otitis media (p <0.001) were more common among snorers than among occasional or never-snorers. Nocturnal symptoms such as breathing problems, sleep hyperhydrosis, sleep-wake transition disorders, and daytime somnolence were associated with children''s snoring. Frequency of children''s snoring was also associated with parental snoring (p <0.001) and smoking (p <0.001). Conclusions: Snoring is common among young children and is associated with previous adenotonsillectomy, allergic rhinitis, respiratory infections, nocturnal symptoms, and parents’ snoring and smoking. The high prevalence of snoring among children with adenotonsillectomy raises the question whether adenotonsillectomy alone is adequate treatment for snoring in young children. [Copyright &y& Elsevier]

Parental behaviors may shape levels of psychopathic traits and antisocial outcomes among youth. To better evaluate the potential causality of these associations, we used eight follow-ups from the Pathways to Desistance study of 1354 offending adolescents (14.3% female; 40.1% black) and examined whether within-individual variation in parenting over time was associated with within-individual variation in psychopathic traits and offending. Multilevel regression models were adjusted for age, gender, ethnicity, contact with parental figure, and self-reported offending. Adolescent self-reported parental warmth was associated with lower psychopathic traits, and parental hostility with higher psychopathic traits. The results indicated that the more supportive and nurturing the parent, the lower the levels of psychopathic traits, whereas the more hostile the parent, the higher the levels, respectively. In addition, self-reported offending was predicted by higher parental hostility and lower maternal warmth. In time-lagged analysis, psychopathic traits did not predict parental behaviors. In young offenders parental warmth may protect against development of psychopathic traits in adolescence, whereas parental hostility may strengthen these traits. We conclude, that parenting quality matters in adolescence. Warm parenting style at this developmental period associates with lower psychopathic features among young offenders possibly lowering the risk of further criminal activity. Highlights: Maternal warmth was associated negatively with psychopathic traits and offending among adolescent delinquents. Paternal warmth protected from psychopathic traits but not from delinquency. Maternal and paternal hostility was linked positively to psychopathic traits and offending. [ABSTRACT FROM AUTHOR]

• The cost-effectiveness of child protection interventions is understudied. • Cost-effectiveness results are not directly transferable to complex populations. • The high prevalence of behavioral problems calls for high-quality research. • The segmentation of families is essential for cost-effective intervention targeting. Background: Children's behavioral problems have high prevalence among families in the child welfare system, raising the need for cost-effective ways to diminish the problems. Objective: We evaluated the cost-effectiveness of the Incredible Years® (IY) Parenting Program for children's behavioral problems compared with a treatment-as-usual (TAU) in families receiving child protection services (CPS) and other family support services in Finland, from the health and social care payer's perspective at the intervention end (post-assessment) and with a 12-month follow-up. Participants and setting: The randomized controlled trial included 102 families of 3–7-year-olds with behavioral problems. Families were recruited from CPS and other family support services in Finland. Methods: Incremental net monetary benefit analysis combined the costs and effects of IY intervention and TAU groups. Costs included intervention costs and register-based children's and mothers' health and social care costs. Effectiveness measures were the Eyberg Child Behavior Inventory and the Child Behavior Checklist. Results: In the post-assessment, the cost-effectiveness results varied according to the effectiveness measures. Compared to TAU, the IY intervention was either not cost-effective or the cost-effectiveness depended on the decision-makers' willingness to pay. In the 12-month follow-up, IY and TAU did not differ in costs or effects. Conclusions: The cost-effectiveness estimates from previously studied populations may not generalize to families receiving CPS. Families receiving CPS are in urgent need of cost-effective support to reduce the high prevalence of children's behavioral problems. Keywords: cost-effectiveness, parenting program, behavioral problems, child protection services, social services. [ABSTRACT FROM AUTHOR]

