Detecting emotional and behavioural problems in paediatric clinics

BACKGROUND: Children with chronic illness have increased rates of mental health problems and psychological difficulties often present as physical conditions. This prevalence survey aims to determine whether children attending general paediatric out-patient clinics are at increased risk of suffering from emotional and behavioural disturbance and whether there is an unmet need for psychiatric liaison to paediatric clinics. METHODS: Participants were 307 children aged 5-15 years attending a representative sample of paediatric out-patient clinics in one UK hospital. A national community sample of 10,438 children aged 5-15 years was used as a comparison group. Parental ratings of child behaviour were obtained using the Strengths and Difficulties Questionnaire (SDQ). Doctors rated the extent of any emotional difficulties using a modification of the SDQ 'impact supplement'. RESULTS: Children attending paediatric out-patient clinics were more than twice as likely (OR = 2.3, 95% CI 1.7-3.1) to score in the abnormal range of the SDQ. Of the 60 (20%) children with a probable psychiatric disorder only 15 had received specialist help from Child Mental Health Services. There were no gender differences in the profile of difficulties with emotional symptoms being particularly evident in both boys (OR = 2.85, 95% CI 1.97-4.11) and girls (OR = 3.04, 95% CI 1.92-4.70). The risk of psychiatric disorder was highest among those children with brain disorders attending neurological clinics (OR = 5.8, 95% CI 2.5-11.3). Clinicians only identified emotional or behaviour problems in a quarter of those children with parent-rated disorder. CONCLUSION: There is an increased prevalence of emotional and behavioural disturbance in children attending paediatric out-patient clinics. The SDQ could be added to routine paediatric assessments to aid appropriate referral of children with a possible psychiatric disorder to child mental health services.     

镇江市学龄前儿童情绪行为问题现况调查及其影响因素分析

目的 了解镇江市学龄前儿童情绪行为问题现况,分析其影响因素,为保持儿童良好的情绪行为状态提供理论依据。方法 采用整群抽样的方法抽取镇江市2 928名学龄前儿童进行调查。使用长处和困难问卷（Strength and Difficulty Questionnaire, SDQ）（家长版）、自编儿童基本情况调查问卷,收集学龄前儿童情绪行为问题及相关信息。主要采用卡方检验和logistic回归分析进行统计分析。结果 镇江市学龄前儿童情绪行为问题检出率为10.41%,男童（11.99%）问题检出率高于女童（8.72%）（χ2 = 12.473,P = 0.002）。回归分析结果显示,学龄前儿童情绪行为问题危险因素有男童（OR = 1.345,P = 0.026）、隔代带养（OR = 1.405,P = 0.022）、母亲偶尔饮酒（OR = 1.369,P = 0.033）,父亲文化程度为初中及以下（OR = 3.061,P = 0.001）、高中/中专（OR = 2.115,P = 0.014）、大专（OR = 1.918,P = 0.033）;儿童没有吸二手烟（OR = 0.516,P＜0.001）是其保护性因素。结论 部分学龄前儿童存在严重的情绪行为问题,且存在多种影响因素,需更进一步研究综合干预方法改善儿童情绪行为问题。     

Assessment of psychological health and quality of life with The Child and Adolescent Health Survey

The National Health Survey for Children and Adolescents plans to collect data on the health status of children and adolescents in the 0-17 years age bracket which can be used for the generalisation and implementation of measures. In this context, assessment of mental and subjective health, in addition to collection of data concerning somatic health, is of great importance in a survey on the health status of children and adolescents in Germany. The proportion of children and adolescents afflicted by--in part long lasting--mental health problems and disorders is considerable. Subjective impairment due to somatic, psychological or social factors result in a reduced quality of life. Last but not least, personal, familial, and social assets of children and adolescents are relevant as protective factors for their mental and subjective health. Experiences and results from the pilot test of the survey demonstrate that the instruments selected for assessing mental health problems (SDQ), health related quality of life (KINDL), and assets (a combination of various scales) are appropriate for epidemiological purposes. They may supply valuable data to estimate the prevalence of mental health problems and psychiatric disorders, to identify risk groups needing intervention, and to describe the subjective health of children and adolescents in Germany.     

