Birim Günay Kılıç

Depression, anxiety and obsessive–compulsive symptoms and quality of life in children with attention-deficit hyperactivity disorder (ADHD) during three-month methylphenidate treatment

The current study was designed to investigate the changes that occur in depression, anxiety, obsessive—compulsive symptoms and health-related quality of life during methylphenidate (MPH) treatment in children with attention-deficit hyperactivity disorder (ADHD). Forty-five treatment naive children with ADHD, aged 8—14, were assessed based on self, parent and teacher reports at the baseline and at the end of the first and third month of MPH treatment regarding changes in inattention, hyperactivity, impulsivity, depression, anxiety and obsessive—compulsive symptoms. Changes in the quality of life were also noted. Repeated measures of analysis of variance (ANOVA) tests with Bonferroni corrections were conducted in order to evaluate the data. Symptoms of inattention, hyperactivity and impulsivity were significantly reduced (p < 0.017) following a three-month MPH treatment. There were significant decreases in depression (p = 0.004), trait anxiety (p = 0.000) and checking compulsion symptom scores (p = 0.001). Moreover, parents reported significant improvements in psychosocial (p = 0.001) and total scores (p = 0.009) of quality of life, despite no change in physical health scores (p > 0.05). Children’s ratings of quality of life measures showed no significant changes in physical health and psychosocial scores (p > 0.05), while total scores significantly improved (p = 0.001) after the treatment. Over a three-month MPH treatment, depression, trait anxiety and checking compulsion symptoms decreased and quality of life seemed to improve along with those of inattention, hyperactivity and impulsivity.

Depression, levels of anxiety and self-concept in girls with Turner's syndrome.

Self-esteem, depressive symptoms and anxiety symptoms in girls with Turners syndrome (TS) were compared to those in girls with familial short stature (FSS) and healthy controls (NC). Eleven girls with TS, 9-17 years of age, all with 45,X0 karyotype, who were matched with 11 girls with FSS and 11 NC girls who had similar socio-demographic characteristics, were enrolled in the study. The Childrens Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Piers-Harris Childrens Self Concept Scale (PHSCS) were used to assess the extent of depression, anxiety and self reported self-esteem. The PHSCS means and standard deviations of the TS, FSS and NC groups were 56.2 +/- 6.7, 62.7 +/- 6.9, and 69.3 +/- 6.0, and the STAIC-state anxiety means and standard deviations were 30.6 +/- 4.5, 28.8 +/- 6.1, and 25.7 +/- 3.7, respectively. Study findings showed that girls with TS had lower self-esteem and higher state anxiety levels than NC (p <0.05). In spite of the small sample size, findings showed that girls with TS were at risk of psychological problems. Therefore, in addition to medical treatment and monitoring, girls with TS should also be supported psychologically by social, educational and psychotherapeutic interventions which aim to address their self-esteem and emotional difficulties.

Multicomponent attention deficits in attention deficit hyperactivity disorder

Abstract  The aim of this study was to examine the specific aspects of attention, such as selective attention, sustained attention, and short‐term memory in children with attention deficit hyperactivity disorder, combined subtype (ADHD‐C). A total of 40 children with a diagnosis of ADHD from the 4th edition of the Diagnostic and Statistical Manual, aged 6–11 years old were compared with 40 controls matched for age and gender on a battery of tests. Short‐term memory span and attention was measured by Visual Aural Digit Span Test–Revised. Stroop test and the Turkish version of Cancellation Test were used to assess selective and sustained attention, respectively. In order to check for factor structure in two groups on the test scores, principal component analysis was conducted for both groups separately. Relative to the comparison children, children with ADHD showed significant deficits on tests that are related to different aspects of attention. The results are consistent with the theories explaining the biological basis of ADHD by scattered attention networks in the brain, which have reciprocal dynamic interactions. Further comparative studies are needed to elucidate whether the cognitive processes that are known to be assessed by these tests are specific to ADHD.

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.