This study examined the incidence of attention-deficit/hyperactivity disorder medication among children and adolescents by sex and age group in Finland during 2008–2019.The data on children and adolescents aged 6–18 years receiving reimbursement for any attention-deficit/hyperactivity disorder medication was collected from the nationwide register on reimbursed purchases. The incidence was calculated as a ratio of the number of new users and the number of age and sex-matched population at risk. Negative binomial models were used to calculate rate ratios (RRs).In 2019, the incidence of attention-deficit/hyperactivity disorder medication was 13.4 per 1000 boys and 4.8 per 1000 girls. Among boys, the incidence became 3.7 times greater during the observed years (RR 95% confidence interval (CI) 2.0, 6.5, P<0.0001), whereas in girls it was 7.6 times greater (RR 95% CI 2.1, 27.4, P=0.0019). The boys had 2.8 times the incidence rate compared with the girls (RR 95% CI 2.2, 3.6, P<0.0001). The increase was associated with age only among boys (P=0.0001). The highest incidence rate 23.4 per 1000 individuals (95% CI 22.5, 24.4) was found in 2019 among 6–8-year-old boys.The incidence of attention-deficit/hyperactivity disorder medication use among children and adolescents increased significantly in Finland during the study period. Incidence was higher among boys, but the increase was greater among girls. The most common group to start attention-deficit/hyperactivity disorder medication was 6–8-year-old boys. These findings warrant critical evaluation of the diagnostic and treatment policies currently available in Finland for the treatment of attention-deficit/hyperactivity disorder and related symptoms. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess parents' satisfaction and perceived usefulness of the Incredible Years® (IY®) parenting programme in the Child Protection Services (CPS) context, where children's behaviour problems are common. Evidence‐based programmes are rarely offered in CPS, and little is known about how they are perceived by parents. We compared parents (N = 62) with (N = 43) and without (N = 19) CPS contact regarding their satisfaction with the IY® parenting programme, with information gathered from weekly and final evaluation forms. The attendance rate of parents to the weekly sessions (max 19) was also calculated. Comparisons between CPS and non‐CPS clients were analysed using multilevel models. Satisfaction scores ranged between 5.8 and 6.2 (max 7) for all studied domains. Mean attendance rate to the group sessions was 11.5 (SD 5.9), and 74% of participants attended at least nine out of 19 sessions. No group differences emerged in satisfaction or attendance between CPS and non‐CPS parents. Parents in CPS committed well to the programme and found it as useful as parents without CPS contact. IY® appears to be acceptable to parents involved in CPS, and their engagement to the programme can be considered as reasonably good. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate associations between internalizing and externalizing symptoms and deficits in executive functions (EF) as well as to examine the overall heterogeneity of EFs in a sample of preschool children attending a psychiatric clinic (n = 171). First, based on cut-off points signifying clinical levels of impairment on the parent-completed Child Behavior Checklist (CBCL), children were assigned into groups of internalizing, externalizing, combined or mild symptoms and compared to a reference group (n = 667) with regard to day care teacher ratings of EFs on the Attention and Executive Function Rating Inventory-Preschool (ATTEX-P). Second, latent profile analysis (LPA) was employed to identify distinct subgroups of children representing different EF profiles with unique strengths and weaknesses in EFs. The first set of analyses indicated that all symptom groups had more difficulties in EFs than the reference group did, and the internalizing group had less inhibition-related problems than the other symptom groups did. Using LPA, five EF profiles were identified: average, weak average, attentional problems, inhibitory problems, and overall problems. The EF profiles were significantly associated with gender, maternal education level, and psychiatric symptom type. Overall, the findings suggest that the comparison of means of internalizing and externalizing groups mainly captures the fairly obvious differences in inhibition-related domains among young psychiatric outpatient children, whereas the person-oriented approach, based on individual differences, identifies heterogeneity related to attentional functions, planning, and initiating one's action. The variability in EF difficulties suggests that a comprehensive evaluation of a child's EF profile is important regardless of the type of psychiatric symptoms the child presents with. [ABSTRACT FROM AUTHOR]

Assessment of behavioral disorders is one of the most commonly encountered tasks in child psychiatry. The Eyberg Child Behavior Inventory (ECBI) is a widespread measurement tool used for assessing conduct problems, though the psychometric properties of the tool have varied in different samples. In this study, the ECBI was evaluated in a Finnish population based sample of children aged 4 to 12 years (n = 1,715). Factor structure and internal consistency of the ECBI and associates of behavioral problems in Finnish children were evaluated. The results showed that a unidimensional one‐factor solution for the ECBI intensity scale was the best fit for the data. The ECBI mean scores were considerably higher in our sample compared to other Nordic countries. Boys scored higher than girls on both ECBI scales, and the mean scores decreased with child's age. Socioeconomic status (SES) was weakly connected to the ECBI scores. Our results highlight the need for country specific reference norms in order to improve the clinical utility of evidence‐based measures for assessing conduct problems. [ABSTRACT FROM AUTHOR]

