Thomas William Teasdale

Psychometric Properties of the Danish Strength and Difficulties Questionnaire: The SDQ Assessed for More than 70,000 Raters in Four Different Cohorts

Background The Strength and Difficulties Questionnaire (SDQ) is a brief behavioural five factor instrument developed to assess emotional and behavioural problems in children and adolescents. The aim of the current study was to evaluate the psychometric properties for parent and teacher ratings in the Danish version of SDQ for different age groups of boys and girls. Methods The Danish versions of the SDQ were distributed to a total of 71,840 parent and teacher raters of 5-, 7- and 10- to 12-year-old children included in four large scale Danish cohorts. The internal reliability was assessed and exploratory factor analyses were carried out to replicate the originally proposed five factor structure. Mean scores and percentiles were examined in order to differentiate between low, medium and high levels of emotional and behavioural difficulties. Results The original five factor structure could be substantially confirmed. The Conduct items however did not solely load on the proposed Conduct scale and the Conduct scale was further contaminated by non-conduct items. Positively worded items tended to load on the Prosocial scale. This was more so the case for teachers than for parents. Parent and teacher means and percentiles were found to be lower compared to British figures but similar to or only slightly lower than those found in the other Nordic countries. The percentiles for girls were generally lower than for boys, markedly so for the teacher hyperactivity ratings. Conclusions The study supports the usefulness of the SDQ as a screening tool for boys and girls across age groups and raters in the general Danish population.

The reliability and validity of the Danish Draft Board Cognitive Ability Test: Børge Prien's Prøve.

The Danish Draft Board has used the same test for assessing general cognitive ability, the Børge Priens Prøve (BPP), for over 50 years during which time all men on reaching the age of 18 become liable for conscription. Data from the test has, over the decades, been used in numerous and wide-ranging research studies. Nonetheless, owing to the special circumstances of its administration, some psychometric properties, which are generally assessed for psychological tests, have not previously been investigated for the BPP. First, since the test is only used at the assessment phase, retesting with the BPP occurs only rarely and under exceptional circumstances. Therefore, its Test-Retest reliability has hitherto not been documented. Second, questions have often been raised as to whether the validity of the BPP is undermined by either a lack of motivation and under-performing among some of the men taking the test, being, as they are, compelled to do so, and/or by gradual obsolescence of the test over the decades of its use. We here present findings from three new studies to show that (a) the BPP has a satisfactory Test-Retest reliability, r=0.77, (b) BPP test scores are not positively associated with expressed attitude to being called upon to serve conscription and (c) the correlation between the BPP and a measure of educational level has remained stable (at about 0.5) through the last two decades. Taken together these three findings further support the continuing value of the BPP in research relating to cognitive ability.

Post-traumatic stress symptoms and psychological functioning in children of parents with acquired brain injury

Introduction/objectives: The effect of parental brain injury on children has been relatively little investigated. This study examines post-traumatic stress symptoms (PSS) and psychological functioning in children with a parent with an acquired brain injury. Participants, materials and methods: The participants were 35 patients with acquired brain injury, their spouses and children aged 7–14 years recruited from out-patient brain injury rehabilitation units across Denmark. Children self-reported psychological functioning using the Becks Youth Inventory (BYI) and Child Impact of Events revised (CRIES) measuring PSS symptoms. Emotional and behavioural problems among the children were also identified by the parents using the Achenbachs Child Behaviour Checklist (CBCL). A matched control group, consisting of 20 children of parents suffering from diabetes, was recruited from the National Danish Diabetes Register. Results: Post-traumatic stress symptoms above cut-off score (<30) were found (CRIES) in 46% of the children in the brain injury group compared to 10% in the diabetes group. The parents in the brain injury group reported more emotional and behavioural problems in their children when compared to published norms (CBCL). Conclusions: When parents have acquired brain injury, their children appear to be at a substantial risk for developing post-traumatic stress symptoms. These results indicate the need for a child-centred family support service to reduce the risk of children being traumatized by parental brain injury, with a special focus on the relational changes within the family.

Parental stress and marital relationships among patients with brain injury and their spouses.

INTRODUCTION/OBJECTIVESnThis study examines parental stress and marital relationship among patients with acquired brain injury and their spouses.nnnPARTICIPANTS, MATERIALS/METHODSnThe participants were 35 patients diagnosed with acquired brain injury and having school-aged children, together with their spouses recruited from out-patients from brain injury rehabilitation units across Denmark. The parents self-reported parental stress using the Parental Stress Index (PSI), marital adjustment using the Dyadic Adjustment Scale (DAS), family functioning using the Family Environment Scale (FES). Additionally, the healthy parents completed the Symptom Checklist 90 (SCL-90) measuring psychological symptoms. A matched control group consisted of parents suffering from diabetes and their spouses, being recruited from the National Danish Diabetes Register.nnnRESULTSnSignificantly more symptoms of parental stress were reported by the brain-injured parents when compared to the diabetic parents (p < 0.05); the brain injured parents also reported significant more family dysfunction (p < 0.05). The healthy parents in the brain injury group rated their marital satisfaction and current relationship happiness significantly lower (p < 0.05) than the healthy control group. The spouses to the brain-injured patients were also significantly more depressed (p < 0.01).nnnCONCLUSIONSnWhen parents have acquired brain injury, they experience more parental stress and family dysfunction. Their spouses are less satisfied in their marital relationship and feel more depressed. These results indicate the need of a family centred supportive service to focus on the relational changes and dysfunctional family processes in families with a brain-injured parent and dependent children.