Verhaltensauffälligkeiten bei Kindern und Jugendlichen

Mental health problems in children and adolescents constitute health impairments with major implications regarding individual wellbeing as well as daily and social functioning. In addition, these problems often burden the social partners of the individual. Within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the parents of 14478 children and adolescents aged 3-17 answered the Strengths and Difficulties Questionnaire (SDQ) which assesses behavioral problems and strengths in the areas emotional problems, hyperactivity, behavioral problems, peer problems and prosocial behavior. According to the results of the Total Difficulties Score (SDQ) 11,5 % girls (G) and 17,8 % boys (B) are classified borderline or abnormal, respectively. 92,5 % (G) and 86,3 % (B) display an adequate pro social behavior. Most prevalent problem areas are behavioral problems (G = 11,9 %, B = 17,9 %), emotional problems (G = 9,7 %, B = 8,6 %) and hyperactivity problems (G = 4,8 %, B = 10,8 %). The test-data of approximately 8,1 % of the respondents with high socio-economic status (SES), 13,4 % of those with middle SES and 23,2 % of those with low SES hinted at mental health problems. Migrants are more frequently affected than non-migrants. Results point at the need for early detection and prevention of commencing mental health problems. Especially the noneasily accessible groups like those with low socioeconomic status or migrants have to be considered.     

Versorgungsbedarf chronisch kranker Kinder und Jugendlicher

Using data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), we studied the association between chronic health conditions and specific health care needs among children and adolescents in Germany. A chronic health condition was defined based on standardized parent questionnaires and computer-assisted parent interviews regarding any lasting illness or health problem, congenital malformation or officially recognized disability. As part of the parent questionnaire, the validated German version of the Children with Special Health Care Needs (CSHCN) screener was used to assess special health care needs. Overall, 38.7% of the study population had at least one chronic health condition, as compared to 73.0% of children and adolescents who were identified as having specific health care needs. Only 25.8% of children and adolescents with chronic health conditions were found to have any special health care needs. However, this proportion varied considerably according to the type of health condition. Overall 3.7% of study participants screened positive for special health care needs, while no specific chronic health condition was reported by their parents. In multiple logistic regression analyses, factors independently associated with the absence of perceived health care needs among children and adolescents with chronic health conditions included female gender, migration background, a lower socioeconomic status, residence in former West Germany, a lower number of concomitant health problems, and the absence of behavioural problems. The identification of special health care needs among children and adolescents without any reported chronic health condition was determined by male gender, having no migration background, and evidence of behavioural problems. Further analyses are necessary to elucidate the relationship between chronic health conditions and health care needs among children and adolescents. These need to focus on specific health conditions and should include additional information on health-related quality of life, health care services use, and psychosocial resources.     

学龄前儿童含糖饮料摄入与情绪行为问题的关联

目的 探讨学龄前儿童含糖饮料(sugar-sweetened beverages,SSBs)摄入情况及其与行为问题的关联,为儿童行为问题预防提供参考依据.方法 于2017年10-11月选择长江中下游流域的扬州、徐州、镇江3座城市,采取随机整群抽样的方法选取7634名3～6岁学龄前儿童为研究对象,通过对父母或监护人进行问...     

学龄前儿童生活方式对情绪与行为问题影响的研究

目的 探讨学龄前儿童生活方式与情绪和行为问题的关联,为其情绪与行为问题干预提供依据。方法 于2015年4-5月分层整群抽取7所幼儿园儿童,对其父母进行问卷调查,调查内容包括儿童生活方式、家庭环境信息和《长处与困难问卷》（Strengths and Difficulties Questionnaire,SDQ）。使用x2和logistic回归对数据进行分析。结果 获得有效问卷2525份。学龄前儿童SDQ困难总分异常检出率为6.4%,同伴交往问题最突出（17.8%）。女童（7.3%）情绪问题检出率高于男童（4.3%）（x2=10.74,P=0.005）。男童多动、同伴交往、亲社会行为、品行问题（16.4%、21.0%、12.4%、7.5%）检出率均高于女童（10.5%、14.2%、6.7%、6.3%）,差异有统计学意义（x2=26.18、25.19、37.55、12.33,P<0.05）。多因素分析发现,视屏暴露时间长、户外运动少、睡眠质量差等不良生活方式是男［OR（95%CI）=1.445（1.064~1.965 ）、2.060（1.190~3.565）、1.498（1.163~1.930）,P < 0.05］、女童［OR（95%CI）=1.575（1.096~2.262）、2.526（1.429~4.465）、1.793（1.326~2.423）,P < 0.05］情绪与行为问题的共同高危因素。 结论 学龄前儿童不良生活方式和情绪与行为问题问题关系密切,且二者皆有可能持续至成年期,应予重视,及时干预。     

