Psychosocial implications of Thalassemia Major

BACKGROUND: Many causes including the chronicity of disease, burden of treatment modalities, morbidities, and the expectation of early death resulting from the disease complications, may lead to psychosocial burden in Thalassemia Major (TM) patients. METHODS: A total of 38 patients with TM and their mothers were recruited to evaluate the psychosocial burden as well as to disclose whether the psychological status of the patients contribute to the compliance with the therapy or to the contrary. Demographic and disease variables were obtained. Child Behavior Check-list (CBCL) was completed by the mothers of the patients. A detailed psychiatric interview based on the 4th edition of the Diagnostic and Statistical Manual diagnostic criteria was performed for each patient. Symptom Distress Checklist 90 (SCL-90) scale was given to all mothers for evaluating their psychopathology. RESULTS: Although CBCL scores remained between the normal ranges, desferrioxamine mesylate (DFO)-compliant patients and the patients with lower ferritin values had significantly higher scores. A total of 24% of the patients had a psychiatric diagnosis including major depression, anxiety disorder, tic disorder, and enuresis nocturnal. The psychiatric diagnosis was significantly higher in the patients who were compliant with desferrioxamine compared with the non-compliant group (P = 0.007). The SCL-90 scores indicated that the mothers who had a child with good adherence to DFO had higher scale scores than the mothers with a poor adherent child. CONCLUSIONS: The increase risk of psychosocial and behavioral problems in thalassemics and their parents indicated the importance of a lifelong psychosocial support for the prevention of mental health issues. The patients and their parents, who were more conscious of the illness, were more worried but more compliant with the therapy and need stronger psychiatric support.     

Population based,controlled study of behavioural problems and psychiatric disorders in low birthweight children at 11 years of age

OBJECTIVE: To evaluate the risk of long term behavioural problems and psychiatric disorders associated with being born with low birth weight. DESIGN/STUDY GROUPS: A population based, controlled follow up study at 11 years of age of 130 low birthweight (LBW) children weighing less than 2000 g at birth who were without major handicaps, and a random sample of 131 normal birthweight (NBW) children born at term weighing over 3000 g. MAIN OUTCOME MEASURES: Validated questionnaires addressing behaviour completed by mothers and teachers and child evaluation by child psychiatrist using a semistructured interview. RESULTS: Behavioural problems, as defined by abnormal scores on more than four of 32 measures, were found in 40% of LBW children compared with 7% of NBW children (odds ratio (OR) 8.2, 95% confidence interval (CI) 3 to 25, p = 0001). A psychiatric disorder was diagnosed in 27% of the LBW children compared with 9% of the NBW children (OR 3.1, 95% CI 1.5 to 6.5, p = 0.001). The LBW children were more often inattentive, had social problems, and low self esteem. None of the pre-, neo-, or peri-natal variables in the LBW group were statistically significant predictors of behavioural outcomes or the presence of psychiatric disorders. Behavioural problems and psychiatric disorders were as common in those with birth weight less than 1500 g as those with birth weight 1500-2000 g. CONCLUSION: An increased risk of behavioural problems and psychiatric disorders persists in LBW adolescents.     

Inhaled corticosteroids do not affect behaviour

AIM: To determine whether children with asthma and on inhaled corticosteroids have more behavioural problems, such as aggressiveness and hyperactivity, as compared with healthy controls and with children under medical care because of other disorders. METHODS: Questionnaires were given to three groups of children: a group of asthmatic children with inhaled corticosteroids (ICS), a group of children attending the ear, nose and throat (ENT) outpatient clinic and the healthy controls. Included were questions about health, medication use, demographical data and about behaviour, including the child behaviour check list (CBCL) and questions about attention deficit hyperactivity disorder (ADHD). RESULTS: Forty asthmatic children on ICS, 50 children visiting the ENT outpatient clinic and 183 healthy controls were studied. The total CBCL and mean ADHD scores of the children on ICS were 28.1 and 9.1, which were both significantly higher than the scores of the healthy controls (20.4 and 7.1), but not when compared with the ENT outpatient group (26.2 and 8.6). Further analysis revealed statistically significant differences between the ICS group and healthy controls in CBCL-axes. There were, however, no differences between the ENT group and the ICS on one side and the healthy controls on the other. CONCLUSION: There is a difference in behaviour between healthy children and asthmatic children on ICS, but not when compared with children visiting the ENT department. Although hyperactivity, aggressiveness and anxiety might occur in children on ICS, this is probably caused by individual susceptibility. Being under specialist care can possibly explain behavioural differences between children on ICS and healthy controls.     

