Cahide Aydin

Broader autistic phenotype in parents of children with autism: Autism Spectrum Quotient-Turkish version

The Autism Spectrum Quotient (AQ) is a self‐assessment screening instrument for measuring the degree to which an individual of normal intelligence shows autistic traits. Genetic factors could be responsible for the relatives of individuals with autism exhibiting higher than normal rates of autism‐related impairments, referred to as the ‘broader autism phenotype’ (BAP). The aim of this study was to test whether there is a difference between the parents of autistic and those of typically developing children (TDC) on AQ scores in a Turkish sample.

Social and Emotional Outcomes of Child Sexual Abuse: A Clinical Sample in Turkey

Childhood sexual abuse is a traumatic life event that may cause psychiatric disorders such as posttraumatic stress disorder and depression. During 2003-2004, 20 sexually abused children were referred to the Child and Adolescent Psychiatry Clinic of Ege University in Izmir, Turkey. Two years later, the psychological adjustment of these children (M age = 9.4 years, SD = 3.63 years, range = 5 to 16 years) is evaluated. Semistructured interviews, a form for the sociodemographic characteristics, are used for evaluations by a child psychiatrist who is blind to the first evaluation. It is determined that sexually abused children have more psychiatric disorders within the first year than 2 years later. However, some behavior problems occur at both short-term and long-term follow-ups.

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.

Altered structural connectivity is related to attention deficit/hyperactivity subtypes: A DTI study

This study aimed to provide novel insights into the white matter (WM) microstructural properties of Attention Deficit/Hyperactivity Disorder (ADHD) subtypes by recruiting a relatively large sample of stimulant-naïve children and adolescents who had no comorbidity other than Oppositional Defiant Disorder and were homogenous according to the DAT1 gene polymorphism. A sample of 72 ADHD subjects and 24 controls aged 8-15 years were enrolled in the study. We applied tract-based spatial statistics to the DTI measures for obtaining fractional anisotropy (FA) and axial, radial diffusivity (AD, RD) measures to explore ADHD type-related differences in WM for the whole brain. Comparing ADHD-Combined group (ADHD-C) with the ADHD predominantly inattentive group (ADHD-I) we detected increased RD in several bilateral brain area and increased AD mostly in left side of the brain, including the body and splenium of the corpus callosum; the anterior and posteriors limbs of the internal capsule; the superior, anterior and posterior corona radiata; the posterior thalamic radiation; and the superior longitudinal fasciculus. Likewise, mostly in the overlapping brain areas, the ADHD-C group presented increased AD values than ADHD-RI. Significant differences among ADHD types could be a preliminary evidence that they have distinct microstructural properties. There were no significant differences in diffusivity between controls and both the ADHD group as whole or any ADHD subgroups.

Childhood sexual abuse and supportive factors

Childhood sexual abuse (CSA) can be a devastating life experience and is associated with a higher incidence of mental disorders and suicide attempts. The aim of this study was therefore to identify predictors of mental disorder and suicide attempt in children and adolescents with a history of CSA.

Combined methylphenidate and atomoxetine pharmacotherapy in attention deficit hyperactivity disorder.

Objectıves. Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) includes stimulant and non-stimulant medications. Our purpose in this study is to investigate efficacy, safety and tolerability of combined methylphenidate and atomoxetine pharmacotherapy. Methods. We included 12 patients of the 824 patients with ADHD using methylphenidate and atomoxetine combined therapy between the years 2010 and 2014. Kiddie-SADS, Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale, Child Behavior Checklist, Clinic Global Impression Scale Severity and Impression (CGIS-S-I) scales were used. Results. Patients were between the ages of 7 and 17 years. Before combined pharmacotherapy the CGIS-S score mean was 5.08. Mean CGIS-S score after the combined pharmacotherapy was 3.08 (P = 0.03; –2,980). The most common side effects were irritability (n = 5, 41.6%), appetite reduction (n = 3, 25%), palpitations (n = 2, 16.7%), headache (n = 1, 8.3%). Conclusıons. Nine of these 12 patients showed significant improvement in their symptoms, combined therapy enhanced the effectiveness of monotherapy.

