Search

Developmental dyscalculia (DD) is a neurodevelopmental disorder specific to arithmetic learning even with normal intelligence and age-appropriate education. Difficulties often persist from childhood through adulthood. Underlying neurobiological mechanisms of DD, however, are poorly understood. This study aimed to identify possible structural connectivity alterations in DD. We evaluated 10 children with pure DD (11.3 plus-or-minus sign 0.7 years) and 16 typically developing (TD) peers (11.2 plus-or-minus sign 0.6 years) using diffusion tensor imaging. We first assessed white matter microstructure with tract-based spatial statistics. Then we used probabilistic tractography to evaluate tract lengths and probabilistic connectivity maps in specific regions. At whole brain level, we found no significant microstructural differences in white matter between children with DD and TD peers. Also, seed-based connectivity probabilities did not differ between groups. However, we did find significant differences in regions-of-interest tracts which had previously been related to math ability in children. The major findings of our study were reduced white matter coherence and shorter tract lengths of the left superior longitudinal/arcuate fasciculus and left anterior thalamic radiation in the DD group. Furthermore, lower white matter coherence and shorter pathways corresponded with the lower math performance as a result of the correlation analyses. These results from regional analyses indicate that learning, memory and language-related pathways in the left hemisphere might underlie DD. Keywords: Mathematical learning disability, diffusion tensor imaging, superior longitudinal fasciculus, anterior thalamic radiation, probabilistic tractography, tract-based spatial statistics

OBJECTIVES: Previous studies suggested that inattention was related particularly with reading problems among students. However, most of the former studies had clinically referred samples. A majority of the studies conducted with nonreferred samples have evaluated academic achievement with single or a few parent- or teacher-rated items. Almost none of the studies have investigated reading, writing, and mathematics achievements in a single sample. Data from low- and middle-income countries on the subject are exceedingly scarce. Objectives of the present study were to compare actual measurements of reading fluency, reading comprehension, reading and writing errors, mathematics achievement, and teacher ratings of attention deficit hyperactivity disorder (ADHD) symptoms in a single sample. METHODS: Teachers rated ADHD symptoms in a single, nonreferred, population sample (n = 2493) of first- to fourth-grade students with a SNAP-4 rating scale. Actual measurements of reading fluency, reading comprehension, reading and writing errors, and mathematics achievement were also obtained. Fluid IQ was evaluated with Ravens Progressive Matrices. Students were grouped into Predominantly Inattentive (PI), Hyperactive/Impulsive (HI), Combined (C), or control groups. Univariate and multivariate analyses were conducted. Statistical significance was set at p

Aim of the present study was to investigate whether 4-years continuity of teacher rated hyperactivity and inattention symptoms were associated with lower academic performance in language, mathematics, and total grade average. Gender, age, fluid IQ, previous academic level, and teacher reported Strengths and Difficulties Questionnaire (SDQ) total problems score at the first assessment were controlled in an urban low-middle-income-country setting. The follow-up sample with full SDQ data consisted of 967 students (boys: 523, 54.1%; girls: 444, 45.9%) from fifth to eight grades. Using cut-off 7 for SDQ Hyperactivity score for each assessment, the students were categorized into four groups: continued group (CG) (4.4%); declining group (DG) (6.9%); increasing group (IG) (9.0%); and consistently low (LG) group (79.6%). In the follow-up assessment, CG and IG had significantly higher SDQ scores when compared with both DG and LG and DG had significantly higher SDQ Hyperactivity and Total problems than LG. CG had significantly lower Mathematics, Language and Total average when compared with all other groups. IG and DG had significantly lower Mathematics, Language and Total average than LG. In regression analysis, odds ratios for CG students were between 5,1 to 7,4 for being in the lowest 25 percentile in all courses. These results imply that teacher reports of hyperactivity and inattention are significant predictors of academic failure, even when the symptoms are below threshold. Therefore, screening students for hyperactivity and inattention early and starting interventions early may be an effective policy to prevent academic failure.

OBJECTIVES: Modified Checklist for Autism in Toddlers (M-CHAT) is widely used internationally to screen autism spectrum disorder (ASD). Three-item Direct Observation Screen (TIDOS) is a novel observational tool which may be used by physicians in a short time as a part of routine well-child visit. It includes the following: (a) Joint Attention, (b) Eye Contact, and (c) Response to Name. We aimed to compare the screening performance of TIDOS and M-CHAT for ASD. MATERIAL AND METHODS: A total of 1345 children aged 16–38 months were examined during well-child care visits at Social Pediatrics Department of Ankara University between May 2015 and May 2016. Five hundred and eleven of 1345 children aged 16—38 months whose parents approved informed consent were enrolled in this study to evaluate the performance of two screening tests: TIDOS and M-CHAT for ASD. The children whose screening tests were positive and controls whose tests were negative had undergone clinical evaluation for the diagnosis of ASD. Clinical evaluation was performed within 2 weeks of the initial M-CHAT, M-CHAT/F, or TIDOS screenings for screening positive children and within 3–9 months for screening randomly selected negative children. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of those tests were determined. RESULTS: ASD was diagnosed in 5 of the 511 children in a healthy child clinic of a university hospital with the prevalence of approximately 1%. All the children with ASD were boys. The growth parameters (including body weight, height, head circumference) did not have any properties. There were no consanguineous marriages among the parents of children with ASD. The ages of mothers and fathers of the children with ASD were in a range between 31–39 years and 31–46 years, respectively. The sensitivity for diagnosis of ASD was found to be 0.60 for both M-CHAT and M-CHAT/F tests. The specificity of M-CHAT and M-CHAT/F tests for diagnosis of ASD was found to be 0.96 and 0.97, respectively. PPV were found to be 0.14 and 0.18, respectively. The sensitivity for diagnosis of ASD was found to be 0.80 for TIDOS. Specificity and PPV in the diagnosis of ASD were found to be 0.99 and 0.80, respectively. NPV for all tests were above 0.99. CONCLUSION: The current study has demonstrated that TIDOS was more sensitive and had higher PPV than M-CHAT. TIDOS has required little time and might be easily combined to routine physical examination of toddlers attending 18- to 36-month well-child clinic visits.

OBJECTIVE: In the last decade, using social network sites (SNSs) has grown and become an integral part of daily routine for adolescents. As known, ADHD is a major public health problem for all addiction types, including the Internet and SNSs addiction. Our aim was to examine the effect of ADHD, impulsivity types, using motivations, internalizing and externalizing symptoms on Facebook (FB) overuse and FB addiction among adolescents. METHODS: Participants were recruited from ADHD and non-ADHD adolescents who were applied to the child and adolescent psychiatry and have an active FB account. We used FB Use and Motivations Form, the Barratt Impulsiveness Scale (BIS), Bergen FB Addiction Scale (BFAS) and Conners-Wells’ Adolescent Self-Report Scale-Long form (CASS:L). RESULTS: Our results indicated that ADHD adolescents have more fake FB accounts, have their own accounts for longer time, are using FB for more motivation types and FB overuse is more frequent than in non-ADHD counterparts. According to the degree of FB use, we have shown that adolescents with FB overuse behaviour have more externalizing symptoms and have higher CASS:L and Barrat impulsivity scores than others. Risk factors for FB overuse are: having a fake FB account and having higher ADHD index scores; risk factors for FB addiction are: higher attentional impulsivity, higher conduct problems scores and higher ADHD index scores. CONCLUSIONS: The results of this study have improved our understanding about the risk factors of a new behavioural addiction type among adolescents.