家庭教养方式与3~6岁儿童情绪行为问题的关联

  目的  探讨家庭教养方式与3~6岁学龄前儿童情绪行为问题的关联及性别差异,为儿童情绪行为问题的早期预防和干预提供参考。  方法  采用分层整群抽样方法,于2021年6月选取安徽省芜湖、六安、阜阳3个市36所幼儿园的9 647名3~6岁儿童为研究对象,采用自编一般情况调查表、父母版长处和困难问卷及父母教养方式量表对儿童监护人进行调查。  结果  儿童困难总分异常检出率为6.5%,男童检出率(7.1%)高于女童(5.8%)。家庭教养方式溺爱性、放任性、专制性和不一致性高分组的儿童情绪行为异常检出率均高于低分组(χ2值分别为210.32,203.87,102.70,212.69,P值均＜0.01),检出率随得分增加呈上升趋势;而民主性高分组的儿童情绪行为异常检出率低于低分组(χ2=156.24,P＜0.01),检出率随得分增加呈降低趋势。Logistic回归分析结果显示,教养方式高水平溺爱性(OR=4.31)、放任性(OR=4.16)、专制性(OR=3.36)、不一致性(OR=4.76)与儿童情绪行为问题高风险相关,而高水平民主性(OR=0.34)与情绪行为问题低风险相关;男童中、高分组溺爱性教养方式出现情绪行为问题的风险高于女童(OR值分别为1.90,2.13)(P值均＜0.05)。  结论  家庭教养方式会影响3~6岁儿童情绪行为问题的发生,男童是溺爱教养方式负面影响的敏感人群,良好的教养方式有益于儿童情绪行为问题的防控。     

学龄前儿童睡眠障碍与情绪行为问题的关联

  目的  探讨芜湖地区学龄前儿童睡眠情况及与儿童情绪行为问题的关联,为改善儿童睡眠质量和情绪行为问题提供依据。  方法  2017年5月对芜湖市12所幼儿园1 158名大班儿童进行整群抽样调查,采用自制问卷调查儿童的一般情况和入睡前情况,采用《长处与困难问卷(SDQ)父母版》和《2~5岁儿童睡眠状况调查问卷》调查情绪行为及睡眠障碍问题。  结果  调查儿童情绪行为问题异常总的检出率为44.21%,其中同伴交往问题最为突出;学龄前儿童入睡前情况存在性别差异,主要体现在是否单独睡眠及睡前是否需要安慰物两个方面;41.97%的学龄前儿童检出至少1种睡眠障碍类型,其中睡眠不安的检出率女童为33.83%,高于男童的25.97%;睡眠影响学龄前儿童情绪行为问题出现,异态睡眠(OR=2.33,95%CI=1.25~4.34)和睡眠不安(OR=4.92,95%CI=1.28~19.00)增加女童该问题的风险,睡眠充足会降低此风险(OR=0.46,95%CI=0.27~0.77);异态睡眠增加男童情绪行为异常的风险(OR=1.86,95%CI=1.08~3.19),而单独睡眠降低该风险(OR=0.59,95%CI=0.37~0.95)。  结论  睡眠障碍增加学龄前儿童情绪行为问题的发生,充足的睡眠及儿童单独的睡眠习惯可减少其情绪行为问题的出现,睡眠与儿童情绪行为问题的发生具有性别差异。     

Some emotional repercussions of adolescent pregnancy in Rio de Janeiro, Brazil (1999-2001)