Posttraumatic stress disorder and risk factors in parents of children with a cancer diagnosis

The purpose of this study was to determine the prevalence of posttraumatic stress disorder (PTSD) in parents of children with cancer. Five questionnaires were administered to 104 parents, including a sociodemographic questionnaire, a traumatic events check list, the Structured Clinical Interview for DSM-IV PTSD and Major Depressive Disorder modules, and the self-rating instrument General Health Questionnaire-12. The prevalence of PTSD was 34.6%. The statistically significant tendency to develop PTSD were found in the female gender, better educational status, death of a loved one, previous history of psychiatric disorder, having a child with poorer prognosis, and the presence of radiotherapy in child's treatment. The vulnerable parents must receive psychosocial support.     

Short-term psychiatric adjustment of children and their parents following meningococcal disease.

OBJECTIVE: To assess short-term changes in child and parent psychiatric status following meningococcal disease. DESIGN: Prospective cohort study; 3-month follow-up using parent, teacher, and child questionnaires. SETTING: Hospital admissions to three pediatric intensive care units and 19 general pediatric wards. PATIENTS: Sixty children aged 3-6 yrs, 60 mothers, and 45 fathers. INTERVENTIONS: We administered measures of illness severity (Glasgow Meningococcal Septicaemia Prognostic Score, days in hospital) and psychiatric morbidity (Strengths and Difficulties Questionnaires, parent and teacher versions; Impact of Event scales; General Health Questionnaire-28). MEASUREMENTS AND MAIN RESULTS: In children admitted to pediatric intensive care units, parental reports at 3-month follow-up showed a significant increase in emotional and hyperactivity symptoms and in related impairment; symptoms of posttraumatic stress disorder were present in four of 26 (15%) children >8 yrs old. Regarding the parents, 26 of 60 (43%) mothers in the total sample had questionnaire scores indicative of high risk for psychiatric disorder and 22 of 58 (48%) for posttraumatic stress disorder. In fathers there was high risk for psychiatric disorder in 11 of 45 (24%) and for posttraumatic stress disorder in 8 of 43 (19%). Severity of the child's physical condition on admission was significantly associated with hyperactivity and conduct symptoms at follow-up. Length of hospital admission was associated with psychiatric symptoms in the child and posttraumatic stress disorder symptoms in parents. There were also significant associations between psychiatric symptoms in children and parents. CONCLUSIONS: Admission of children to pediatric intensive care units for meningococcal disease is associated with an increase in and high levels of psychiatric and posttraumatic stress disorder symptoms in children and parents. Length of admission is associated with psychiatric symptoms in children and posttraumatic stress disorder symptoms in parents. Pediatric follow-up should explore psychiatric as well as physical sequelae in children and parents.     

Recognition of psychiatric disorders, and self-perceived problems. A follow-up study from age 8 to age 18

OBJECTIVE: To study the rate of, and factors associated with, recognition of psychiatric disorders and self-perceived problems among 18-year-old adolescent boys. METHOD: The study population consisted of 2347 Finnish boys born during 1981 attending military call-up (79.7% of the original sample). At age 8, the boys were evaluated by parental and teacher Rutter scales and by self-reports using the Child Depression Inventory (CDI). At military call-up 10 years later, the boys filled in the Young Adult Self-Report (YASR). Information about psychiatric disorders recognized at the military call-up health examination was obtained from the national military register. RESULTS: About 4.6% of boys were recognized as having a psychiatric disorder at the military call-up medical examination. In addition, 23.1% of boys reported emotional, behavioral or relational difficulties but were not recognized as having an ICD 10 psychiatric diagnosis at the military call-up medical examination. A higher level of psychopathology, problems across different life domains and early onset of problems were more strongly associated with recognition of psychiatric disorder than with self-reports of difficulties without a recognized psychiatric disorder. All informant sources, parents, teachers and children themselves at age 8, independently predicted recognition of psychiatric disorders and perceived difficulties 10 years later. CONCLUSIONS: Only a minority of adolescents with psychiatric problems are recognized as having a psychiatric disorder in the health services. Efforts to prevent psychiatric disturbance in early life are emphasized. The use of screening methods in school health settings to detect children in need of child mental health services is justified.     