WOS: 000422640800005 Objective: Although it has been suggested that attention-deficit/hyperactivity disorder (ADHD) is common in children who were abused and that ADHD can be a risk factor for abuse itself, there are very few studies which investigated whether adult ADHD is associated with childhood abuse and neglect. The aim of this study was to fill this gap in the literature. Method: Seventy adults with DSM-IV ADHD diagnosis and 70 healthy control subjects were included in the study. We used Adult ADHD Self Rating Scale (ASRS) and Wender Utah Rating Scale (WURS) to support the diagnosis. All subjects were assessed using Childhood Trauma Questionnaire (CTQ), Adverse Childhood Experiences (ACE) Scale, Post-traumatic Stress Disorder Checklist (PCL), Dissociative Experiences Scale (DES), and Symptom Checklist-90Revised. Results: ADHD subjects had higher ASRS inattentiveness, hyperactivity/impulsivity, WURS, and Symptoms Checklist-90 (SCL-90) General Symptom Index scores than controls. ADHD group also had higher PCL, DES and ACE scores. In CTQ, ADHD subjects had higher emotional abuse and neglect scores than control subjects. ASRS and WURS scores were correlated with PCL, ACE, CTQ Emotional Abuse, and DES scores; WURS score was also correlated with CTQ Physical Abuse and Neglect scores. Regression analysis indicated that general level of psychopathology was most significantly associated with DES and PCL scores. Conclusions: Results suggested that ADHD cases were more commonly exposed to emotional abuse and neglect. They had significantly more dissociative experiences and reported Posttraumatic Stress Disorder (PTSD) symptoms more frequently. The results pointed to the importance of childhood traumatic and adverse experiences in adults with ADHD.

The study assessed the feasibility of using a Turkish-version of the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R/F) as a screening tool for an urban low risk population of young children. M-CHAT-R/F was completed for 6,712 children between ages 16 to 36 months living in Istanbul, Turkey. Autism Diagnostic Observation Schedule-2 was served as the main measure for diagnosis. M-CHAT-R/F screen was positive for 9.8% of children. At follow up interview, 39.7% of initial screen-positive children met criteria for ASD. The study identified 57 (1 in 117) children with ASD (0.8%; 95% CI: 0.063%−1.05%). M-CHAT-R/F performed comparably in Turkey as in United States. Implications of the study for future universal screening for autism in Turkey is also discussed.

Objective: To determine the factors associated with type of ADHD prescription and re-admission of the cases to the outpatient clinics between January-July 2013. Method: The Ministry of Health prescription database, which included prescriber, region, age and gender data and contained almost 20% of IMS data. Results: A total of 73,189 prescription were prescribed to a total of 41,341 (30,014 males; 72.7%) patients. 38645 (93.5%) of the patients were between 6 and 18 years of age. The most frequently prescribed drug was OROS methylphenidate (MPH, 59.7%) followed by IR MPH, atomoxetine and combination of drugs. There were several regional differences in prescription practice. Treatment choice changed significantly with age and gender. Rate of repeated prescription was highest among 6-18 year-old male subjects receiving combination treatment. Conclusions: ADHD treatment choice seemed to be heavily influenced by official regulations. Age, gender and drug of choice were important factors associated with treatment adherence. © 2016, Cukurova Univ Tip Fakultesi Psikiyatri Anabilim Dali. All rights reserved.

To investigate the effect of Attention Deficit Hyperactivity Disorder (ADHD), antisocial behavior and anxiety/depression ratings of mothers, and child and adolescents' age, gender, ADHD subtype, and comorbidity on one-month drug treatment response to OROS methylphenidate in ADHD in a naturalistic setting.The analyses included 223 subjects (191 boys, 32 girls; age 6-15 years, mean: 9.4) treated with OROS methylphenidate (18-72 mg/day, mean: 31 mg/d; 0.4-1.4 mg/kg/d) for one-month. Treatment response was defined as larger than 25% or more decrease in pre-treatment the Conners Parent Rating Scale (CPRS) or the Conners Teacher Rating Scale (CTRS) total scores and the Clinical Global Impression improvement with drug treatment 3 (minimally improved) or higher. Maternal ADHD, antisocial behavior and anxiety/depression ratings were obtained by the Adult Self Rating (ASR). Logistic regression analyses were computed in order to calculate the effects of gender; age; ADHD subtype; comorbid anxiety disorder, learning disorder, oppositional defiant/conduct disorder; maternal ASR Anxiety/Depression, ADHD and Antisocial scores.35.2% of subjects had statistically significant 25% or more decrease in pretreatment CPRS total scores and 38.6% of subjects had statistically significant 25% or more decrease in pretreatment CTRS total scores. The subjects with comorbid anxiety disorder had the poorest drug response. Maternal self-reported antisocial and anxiety/depressive symptomatology were statistically significantly associated with worse response to treatment in terms of CPRS (respectively, OR=0.83, 95% CI: 0.75-0.92, p0.01; OR=0.95, 95% CI: 0.9-0.99, p0.05) and CTRS total scores (OR=0.9, 95% CI: 0.82-0.99, OR=0.95, 95% CI: 0.91-1, p0.05). Baseline rating scores were also important predictors of drug treatment response. Effects of age, gender and maternal ADHD were not statistically significant.ADHD children and adolescents with comorbid anxiety disorders and those whose mothers have more self-reports of antisocial and depressive symptoms showed less favorable short-term response to OROS-MPH. These subjects may require further attention and additional interventions to augment treatment with OROS methylphenidate.