We investigated in a child psychiatric sample whether preschool age executive functions (EFs) associate with concurrent and school age psychiatric symptoms and ADHD diagnosis. At baseline the children (n = 172) were 4–7 years old, at follow-up (n = 65) 8–13 years. EFs were measured at baseline with Attention and Executive Function Rating Inventory—Preschool Version, psychiatric symptoms were measured at both timepoints by Child Behavior Checklist. Information on diagnoses was collected from medical records. Deficits in EFs were associated with more concurrent externalizing and attention symptoms, but less internalizing symptoms. Preschool EFs predicted only school age attention symptoms. Preschool EFs were associated with both concurrent and school age ADHD diagnosis. Our results emphasize the importance of recognizing EF deficits early to arrange appropriate support to reduce later problems. More research is needed to understand the role of EFs over time in the manifestation of psychiatric symptoms in child psychiatric patients. [ABSTRACT FROM AUTHOR]

Earlier studies on adults have shown that functional connectivity (FC) of brain networks can vary depending on the brain state and cognitive challenge. Network connectivity has been investigated quite extensively in children in resting state, much less during tasks and is largely unexplored between these brain states. Here we used functional magnetic resonance imaging and independent component analysis to investigate the functional architecture of large-scale brain networks in 16 children (aged 7–11 years, 11 males) and 16 young adults (aged 22–29 years, 10 males) during resting state and visual working memory tasks. We identified the major neurocognitive intrinsic connectivity networks (ICNs) in both groups. Children had stronger FC than adults within the cingulo-opercular network in resting state, during task performance, and after controlling for performance differences. During tasks, children had stronger FC than adults also within the default mode (DMN) and right frontoparietal (rFPN) networks, and between the anterior DMN and the frontopolar network, whereas adults had stronger coupling between the anterior DMN and rFPN. Furthermore, children compared to adults modulated the FC strength regarding the rFPN differently between the brain states. The FC within the anterior DMN correlated with age and performance in children so that the younger they were, the stronger was the FC, and the stronger the FC within this network, the slower they performed the tasks. The group differences in the network connectivity reported here, and the observed correlations with task performance, provide insight into the normative development of the preadolescent brain and link maturation of functional connectivity with improving cognitive performance. [ABSTRACT FROM AUTHOR]

Friendships and romantic relationships may function as protective and risk factors for psychopathic traits. To better understand potential causal associations, we investigated whether within-individual changes in relationship characteristics were related to changes in psychopathic traits over time. Data were derived from ten repeated measurements of the Pathways to Desistance longitudinal study of 1354 offending adolescents (14.3% female; 40.1% Black). Analyses were adjusted for age, gender, ethnicity, self-reported offending and living facilities. Relationships of high quality were associated with lower psychopathic traits, whereas antisocial behavior and antisocial influence in relationships were related to higher psychopathic traits. Within-individual analysis indicated that time-invariant individual characteristics did not confound these associations. The findings suggest that the quality and antisocial activities of interpersonal relationships can affect positively or negatively on the levels of psychopathy. [ABSTRACT FROM AUTHOR]

The aims of this study were twofold: First, to describe a comprehensive assessment model utilized in a center specializing in child sexual abuse (CSA) investigations, and second, to describe the nature and characteristics of the families and allegations assessed, and analyze how case characteristics are related to the assessment outcomes of the CSA allegations. The sample consisted of 145 children who participated in a forensic CSA investigation between 2006 and 2011 at the Forensic Psychology Center in Helsinki University Central Hospital. Variables related to family characteristics and the alleged CSA were assessed. In the majority of the cases, the allegation was not substantiated, while a quarter of the allegations remained inconclusive. CSA was confirmed in 17% of the cases. Most of the investigated children and their families had several psychosocial risk factors in their background. The children and families involved in CSA investigations seemed to be a high-risk group in terms of psychiatric symptoms and multiple family background adversities. These were, however, unrelated to the assessment outcome. The importance of using a hypothesis testing approach is discussed, as well as how this can be done in practice. [ABSTRACT FROM AUTHOR]