Psychiatric outcomes at age seven for very preterm children: rates and predictors

Background: Uncertainty remains about the rate of specific psychiatric disorders and associated predictive factors for very preterm (VPT) children. The aims of this study were to document rates of psychiatric disorders in VPT children aged 7 years compared with term born children, and to examine potential predictive factors for psychiatric diagnoses in VPT children. Methods: Participants were 177 VPT and 65 term born children. Perinatal medical data were collected, which included brain abnormalities detected using magnetic resonance imaging. The Infant‐Toddler Social‐Emotional Assessment (ITSEA) and Strengths and Difficulties Questionnaire (SDQ) were administered at 2 and 5 years respectively. At 7 years of age, the Developmental and Well‐being Assessment (DAWBA) was used to indicate psychiatric diagnoses. Results: Compared with term born children, VPT children had three times the odds of meeting criteria for any psychiatric diagnosis at age 7 years (odds ratio 3.03; 95% confidence interval 1.23, 7.47, p = .02). The most common diagnoses were anxiety disorders (11% VPT, 8% term), attention‐deficit/hyperactivity disorder (10% VPT, 3% term) and autism spectrum disorder (4.5% VPT, 0% term). For VPT children, those with severe global brain abnormalities (p = .02), those who displayed social‐emotional problems at age 5 (p = .000) and those with higher social risk at age 7 (p = .001) were more likely to meet criteria for a psychiatric illness at age 7. Conclusions:  Compared with term born children, VPT children have higher rates of psychiatric diagnoses at early school age, predicted by neonatal brain abnormalities, prior social‐emotional problems and social factors.     

Psychiatric disorders in youth with perinatally acquired human immunodeficiency virus infection

BACKGROUND: Clinical reports from the United States indicate substantive mental health problems in perinatally human immunodeficiency virus (HIV)-infected youth that pose substantial barriers to optimizing their health. This pilot study explores rates and types of psychiatric and substance use disorders, as well as emotional and behavioral functioning in perinatally HIV-infected children and adolescents. METHODS: Forty-seven perinatally-infected youths (9-16 years of age) and their primary caregivers recruited from a pediatric HIV clinic were interviewed using standardized assessments of youth psychiatric disorders and emotional and behavioral functioning, as well as measures of health and caregiver mental health. RESULTS: According to either the caregiver or child report, 55% of youths met criteria for a psychiatric disorder. The most prevalent diagnoses were anxiety disorders (40%), attention deficit hyperactivity disorders (21%), conduct disorders (13%), and oppositional defiant disorders (11%). However, the majority of caregivers and children scored in the normative range on the symptom questionnaires on emotional and behavioral functioning. None of the demographic or child health variables or measures of caregiver mental health was significantly associated with presence of a child psychiatric disorder. There was an association between caregiver mental health and child emotional and behavioral functioning. CONCLUSIONS: Standardized assessments of mental health identified very high rates of psychiatric disorders, primarily in the anxiety and behavioral domains, in this sample of youth with perinatal HIV infection. Mental health interventions should be integrated into medical care to help members of this highly vulnerable population optimize their health and well-being.     