Objective: To investigate the incidence of iodine deficiency (ID) and its effects on mental function in children referred to the Dr. Sami Ulus Maternity and Children’s Training and Research Hospital with a prospective diagnosis of attention deficit/hyperactivity disorder (ADHD). Methods: The study was conducted on 89 children referred in the period from September 2009 to June 2010 with a diagnosis of ADHD. A questionnaire was given to all parents. Conners’ rating scales were applied to the parents (CPRS) and teachers (CTRS), and revised Wechsler intelligence scale for children (WISC-R) to the children. Serum thyroid-stimulating hormone, free triiodothyronine and free thyroxine, thyroglobulin, anti-thyroid peroxidase, anti-thyroglobulin, and urinary iodine levels were measured in all children. Results: Median age was 9.41±1.95 years, and 83.1% of subjects were male. The mean urinary iodine level of the children was 92.56±22.25 μg/L. ID was detected in 71.9% of subjects and all were mild ID. There was no significant relationship between urinary iodine levels with WISC-R subtest scores and CPRS. However, a significant association was found between urinary iodine levels and hyperactivity section of CTRS (p

Emotional availability (EA) is a method to assess early parent-child dyadic interactions for emotional awareness, perception, experience, and expression between child and parent that describe global relational quality (Z. Biringen & M. Easterbrooks, 2012). The current study aimed to examine the effects of an infant's diagnosis of autism spectrum disorders (ASDs), other psychiatric disorders (OPD), and developmental delay (DD) on the maternal EA Scale (EAS; Z. Biringen & M. Easterbrooks, 2012; Z. Biringen, J.L. Robinson, & R.N. Emde, 2000) scores and the relative contributions of infant's age, gender, diagnosis, developmental level, and maternal education on EAS scores in a clinical Turkish sample. Three hundred forty-five infant-mother dyads participated in this study. Results of the research indicated that EAS adult scores were associated with maternal education and infant's diagnosis whereas child scores were associated with infant's age, diagnosis, and developmental level. Infants' involvement and responsiveness to the mother were lower in the group with ASD. Children with OPD, particularly when their mothers have lower education, might be at increased risk of having problems in parent-child interactions. Young ASD subjects with developmental delay are in greatest need of support to increase reactions toward their mother. These findings underscore the importance of using all of the EA dimensions rather than only one measure on children in high-risk populations.

The social defeat (SD) hypothesis of schizophrenia posits that repeated experiences of SD may lead to sensitization of the mesolimbic dopaminergic system and to precipitation of psychosis. Based on previous definitions adapted to a human experimental paradigm, we prepared a computer simulation of SD to mimic this subjective experience. We measured prefrontal cortex (PFC) activity in subjects with schizophrenia and healthy controls during exposure to a single SD experience with functional near infrared spectroscopy. PFC activity declined in both groups. Compared with the control condition, SD exposure was associated with a broader decline in left ventromedial, right medial and right lateral PFC activity in healthy controls (n=25), and a sharper decline in right ventrolateral PFC activity in subjects with schizophrenia (n=25). The activity in the right ventrolateral PFC, was significantly lower in patients compared with controls. This may be due to a deficiency in emotion regulation or self-control, or it may be related to impaired empathy in schizophrenia. Different patterns of brain activity during the SD experience in subjects with schizophrenia versus healthy controls may provide indirect evidence regarding the SD hypothesis of schizophrenia.

Successful treatment of school refusal must target several areas, since there are child, parent and family based reinforcers. This requires an integrated treatment including psychopharmacology, psychoeducation, somatic management techniques, cognitive-behavioral restructuring, social and communication skills training and working with parents. A vital part of treatment is establishing rewards and punishments, contingency management and exposure to school. However, these goals cannot be achieved in every case with outpatient treatment. Here, we have presented two cases, who were hospitalized due to severe symptoms which were not responsive to routine treatment. Multimodal treatment involving a three-stage cognitive behavioral intervention, family therapy, social skills training, relaxation training, contingency management and pharmacotherapy was used.

Several studies have shown that iron deficiency and ferritin levels are associated with parent and teacher Attention Deficit Hyperactivity Disorder (ADHD) ratings. Although there are conflicting results, it has also been reported that iron supplementation may help to decrease ADHD symptoms. When all these previous studies are taken into account, it is clear that a large study investigating the effects of iron deficiency and ferritin levels on routine pharmacological treatment of ADHD with stimulants would be helpful to elucidate this treatment from a clinical point of view.A total of 345 subjects with combined or predominantly hyperactive-impulsive (PHI) subtypes of ADHD were included. All diagnoses were based on the DSM-IV criteria and ascertained by direct interviews conducted by the authors, who are experienced child psychiatrists certified in the use of the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) semi-structured interview. The two treatment response criteria were: 1) 25% or more decrease in pre-treatment Conners Parent Rating Scale (CPRS) and Conners Teacher Rating Scale (CTRS) Hyperactivity (HA) and Total Problems scores; 2) CPRS and CTRS HA scores lower than the cut-off point ("very improved").A total of 255 (73.9%) patients were on OROS-methylphenidate (OROS-MPH) and 90 (26.1%) were on immediate release methylphenidate (IR-MPH). The mean±sd of OROS-MPH and IR-MPH doses were 28.8±8.1 and 20.9±7.1 mg, respectively. More than half (52.5%) of the subjects were previously drug-naive at treatment inception. Two hundred and seventy eight (80.6%) subjects had combined subtype ADHD and the remainder had predominantly hyperactive-impulsive subtype. Only 60 (17.4%) of the subjects had no comorbid disorders, while 38.3% had one comorbid disorder, 32.8% had two comorbid disorders, and 11.6% had three or more comorbid disorders. The most frequent comorbidity was Oppositional Defiant Disorder/Conduct Disorder (ODD/CD, 51.6%), followed by Learning Disabilities (LD, 35.4%) and Anxiety Disorders (AD, 15.9%). Logistic regression analysis showed that subjects with comorbid ODD/CD and LD were less likely to respond to treatment. Ferritin levels and iron deficiency were not associated significantly with outcomes.In a large sample of subjects with combined or predominantly hyperactive-impulsive subtypes of ADHD, after controlling for several factors, we found that neither iron deficiency (ferritin12 ng/ml) nor ferritin levels were associated with less favorable short-term treatment outcomes with stimulants. Subjects with comorbid ODD/CD and LD were less likely to have a 25% or more decrease in CTRS Total score. The presence of ODD/CD was also a negative predictor of treatment response in terms of CPRS Total and HA scores. The lack of a negative treatment response in ADHD subjects with iron deficiency and lack of a negative association with ferritin levels suggest that the relationship between iron metabolism and ADHD, a highly heterogeneous disorder, may be more complicated than previously believed.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders of childhood and adolescence. There are currently three subtypes of ADHD: combined, inattentive and hyperactive-impulsive, as defined by the DSM-IV-TR criteria1. The exact pathophysiology of ADHD symptoms remains unclear, although several converging lines of investigation suggest that both genetic and environmental factors, and their interactions, are important. An emerging interest of research in recent years has been the investigation of a possible association of iron metabolism as a risk factor for ADHD. To date, although a number of studies have shown that children with ADHD have lower mean ferritin levels when compared with normal controls, and that low serum ferritin levels are related with more severe ADHD ratings, as reported by teachers and/or parents 1–5, other studies have also reported negative findings6–7 . Understandably, a number of studies have also focused on the utility of iron supplementation in ADHD; these studies have yielded conflicting results8–9. It has also been shown that iron deficiency during infancy might lead to learning and memory problems, which might also have enduring effects in grade-school period10. In a relatively small sample, we previously reported that there were no significant correlations between ferritin level and performance in vigilance and sustained attention tasks, executive function tests like planning and organization, complex problem solving, set shifting, and response monitoring3. In another distinct sample, we also showed that presence of comorbid conditions might also increase the effect of lower iron stores on behavioral measures11. However, the sample size of this latter study did not allow us to control for the effects of ADHD subtype as well as different comorbid conditions on parent and teacher ratings. In this study, our aim was to investigate the relationship between age, gender, ferritin level, hemoglobin, mean corpuscular volume (MCV), reticulosite distribution width (RDW) with parent and teacher reports and cognitive measures in a large sample of children and adolescents with ADHD. The control of ADHD subtype and specific comorbid condition categories is important since it has been shown that both are associated with symptom ratings12–13. We therefore also controlled for confounders including ADHD subtype (combined, inattentive, hyperactive-impulsive), presence of comorbid conditions (grouped into four: anxiety disorders, oppositional defiant/conduct disorder, learning disabilities and other conditions including tic disorders, elimination disorders, and mood disorders). We selected the hematological variables since iron deficiency is usually defined by low serum ferritin levels, or low MCV and high RDW values. We also selected Digit Span, Digit Symbol and Trail Making Test Part A as attentional indices. Based on our prior findings, we predicted that after controlling for the above mentioned variables, parent and teacher reported hyperactivity ratings would be negatively associated with ferritin level. We also predicted that ferritin level would not be significantly associated with attention problems ratings and cognitive measures.