Relationship Between Sleep Problems and Quality of Life in Children With ADHD

Objective: The purpose of this study is to assess the sleep behaviors, sleep problems and frequency, and relationship with psychiatric comorbidities in ADHD Combined type and to evaluate the effect of sleep problems on quality of life. Method: Forty-six boys, aged 7 to 13 years, with ADHD-combined type and 31 healthy boys were included. ADHD children were never treated for sleep or psychiatric disorders. Intelligence quotient (IQ) test scores were minimum 80, body mass index were normal and did not have medical disorders. Parents completed Children’s Sleep Habits Questionnaire, Conners’ Parent Rating Scale and The Pediatric Quality of Life Inventory (PedsQL) and participants were asked about sleep behaviors and were administered PedsQL and Schedule for Affective Disorders and Schizophrenia. Results: The frequency of sleep problems in ADHD is 84.8%, higher than the control group (p = .002). Evaluating PedsQL scores, the quality of life is worse in physical, psychosocial health, and total life quality (p < .05). ADHD group with sleep problems have more night wakings than control group with sleep problems (p = .02). The comorbidity do not increase sleep problems. The frequency of parasomnias is increased in group with learning disorders (p = .05). Conclusion: The results of this study, which controls for a number of possible confounders found in previous examinations of ADHD and sleep, support the results of a number of other studies that have found an increased overall prevalence of parent-reported sleep disturbances in children with ADHD compared with healthy control participants. As the ADHD group have more night wakings than the control group through the night, it is thought that night wakings that cause a partitioned sleep may be important signs seen in ADHD. That could be suggested by two hypotheses. First one is that, daytime sleepiness is more common in ADHD and those children present excessive hyperactivity during the day to stay awake and the second one is the improvement of ADHD signs when the drugs for sleepiness are used. Usage of standardized and valid diagnostic criteria, exclusion of adolescence, gender, socioeconomic level, primary sleep problems, medical disorders and low IQ level, making allowances for effect of comorbidities and having compared with the control group are the important methodological features of this study. The most important limitation of this study is small sample size that makes the findings less generalizable to other groups of children with ADHD, and another one is not having used objective measurements together with subjective measurements. In conclusion, these results underscore the importance of screening all children who have a symptom constellation suggestive of ADHD for sleep problems that may either play a causative role or exacerbate the clinical appearance of ADHD in a given child. Correct evaluation and treatment of sleep problems increase the life quality of family and child and also decrease the severity of ADHD symptoms.

Paternal X could relate to arithmetic function ; study of cognitive function and parental origin of X chromosome in Turner syndrome

Background: 45,X Turner syndrome (TS) female subjects have visuospatial skill and social cognition deficits that may arise from X‐linked imprinting. The aim of the present study was to compare phenotypic characteristics and neurocognitive pattern of 12 monosomic TS girls, according to X‐linked imprinting.

Clinical Review of 95 Patients with 46,XX Disorders of Sex Development Based on the New Chicago Classification

STUDY OBJECTIVE The aim of our study was to determine the etiologic distribution of 46,XX disorder of sexual development (DSD) according to the new DSD classification system and to evaluate the clinical features of this DSD subgroup in our patient cohort. PARTICIPANTS The evaluation criteria and clinical findings of 95 46,XX patients were described by clinical presentation, gonadal morphology, genital anatomy, associated dysmorphic features, presence during prenatal period with/without postnatal virilization, hormonal characteristics, and presence or absence of steroidogenic defects among 319 patients with DSD. RESULTS Types and ratios of each presentation of our 95 patients with 46,XX DSD were as follows: 82 had androgen excess (86.3%): (74 had classical congenital adrenal hyperplasia, 2 had CAH variant possibility of P450-oxidoreductase gene defect), 6 had disorders of ovarian development (6.3%): (1 patient had gonadal dysgenesis with virilization at birth with bilateral streak gonad, 4 patients had complete gonadal dysgenesis, and 1 patient had ovotesticular DSD) and 7 had other 46,XX DSD. Two sisters, who had 46,XX complete gonadal dysgenesis,were diagnosed with Perrault Syndrome with ovarian failure due to streak gonads and associated with sensorineural deafness. CONCLUSION 46,XX DSD are usually derived from intrauterine virilization and CAH is the most common cause of 46,XX DSD due to fetal androgen exposure.

Family Functioning, Comorbidities, and Behavioral Profiles of Children With ADHD and Disruptive Mood Dysregulation Disorder.