This study analyzed the association between early pregnancy and negative emotional repercussions for adolescents, according to socio-demographic and psychosocial variables. The study interviewed 1,228 adolescents in maternity hospitals in the City of Rio de Janeiro. Emotional repercussions were evaluated with negative self-assessment variables, showing little or no expectation towards the future, as well as psychological distress. The chi2 test and odds ratio were used to analyze the data. Adolescents who reported a negative reaction by the family felt less valued (OR 1.8), with little expectation towards the future (OR 2.3), and presented major psychological distress (OR 1.5). Those not enrolled in school when they became pregnant also showed worse self-esteem (OR 1.9) and fewer expectations towards the future (OR 2.2). Greater psychological distress was inversely related to frequency of prenatal care (0.7). The article concludes that family support, regardless of original social conditions, was identified as the principal factor for minimizing negative emotional repercussions of pregnancy during adolescence.     

Personale, familiäre und soziale Schutzfaktoren und gesundheitsbezogene Lebensqualität chronisch kranker Kinder und Jugendlicher

INTRODUCTION: The present publication describes chronic conditions of children and adolescents (asthma, ADHD, obesity) in relation to personal, familial and social resources and to health-related quality of life (HRQOL). A database of these investigations is the German health interview and examination survey of children and adolescents (KiGGS), which is representative for 0 to 17 year-olds. The above mentioned chronic conditions occur frequently in this age group and are assumed to have an influence on quality of life and to be related to a lower level of protective factors. METHODS: The investigations used the data of 6813 children and adolescents within the age group of 11 to 17 who participated in the KiGGS study. Information about diagnosed chronic conditions was given by the parents within the framework of the computerassisted medical interview (CAPI) and by completing questionnaires. The personal, familial and social protection factors as well as the quality of life were assessed by the questionnaires, filled in by the adolescents themselves. Instruments used were the Social Support Scale, the Family Climate Scale and KINDL-R. RESULTS: Children and adolescents with asthma seem to have no deficits in the health-related quality of life and in the field of protective factors. This differs from the situation of the obese children as well as from the children with ADHD. Both groups show significant deficits in the health-related quality of life and protection factors. DISCUSSION: The chronic conditions investigated show remarkable differences in the scale values for measuring protective factors and health-related quality of life. Possible explanations are: For asthma as a chronic disease with somatic manifestation effective treatments and therapies exist, so that it has nearly no influence on the self-assessed quality of life. ADHD and obesity result in a decrease of quality of life and in the field of protective factors, possibly caused by social stigmatisation, isolation and demotivation of the concerned children and adolescents. Therefore it is important to support those children and adolescents to cope with their disease-related problems. The results illustrate that in addition to the immediate effects of chronic conditions on the concerned children and their families, it is the quality of life and the familial and social environment that should be specifically addressed in further studies.     

儿童心理危机干预培训对学龄儿童情绪和行为问题的改善作用

目的探讨心理危机干预培训对改善学龄儿童情绪、行为和人际交往问题的有效性。方法对383名学龄儿童实施心理危机干预培训,并运用长处和困难问卷(Strengths and Difficulty Questionnaire,SDQ)家长版和教师版分别于基线、干预后3个月和6个月进行评估,比较各因子得分变化。结果 SDQ(家长版和教师版)多动问题因子和SDQ(教师版)困难总分的干预后3个月得分低于基线,且干预后6个月进一步降低(F=28.14~87.53,P0.05);SDQ(家长版)困难总分的干预后3个月和6个月得分均显著低于基线(F=8.11,P0.05);SDQ(教师版)亲社会行为因子的干预后3个月得分显著高于基线,且干预后6个月得分进一步增高(F=27.99,P0.05)。结论心理危机干预培训可以改善学龄儿童的情绪、行为和人际交往问题。     

家庭生态系统视角下长子女情绪和行为问题研究

目的 研究二孩家庭中长子女情绪和行为问题现状,并在家庭生态系统内分析其影响因素.方法 于2020年4-7月在河南省商丘市选取538名长子女为研究对象,采用长处和困难问卷、儿童版父母教养方式问卷以及家庭亲密度和适应性量表进行调查.结果 长子女情绪和行为困难总分异常检出率为15.1％(81/538),多因素Logistic...     