Consecutively referred subjects (N = 537) to an outpatient clinic were evaluated to compare the Attention Deficit Hyperactivity Disorder Combined (ADHD-C) and predominantly inattentive (ADHD-PI) subtypes using parent and teacher ratings and neuropsychological variables. Statistical significance was at P < 0.002 adjusted for multiple comparisons. ADHD-PI subjects were older, more likely to be female, higher socioeconomic status, had lower Child Behavior Checklist and Teacher Report Form Aggression, Delinquency and Social Problems scores, and higher Withdrawal and Competence scores, compared to ADHD-C subjects. Comorbid conduct problems were more common among ADHD-C subjects. There were no differences in terms of anxiety/depression, and neuropsychological measures. The study is unique in that it provides data on a broad range of measures from a middle income developing country with important confirmation of similar pattern of differences and similarities between ADHD-C and ADHD-PI subtypes previously reported in North American and Western European samples.

Objective The Psychopathy Checklist Revised (PCL-R) and Temperament and Character Inventory (TCI) have been used extensively in research of personality disorders; however, no previous study has investigated the relation between psychopathy factors and temperament and character traits in patients with antisocial personality disorder (ASPD). Our aim was to fill this gap in the literature. Methods The PCL-R Factor scores and the TCI temperament and character scores were evaluated in 68 men with ASPD and 65 healthy male controls. Results The ASPD cases had significantly higher PCL-R Factor 1, Factor 2, and Total scores, as well as significantly higher TCI Novelty Seeking and Harm Avoidance scores, whereas the control group had higher TCI Reward Dependence, Persistence, Self-Directedness, and Cooperativeness scores. Correlation analysis revealed that, in the whole study group, PCL-R Factor 1, Factor 2, and Total scores were positively correlated with Novelty Seeking and Harm Avoidance scores and negatively correlated with Reward Dependence, Persistence, Self-Directedness, and Cooperativeness scores. When each group was analyzed separately, the correlations were not significant. Regression analysis supported the main findings. Conclusion Our results showed that both PCL-R Factor 1 score, which is claimed to reflect “core psychopathy,” and PCL-R Factor 2 score, which reflects criminal behaviors, were positively correlated with Novelty Seeking and Harm Avoidance and were negatively correlated with Reward Dependence in the whole sample. The reduced variance of PCL-R in each group might lead to nonsignificant associations within groups. Without the subjects with severe psychopathy in the present study, it might not be possible to show the association.

The objective of this study is to compare the course of metabolic effects of olanzapine and quetiapine, two atypical antipsychotics with similar structure and receptor binding affinities but clinically observed different metabolic ef- fects. This 6 week, single blind, randomized, controlled study was carried out during a structured treatment protocol in a female inpatient service, thus enabled to control effects of energy expenditure and other life style related factors. Subjects were randomly assigned into olanzapine (n=15) and quetiapine (n=15) groups. Weight and calorie intake (CI) were meas- ured daily. Symptom severity and serum leptin levels (SLL) were measured biweekly. Serum lipids were measured at baseline and 6th week. Olanzapine treatment was associated with more severe weight gain (F=11.2, p

Purpose:To evaluate the prevalence of refractive errors, strabismus, nystagmus, and congenital cataract in children with Down syndrome and control subjects of similar age.Methods:Seventy-seven children with Down syndrome and 151 control subjects were evaluated for the prevalence of ocular findings.Results:Ocular findings were discovered in 97.4% of children with Down syndrome and 42.4% of control subjects (P < .0001). The point prevalence of nystagmus, strabismus, hypermetropia, astigmatism, and congenital cataract was significantly higher in children with Down syndrome (P < .0001 for the first four categories, and P < .01 for congenital cataract).Conclusion:Evaluation, treatment, and regular review of ocular and refractive findings in children with Down syndrome is urgently needed.

Attention deficit – hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders of childhood. ADHD consists of two symptom domains, hyperactivity/impulsivity and inattentiveness.1 Although numerous studies conducted with children with ADHD have been published each year, the exact pathophysiology of the symptoms is unclear at the moment. However, many studies using different methodologies have indicated that dopamine is a key element of ADHD pathophysiology. Rats with lesions involving the ventral tegmental area have hyperactivity and problems in focusing on specific stimulus. These animals also have difficulties in shifting behavior. 2 Similarly, cortical DA deficiency causes hyperactivity, problems in inhibition, spatial orientation and temporal organization. The changes in prefrontal cortical areas also lead to reactive changes of the subcortical dopaminergic system.3 These studies indicate that dopamine may have an important role in all of the main symptom domains of ADHD. Some authors suggested that the lack of efficient dopaminergic control in the cortical and limbic striatal areas might result in selective attention and behavioral inhibition. 4,5 Iron is a coenzyme of tyrosine hydroxylase, which is critical in dopamine synthesis. 6 Iron is also related with monoamine oxidase, which is critical for the degradation of dopamine. Iron is colocalized with dopaminergic neurons in the brain, 6 and D2 and D4 receptor and dopamine transporter densities decrease with decreased brain iron levels.7,8 All these results suggest that iron metabolism may have important role in ADHD pathophysiology. However, the relationship of ADHD and iron metabolism has not been thoroughly studied. One study showed that children with ADHD had lower mean ferritin levels when compared with normal controls and that low serum ferritin levels were related to more severe symptoms, as indicated by higher Conners Parent Rating Scale scores. 9 Other studies have focused on the utility of iron supplementation in ADHD, with conflicting results. 10 The published studies have not investigated the possible relationship between iron levels and cognitive functioning of children with ADHD. This is surprising in the light of the previous studies that children with ADHD perform relatively worse than controls in vigilance and sustained attention tasks, executive function tests such as planning and organization, complex problem solving, set shifting, verbal learning, memory tests, motor inhibition and response monitoring. 11–20 Iron deficiency without anemia can cause cognitive problems because brain iron levels decrease before anemia becomes evident.21 Indeed, children with iron deficiency with or without anemia have been shown to have significant cognitive problems including lower IQ, motor problems, spatial memory, and selective attention,22,23 which can last for years. 24 The aim of the present study was to investigate the relationship between ferritin, hemoglobin, mean corpuscular volume (MCV) and red cell distribution width (RDW) and neuropsychological measures obtained by a broad test battery in children and adolescents with ADHD. We selected these variables because iron deficiency is usually defined by low serum ferritin levels, or low MCV and high RDW. Anemia is clearly defined as having low serum hemoglobin values. The neuropsychological test battery was selected to cover executive functions and attentional processes.