Psychosocial aspects and psychiatric disorders in children with thalassemia major

β-thalassemia major (TM), a chronic, genetically determined hematological disorder, has received little investigation on the psychological aspects of the disease and the psychosocial adjustment of patients with this anemia. In the present study, the aim was to assess the mental capacity, self-image, hopelessness and anxiety displayed by children who suffered from TM, and to investigate the existence of psychiatric disorders in these children. Twenty-five children (16 boys and 9 girls) with TM, 12.0–19.6 years old, from the Hematology Unit of the Department of Pediatrics at the SSK Tepecik Teaching Hospital, were included in the study. Fifteen healthy cases matched for age, sex and socio-economic status were used as controls. The Wechsler Intelligence Scale for Children (or Wechsler Adult Intelligence Scale), Offer Self-Image Questionnaire, Beck Hopelessness Scale, Trait Anxiety Inventory, Symptom Check List (revised) and the Family Assessment Device were performed on all patients. Then, the patients were evaluated for a psychiatric disorder by a psychiatrist (according to the diagnostic criteria of the Diagnostic and Statistical Manual IV of the American Psychiatric Association). The results for the patients and control cases were compared statistically using Mann-Whitney and Kruskal-Wallis tests. Self-image was found to be significantly lower in patients with TM than in control cases (P < 0.01). Hopelessness and Trait-Anxiety scores were determined to be significantly higher in patients with TM than in control cases (P < 0.01 and P < 0.05, respectively). Eighty percent of the patients with TM have had at least one psychiatric disorder. As a result, the study showed that most of the patients with TM had severe psychosocial problems. Relying on these data, it was concluded that medical therapy of these patients should be supported with psychological aid and psychiatric treatment.     

Symptoms of presentation in hyperactive and clinic children

Symptoms of presentation at a child psychiatric clinic were compared in a group of 100 children described as hyperactive and a similarly aged group of 229 children referred to the clinic for the full range of child psychiatric problems.
The hyperactive children showed significantly more speech problems, sleep problems and nightmares, and management problems and temper tantrums than the clinic group. These problems presented more frequently in boys.
Depression, headache and abdominal pain occurred at an older age in the full clinic group of children, who came significantly more often from single families.     

A controlled study of psychiatric morbidity among developmentally disabled children in the United Arab Emirates

A cross-sectional study of the prevalence of psychiatric problems among 26 children each with a learning disability (mental retardation) and specific speech disorder was conducted in an Arab population using the Rutter Behavioural Scale, and compared with a community sample of 100 control children matched for age. The prevalence of psychiatric problems, as identified by both the parents and the teachers was 35, 19 and 4 per cent respectively, in the learning disabled, speech impaired and control groups. Children with global disability or mental retardation showed significantly higher rates of psychiatric morbidity than those with specific speech disorder, both of which were significantly higher than that in the control group. Higher rates of psychiatric problems noted in the developmentally disabled children may be the result of specific socio-demographic and cultural factors in addition to neurodevelopmental factors and low IQ.     

Tuberculosis meningitis and attention deficit hyperactivity disorder in children

The purpose of this study was to investigate the prevalence of attention deficit hyperactivity disorder (ADHD) in children who recovered from tuberculous meningitis (TBM) as part of an ongoing TBM research project. During this study, each TBM group subject underwent a thorough clinical-neurological examination, and a test battery which included the child behaviour check list (CBCL) Teacher's Report Form and Conners Rating Scale. The parents and teachers of each of the 21 TBM group and 21 control group subjects completed the above-mentioned questionnaires. All 21 TBM group subjects displayed symptoms of ADHD. The TBM group was significantly more hyperactive and unable to sustain attention than the control group. Furthermore, TBM group subjects were perceived as being significantly more unpopular, obsessive, compulsive and aggressive than the control group subjects. With regard to the frequency of externalizing behaviour, the TBM group subjects displayed significantly more externalizing behaviours as well as symptoms of attention deficit and hyperactivity. No significant differences between parents' and teachers' ratings were found. We conclude that ADHD is a common long-term complication of TBM.     

Developmental delay in offspring of parents with affective disorders and depression: psycho-social sequels or a constitutional state?

