Bahar Gökler

Atopic features in early childhood autism

BACKGROUND Autism is a developmental disorder of unknown etiology. Sensitivity to dietary and environmental antigens has been considered in its pathogenesis. AIM To examine immediate hypersensitivity in early childhood autism. METHODS We investigated 30 autistic children (23 boys, seven girls 2-4 years old) for atopic history, serum IgG, IgA, IgM, IgE levels, and skin prick tests (SPT) with 12 common antigens. RESULTS Nine/30 autistic children (30%) and 1/39 (2.5%) age-matched neurological controls from the same hospital had a family history suggestive of atopy (p<0.005). No patient in the autism and 28% in control group had symptoms of respiratory allergy (wheezing or asthma) (p<0.005), and 6/30 (20%) autistic vs. 7/39 (17%) control children had history suggesting other allergic disorders (p=ns). Eleven/23 (47.8%) autistic children had at least one positive skin test, similar to age-matched population controls. Serum IgG, IgA, and IgM levels were within age-appropriate limits. Serum IgE was elevated in four patients (13.3%). Specific IgE levels were negative in four cases with multiple SPT positivity. CONCLUSIONS This study suggests allergic features based on history, skin tests, and serum IgE levels are not frequent in young autistic children despite family history. This discrepancy between predisposition and manifestation might imply immunological factors or environmental conditions.

Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!

OBJECTIVES The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

Munchausen by Proxy Syndrome: A Case Series Study from Turkey

Munchausen syndrome by proxy (MSBP) is a rare form of child abuse in which a caregiver deliberately exaggerates, fabricates, and/or induces health problems in those in their care. The condition is extremely difficult to characterize and diagnose, as it manifests in many forms, often confusing the medical team. Insufficient knowledge regarding the syndrome and rare consideration of the differential diagnosis results in failure to recognize the problem. Literature suggests that an increase in physician awareness of the disorder can prevent or reduce its morbidity and mortality. For this reason, we believe that case series can help increase current knowledge on epidemiology, aetiology, diagnostic criteria, advised management of MSBP, and the psychological portrait of the perpetrator. Additionally, no data from Turkey has previously been presented on this issue. This study aimed to report characteristics of MSPB victims and alleged perpetrator, which were diagnosed and managed by a multidisciplinary team.

Erken doğan çocuklarda dikkat eksikliği hiperaktivite bozukluğu ve ilişkili doğum öncesi risk etkenleri

Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Halime Tuna Çak MD, Hacettepe University, Child and Adolescent Psychiatry, Ankara, Turkey E-mail: tunacak@yahoo.com Re cei ved/Ge lifl Ta ri hi: 06.01.2013 Ac cep ted/ Ka bul Ta ri hi: 04.03.2013 Türk Pediatri Arşivi Dergisi, Galenos Yayınevi tarafından basılmıştır. / Turkish Archives of Pediatrics, published by Galenos Publishing Attention deficit hyperactivity disorder and associated perinatal risk factors in preterm children Original Article

An Adolescent with Bipolar Disorder Responding to a Lower Lithium Concentration at Maintenance Treatment

Even in the face of scant data-based reasons, lithium has been recognized for several decades as an effective and safe agent in the treatment of bipolar affective disorder of adolescents (Lena et al. 1978; McKnew et al. 1981; DeLong 1990; Geller et al. 1998; Kafantaris et al. 2003). It is approved by the Food and Drug Administration (FDA) without having gone through the FDA vetting process due to being ‘‘grandfathered’’ in for the treatment of bipolar affective disorder of adolescents. It is also one of the first-line agents as monotherapy for adolescent bipolar cases, although this knowledge is based on a consensus and not derived from databased studies (Kowatch et al. 2005). A frequently mentioned subject in the literature regarding the use of lithium for acute and prophylactic treatment is the achievement of effective blood levels. In adults, the therapeutic blood level range is 0.8–1.5 mmol=L for acute treatment and 0.6–1.0 mmol=L for maintanence (Hamer 2005). The serum lithium concentrations recommended in adults have been applied to children and adolescents (Sproule 2002). Due to the narrow therapeutic window, dosage is recommended to be based on serum concentrations of lithium between 0.6 and 1.2 mmol=L and adopted according to the clinical response (Sproule 2002; Gerlach et al. 2006). At increasing plasma concentrations of lithium, increased numbers of responders were expected; however, it was also observed that individual patients may respond at concentrations lower than 0.8 mmol=L (Sproule 2002). This is explained largely by genetically determined individual differences. The current report presents an adolescent boy with a diagnosis of rapidcycling bipolaraffective disorderwho responded to prophylactic lithium treatment at very low concentrations.