Objective: Although children with attention deficit hyperactivity disorder (ADHD) are at increased risk for later onset of antisocial personality disorder (APD) as adults, the utility of ADHD as either a comorbid diagnosis (ADHDc) or dimensional symptoms (ADHDd) in predicting behaviour and substance use problems in APD subjects has not been examined. Method: A total of 105 adult male offenders with Structured Clinical Interview for Axis II Disorders (SCID-II)-based DSM-III-R APD were studied in terms of: (i) psychopathy scores on the Hare Psychopathy Checklist–Revised (PCL-R); (ii) ADHDc diagnostic comorbidity on clinically administered DSM-IV questionnaire; and (iii) ADHDd dimensional symptoms by means of Wender Utah Rating Scale (WURS) and Conners Adult ADHD Rating Scale (CAARS) during a 12 month study period (May 2005–May 2006). Results: Sixty five per cent of APD subjects met criteria for ADHDc diagnostic comorbidity with significantly increased rates of childhood neglect, parental divorce and suicide attempt, but not of psychopathy. APD subjects with ADHDd symptoms were noted to have earlier onset and increased rate of self-injurious behaviour (SIB), suicide attempt, and psychopathy. The psychopathy scores, in turn, were predictive of earlier onset of SIB and behavioural problems. Conclusion: Both ADHDc diagnostic comorbidity and ADHDd symptoms need to be assessed in APD subjects and the dimensional measures may be better in detecting earlier onset SIB, suicide attempt and other behavioural problems.

BACKGROUND AND PURPOSE: One former study reported higher prefrontal N-acetylaspartate (NAA) levels in patients with Asperger syndrome (AS). The objective of the current study was to test the hypothesis that patients with AS would have higher dorsolateral prefrontal and anterior cingulate cortex NAA/creatine (Cr) and that NAA/Cr would be correlated with symptom severity. MATERIALS AND METHODS: NAA/choline (Cho), NAA/Cr, and Cho/Cr values revealed by 1H-MR spectroscopy in 14 right-handed male patients with AS (6 medicated with risperidone), 17–38 years of age, diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were compared with those of 21 right-handed male controls frequency-matched by age and intelligence quotient scores. RESULTS: Patients with AS had significantly higher anterior cingulate NAA/Cho levels (z = −2.18, P = .028); there was a statistical trend for higher anterior cingulate NAA/Cr (z = −1.81, P = .069) that was significant when only the unmedicated patients with AS were taken into account (z = −1.95, P = .050). There were no significant differences in dorsolateral prefrontal MR spectroscopy values. CONCLUSIONS: Our findings show that individuals with AS had higher NAA/Cho levels in the right anterior cingulate compared with healthy controls and that higher anterior cingulate NAA/Cho levels were correlated with higher Yale-Brown Obsessive Compulsive Scale total scores.

Objective: The aim of this study was to investigate karyotype abnormalities, MECP2 mutations, and Fragile X in a clinical population of children with Autism Spectrum Disorders (ASD) using The Clinical Report published by the American Academy of Pediatrics. Methods: Ninety-six children with ASD were evaluated for genetic testing and factors associated with this testing. Results: Abnormalities were found on karyotype in 9.7% and in DNA for fragile X in 1.4%. Karyotype abnormalities include inv(9)(p12q13); inv(9)(p11q13); inv(Y)(p11q11); Robertsonian translo-cation (13;14)(8q10q10) and (13,14)(q10q10); 9qh+; Yqh+; 15ps+; deletion 13(p11.2). Conclusion: Genetic testing should be offered to all families of a child with an ASD, even not all of them would follow this recommendation. Although karyotype and FRAXA assessment will yield almost 10% positive results, a detailed history and physical examination are still the most important aspect of the etiological evaluation for children with ASD. Also, it is important to have geneticists to help in interpreting the information obtained from genetic testing.

Offspring of individuals with schizophrenia are at increased baseline risk for a range of early mental disorders. Studies investigating the premorbid characteristics of individuals with schizophrenia indicate that they suffer from social, behavioral, attentional and neurocognitive impairments, often resembling attention deficit hyperactivity disorder (ADHD). In this study, we compared the executive functioning and general intelligence among three groups: (i) children and adolescents with DSM-IV ADHD (n=41), (ii) "high-risk" (HR) offspring of parents with DSM-IV schizophrenia, and (iii) normal comparison subjects (n=35). Our results indicated that both HR and ADHD groups had lower Verbal IQ scores. ADHD cases had significantly lower percent correct and total errors in Wisconsin Cart Sorting Test when compared with normal comparison subjects. The HR cases also had lower Performance IQ scores as well as worse abstraction--flexibility and comprehension performance. The HR group was further stratified with (HR-A) and without (HR-NA) comorbid ADHD, and HR-A subjects were significantly noted to be more impaired on most tests. The overall worse performance of HR offspring was attributable to significantly lower performance among the HR-A youth. Further, our results suggested that the most profoundly impaired HR subjects were in fact children and adolescents who also met criteria for ADHD. Future studies with broader neuropsychological test batteries are necessary to investigate the differences and similarities between ADHD and the HR-A subgroup.

Objective: Within the framework of the Mental Health Surveys of Turkey, the authors investigated the distribution and prevalence of parent-reported behavioral and emotional problems in a nationally representative sample of 2- to 3-year-old children. Method: A cross-sectional population-based survey from October 1996 through March 1997 using a self-weighted and equal probability sample of Turkish toddlers ( N = 638) was conducted. The Child Behavior Checklist Total Problem scores and Household Questionnaire reports by parent informant source (response rate 94.3%) were examined for the effects of child gender, age, urban/suburban/rural residence, and geographic region using multiple regression analyses. Results: Overall, the total problem scores placed 11.9% of the children in the clinically significant range and 18.6% of the children in the borderline range. Urban residence was significantly correlated with the Total Problem scores, Internalization and Externalization scores, and six Child Behavior Checklist syndrome scale scores. The child's age, gender, or parental employment status did not affect Total Problem scores. With respect to the Child Behavior Checklist syndrome scale, girls had higher Anxious/Depressed scores than boys, and 2-year-olds had higher Somatic Complaints scores than the 3-year-old children. None of the children with reported emotional and behavioral problems were referred to any mental health services. Conclusion: As part of a national mental health policy in Turkey, there is an urgent need to develop early childhood intervention services that emphasize home visits, center-based child care in the community, and caregiver and provider education and training.