At an early age, offspring of parents with affective disorders and long-lasting depression exhibited elevated rates of psychomotor and language delay, behavior problems and a greater need for somatic psychiatric care compared to matched control children (Harjan 1988, I, II, III). The present report analyses the problem of these children regarding psychomotor and language delay (PMLD) seen in a great number of children and somewhat more often in boys compared with those without this handicap. The study shows that children with PMLD of parents with affective disorders and long-lasting depression differ from those without PMLD with respect to early behavior problems, need for child psychiatric care during latency, and they are loaded by more broken homes and longer stay in pediatric wards. The two groups are similar in aspects of low social standing, mean parental age, perinatal risk factors, delayed somatic growth, incidence of psychiatric registrations and rate and nature of somatic disorders. The developmental delay may be a hereditary disturbance either related to affective disorder or to a concomitant factor, or the developmental delay may relate to the adverse environmental situation. It is also obvious that simultaneous parental illness, social breakdown and genetic constitution form a critical multifactoral loading on the child. The high rate of developmental delay among offspring of parents with affective disorders stresses the importance of giving attention to the children of parents with affective disorders and long-lasting depression. The developmental delay per se is an important disorder for early behavior problems and need for child and youth psychiatric care.     

A study of psychiatrically normal children in a hospital based child guidance clinic

A total of 1330 children who attended a hospital-based child guidance clinic in last three years were studied retrospectively. 7.37% of these were found to have no psychiatric disorder. Epilepsy and scholastic backwardness without any psychiatric disorder, together constituted 70.41% of this group. Children referred to a child guidance clinic require proper assessment to detect psychiatrically normal children who would otherwise receive unnecessary label of psychiatric disorder and treatment.     

Psychosocial determinants of behaviour problems in Brazilian preschool children

BACKGROUND: This investigation aimed at examining, through an epidemiological study, the social demographic, family and individual determinants of behaviour problems in preschool children. METHOD: Six hundred and thirty-four children, age four years, and their mothers, belonging to a cohort of 5,304 children being followed from birth, took part in the study. During a home visit, the child's behaviour problems and IQ were examined, as well as the prevalence of maternal psychiatric disorder, the quality of the home environment, and other social demographic, family and individual factors. RESULTS: The results revealed a prevalence of children's behaviour problems of 24% (clinical and borderline groups). Regression analysis showed that maternal psychiatric disorder, education and age, number of younger siblings and quality of the home environment explained 28% of the variance of the child's behaviour problems. CONCLUSIONS: The results point to the multi-determination of child behaviour problems.     

Children's perceptions of parental emotional neglect and control and psychopathology

Background: Parental emotional neglect is linked to psychiatric disorder. This study explores the associations between children’s perceptions of parental emotional neglect and future psychopathology. Methods: In a school‐based longitudinal study of nearly 1,700 children aged 11–15 we explored children’s perceptions of parenting, as measured by the Parental Bonding Instrument (PBI) at age 11, and their associations with later psychiatric diagnosis at age 15, as measured by computerised psychiatric interview. Rather than using the traditional four‐category approach to the PBI, we identified groups of children, classified according to their perceptions of parenting, using latent class analysis. Results: A small group of children (3%) perceived their parents as almost always emotionally neglectful and controlling. This group had an increased odds of psychiatric disorder (OR 2.14; 95% CI 1.29–4.50), increased overall (standardised) psychiatric symptom scores (B = .46; 95% CI .16–.75) and increased scores in all psychiatric subscales except substance‐use at age 15, despite no increase in psychiatric referral at age 11. Analyses controlled for key potential confounders (e.g., socioeconomic status). Conclusions: Although our findings are limited by having no objective evidence that children’s perceptions of emotional neglect are directly associated with actual neglect, children’s perceptions of neglect and control are associated with over twice the odds of psychiatric disorder at age 15. Children’s perceptions that parents are emotionally neglectful and controlling are independently associated with later psychiatric disorder and should be taken seriously as a risk factor for future psychopathology.     

Prevalence of behavioral symptoms and the relationship of child, parent, and family variables in 4- and 5-year-olds: results from the Ontario Child Health Study

This study presents the frequency of behavioral symptoms in 4- and 5-year-old children as reported by parents in the Ontario Child Health Study. It also examines the relationship of the presence of child, parent, and family variables with parent-reported total scale scores. Eight of the 135 items were reported to be present by the parents of 50% or more of the 437 children in the sample. For 18 items, the prevalence rates for boys were significantly higher than for girls. Multiple regression analysis resulted in slightly different child, parent, and family variables influencing scores when total scores and scores on severe items only were used as dependent variables. Two variables appeared in both models: general health of the child and family status. Some of the child, parent, and family variables found to be associated with behavior disorder in older children do not appear to have as strong an association with disorder in 4- and 5-year-olds.     

