Koray Kara

P50 sensory gating in children and adolescents with ADHD and effects of methylphenidate administration on P50 sensory gating / Dikkat eksikliği hiperaktivite bozukluğu tanılı çocuk ve ergenlerde P50 duyusal kapılama ve metilfenidat tedavisinin P50 duyusal kapılama üzerine etkisi

Objective: The P50 is thought to resect a sensory gating mechanism and prevent information overload in humans. Failure to inhibit the P50 auditory event evoked response can occur in attention deficit hyperactivity disorder (ADHD) patients. The aims of the present study were to examine the inhibition of the P50 auditory event evoked potential and the effects of methyphenidate administration on P50 parameters in children and adolescents diagnosed with ADHD. Methods: Twenty-two drug-free subjects, aged 9-14, who were diagnosed with ADHD (the combined type) according to the DSM-IV criteria, and 18 mentally and physically healthy subjects, aged 9-12, were included in the study. First, P50 parameters were measured in drug-free ADHD subjects and healthy controls. Following this measurement, 10 mg of methylphenidate was administered to the ADHD group. The P50 measurement was repeated 1 hour following methylphenidate administration in the ADHD subjects. The healthy control group was not re-examined. Results: A significant difference was found in P50 test latency, test amplitude, and P50 ratio values between the ADHD group and healthy controls. Significant differences were also found in conditioning latency, test latency, test amplitude, and P50 ratio values between before and after methyphenidate administration in the ADHD group. Conclusions: The results of the present study point out an association between P50 and ADHD and they also show that methyphenidate administration increases the P50 suppression level. Since, this is the first study evaluating sensory gating in children and adolescents with ADHD, it should be considered as a preliminary study. Further studies with large study samples are warranted.

Çocuk ve ergen psikiyatrisi polikliniğine başvuran hastalarda tanı dağılımı / Diagnoses of patients referring to a child and adolescent psychiatry outpatient clinic

Diagnoses of patients referring to a child and adolescent psychiatry outpatient clinic Objective: The aim of the present study is to identify the diagnoses of patients who referred to a child and adolescent psychiatry outpatient clinic. Method: Medical records of 538 patients referred to the Children and Adolescent Psychiatry outpatient clinic at Gulhane Military Medical School, between January 2009 and June 2009 were studied retrospectively. Results: It was found that the patients were mostly male and within 7 to 18 years of age. It was also determined that three quarters of patients had at least one diagnosis and the diagnosis rate in children between the ages of 0-6 was 50 percent. Comorbid diagnoses were found in 13.7 percent of all cases and they were mainly in the attention deficit hyperactivity disorder (ADHD) group. The most common diagnoses were ADHD, generalized anxiety disorder, mental retardation, depression and enuresis, respectively. The most common diagnosis in all age subgroups was ADHD. While the most common diagnoses in boys are ADHD, mental retardation, generalized anxiety disorder, enuresis and depression respectively, they were ADHD, generalized anxiety disorder, depression, mental retardation and enuresis in girls. Conclusion: To know the most common diagnoses, diagnosis differences within genders and possible diagnoses for certain age groups will be useful for improving child and adolescent psychiatry services.

Investigation of distinctive characteristics of children with specific learning disorder and borderline intellectual functioning

Background Borderline intelligence function (BIF) and specific learning disorder (SLD) are common diagnoses in children who are brought up for learning problems and school failure. Objective The aim of our study was to determine whether there were distinctive aspects of cognitive testing routinely used in evaluating SLD and BIF and investigate emotion regulation skills and minor neurologic symptoms. Method Sixty children (30 SLD and 30 BIF) who are currently attending primary school are selected for study. Visual Aural Digit Span Test – Form B, Gessel Figure Drawing Test, Bender Gestalt Visual Motor Perception Test, WISC-R, Emotion Regulation Scale (ERS) and Neurological Evaluation Scale (NES) was administered. Results There was no statistically significant difference between groups in cognitive tests. The emotional regulation ability measured by the emotional regulation subscale was better in the SLD group than the BIF group (p = 0.014). In the NES, sensory integration (p = 0.008), motor coordination (p = 0.047) and other (p < 0.001) subscales showed higher scores in the BIF group. Discussion It has been shown that cognitive tests don’t have distinguishing features in the evaluation of SLD and BIF. Emotion regulation subscale score of ERS and sensory integration, motor coordination, and total scores of NES can be used in both discrimination of groups.