WOS: 000353367600015, PubMed: 25866528, Objective Altered serum S100B protein levels have been shown in several psychiatric disorders. Our aim was to investigate whether plasma S100B is different in patients with panic disorder (PD) when compared with controls. Our second aim was to investigate whether treatment with SSRIs have an effect on S100B levels in patients with PD. Methods The sample included 32 patients diagnosed with PD (21 women, 11 men) per DSM-IV criteria and 21 healthy controls (11 women, 10 men). S100B levels were measured with BioVendor Human S100B ELISA (Enzyme Linked Immunosorbent Assay) kit. Results 14 patients were not on drug treatment (43.8%) while 18 patients were taking various SSRls. Median S100B value was 151.7 pg/mL (minimum-maximum: 120.4-164.7 pg/mL) in the control group, 147.4 pg/mL (minimum-maximum: 138.8-154.1 pg/mL) in the drug free group and 153.0 pg/mL (minimum-maximum: 137.9-164.7 pg/mL) in the treatment group. Kruskal-Wallis analysis showed a significant diffrerence among the three groups (z=9.9, df=2, p=0.007). Follow up Mann-Whitney-U tests indicated that while the control and the patients with treatment were not significantly different (z=-0.05, p=0.96), there were significant differences between the control group and untreated patients (z=-2.6, p=0.009) and treated and untreated patients (z=-3.0, p=0.003). Conclusion Our results suggested that, serum S100B protein level might be decreased in untreated PD patients and that patients who were treated with SSRIs had similar S100B level to healthy controls.

The association of obesity with sexual dysfunctions is complex and far from clear. Most former studies consisted of small samples and did not control several possible confounding factors.Our aim was to investigate the association of BMI with current sexual dysfunction in males and females in a nationally representative population sample after controlling for age, the presence of cardiovascular disorders, diabetes, hypertension, thyroid diseases, anxiety and depression and also menopause in women. The sample included a total of 4162 subjects (2081 females and 2081 males). The most frequent sexual problem was premature ejaculation (8.8%) in males and hypoactive sexual desire disorder (13.9%) in females. Univariate analysis showed that hypoactive sexual desire and erectile dysfunction in males and hypoactive sexual desire, lack of pleasure from sexuality and sexual pain in females were associated with obesity. Multivariate analysis indicated that age was significantly associated with almost all types...

To evaluate the central corneal thickness (CCT) in children with intellectual disability (ID) and to determine the association between ID-related variables and CCT.A total of 77 subjects with ID and 38 healthy controls were included in the study. The subjects with ID were subdivided into mild (IQ 50-69; n = 34), moderate (IQ 35-49; n = 30), and severe (IQ34; n = 13) groups and syndromic (n = 40) versus nonsyndromic (n = 37) distinctions. All children underwent CCT assessment by ultrasound pachymetry, in addition to complete ophthalmologic examination. Analysis of variance, chi test, and linear regression analysis were used for statistical analysis.CCT was significantly higher in the ID group (549.7 +/- 21.4 microm) than that the control group (521.6 +/- 16.9 microm; P0.0001). Linear regression analysis revealed that presence of syndromic etiology significantly predicted higher CCT among the individuals with ID (P0.0001).Children with ID have an increased CCT compared with healthy controls. Syndromic etiology is the only variable that predicts higher CCT among the individuals with ID. Although the finding of an increased CCT in children with ID is statistically significant, it is not clinically significant.

We compared ratings on the Three-Item Direct Observation Screen test for autism spectrum disorders completed by pediatric residents with the Social Communication Questionnaire parent reports as an augmentative tool for improving autism spectrum disorder screening performance. We examined three groups of children (18–60 months) comparable in age (18–24 month, 24–36 month, 36–60 preschool subgroups) and gender distribution: n = 86 with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) autism spectrum disorders; n = 76 with developmental delay without autism spectrum disorders; and n = 97 with typical development. The Three-Item Direct Observation Screen test included the following (a) Joint Attention, (b) Eye Contact, and (c) Responsiveness to Name. The parent Social Communication Questionnaire ratings had a sensitivity of .73 and specificity of .70 for diagnosis of autism spectrum disorders. The Three-Item Direct Observation Screen test item Joint Attention had a sensitivity of .82 and specificity of .90, Eye Contact had a sensitivity of .89 and specificity of .91, and Responsiveness to Name had a sensitivity of .67 and specificity of .87. In the Three-Item Direct Observation Screen test, having at least one of the three items positive had a sensitivity of .95 and specificity of .85. Age, diagnosis of autism spectrum disorder, and developmental level were important factors affecting sensitivity and specificity. The results indicate that augmentation of autism spectrum disorder screening by observational items completed by trained pediatric-oriented professionals can be a highly effective tool in improving screening performance. If supported by future population studies, the results suggest that primary care practitioners will be able to be trained to use this direct procedure to augment screening for autism spectrum disorders in the community.

Despite significant heritability of autism spectrum disorders (ASDs), their extreme genetic heterogeneity has proven challenging for gene discovery. Studies of primarily simplex families have implicated de novo copy number changes and point mutations, but are not optimally designed to identify inherited risk alleles. We apply whole exome sequencing (WES) to ASD families enriched for inherited causes due to consanguinity and find familial ASD associated with biallelic mutations in disease genes (AMT, PEX7, SYNE1, VPS13B, PAH, POMGNT1), some implicated for the first time in ASD. At least some of these genes show biallelic mutations in nonconsanguineous families as well. These mutations are often only partially disabling or present atypically, with patients lacking diagnostic features of the Mendelian disorders with which these genes are classically associated. Our study shows the utility of WES for identifying specific genetic conditions not clinically suspected and the importance of partial loss of gene function in ASDs.

Iron is a co-factor of tyrosine hydroxylase which is a critical enzyme in dopamine synthesis. Dopamine has been implicated in the pathophysiology of attention deficit hyperactivity disorder (ADHD). Our objective was to investigate the association of ferritin level with parent and teacher ratings and cognitive measures after controlling for age, sex, ADHD subtype, comorbid conditions, hemoglobin, mean corpuscular volume and reticulocyte distribution width in a large sample.The study included 713 children and adolescents with ADHD (613 boys; age 7-15 years). Conners' Parent Rating Scale (CPRS) and Conners' Teacher Rating Scale (CTRS) were obtained. In a subgroup of patients we conducted Digit Span, Digit Symbol, Trail-making Tests as measures of attention and executive functioning.Multiple regression analysis indicated that CPRS Hyperactivity score was significantly associated with ferritin level (B =-0.12; t =-3.1; P0.01). Other CPRS and CTRS scores as well as cognitive measures were not associated with ferritin level.Although it is not possible to make an inference on causality in cross-sectional studies, the results of this largest-scale cross-sectional field study to date suggest that lower ferritin level might be associated with parent-reported hyperactivity after controlling for important confounding factors.

