Marie Wadsby

The psychometric properties of the Trauma Symptom Checklist For Children (TSCC) in a sample of Swedish children

OBJECTIVE To evaluate the psychometric properties of the Swedish version of the Trauma Symptom Checklist for Children (TSCC) and to study traumatic symptoms in a normative group of Swedish children and adolescents. METHOD A normative group of 728 children and adolescents age 10-17 and a clinical group of 91 children and adolescents known to have experienced sexual abuse participated in the study. A test-retest procedure was conducted with 79 participants from the normative group. RESULTS Good reliability such as internal consistency (Cronbachs alpha) for the total scale .94 (ranging in the clinical scales .78-.83) and test-retest for the total scale r=.81 (ranging in the clinical scales .67-.81) were found. The confirmatory 6-factor analysis explained 50.7% of the variance. Other validity measures such as concurrent validity and criterion related validity were also shown to be satisfactory. The normative sample of Swedish children and adolescents showed lower means on the subscales than has been reported in previous studies from a number of other countries. CONCLUSION The Swedish version of TSCC has been shown to be a screening instrument with satisfactory psychometric qualities that is capable to identify trauma symptoms among children and adolescents who have themselves self-reported experiencing trauma or for whom clinicians have identified traumatic experiences.

Visual and cerebral sequelae of very low birth weight in adolescents

Objective: To describe the visual functions and relate them to MRI findings and the intellectual level in adolescents born with very low birth weight (VLBW). Design: Population-based case–control study. Patients: 59 15-year-old VLBW adolescents and 55 sex and age-matched controls with normal birth weight. Main outcome measures: Objective clinical findings (visual acuity, stereo acuity and cycloplegic refraction) were recorded. Structured history taking was used to identify visual difficulties. The intellectual level was assessed with the Wechsler Intelligence Scale for Children (WISC). All VLBW adolescents underwent MRI of the brain. Results: Significant differences were found between the VLBW adolescents and controls regarding visual acuity (median −0.11 and −0.2, respectively; p = 0.004), stereo acuity (median 60″ and 30″, respectively; p<0.001), prevalence of astigmatism (11/58 and 0/55, respectively; p<0.001) and in full-scale IQ (mean IQ 85 and 97, respectively; p<0.001) and performance IQ (mean 87 and 99, respectively; p = 0.002). The structured history also revealed a borderline significant difference between the groups (mean problems 0.46 and 0.15 respectively; p = 0.051). 30% (17/57) of the VLBW adolescents had abnormal MRI findings and performed worse in all tests, compared with both the VLBW adolescents without MRI pathology and the normal controls. Conclusion: This study confirms previous observations that VLBW adolescents are at a disadvantage regarding visual outcome compared with those with normal birth weight. In 47%, visual dysfunction was associated with abnormal MRI findings and in 33% with learning disabilities. The adolescents with abnormal MRI findings had more pronounced visual and cognitive dysfunction. The findings indicate a cerebral causative component for the visual dysfunction seen in the present study.

Very-low-birth-weight children at school age: academic achievement, behavior and self-esteem and relation to risk factors

Objective: To investigate school performance, behavior and self-esteem of children with very low birth weight (VLBW). Methods: All children with birth weight below 1501 g (VLBW) and normal birth weight controls, born in the south-east region of Sweden during a 15-month period in 1987-88, were enrolled in a prospective follow-up study. At the age of 9 years, 81% and 82%, respectively, were re-examined regarding growth, neurofunctional classification, academic achievement tests, need for special education and behavioral problems. At 12 years, 89% and 76%, respectively, were re-examined regarding growth, neurofunctional classification, visual acuity and self-esteem. Results: VLBW children were shorter and lighter, and differed from the controls with regard to neurological functional classification. They produced poorer results in most academic achievement tests. When the comparison was restricted to children with normal intelligence, almost all the differences in other academic achievements disappeared. VLBW children had more reading difficulties but were less often than expected defined as dyslexics compared to control children. We did not find any major disparity in visual acuity and self-esteem between the groups. Low Apgar scores, intracranial hemorrhage and the need for mechanical ventilation neonatally were associated with poorer results in most outcome measures. Neurofunctional assessments in early childhood were associated with most outcome measures. The mothers education was related to delayed reading skills and need for special education. Conclusions: Although VLBW children performed less well in most academic achievement tests and on some behavioral subscales, those who had a normal intellectual capacity did not differ in any important aspects from the controls.

Evaluation of the Swedish version of the ENRICH Marital Inventory

The Swedish version of the marital inventory ENRICH (Evaluating & Nurturing Relationship Issues, Communication & Happiness) was tested and evaluated in a study comprising 176 individuals in 4 different groups. Test-retest reliability (0.65-0.94) and Cronbachs alpha (0.69-0.97) were calculated. Comparisons between sexes, between groups, and between different instruments were found to give a satisfactory outcome. Discriminant analyses showed a total of 90.9% correctly classified individuals. In conclusion, the ENRICH Marital Inventory was noted to be a properly reliable and valid instrument to use in assessing marital satisfaction.