Background: Sleep may underlie psychiatric symptoms in young children. However, not many studies have reported on sleep and its associations with symptoms in young child psychiatric patients. Objectives: To assess the amount and quality of sleep and how sleep associates with psychiatric symptoms in young child psychiatric patients. Furthermore, we evaluated how sleep and daytime somnolence differed in patients and their age- and gender-matched controls. Method: The sample consisted of 139 3- to 7-year-old child psychiatric outpatients and 139 age- and gender-matched controls from community. We evaluated sleep and daytime somnolence with the Sleep Disturbance Scale for Children in all children and psychiatric symptoms with Child Behaviour Checklist (CBCL) in the patient group. Family background information was collected from the patients. Results: Of the patients, 31.6% had a significant sleep problem and 14.4% slept too little. The most typical sleep problems were restless sleep (31.7%), morning tiredness (21.6%) and difficulties getting to sleep at night (18.7%). All types of sleep problems were associated with CBCL total, internalising and externalising problems (all p-values < .01). We observed a strong association between all types of sleep problems and emotionally reactive subscale (p-value < .001). Furthermore, parent-reported sleep problems increased significantly the risk of having high scores on total (odds ratio (OR) = 5.3, 95% confidence interval (CI) = [2.2, 12.6], p < .001), external (OR = 3.7, 95%, CI = [1.6, 8.5], p < .01) and internal (OR = 2.5, 95% CI = [1.1, 5.5], p < .05) scores after controlling for age, gender, family structure and parent’s educational level. Even mild sleep disturbance increased the intensity of psychiatric symptoms. Compared to controls, patients slept less (p < .001) and had significantly more frequent restless sleep, nightmares and morning and daytime somnolence. Conclusion: Sleep problems and too little sleep are prevalent in young child psychiatric patients, and they relate strongly to the intensity of psychiatric symptoms. Identification and treatment of sleep problems should be a routine part of the treatment plan for young child psychiatric patients. The results emphasise the need for assessing sleep in young child psychiatric patients, as treating the sleep problem may reduce psychiatric symptoms. [ABSTRACT FROM AUTHOR]

Background:Psychopathy research has thus far focused mostly on child, male, and delinquent samples, but the results are most likely non-generalizable to adolescent girls with mental health disorders. Aim:The present study aimed to compare self-rated psychopathic traits between female psychiatric outpatients and girls in the community, and to investigate how psychopathic traits relate to psychiatric disorders. Method:The outpatient sample comprised 163 girls aged 15–17-years recruited from municipal mental health services. Psychiatric diagnoses were assessed based on the ICD-10 classification. The community sample comprised 355 girls from secondary, vocational, and high schools. The Youth Psychopathic trait Inventory (YPI) served as a self-assessment tool. Results:Treatment-seeking girls exhibit a more impulsive and irresponsible lifestyle than do girls in the community. Girls with externalizing psychopathology, unlike those with an internalizing disorder, exhibit more deficient affective experience than do girls in the community. Psychopathic traits associate with having a psychiatric disorder, a depressive disorder, ADHD, and a conduct disorder. Conclusions:The psychiatric examination of treatment-seeking adolescent girls would likely benefit from screening for psychopathy and its underlying components. [ABSTRACT FROM PUBLISHER]

The aim of this study was to explore the relationship between sleep, including both qualitative and quantitative aspects, and delinquent behaviour while controlling for psychopathic features of adolescents and parental supervision at bedtime. We analysed data from a nationally representative sample of 4855 Finnish adolescents (mean age 15.3 years, 51% females). Sleep problems, hours of sleep and delinquency were evaluated via self-report. Psychopathic features were measured with the Antisocial Process Screening Device - Self-Report. In negative binomial regressions, gender and sleep-related variables acted as predictors for both property and violent crime after controlling for psychopathic features and parental supervision at bedtime. The results suggest that both sleep problems (at least three times per week, at least for a year) and an insufficient amount of sleep (less than 7 h) are associated with property crime and violent behaviour, and the relationship is not explained by gender, degree of parental supervision at bedtime or co-occurring psychopathic features. These results suggest that sleep difficulties and insufficient amount of sleep are associated with delinquent behaviour in adolescents. The significance of addressing sleep-related problems, both qualitative and quantitative, among adolescents is thus highlighted. Implications for a prevention technique of delinquent behaviour are discussed. [ABSTRACT FROM AUTHOR]