Reliability and validity of the turkish version of the social communication scale.The aim of this study was to evaluate the reliability and validity of the Turkish version of the Social Communication Scale (SCQ).Throughout 2010-2011, we evaluated children who were between 18-60 months of age in the outpatient clinic who were diagnosed as having autism (n=49) or pervasive developmental disorder not otherwise specified (n=18) according to the DMS-IV criteria. The control group consisted of 51children with developmental delay (25 mental retardation, 26 speech delay) and 71 children with typical development in the same age group. We used a one way analysis of variance and post-hoc Tukey HSD test to compare the SCQ scores of the groups. For the reliability and validity analysis the Cronbach alpha, item-total score correlations and test-retest correlations were used. Principal components analysis and varimax rotation were used to find the factor solutions. Receiver Operator Characteristic (ROC) curves were utilised to detect cut-off scores, sensitivity, specificity, and negative and positive predictive values.The analysis yielded 3 factors named Language, Reciprocal Social Interaction and Stereotypic Behaviors/Restricted Areas of Interest. The Cronbach alpha value of the total score was 0.88. The test-retest correlation was high (r=0.90, p0.01). The SCQ Total, Language, Reciprocal Social Interaction and Stereotypic Behaviors/Restricted Areas of Interest scores were significantly different among the groups. The SCQ Total, Reciprocal Social Interaction and Stereotypic Behaviors/Restricted Areas of Interest scores were highest in the autism spectrum disorders group. The SCQ Language and Stereotypic Behaviors/Restricted Areas of Interest scores were not significantly different between the developmental delay and the typical development groups. ROC analysis indicated that the SCQ Total and Reciprocal Social Interaction scores differentiated very well between the autism spectrum and control group (area under the curve 0.89 and 0.91) while the Stereotypic Behaviors/Restricted Areas of Interest score differentiated less (0.72). Using a cut-off score of 14.5 for the SCQ Total score, sensivity was 0.84, specificity was 0.81, positive predictive value was 0.82 and negative predictive value was 0.83. Using a cut-off score of 7.5 for the SCQ Reciprocal Social Interaction score, sensivity, specifity, positive predictive value and negative predictive value were 0.91, 0.82, 0.83, 0.90, respectively.The results indicated that in children younger than 60 months of age the SCQ Total score can differentiate subjects with autism spectrum disorders from children with developmental delay and typically developing controls; however, the Reciprocal Social Interactions score was more sensitive and specific. On the other hand, the negative and positive predictive values indicated that there was a fair percentage of false negatives and positives. Our results showed that, particularly in younger children, the Reciprocal Social Interaction items were more specific and were more helpful for differentiation of the children with autism spectrum disorders. The availability of the SCQ as a shorter and more practical form of the Autism Diagnostic Interview, revised in Turkish, is important as both a research and clinical tool.

Objective: To investigate the interaction of treatment-related hemodynamic changes with genotype status for Synaptosomal associated protein 25 (SNAP-25) gene in participants with attention deficit hyperactivity disorder (ADHD) on and off single dose short-acting methylphenidate treatment with functional near-infrared spectroscopy (fNIRS). Method: A total of 15 right-handed adults and 16 right-handed children with DSM-IV diagnosis of ADHD were evaluated. Ten milligrams of short-acting methylphenidate was administered in a crossover design. Results: Participants with SNAP-25 DdeI T/T genotype had decreased right deoxyhemoglobin ([HHb]) with treatment. SNAP-25 MnlI genotype was also associated with right deoxyhemoglobin ([HbO2]) and [HHb] changes as well as left [HHb] change. When the combinations of these genotypes were taken into account, the participants with [DdeI C/C or T/C and MnlI G/G or T/G] genotype had increased right [HHb] with MPH use whereas the participants with [DdeI T/T and MnlI T/T] or [DdeI T/T and MnlI G/G or T/G] genotypes had decreased right prefrontal [HHb]. Conclusions: These results suggested that SNAP-25 polymorphism might be associated with methylphenidate induced brain hemodynamic changes in ADHD participants. © 2011 SAGE Publications.

Objective: It has been suggested that both low iron and zinc levels might be associated with Attention Deficit Hyperactivity Disorder (ADHD) symptoms. However, the association of zinc and iron levels with ADHD symptoms has not been investigated at the same time in a single sample. Method: 118 subjects with ADHD (age = 7–14 years, mean = 9.8, median = 10) were included in the study. The relationship between age, gender, ferritin, zinc, hemoglobin, mean corpuscular volume and reticulosite distribution width and behavioral symptoms of children and adolescents with ADHD were investigated with multiple linear regression analysis. Results: Results showed that subjects with lower zinc level had higher Conners Parent Rating Scale (CPRS) Total, Conduct Problems and Anxiety scores, indicating more severe problems. CPRS Hyperactivity score was associated both with zinc and ferritin levels. Conners Teacher Rating Scale (CTRS) scores were not significantly associated with zinc or ferritin levels. Conclusions: Results indicated that both low zinc and ferritin levels were associated with higher hyperactivity symptoms. Zinc level was also associated with anxiety and conduct problems. Since both zinc and iron are associated with dopamine metabolism, it can be speculated that low zinc and iron levels might be associated with more significant impairment in dopaminergic transmission in subjects with ADHD.

Purpose:To evaluate the prevalence of refractive errors and strabismus in children with tuberous sclerosis and in control subjects.Methods:Twenty-three children with tuberous sclerosis and 151 control subjects were evaluated. All children underwent cycloplegic autorefraction or retinoscopy, slit-lamp biomicroscopy, and dilated fundus examination. Ocular alignment was assessed by the Hirschberg, Krimsky, or prism cover test.Results:The total prevalence of hypermetropia and amblyopia was significantly higher in patients with tuberous sclerosis (P = .035) than in the control subjects (P = .002).Conclusion:A high prevalence of hypermetropia seems to be an additional feature of tuberous sclerosis. Early screening for this amblyogenic factor is indicated in patients with tuberous sclerosis.