Demonstration of Uniparental-Isodisomy on Chromosome 22q11.2 in a Patient With Childhood Schizophrenia and Facial Dysmorphology by Whole-Genome Analysis

Case Report An 8-year-old girl was referred because of mental retardation and behavioral problems. Written, informed consent was obtained from the parents for the publication of the patient’s details. She was born to consanguineous parents at 31–32 weeks’ gestation. Her birth percentiles were in normal ranges. Her developmental milestones were slightly delayed. There was no history of psychiatric disorder in the relatives except that there were two members with idiopathic mental retardation. Her physical assessment at age 8 revealed elfin-like facial features, sparse medial eyebrows, arched eyebrows, hypertelorism, depressed nasal bridge, bulbous nasal tip, downturned corners of mouth, thick lower lip, and joint laxity. Imaging studies were normal. Psychiatric evaluation at age 3 revealed language-development delay, restricted social relationships, echolalia, and lack of interest in peer-relationships and toys. Her psychometric evaluation with developmental tests showed a 1-year delay. Echolalia, social-relationship restrictions, and not having imaginary play were noted as autistic-like features. At age 6, unrealistic fears, psychomotor agitation, disorganized behavior, auditory and visual hallucinations, incoherence, irrelevant and disorganized speech, and delusions were observed. She was diagnosed as “very-earlyonset schizophrenia” according to the DSM-IV criteria. Her Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) scores were 75 and 72, respectively. Her psychiatric disorder severity score was 6, according to Clinic Global Impression Scale–Severity (CGIS–S). Her karyotype and FISH analysis were normal. Whole-genome analysis by Affymetrix Human SNP Assay 6.0 kit revealed inherited copy-number variations (CNVs) and loss-of-heterozygosity (LOH) on a number of regions, which could be due to the parental consanguinity. LOH on chromosome 22 cent-q11.2 spanned 6 Mb. CNV analysis showed no evidence of any deletion in this region. The same analysis for the parents was normal. Microsatellite marker analysis with 8 markers confirmed maternally-inherited UPD (Figure 1). Catechol-O-methyltransferase (COMT) gene at 22q11, which has been identified as a susceptibility locus for schizophrenia, revealed 100-fold down-regulation, as compared with a control group. Therefore, it could be speculated that COMT could be one of a number of other genes down-regulated in this UPD region that may have contributed to the clinical presentation. In conclusion, this is the first report reinforcing the link between FIGURE 1. Microsatellite Marker Analysis of the Family (microsatellite markers in the UPD region are highlighted in gray) LETTERS

The Psychometric Properties of Turkish Version of Autism Spectrum Screening Questionnaire in Children aged 6-18 years

OBJECTIVE The objective of this study is to determine the psychometric properties of the Turkish version of the Autism Spectrum Screening Questionnaire (ASSQ-TR) and to find the best cutoff score for Pervasive Developmental Disorder (PDD) cases. METHOD Children between 6 to 18 years old with diagnoses of PDD, Obsessive Compulsive Disorder (OCD), and Attention Deficit Hyperactivity Disorder (ADHD) were included. The healthy control (HC) group was recruited from children who did not have any psychiatric complaints or history. Furthermore, parents of 268 children filled the ASSQ-TR. Of the children, 51 were PDD, 67 were ADHD, 50 were OCD, and 100 were HC. In order to show the reliability of the ASSQ-TR, Cronbachs alpha values and test-retest were evaluated. ROC analyses was carried out to show concurrent validity and to determine the cutoff score. RESULTS The Cronbachs alpha of ASSQ-TR is 0,86, while the test-retest reliability is r: 0,98. Total ASSQ-TR scores of children with PDD (27,96±9,5) were significantly higher than other groups (p<0,001). ROC analysis of ASSQ-TR showed the area under curve to be 0,97 with a cutoff of 16, having the maximum sensitivity (94,1%), specificity (89,0%), and 90,7% diagnostic accuracy of PDD versus HC scores. CONCLUSIONS Our pilot data showed that ASSQ-TR is a reliable instrument that successfully differentiates clinically diagnosed PDD from HC. This instrument might therefore be useful for the screening of PDD in school-aged children in Turkish populations.