Prevalence of psychiatric disorders in preschoolers

Background: Many disorders in childhood and adolescence were already present in the preschool years. However, there is little empirical research on the prevalence of psychiatric disorders in young children. A true community study using structured diagnostic tools has yet to be published. Methods: All children born in 2003 or 2004 in the city of Trondheim, Norway, who attended the regular community health check‐up for 4‐year‐olds (97.2% of eligible children) whose parents consented to take part in the study (N = 2,475, 82.0%) were screened for behavioral and emotional problems with the Strengths and Difficulties Questionnaire (SDQ). A screen‐stratified subsample of 1,250 children took part in a furthermore comprehensive study including a structured diagnostic interview (the Preschool Age Psychiatric Assessment, PAPA), which 995 parents (79.6%) completed. Results: The estimated population rate for any psychiatric disorder (excluding encopresis – 6.4%) was 7.1%. The most common disorders were attention deficit hyperactivity disorder (1.9%), oppositional defiant disorder (1.8%), conduct disorder (0.7%), anxiety disorders (1.5%), and depressive disorders (2.0%). Comorbidity among disorders was common. More emotional and behavioral disorders were seen in children whose parents did not live together and in those of low socioeconomic status. Boys more often had attention‐deficit/hyperactivity disorder (ADHD) and depressive disorders than girls. Conclusions: The prevalence of disorders among preschoolers was lower than in previous studies from the USA. Comorbidity was frequent and there was a male preponderance in ADHD and depression at this early age. These results underscore the fact that the most common disorders of childhood can already be diagnosed in preschoolers. However, rates of disorder in Norway may be lower than in the USA.     

Inflammatory Bowel Disease in Children and Adolescents: a Somatic and Psychiatric Investigation

ABSTRACT. Twenty consecutive patients between 9 and 18 years of age with inflammatory bowel disease (IBD) [ulcerative colitis (UC) or Crohn's disease (CD)] were assessed for the presence of psychiatric disorder. The prevalence of psychiatric disorder using the DSM-111-R criteria (Diagnostic and Statistical Manual 3rd ed., revised), was 60% in the IBD group compared to 15% in a matched control group ( p =0.009). The psychiatric disturbances were mainly depressive or anxiety disorders. The IBD children also scored significantly higher ( p =0.0028) on the Child Behaviour Checklist (CBCL) which was completed by the mothers. This indicates more behavioural problems in the IBD group than in the control group. The present study suggests that children and adolescents with IBD comprise a population at high risk for developing a psychiatric disorder that may not be overt but nevertheless plays an important interactive role in the course of the disease.     

A population‐based investigation of behavioural and emotional problems and maternal mental health: associations with autism spectrum disorder and intellectual disability

Background: While research indicates elevated behavioural and emotional problems in children with autism spectrum disorders (ASD) and decreased well‐being in their parents, studies do not typically separate out the contribution of ASD from that of associated intellectual disabilities (ID). We investigated child behavioural and emotional problems, and maternal mental health, among cases with and without ASD and ID in a large population‐representative sample. Methods: Cross‐sectional comparison of child behavioural and emotional problems and maternal mental health measures among 18,415 children (5 to 16 years old), of whom 47 had an ASD, 51 combined ASD with ID, 590 had only ID, and the remainder were the comparison group with no ASD or ID. Results: The prevalence of likely clinical levels of behavioural and emotional problems was highest among children with ASD (with and without ID). After controlling for age, gender, adversity, and maternal mental health, the presence of ASD and ID significantly and independently increased the odds for hyperactivity symptoms, conduct, and emotional problems. Emotional disorder was more prevalent in mothers of children with ASD (with or without ID). The presence of ASD, but not ID, significantly increased the odds for maternal emotional disorder. As has been found in previous research, positive maternal mental health was not affected by the presence of ASD or ID. Conclusions: ASD and ID are independent risk factors for behavioural and emotional problems. ASD (but not ID) is positively associated with maternal emotional disorder. Approaches to diagnosing hyperactivity and conduct problems in children with ASD may need to be reconsidered.