Objective: To evaluate the epidemiology of attention problems using parent, teacher, and youth informants among a nationally representative Turkish sample. Method: The children and adolescents, 4 to 18 years old, were selected from a random household survey. Attention problems derived from the Child Behavior Checklist (CBCL) ( N = 4,488), Teacher Report Form (TRF) ( N = 2,360), and the Youth Self Report (YSR) ( N = 2,206) were examined. Results: The CBCL and TRF attention problems scores were higher among young male children, whereas the YSR reported scores were higher among older adolescents without a gender effect. The CBCL and YSR scores were also higher by urban residence. Conclusion: Compared with other European samples, our national sample had higher mean attention problems scores than the Scandinavian but lower mean scores than the former Soviet Union samples. In addition to elucidating the profile of attention problems in Turkey, our results also contribute to understanding the comparative global epidemiology of attention problems. (J. of Att. Dis. 2008; 11(5) 538-545)

To evaluate the ocular findings and refractive errors in children with intellectual disability and in controls of average intellectual development of similar socioeconomic backgrounds.The study was conducted at Diskapi Children's Hospital in Ankara, Turkey: 724 subjects with intellectual disability and 151 control subjects were evaluated. The subjects with intellectual disability were subdivided into mild (IQ 50-69, n = 490), moderate (IQ 35-49, n = 164), and severe (IQ34, n = 70) groups, and syndromic (n = 138) versus nonsyndromic (n = 586) disability. All children underwent cycloplegic autorefraction or retinoscopy, slit-lamp biomicroscopy, and dilated fundus examination. Ocular alignment was assessed by Hirschberg, Krimsky, or prism cover test. The main outcome measure was the prevalence of refractive errors and ocular findings.Seventy-seven percent of subjects with intellectual disability, and 42.4% of controls, had ocular findings. The children with intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than controls. Children with syndromic intellectual disability had significantly more nystagmus, strabismus, astigmatism, and hypermetropia than subjects with nonsyndromic intellectual disability. Increasing severity of intellectual disability was related to higher prevalence of nystagmus, strabismus, astigmatism, hypermetropia, and anisometropia.From a public health perspective, evaluation and treatment of ocular and refractive findings in children with moderate, severe, and syndromic intellectual disability categories is urgently needed and likely to be highly effective in alleviating future health and social care costs, as well as improving the productive lives of individuals with intellectual disability.

Our aim was to investigate the relation between behavioral symptoms and hematological variables which are related with iron deficiency and anemia, ferritin, hemoglobin, mean corpuscular volume (MCV), and reticulosite distribution width (RDW) in children and adolescents with pure Attention Deficit Hyperactivity Disorder (ADHD) or ADHD comorbid with other psychiatric disorders. The sample consisted of 151 subjects with ADHD, 45 of these subjects had other comorbid conditions. Conners Parent (CPRS) and Teacher Rating Scales (CTRS) were obtained. Comorbid ADHD subjects had lower mean hemoglogin and MCV. In the ADHD group in general, CPRS and CTRS Total scores were significantly negatively correlated with ferritin level. When only pure ADHD subjects were taken into account, the correlations did not reach statistical significance. Overall, these results suggested that lower ferritin level was associated with higher behavioral problems reported by both parents and teachers. Presence of comorbid conditions might increase the effect of lower iron stores on behavioral measures.

AimsTo evaluate the effects of internal displacement and resettlement within Turkey on the emotional and behavioral profile of children, age 5–18 after controlling for possible confounding and demographic variables.MethodsWe conducted a national population survey using a self-weighted, equal probability sample. We compared the CBCL, TRF and YSR responses regarding children with (n= 1644) and without (n= 1855) experience of internal displacement. We examined the effects of gender, age, paternal employment, resettlement, urban residence and physical illness.ResultsThe children and adolescents with internal displacement had significantly higher internalizing, externalizing and total problem scores on the CBCL and YSR, and higher internalizing scores on the TRF. The effect of displacement was related to higher internalizing problems when factors like physical illness, child age, child gender and urban residence were accounted. The overall effect was small explaining only 0.1–1.5% of the total variance by parent reports, and not evident by teacher reports.DiscussionsTo our knowledge the present study is the first to examine Turkish children and adolescents with and without experience of internal displacement. The results are consistent with previous immigration studies: child age, gender, presence of physical illness and urban residence were more important predictors of internalization and externalization problem scores irrespective of informant source.

Objective:To determine whether Child Behavior Checklist/4–18 (CBCL) and Teacher Report Form (TRF) scores of children and adolescents with a first-time diagnosis of attention-deficit hyperactivity disorder (ADHD) are different and whether there is a similar difference in normal control subjects.Method:We analyzed the CBCL and TRF scores of 146 patients (124 boys and 22 girls, aged 6 to 18 years; mean age 11.0 years, SD 3.6). We analyzed the same scores for 274 age and sex-matched control subjects recruited from a nationally representative sample.Results:Subjects with ADHD had significantly higher CBCL and TRF scores than control subjects. Age was significantly correlated with scores on the CBCL and TRF subscales Social Withdrawal, Somatic Complaints, and Internalization Problems; with scores on the CBCL subscale Attention Problems; and with scores on the TRF subscale Anxiety–Depression. In the group with ADHD, age was negatively correlated with scores on the CBCL and TRF subscale Externalizing Problems and with scores on the TRF subscale Aggressive Behavior. In the control group, the only significant correlation was between age and the CBCL subscale Somatic Complaints score.Conclusions:These results indicate that underdiagnosis of ADHD in childhood may cause the emergence of greater internalization problems in adolescence. attention-deficit hyperactivity disorder

An 85-year-old female was referred to our hospital with right hip pain following a fall at home. She was hospitalized to the department of orthopedic surgery for an operation for trochanter major fracture. She had hypertension and a history of a motor vehicle accident about 10 years ago. During her preoperative evaluation, chest X-ray showed an increased density like an anterior mediastinal tumor. The patient was referred to thoracic surgery and on physical examination there was a fixed, hard sternal mass about 10x10 cm in diameter. The motor vehicle accident on her anamnesis explained the findings on her X-ray and physical examination. A thoracic computed tomography scan well demonstrated the sternal malunion which mimicked a motion artifact (Figure 1, 2). The patient did not remember the details about the motor vehicle accident but she gave the information that she has been hospitalized at that time and as understood from her anamnesis she was treated conservatively. An operation was planned for sternal reconstruction but due to her advanced age, it was not done.

Objective: The molecular genetic of personality disorders has been investigated in several studies; however, the association of antisocial behaviours with synaptosomal-associated protein 25 (SNAP25) gene polymorphisms has not. This association is of interest as SNAP25 gene polymorphism has been associated with attention-deficit hyperactivity disorder and personality. Methods: We compared the distribution of Ddel and Mnll polymorphisms in 91 young male offenders and in 38 sex-matched healthy control subjects. We also investigated the association of SNAP25 gene polymorphisms with severity of psychopathy and with temperament traits: novelty seeking, harm avoidance, and reward dependence. Results: The Mnll T/T and Ddel T/T genotypes were more frequently present in male subjects with antisocial personality disorder (APD) than in sex-matched healthy control subjects. The association was stronger when the frequency of both Ddel and Mnll T/T were taken into account. In the APD group, the genotype was not significantly associated with the Psychopathy Checklist–Revised scores, measuring the severity of psychopathy. However, the APD subjects with the Mnll T/T genotype had higher novelty seeking scores; whereas, subjects with the Ddel T/T genotype had lower reward dependence scores. Again, the association between genotype and novelty seeking was stronger when both Ddel and Mnll genotypes were taken into account. Conclusion: Ddel and Mnll T/T genotypes may be a risk factor for antisocial behaviours. The association of the SNAP25 Ddel T/T and Mnll T/T genotypes with lower reward dependence and higher novelty seeking suggested that SNAP25 genotype might influence other personality disorders, as well.