慢性病儿童心理行为特征及影响因素探讨

【目的】探讨慢性病儿童的心理行为特点及相关因素。【方法】采用少儿艾森克个性问卷(Eysen-ckPersonalityQuestionnaire,EPQ)和Achenbach儿童行为筛查量表(AchenbachChildBehaviorChecklist,CBCL,),对研究儿童进行测试和比较,并收集患儿个人及父母健康状况等信息,进行多元逐步回归分析。【结果】除12~16岁组男童外,慢性病组中其他年龄组儿童CBCL总分和内向性行为得分均显著高于正常对照组;慢性病6~11岁组中男童在抑郁、交往不良、多动和攻击性因子得分和女童在抑郁、社交退缩、体诉、性问题和攻击性因子得分显著高于正常对照组(P<0.05);12~16岁女童组在焦虑强迫、体诉、抑郁退缩、不成熟和残忍因子得分显著高于对照组。多元线性回归分析后得出:影响慢性病儿童CBCL总分的因素由强到弱为年平均住院天数、父母心理状况、疾病稳定情况、父母亲健康状况以及患儿课外活动和体育活动影响程度。【结论】慢性病儿童有更多的心理行为问题,在治疗躯体疾病的同时,对慢性病息儿及家庭进行社会心理干预非常必要。     

鄂尔多斯市蒙汉族5～7岁儿童心理行为发育与家庭养育环境的调查和分析

目的了解鄂尔多斯市5～7岁儿童心理行为发育状况,探讨儿童养育环境对其的影响。方法采用儿童心理行为量表（SDQ）和家庭养育环境量表对鄂尔多斯市234名5～7岁儿童进行问卷调查。结果 234名儿童的心理发育水平处于正常总体范围;不同性别儿童在行为和社会关系维度差异有统计学意义（P〈0.05）;不同民族儿童的心理行为发育差异没有统计学意义;不同家庭养育环境对儿童心理行为发育有影响,差异有统计学意义（P〈0.01）。结论儿童的心理行为发育状况与性别、家长育儿感受、养育态度、夫妻关系和家庭生活有关,而与民族无关。     

Childhood and early adult predictors of risk of incident back pain: Ontario Child Health Study 2001 follow-up

Musculoskeletal disorders of the back and spine are a leading cause of disability in working-age populations. There is limited information on the potential consequences of childhood socioeconomic and health status on the risk of incident back pain in early adulthood. The authors describe factors associated with having had a first episode of back pain during the past year in the Ontario Child Health Study, a prospective cohort study of children who were aged 4-16 years at the time of enrollment in 1983 and were resurveyed in 2001. Respondents reporting a first episode of back pain (n=143) were compared with respondents who had never experienced back pain (n=896). The annual incidence of a first episode of back pain in this sample of young adults was 74.7/1,000. Following adjustment for age, sex, childhood conditions, childhood health status, and measures of early adult health, behavior, socioeconomic status, and work environment, the risk of incident back pain was associated with both low (odds ratio (OR)=1.86, 95% confidence interval (CI): 1.14, 3.03) and moderate/high (OR=1.85, 95% CI: 1.07, 3.02) levels of psychological distress, current heavy smoking (OR=1.85, 95% CI: 1.10, 3.10), lower levels of parental education in childhood (OR=1.72, 95% CI: 1.06, 2.80), and emotional or behavioral disorders in childhood (OR=1.87, 95% CI: 1.02, 3.41). The associations of low childhood socioeconomic status and childhood emotional and behavioral disorders with risk of incident back pain in early adulthood are important findings with implications for better understanding the etiology of soft-tissue disorders.     