Background: In general psychiatric services, cost-benefit screening instruments for psychopathic traits in adolescents are needed. The aim of the present study was to study the psychometric properties of the Finnish versions of the Youth Psychopathic traits Inventory (YPI) and the Antisocial Process Screening Device (APSD-SR) in community youth. As gender-specific differences exist in psychopathic traits, we analyzed the data separately in girls and boys. Methods: The YPI and the APSD-SR were administered to 372 9th graders (174 boys and 198 girls) with a mean age of 15.06 years (SD 028). Cronbach's alphas were used to study internal consistency. The factor structures of the self-assessments were studied using both Confirmatory Factor Analysis (CFA) and Principal Component Analysis (PCA). Results: In both self-assessments, boys scored significantly higher in the total scores, Interpersonal and Affective dimension scores as well as in most sub-dimensions. In the YPI, the alpha values for total and dimensional scores ranged from 055 to 0.91 in boys and from 0.74 to 0.89 in girls and, in the APSD-SR, respectively, from 038 to 0.78 and from 0.29 to 0.78. In CFA, the three-factor model produced poor fit for both self-assessments. For the ten sub-dimensions of the YPI, the PCA suggested two factors. Extending the model into three components showed sutxiimension loadings according to the original dimensions. For the APSD-SR, the PCA regaled a five-factor structure in the male sample and a six-factor one in the female group. When limiting the model to a three factor-model, we obtained a structure, which resembled the original dimensions. Conclusions: Both the YPI and the APSD-SR are promising tools of screening for psychopathic features in Finnish community youth. The YPI turned out to be slightly better than the APSD-SR in both reliability and factor structure. However, the original three-factor models did not find support Both self-assessments were somewhat weak for tapping the callous-unemotional traits of the psychopathic character, but, again, the YPI worked better than the ASPD-SR Both self-assessments revealed significant gender differences in psychopathic character traits. [ABSTRACT FROM AUTHOR]

The current study assessed the associations between sleep and psychosocial symptoms in 157 Finnish adolescents with inflammatory bowel disease (IBD). Sleep trouble was self-rated in Sleep Self-Report (SSR) and in Youth Self-Report (YSR). Psychosocial symptoms of the adolescents were assessed by the YSR and Child Behavior Checklist (CBCL). Patients reporting sleep trouble had significantly more psychosocial symptoms than their counterparts without sleep trouble. This was shown in the CBCL and YSR scales of total problems (p < 0.01), anxious/depressed mood (p < 0.05), and aggressive behavior (p < 0.01). Additionally, SSR sleep problem subscale scores indicating lower sleep quality (bedtime, sleep behavior) associated significantly with attention problems (p < 0.05). These results point out that sleep trouble should be recognized and treated in adolescents with IBD to possibly avoid the emerging of psychosocial symptoms. [ABSTRACT FROM AUTHOR]

Aim To characterize mother-child interaction in children with suspected gastrointestinally manifested cow's milk allergy ( GI- CMA) and to explore factors associated with the parentally perceived symptoms. Methods We invited a randomly selected group of children with suspected GI- CMA and their mothers to take part in a video recording of them playing together. The mother-child interaction was rated using the Emotional Availability Scales ( EAS, 4th edition) and compared with national normative data. Results Video recordings were conducted with 24 patients (15 girls and nine boys) with a median age of 10.1 months (range 2.1-20.5 months) undergoing a double-blind, placebo-controlled food challenge for cow's milk allergy. The EAS profile in the challenge negative group (17/24) was significantly different from the normative data. The scores for maternal sensitivity (p = 0.0049) and nonintrusiveness (p = 0.0192), together with child responsiveness (p = 0.0053) and involvement of mother (p = 0.0085), were all significantly lower when compared to the normative data. The dimensions of maternal nonhostility and structuring, as well as the scores of the challenge positive group, did not differ from the normative data. Conclusion Dysfunctional mother-child emotional interaction was frequent in young children with suspected GI- CMA ruled out by the cow's milk challenge. Appropriate psychological support should be considered. [ABSTRACT FROM AUTHOR]

