Runa Uslu

How Applicable Are Ages and Stages Questionnaires for Use With Turkish Children

The majority of eligible children cannot access early intervention services in Turkey, often because they are not assessed. The authors adapted the Ages and Stages Questionnaires (ASQ) for Turkish children ages 3 to 72 months. Study participants consisted of 375 children who were classified as at risk for developmental delays, 564 children considered not at risk for developmental delays (both groups according to standardized assessments), and 39 children with known disabilities. The ROC analyses indicated that a two-domain criterion for classification would be used to classify children as at risk, unlike the original ASQ, which had a one-domain classification. The sensitivity, specificity, positive predictive value, and negative predictive value of ASQ were .94, .85, .97, and .75, respectively. Test—retest and interrater reliabilities calculated as overall percentage agreements were found to be 82% and 87%, respectively. The results demonstrated that the ASQ could be used to screen Turkish children who are at risk for developmental delays.

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.

Lower urinary tract conditions in children with attention deficit hyperactivity disorder: correlation of symptoms based on validated scoring systems.

PURPOSE We investigated whether certain voiding problems have a higher incidence in patients with attention deficit disorder with hyperactivity compared to age matched controls. MATERIALS AND METHODS We used the Conners Parent Rating Scale-revised for attention deficit disorder with hyperactivity and lower urinary tract symptom score to evaluate voiding problems. A total of 62 children with attention deficit disorder and 124 healthy controls were enrolled. We evaluated uroflowmetry patterns in both groups. Residual urine volumes and Bristol stool scale were noted. We examined the correlation between total Conners Parent Rating Scale-revised and lower urinary tract symptom score in patients with attention deficit disorder. Additionally we analyzed each index of the Conners Parent Rating Scale-revised separately in terms of correlation with symptom subgroups for lower urinary tract symptom scores. RESULTS Mean ± SD total lower urinary tract symptom score was 11.1 ± 2.9 in patients with attention deficit disorder with hyperactivity and 3.2 ± 1.3 in controls, a difference that was statistically significantly (p <0.001). With the exception of constipation, mean scores of all lower urinary tract symptom subindices were significantly higher in patients with attention deficit disorder compared to controls. Symptoms evaluated in lower urinary tract symptom score were mostly correlated with attention deficit disorder index of the Conners Parent Rating Scale-revised. If a child with attention deficit disorder has a high index in the Conners Parent Rating Scale-revised, he or she is more likely to have urgency. Also, if a child with attention deficit disorder has a high hyperactivity subscale score, he or she is more likely to have enuresis. CONCLUSIONS Voiding problems are more common in children with attention deficit disorder with hyperactivity than in age matched controls. Urgency and enuresis are the outstanding problems in children with attention deficit disorder. Simultaneous use of the Conners Parent Rating Scale-revised and lower urinary tract symptom score questionnaire should be encouraged in patients with attention deficit disorder to allow a structured and quantitative evaluation of these overlapping problems.

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.

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.

Sociodemographic characteristics of Turkish parents in relation to their recognition of emotional maltreatment

OBJECTIVES To develop an instrument which could assess the extent to which emotionally maltreating parental behavior was recognized by Turkish parents (Study 1) and to evaluate a group of parental and family characteristics that were related with their recognition of emotional maltreatment (Study 2). METHODS Self-administered instruments were used in both studies. In Study 1, a representative sample consisting of a total of 498 parents of children attending public and private preschools, elementary, and high schools in Ankara, were recruited. A 21-item Recognition of Emotional Maltreatment Scale (REMS) was developed. In addition to exploratory and confirmatory factor analyses were performed and convergent validity was examined by utilizing the Child Abuse Potential Inventory (CAPI) and the Parental Acceptance Rejection Questionnaire (PARQ). Its test-retest reliability and internal consistency were also investigated. In Study 2, a total of 296 parents who were various public and private sector office workers and maintenance employees were recruited. Parents completed a socio-demographic form and the REMS. RESULTS In Study 1, exploratory factor analyses revealed four factors. A confirmatory factor analysis indicated that the four-factor model met the criteria standards for adequacy of fit. A moderate correlation of the REMS with CAPI and PARQ (r=.40 and .44, respectively) supported its convergent validity. Its test-retest stability was .73 and internal consistency was .70. In Study 2, a three-way analysis of variance showed that gender of the parent, family income and parent education were significant. Correlation analyses showed that there were significant negative correlations of mean REMS scores with parental age (r=-.27; p<.0001) and positive correlations with number of children in the family (r=.20; p<.007). Mothers who were housewives had higher mean REMS scores than employed mothers. CONCLUSIONS The REMS had acceptable validity and reliability properties. Fathers, parents with lower income and lower education levels showed lesser recognition of child emotional maltreatment. Maternal unemployment, younger parent age and more children in the family were related with lower levels of recognition. PRACTICE IMPLICATIONS This is the initial effort in developing an instrument that may guide professionals in the selection and assessment of at-risk parent groups which need educational programs regarding child emotional maltreatment.

Psychoeducation and Expressed Emotion by Parents of Children with Learning Disorders

The present study assessed use of a psychoeducation group program on expressed emotion, family functioning, and child behavior by parents of children with learning disorders. 81 parents of children with learning disorders were randomly assigned to a psychoeducation group program (n = 46) or to a regular treatment group (n = 35). A semistructured interview for parental expressed emotion, self-reports of family functioning, and child behavior were utilized at baseline and after an 8-session psychoeducation group program. Parents who attended the program differed significantly from parents in the regular treatment group on measures of criticism, warmth, and positive remarks, and overall expressed emotion, but not on measures of perceived family functioning and child behavior. Findings indicate a psychoeducation group program could be effective in helping parents to establish a more positive emotional climate in their relationships with their children who have learning disorders.

Underinvolved Relationship Disorder and related factors in a sample of young children

BACKGROUND AND AIMS The interaction between the infant and the caregiver is stated to be very important in the development of a child. When there is inadequacy of interaction, several emotional and developmental problems can emerge. We aimed to investigate the socio-demographic and clinical features of children diagnosed with Underinvolved Relationship Disorder according to the DC:0-3R classification system. STUDY DESIGN AND METHODS Four hundred and fifty seven children aged between 1 and 59 months, who had been admitted to an infant mental health clinic were assessed using the DC:0-3R classification system and the whole sample was divided into two groups, the group in which Underinvolved Relationship Disorder between the child and the caregiver had been detected (URD), and the group in which this had not been detected (NURD). These two groups were compared with regard to socio-demographic features, reasons for referral, primary diagnoses, relational disorders, medical/developmental conditions, psychosocial stressors and the Parent-Infant Relationship Global Assessment Scale (PIRGAS) scores of children. RESULTS Language delay, insufficient social interaction and aggression were found to be significantly more frequent reasons for referral in URD. Disorders of Relating and Communicating (equivalent to the Pervasive Developmental Disorders in DSM IV) and Deprivation/Maltreatment Disorder were more frequent primary diagnoses, Verbally or Physically Abusive Relationship Disorder was significantly more frequent relational disorder in URD. Mild and moderate mental retardation were significantly more frequent in URD, and social environment, educational/child care and health-care access challenges were found to be more frequent psychosocial stressors in the parents of URD. The Mean PIRGAS scores were significantly lower in URD connoting that the parent-infant relationship is poorer. CONCLUSIONS The diagnosis of Underinvolved Relationship Disorder according to the DC:0-3R classification system is related to some developmental and psychosocial problems.