Determination of Clinical and Socio-demographical Differences of Adolescents Applying to a Treatment Center with Family Encouragement or the Decision of the Probation Office and Determination of Predictive Factors in Maintaining Soberness among Probation Cases

INTRODUCTION This study has two objectives. The first objective of this study was the determination of some basic clinical and socio-demographical differences among the adolescents with substance abuse who apply to a treatment center with support from their family or by order of the probation office. The other objective of this study was the determination of the predictive factors in maintaining soberness among adolescents who successfully complete the probation treatment process. METHODS The target population of this study is young adults under 19 years of age who apply to a substance addiction center for adolescents as a result of encouragement from their family or ordered by the Probation Office between 2005 and 2013. These two groups were analyzed in terms of socio-demographical characteristics such as age, the age at which they tried the substance, the age at which they applied to the treatment center, sex, substances they used, education period, employment history, and street life experience. The Statistical Package for the Social Sciences (SPSS) 18.0 software was used for the statistical analysis. RESULTS It was detected that among the cases who applied to the treatment center with family support, their education period was longer than probation (PR) cases (p<0.0001), and the rates of previous treatment, their mother being alive, and having street life experiences were more frequent (p values: <0.0001; =0.010; =0.027; <0.0001, respectively) and employment history was higher among PR cases (p<0.0001). In terms of the substances used, ecstasy, alcohol, inhalants, and volatile substances are more common among those applying with family support (p=0.018; 0.001; <0.0001, respectively). However, use of cannabis was found to be more common among PR cases (p<0.0001). It was found that PR cases who successfully completed their treatment process had married parents (p=0.008) and had more years of education (p=0.004). It can be predicted that if the subject is well educated and does not use multiple substances or have an alcohol history, the treatment process for PR cases can be successfully completed. (R2=0.176; p<0.0001). CONCLUSION The rates of completing the treatment among cases analyzed in this study were higher than those among cases from adults. In the studies conducted, the results of the treatment efficiency among PR cases were inconsistent. This inconsistency may result from, except for legal obligations, having different circumstances such as socio-economic factors during the treatment period.

Does the quality of life in autism spectrum disorder differ from other chronic disorders and healthy children

Objective: Autism spectrum disorder (ASD) is characterized by deficits in social interaction, communication, restricted interests, and repetitive patterns of behavior. This study examined quality of life (QoL) and related clinical factors in children with ASD, compared to children with Attention Deficit Hyperactivity Disorder (ADHD), children with asthma, and healthy controls (HC). Methods: QoL was assessed by the Pediatric Quality of Life Inventory 4.0 (PedsQLTM 4.0). Additionally, parents of the children provided socio-demographic information and filled out an evaluation questionnaire, child behavior check list (CBCL), and Turgay DSM-IV disruptive behavior disorders rating scale (T-DSM-IV-S). Results: The physical health, psychosocial health, social functioning, and scale total score of the ASD group were significantly lower than those of the three comparison groups. The school functioning score domain was lower in the ASD group than in the asthma and HC groups. In contrast, the emotional functioning domain assessments did not reveal statistically significant differences between the ASD group and the comparison groups. In the ASD group, the total problem score, inattention, and hyperactivity scores were significantly higher than both the asthma and HC groups, and the internalizing scores were higher than the healthy group. Conclusion: The poor QoL is most likely due to functional losses and problem behaviors related to ASD and may negatively affect not only children with ASD but also the whole life of the family.