Abstract: Developmental studies have demonstrated that cognitive processes such as attention, suppression of interference and memory develop throughout childhood and adolescence. However, little is currently known about the development of top-down control mechanisms and their influence on cognitive performance. In the present study, we used functional magnetic resonance imaging to investigate modulation of activity in the ventral visual cortex in healthy 7–11-year-old children and young adults. The participants performed tasks that required attention to either face (Fs task) or scene (Sf task) images while trying to ignore distracting scene or face images, respectively. A face-selective area in the fusiform gyrus (fusiform face area, FFA) and an area responding preferentially to scene images in the parahippocampal gyrus (parahippocampal place area, PPA) were defined using functional localizers. Children responded slower and less accurately in the tasks than adults. In children, the right FFA was less selective to face images and regulation of activity between the Fs and Sf tasks was weaker compared to adults. In the PPA, selectivity to scenes and regulation of activity, there according to the task demands were comparable between children and adults. During the tasks, children activated prefrontal cortical areas including the middle (MFG) and superior (SFG) frontal gyrus more than adults. Functional connectivity between the right FFA and left MFG was stronger in adults than children in the Fs task. Children, on the other hand, had stronger functional connectivity than adults in the Sf task between the right FFA and right PPA and between right MFG and medial SFG. There were no group differences in the functional connectivity between the PPA and the prefrontal cortex (PFC). Together the results suggest that, in 7–11-year-old children, the FFA is still immature, whereas the selectivity to scenes and regulation of activity in the PPA is comparable to adults. The results also indicated functional immaturity of the PFC in children compared to adults and weaker connectivity between the PFC and the rFFA, explaining the weaker regulation of activity in the rFFA between the Fs and Sf tasks. [Copyright &y& Elsevier]

Abstract: Objective: To assess the link between sleep-disordered breathing and cognitive function in children. To identify correlations among polysomnography, upper respiratory infections, or cephalometric as well as rhinometric measures. Methods: This study is based on a questionnaire survey of snoring in a population cohort of 2100 children. Altogether, 44 snorers and 51 non-snorers participated in this community based clinical study. All children underwent polysomnography, cephalometry and rhinometric measurements. In addition, a standardized test of intelligence (WPPSI-R), a neuropsychological test battery (NEPSY) and a parental questionnaire on behavioral symptoms (CBCL) were administered. Results: Frequently snoring children scored lower in Language functions (Comprehension of Instructions, P =0.01; Speeded naming, P =0.007) and had more internalizing problems, P =0.04 than did the non-snoring group. However, the polysomnography parameters of these snoring children revealed no major sleep-related breathing disorder. OAHI, mean lowest SpO2 and respiratory effort correlated with Auditory Attention (P <0.05), Body Part Naming (P <0.05) and Memory (P <0.05). Tonsillar size correlated with OAHI (P <0.01) and respiratory effort (P =0.01) and respiratory airflow (P <0.01). In cephalometry, the minimal distance from velum to posterior wall was shorter showing the shorter length among snorers than non-snorers, 5.5mm vs. 6.6mm, respectively (P <0.05). Recurrent upper respirataory infections (URIs) were common among the snoring than non-snoring children (P =0.01). Children suffering recurrent URIs have more somatic complaints than children without recurrent URIs (P <0.01). Conclusions: Snoring children with apparently normal and/or no obstructive apnea, hypopnea, or marked SpO2 desaturations appear to suffer impairment in neurocognitive and behavioral functions compared to non-snoring children. These snoring children did not reveal any major abnormalities of polysomnographic parameters, such as sleep-related breathing disorder, including partial upper airway obstruction. Polysomnographic parameters also correlated poorly with neurocognitive test results in these snoring children. The correlations between polysomnography and upper respiratory infections, with cephalometric and rhinometric measures, were also poor. [Copyright &y& Elsevier]

Aim: The aim of this study was to describe the child-reported coping strategies for hospital-related fears in 4–6-year-old children. Method: The data were collected by semi-structured interviews of 4–6-year-old volunteering children ( n= 82) in Finland. Thirty-four children were interviewed in hospital, and 48 in kindergarten. The children were chosen through a purposive sampling method, in which volunteers were asked to take part in the study. The data were analysed with quantitative and qualitative methods. Results: The most frequent child-reported coping strategies were: the presence of parents and other family members (81/517, 15.7%), the help of the hospital personnel (58/517, 11.2%), positive images and humour (57/517, 11%), play (57/517, 11%) and the child's own safety toy (45/517, 8.7%). The children interviewed in hospital mentioned significantly more often play ( P= 0.000) as their coping strategy than children interviewed in a kindergarten. Children interviewed in kindergarten expressed significantly more often the presence of parents ( P= 0.032) and the help of the doctor ( P= 0.012) as their coping strategy than the children interviewed in the hospital. Conclusions: The results showed that children have many coping strategies, especially ones in which the children themselves play an active role. Besides, the traditional methods for alleviating fear, children need possibilities to use coping methods in which they have an active role giving them a feeling of some control over the hospital environment and medical procedures. [ABSTRACT FROM AUTHOR]