Objective: Children with ADHD-combined type (ADHD-C), disruptive mood dysregulation disorder (DMDD), and healthy controls (HC) were compared with respect to the sociodemographic features, psychiatric comorbidities, behavioral patterns, and family functioning. Method: Research groups were identified using the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL). Conners’ Rating Scale–Revised Long Form, Wechsler Intelligence Scale for Children–Revised (WISC-R) test, Sociodemographic Questionnaire, and Family Assessment Device (FAD) were administered to research groups. Results: DMDD group’s rate of psychiatric comorbidity was higher than the ADHD-C group’s rate. In most of the subscales of Conners, DMDD group’s average scores were higher than the other groups’ scores. In “Communication,” “Affective Responsiveness” subscales of FAD, DMDD group’s average scores were higher than the ADHD-C group’s scores. In “Affective Involvement,” “General Functioning” subscales of FAD, DMDD group’s average scores were higher than the other groups’ scores. Conclusion: Children with DMDD were distinguished from children with ADHD-C by their higher comorbidity rate, more impaired behavioral patterns, and family functioning.

Mothers ' alexithymia, depression and anxiety levels and their association with the quality of mother- infant relationship: A preliminary study

Abstract Objective. To evaluate the relationship between mothers and their developmentally normal infants in terms of maternal alexithymia, depression and anxiety, and marital satisfaction. Methods. Fifty children between 18 and 48 months of age, and their mothers, were referred consecutively to the Infant Mental Health Unit of Ankara University School of Medicine, Department of Child and Adolescent Psychiatry. The sociodemographic features of the families and the depressive symptoms, anxiety, marital satisfaction and alexithymia levels of the mothers were assessed. The relationships between children in normal developmental stages and their mothers were evaluated and rated using a structured clinical procedure. Results. There was a negative correlation between the mothers’ alexithymia scores and the quality of the mother-infant relationship (p < 0.05). Mothers with high alexithymia showed higher depression and lower relationship qualities than mothers with low alexithymia, according to the correlation analysis. When depression and anxiety were controlled, high alexithymia levels were predictive of a low, impaired mother-infant relationship. Conclusion. Since alexithymia is a trait-like variable which has a negative correlation with impairment in a mother-infant relationship, it must be investigated in the assessment of mothers’ interactions with their babies.

Cyberbullying among a clinical adolescent sample in Turkey: effects of problematic smartphone use, psychiatric symptoms, and emotion regulation difficulties

ABSTRACT BACKGROUND: Cyberbullying, has concerned professionals due to increased use of media over time and as predicted, this type of bullying is fairly common among adolescents. We aimed to define the prevalence of cyberbullying and cyber victimization, examine relationships between problematic smartphone (SP) use (PSU), psychiatric symptoms and emotion regulation difficulties in a clinical adolescent sample. Also, we aimed to predict risk factors of being an E-Victim and E-Bully. METHODS: One hundred and fifty adolescents have recruited the study. Demographic Information Form, Problematic Mobile Phone Usage Scale, Brief Symptom Inventory, Difficulties in Emotion Regulation Scale, E-Victimization–E-Bullying Scale were filled out by adolescents. RESULTS: Our results indicated that the prevalence of cybervictimization and cyberbullying were 62.6% and 53.3%, respectively. BEVEB (Both E-Victim and E-Bully) group adolescents were older than NVB (Non-Victim/Bully) groups. Access internet via own SP, PSU, problems in strategies and impulse control and were significantly higher and “lack of awareness” scores were significantly lower in BEVEB group than others. In addition, when compared with OEV (only E-Victims) group, BEVEB group had also higher hostility scores. Logistic regression analysis revealed that high scores of “lack of awareness” and higher E-bullying scores increase the risk of being an E-Victim; and higher scores of hostility and E-victimization and lower scores of “lack of awareness” (in other words being more aware of feelings) increase the risk of being an E-bully. CONCLUSIONS: According to analyses, contrary to our expectations, PSU was important but not an independent predictor of being an E-Victim/E-Bully. Our results also demonstrated an interesting finding: lack of awareness is a risk factor for being an E-victim. We interpreted this result as could not be aware of feelings increase the victimization risk. On the other hand, E-Bullies have higher hostility and victimization while having lower “lack of awareness” scores. It could be speculated that, re-victimization and being aware of hostility feelings could increase the cyberbullying among adolescents. In addition being an E-Bully could be a consequence of being an E-victim and increasing hostility and awareness over time. These results should be re-examined in larger clinical samples.