Alexithymia, depression and anxiety in parents of children with neurodevelopmental disorder: Comparative study of autistic disorder, pervasive developmental disorder not otherwise specified and attention deficit-hyperactivity disorder

Recent studies have shown that individuals with neurodevelopmental disorders and their relatives have problems expressing and recognizing emotions, but there is a lack of studies on alexithymia, and the relationship between parental alexithymia and depression–anxiety symptoms in these groups. The aim of this study was therefore to measure alexithymia, depression, and anxiety levels in parents of children with pervasive developmental disorders and attention deficit–hyperactivity disorder (ADHD), and determine whether there is a positive correlation between the childs neurodevelopmental problem severity and parent scores.Background: Recent studies showed that individuals with neurodevelopmental disorders and their relatives have problems to express and recognize emotions but there is a lack of studies concerning alexithymia levels and relationships between parental alexithymia and depressionanxiety symptoms in these groups. Objective: We aimed to determine alexithymia, depression, anxiety levels of parents in children with pervasive developmental disorders and ADHD, also examine if there is a positive correlation between child’s neurodevelopmental problem’s severity and parental scores. Methods: Parents of 29 AD, 28 PDD-NOS and 29 ADHD children have recruited the study. Sociodemographic data form, TAS-20, BDI, STAI-I and STAI-II were applied to groups. Results: Our results demonstrated that alexithymia symptoms are higher among parents of children with AD than others but unexpectedly, also these symptoms were higher in ADHD parents than PDD-NOS groups’. In addition, there were unexpected differences according to alexithymia subtypes while only the difference in maternal TAS-1 scores (difficulty in describing feelings) were statistically significant. Parental depression, state anxiety scores were increased as the child’s symptom severity increased, but trait anxiety symptoms were higher among AD and ADHD group than PDD-NOS. In all groups, maternal depression and anxiety scores were higher than paternals and differences were significant for depression and A cc ep te d A rt ic le This article is protected by copyright. All rights reserved. anxiety types among AD, and for only anxiety types among ADHD parents. We noticed that AD group had the strongest correlational relationship between parental depression-anxiety and alexithymia statements. Conclusion: Alexithymia, depression and anxiety levels are necessary to remember while studying with parents of children with neurdodevelopmental disorders.

Assessment of relationship between comorbid oppositional defiant disorder and recognition of emotional facial expressions in children with attention-deficit/hyperactivity disorder

ABSTRACT Objectives: Attention-deficit/hyperactivity disorder (ADHD) is the most frequent neurobehavioural disorder in childhood. ADHD is associated with impaired academic performance, cognitive, and emotional deficits. Moreover, comorbid oppositional defiant disorder (ODD) is leading to more severe impairment in social performance. Social cognition involves recognition, encoding, and interpretation of emotions from faces. Basic facial expressions that include sadness, happiness, anger, disgust, fear, and surprise are the easiest emotions to recognize. We aimed to demonstrate facial expression recognition impairments that might occur more frequently in children with co-occurring ADHD/ODD than patients with ADHD only. Thus, children with the co-occurrence of ODD may suffer more severely from social and behavioural difficulties. Methods: Forty patients diagnosed with ADHD and/or co-occurring ADHD/ODD according to DSM-IV-TR criteria were compared with a parallel (by gender, age, and educational state) 11 healthy children as a control group in this study. Clear facial images of each emotion were used as well as two additional sets of photos include 50% blurred images and cropped eye images were added as distractors then all images represented with black and white tone for emotion recognition task via facial expression. Angry expressions presented as target expressions. DSM-IV-Based Screening and Rating Scale for Children and Adolescents with attention deficit and disruptive behaviour disorders, the Conners’ Teachers Rating Scale/Revised Long Form and the Conners’ Parent Rating Scale/Revised Long Form were used to provide diagnostic objectivity. Results: Control group statistically performed better than ADHD group on recognition of emotional facial expressions. Results showed no statistically significant differences between the ADHD and ADHD/ODD group on recognition of emotional facial expressions. However, according to results of emotion recognition task via facial expressions, there were statistically significant differences between pure ADHD and comorbid ADHD+ODD groups in happy and neutral expressions. ADHD/ODD group tend to attribute more meaning to neutral facial expressions. Additionally there was statistically significant difference between control group and ADHD group according to recognition of angry expressions. There were statistically significant differences between the groups according to recognition of sad expressions in all clear, blurred, and eye photographs. Conclusions: Difficulties in recognizing emotional facial expressions were observed in children with ADHD. A statistically significant association was established between presence of ADHD and impaired recognition of facial emotion expressions independent from the scores of the disruptive behaviour rating scale. Comorbid ODD was not associated with recognition of emotional facial expressions including angry expressions. Recognition of angry expressions was not found as a predictor for disruptive behaviour disorders.

Relationship between perceived parenting style with anxiety levels and loneliness in visually impaired children and adolescents

Visual impairment is a risk factor for psychiatric disorders in the affected children and adolescents, but there are only a limited number of studies concerning the mental health characteristics of visually impaired children and adolescents. Objective The aim of this study was to determine levels of loneliness and anxiety in visually impaired children and adolescents, to analyze parenting style perceived by visually impaired children and adolescents, to compare those with typically controls. Methods The study included 40 children and adolescents with visually impairment and 34 control group without visual impairment. Sociodemographic data form, the UCLA loneliness scale, and the State-Trait Anxiety Inventory for Children were used in both groups. The parenting Style Scale was used to determine perceived parental attitudes. Results This study found more loneliness and trait anxiety levels in visually impaired children and adolescents compared to the control group. Authoritative parenting style was the most frequent type of parental attitude in the visually impaired group. In visual impairment group, loneliness level was higher in subgroups of authoritative and permissive-indulgent parenting style. However, level of trait anxiety was higher in authoritative parenting style subgroup compared to the control group. Discussion The results of this study showed higher loneliness and anxiety levels in visually impaired children and adolescents. Further studies are needed to determine psychopathological risks in this population