Fifteen years after parental divorce: mental health and experienced life-events

The children who experienced their parents’ divorce when the divorce rate in Sweden had begun to grow to higher levels than in preceding decades are today adults. The aim of this study was to investigate if adults who had experienced parental divorce 15 years before the time of our study, differed in mental health from those with continuously married parents, taking into account life events other than the divorce. Instruments used were the Symptom Checklist (SCL-90) measuring mental health and the Life Event questionnaire capturing the number and experience of occurred events. Forty-eight persons, who were 7–18 years old when their parents divorced, constituted the divorce group, and 48 persons matched on age, sex and growth environment formed the study groups. The SCL-90 showed a limited difference between the groups, but not concerning total mental health. A main finding was a difference with regard to sex and age; women aged 22–27 in the divorce group displayed poorer mental health than other participants in both groups. The results from the Life Event questionnaire showed that the divorce group had experienced a significantly larger number of events, and more life events were described as negative with difficult adjustment. A regression analysis showed a significant relation between the SCL-90, Global Severity Index and life events experienced as negative with difficult adjustment, divorce events excluded, but not with the divorce itself. It seems highly desirable to pay more attention than has thus far been paid to girls with experience of childhood divorce at age 7–12.

Academic achievement, behavioural outcomes and MRI findings at 15 years of age in very low birthweight children

Aim: To assess cognitive, academic and behavioural functions in 15‐year‐old very low birthweight (VLBW) children and relate results to gender, neonatal risk factors, growth and magnetic resonance imaging (MRI) findings.

Children of mothers who are at psycho-social risk. Mental health, behaviour problems and incidence of child abuse at age 8 years

Of the 1575 pregnant women registered at the public Antenatal Health Care Service in the city of Linköping, Sweden, during 1983, an index-group of 78 women were identified who met specific well-defined psychosocial risk-criteria related to drug addiction, mental insufficiency, and particular social circumstances of possible relevance to problems of pregnancy and early child development. Seventy-eight pregnant women who did not meet the inclusion criteria were used as a reference group. The present study was an 8-year follow up in which 47 of the original index children and 57 of the original reference children were examined on indices of mental health, and the presence of child abuse. Their mental health was assessed on the basis of a Symptom and Behaviour Interview (SBI) with the mother and a Child Behaviour Checklist (CBCL) completed by the mothers and the teachers. The incidence of child abuse was obtained from Social Welfare records. The index children displayed significantly poorer mental health as assessed by the SBI and the CBCL, had a more negative self-image, and child abuse had been investigated in 30°10 of the index families compared to 1 % in the reference families. The study suggests, based on the suboptimal development of the risk children, that screening for early psychosocial risk factors should be done routinely and be combined with early interventions.

Adolescents selling sex: Exposure to abuse, mental health, self-harm behaviour and the need for help and support—a study of a Swedish national sample

Background: Selling sex is not uncommon among adolescents and we need to increase our knowledge of how this affects them. Aim: The aim of this study was to investigate adolescents who sell sex regarding sexual, mental and physical abuse, mental health as estimated by using the Hopkins Symptom Check List-25 (HSCL-25), self-harm behaviour and the adolescents’ experience of receiving help and support. Methods: The study was carried out on a national representative sample of adolescents (mean age 18.3 years) in Swedish high schools in the final year of their 3-year programme. The study had 3498 participants and a response rate of 60.4%. Results: Of the adolescents, 1.5% stated that they had sold sexual services. The selling of sex was associated with a history of sexual, mental and physical abuse. Poorer mental health and a higher degree of self-harm behaviour were reported among the adolescents who had sold sex. Help and support was sought to a greater extent by adolescents who had sold sex but these adolescents were not as satisfied with this help and support as the other adolescents. Conclusions: Adolescents that sell sex are a group especially exposed to sexual, mental and physical abuse. They have poorer mental health and engage in more self-harm behaviour than other adolescents. They are in need of more help and support than other adolescents and it is reasonable to assert that more resources, research and attention should be directed to this group to provide better help and support in the future.

Mental health, behaviour problems and incidence of child abuse at the age of 16 years. A prospective longitudinal study of children born at psychosocial risk.

Of the 1,575 pregnant women registered at the public Antenatal Health Care Service in the city of Linköping, Sweden during 1983, an index group of 78 women was identified that met specific well-defined psychosocial risk criteria related to drug addiction, mental insufficiency, and particular social circumstances of possible relevance to problems of pregnancy and early child development. A further 78 pregnant women who did not meet the inclusion criteria were used as a reference group. The present study is a 16-year follow-up in which 43 (57%) of the original index children and 63 (82%) of the original reference children were examined on indices of mental health, and the presence of child abuse. Their mental health was assessed with the Child Behaviour Checklist (CBCL) completed by the mothers and the Youth Self-Report (YSR) completed by the adolescents. The incidence of child abuse and Social Welfare interventions was obtained from Social Welfare records. The index children, especially the boys, displayed significantly poorer mental health as assessed by both CBCL (p<0.05) and YSR (p<0.02). Being an index child increased the odds ratio 16–27 times for different Social Welfare interventions, and child abuse had been investigated in 27% of the index children compared to 1% of the reference children.

Academic achievement in children of divorce

Abstract The influence of parental divorce on Swedish childrens final grades from compulsory school was studied. The study group comprised all children ( n = 74) of a 1-year-sample of divorcing parents, who finished school within 1 year before, to 5 years after the parental divorce. Each child was matched with two classmates of the same sex from nondivorced homes, born at approximately the same time (control group). Comparisons of grade point average were made among children with different socioeconomic status. The grades of the children of divorce and the controls were similar, but children of manual workers were found to have a lower grade point average than children of higher level nonmanual employees. Thus, the study indicates that parental divorce in itself does not imply a significantly detoriated outcome in final school grades among children.