562名医务人员子女心理行为状况调查

目的 了解儿童心理行为状况,为改善儿童心理行为问题提供依据。方法 针对本院医务人员子女采用整群随机抽样的方法,通过手机端发放长处和困难问卷(Strengths and Difficulties Questionnaire,SDQ)电子版进行调查,收集儿童心理行为健康相关信息。结果 本研究纳入观察病例共562份,年龄均值(8.06±3.251)岁。其中,男275名(48.9%),女287名(51.1%);学龄期儿童311名(55.3%),学龄前期儿童251名(44.7%)。SDQ困难总分评定异常者12.9%,边缘状态者18.1%,正常者69%。情绪问题 、品行问题 、同伴关系问题 、多动问题 、困难总分、亲社会行为各因子异常检出率分别为9.6%、9.8%、19.2%、18.1%、12.9%、7.8%。不同性别儿童SDQ困难总分、情绪症状、亲社会行为、品行问题差异无统计学意义(P>0.05)。男生多动问题、同伴关系问题评分分别为(3.87±1.471)分、(4.53±1.542)分,分别高于女生的(3.65±1.415)分、(4.31±1.554)分,差异有统计学意义(t=0.96、7.65,P<0.05)。学龄前期儿童与学龄期儿童情绪症状、品行问题、亲社会行为差异无统计学意义(P>0.05)。学龄期儿童同伴关系问题、多动问题、困难总分评分分别为(4.53±1.507)分、(3.85±1.298)分、(12.15±3.613)分,分别高于学龄前期儿童的(4.26±1.652)分、(3.54±1.402)分、(11.45±4.39)分,差异有统计学意义(t=5.36、6.57、14.32,P<0.05)。结论 调查发现,本院医务人员子女心理行为问题发生率较高。应进一步核实诊断,根据不同的心理特征及年龄分类,及早给予心理支持和干预,并由心理医生对这一群体进行长期随访。     

Comorbidity of chronic somatic illness and psychological disorders. Problems in outpatient mental health care

Especially when chronic, the presence of a somatic disorder is accompanied by various levels of psychological stress, which can range up to comorbidity with mental disorders. In addition, chronic somatic diseases and mental disorders are often interdependent. Treatment for persons with mental and somatic comorbidity is frequently offered in the context of medical rehabilitation. As skills of psychotherapists are concerned, comorbidity needs a bio-psychosocial approach in which knowledge of medicine, psychology, and social sciences is integrated. In addition to the expert skills of psychotherapists, interprofessional training, basic knowledge, and communication with physicians are necessary. The present article outlines conditions for outpatient psychotherapeutic care of persons with chronic somatic diseases and addresses central problems in the differential diagnosis of mental and somatic disorders as well as treatment indications when comorbidity is present. Selected examples for the diagnosis and treatment of patients with cardiovascular disorder and diabetes, respectively, illustrate these aspects.     

Psychische Gesundheit von Kindern und Jugendlichen in Deutschland

The Mental Health Module (BELLA study) examines emotional well-being and behaviour in a representative sub-sample of 2,863 families with children aged 7 to 17 from the National Health Interview and Examination Survey for Children and Adolescents (KiGGS). The prevalence of mental health problems was determined using the Strengths and Difficulties Questionnaire (SDQ) and additional standardised screening measures. Of children and adolescents, 21.9 % (95 %CI: 19.9-24.0) showed signs of mental health problems. The psychiatric disorders observed included anxiety (10.0 %; 95 % CI: 8.7-11.6), conduct disorder (7.6 %; 95 % CI: 6.5-8.7) and depression (5.4 %; 95 % CI: 4.3-6.6). Of the risk factors examined, adverse family climate and low socioeconomic status stand out particularly as negative contributors. When several risk factors occur simultaneously, the prevalence of mental health problems increases markedly. Conversely, positive individual, family and social resources coincide with an absence of mental health problems. Children and adolescents with mental health problems display distinctly impaired health-related quality of life, and far from all of them are receiving treatment. Identifying high risk groups therefore requires the assessment of available resources in addition to the usual risk factors for mental and subjective health. Strengthening these resources should be a key objective, both in prevention and in interventions.     

Parent Perceptions of the Impact of Chronic Pain in Children and Adolescents

In this exploratory study we describe the impact of chronic pain in children and adolescents. Information was gathered from the parents of 43 children (ages 7 to 16 years) referred for psychological management of chronic pain in a tertiary care setting. Parents completed a questionnaire about their child's experience of pain over the past year, its impact on child and family day-to-day activities, and treatments sought. Their responses depict clinically significant levels of pain and associated disability, requiring multiple contacts with health care providers. Although these data are preliminary, they suggest that complex pain problems in children and adolescents can be associated with both personal costs to families and economic costs to the health care system. There is a compelling need for effective treatments for children and adolescents with chronic pain that specifically target prevention or reduction of disability.