Neuropsychological evaluation of children and adolescents with acute carbon monoxide poisoning

Objectives Carbon monoxide (CO) poisoning is a worldwide health problem. We have limited information regarding psychological adversities of CO poisoning in children and adolescents. The aim of this study was (1) to investigate the effects of severe CO poisoning on cognitive functions, mood, and behaviors in children and adolescents and (2) to identify factors related to occurrence of neuropsychological symptoms. Methods This study included pediatric patients, who were evaluated after CO poisoning at the Department of Child and Adolescent Psychiatry between January 2012 and April 2013. The patients were evaluated at 2 time points. The first evaluation was done when they were discharged from emergency department, and the second evaluation was done 1 month after CO poisoning. Turkish versions of internationally recognized tests were used to evaluate anxiety, depressive symptoms, attention, visual-spatial skills, memory, and behaviors of patients. Results Twenty-seven patients were analyzed. The mean age of the patients was 11.8 ± 2.7 years (range, 6–18 years). The mean carboxyhemoglobin level was 31.5% ± 7.8% (range, 19%–51%) dir. Delayed neurological sequel was observed in only 1 patient, who had headache and tinnitus. We found that carboxyhemoglobin level was not correlated with later neuropsychiatric test scores. However, we found a correlation between history of loss of consciousness and anxiety symptom level, hyperbaric oxygen (HBO) therapy session and behavioral problems, and time to HBO therapy and attention problems. Conclusions We suggest that CO exposure duration, history of loss of consciousness, time to HBO therapy, and the number of HBO therapy session affect neuropsychological symptom levels and occurrence of attention and behavioral problems.

Relationship between self-injurious behaviors and levels of aggression in children and adolescents who were subject to medicolegal examination

Aggression, which is defined as a behavior causing harm or pain, is a behavioral pattern typically expected in children and adolescents who are involved in criminal activities. The aim of this study was to examine the relationship between aggression and self‐injurious behavior (SIB) in children and adolescents. The study was performed in 295 cases which were sent for medicolegal examination. The mean age of the subjects was 14.27 ± 1.05 years (age range 10–18 years). The aggression levels of the subjects were determined using the Aggression Questionnaire (AQ), which is an updated form of the Buss‐Durkee Hostility Inventory. The mean total AQ score of the subjects with and without SIB was 78.04 ± 21.0 and 62.75 ± 18.05, respectively (p < 0.01). There were significant statistical differences between the two groups with respect to their subscale scores (p < 0.01). It was concluded that the levels of aggression increased in children and adolescents who were involved in criminal activities when the SIBs increased.

Anger and aggression level in parents of children with attention deficit and hyperactivity disorder

Objective: In this study we aimed to assess the aggression and trait anger-anger expression levels in parents of children with attention deficit and hyperactivity disorder (ADHD) and to investigate the relationship between symptoms of ADHD/oppositional defiant disorder and aggression and anger levels of parents. Methods: The study sample consisted parents of 58 children diagnosed with ADHD between 6-14 ages. The healthy control group consisted of 54 healthy childrens parents. Both ADHD and healthy group were assessed with Sociodemographic Data Form, Buss-Perry Aggression Questionnaire and Trait Anger Expression Inventory. Symptoms of ADHD in children were evaluated with the DSM-IV Based Behavior Disorders Screening and Rating Scale. Results: We found that trait anger level of mothers was higher in ADHD group than the control group. Anger control scores of ADHD parents was lower than the control group. Buss-Perry aggression questionnaire total aggression score and hostility subscale score was found to be higher In ADHD group than healthy control group. Additionally, attention deficit and oppositional defiant symptom levels of ADHD children were in relation with hostility level of parents and trait anger level of mothers. Conclusion: In our study trait anger and total aggression levels of mothers were found to be higher in ADHD group than healthy control group. Anger control levels of parents of ADHD group were lower than the control group. Parents of children with ADHD should be aware of their emotion and behavior related to anger and aggression during the treatment of child.

Depression and anxiety levels of children and adolescents with ADHD

Objective: The aim of this study is to compare the depression and anxiety levels of children with ADHD with healthy controls. Method: 47 children and adolescents with ADHD and aged between 7-12 years were evaluated according to DSM-IV and 44 healthy children and adolescents who matched to patients in terms of age and education level were included in this study. Sociodemographic data form, parent-report of Children\s Depression Inventory (PR-CDI), child-report Children\s Depression Inventory (CR-CDI), Spence Children\s Anxiety Scale (SCAS) were applied to the participants. Results: It was revealed that depression and anxiety levels of children with ADHD were significantly higher than healthy controls. Depressive symptom levels were positively correlated with age and anxiety symptom levels. The panic/agoraphobia, separation anxiety, social phobia, generalized anxiety subscales’ scores of SCAS in ADHD were significantly higher than healthy controls. Conclusions: The comorbidity of depression and anxiety disorders is found to be frequent in ADHD samples.