SUBSTANCE USE DURING PREGNANCY AND POSTNATAL OUTCOMES

Substance exposure in utero has been associated with physical birth defects and increased risk of regulatory and neuropsychological difficulties. The aims of this study were to describe women who use substances and are in treatment with respect to the type and number of substances used during pregnancy, as well as their background, and to examine the effect substance use has on gestational age, birth weight, and the development of neonatal abstinence syndrome at birth. A sample of 161 pregnant women and their 163 newborn children were included. The results indicate that the children whose mothers continued to use substances throughout their pregnancies were born at a lower gestational age (Chi-Square = 15.1(2), P < .01); children exposed to poly-substances in utero were more affected than those exposed to only alcohol and those with no substance exposure. The same children were more vulnerable to the development of neonatal abstinence syndrome at birth (Chi-Square = 51.7(2), P < .001). Newborns who were exposed primarily to alcohol in utero were at a significant risk of being born with low birth weight (Chi-Square = 8.8(2), P < .05) compared with those exposed to other types of substances. More than 50% of the mothers ceased using any substances (with the exception of tobacco) by birth, indicating that the treatment program did have an interventional effect on the mothers. The mothers’ ability to either cease or decrease the use of substances during pregnancy appears to have direct positive effect on their newborns.

Cognitive and Social Development in Preschool Children Born to Women Using Substances

Prenatal substance exposure is associated with physical birth defects and increased risk of regulatory and neuropsychological difficulties of children born to mothers using substances while pregnant. Myriad factors, such as maternal psychopathology, stress, and poor living circumstances, may influence childhood development in addition to the teratological effect of prenatal substance exposure. This study explores the long-term developmental consequences in children from birth to age 7 born to women using substances and are in treatment. A series of t tests were performed to explore group effects on the cognitive and social dimensions of Griffiths Mental Development Scales compared with Swedish norms. The results showed significant effects on eye and hand coordination in children aged birth to 7 years and on hearing and speech, practical reasoning, and the general quotient in children aged 3 to 7 years. Children who were exposed primarily to alcohol in utero scored significantly lower on the personal and social skills subscale, eye and hand coordination subscale, and the general quotient than children exposed primarily to substances other than alcohol. These effects did not appear to be mediated by the mothers’ social background or treatment history. The results suggest that children who are exposed to substances, in particular alcohol, in utero are vulnerable overall, but especially in eye and hand coordination and personal and social skills.

Prenatal exposure to alcohol, and gender differences on child mental health at age seven years

Background It remains uncertain whether exposure to lower doses of alcohol is damaging to the developing fetus. The present study aimed to investigate associations for boys and girls between prenatal exposure to binge drinking and lower doses of alcohol in pregnancy, and parent-reported behavioural and emotional development at age seven. Methods This study used data from the Danish National Birth Cohort. Associations between cumulated alcohol exposure and binge drinking from full pregnancy and parent scores on the Strengths and Difficulties Questionnaire (SDQ) measured at age seven were investigated. The SDQ was used as continuous externalising/internalising scores, and as above/below cut-off for the specific scales of hyperactivity/inattention, conduct, emotional and peer problems. Inclusion criteria were information on alcohol exposure from three interviews, SDQ scores at age seven and being born full term (n=37u2005152). Results Controlling for relevant confounders, small positive associations were observed between binge drinking and internalising (relative change in mean: 1.04–1.06), externalising scores (relative change in mean: 1.01–1.07), and conduct scores (OR 1.12 to 1.23) for boys. No associations were observed with lower doses of alcohol. Conclusions Exposure to binge drinking is weakly associated with impaired behavioural and emotional development measured at age seven. Large differences in background characteristics were observed between the groups defined by cumulated alcohol exposure, leaving the interpretations of findings uncertain.

Cognitive impairment in the preclinical stage of dementia in FTD-3 CHMP2B mutation carriers: a longitudinal prospective study

Objective and methods A longitudinal study spanning over 8u2005years and including 17 asymptomatic individuals with CHMP2B mutations was conducted to assess the earliest neuropsychological changes in autosomal dominant neurodegenerative disease frontotemporal dementia (FTD) linked to chromosome 3 (FTD-3). Subjects were assessed with neuropsychological tests in 2002, 2005 and 2010. Results Cross-sectional analyses showed that the mutation carriers scored lower on tests of psychomotor speed, working memory, executive functions and verbal memory than a control group consisting of not-at-risk family members and spouses. Longitudinal analyses showed a gradual decline in psychomotor speed, working memory capacity and global executive measures in the group of non-demented mutation carriers that was not found in the control group. In contrast, there were no significant group differences in domain scores on memory or visuospatial functions. On an individual level the cognitive changes over time varied considerably. Conclusion Subjects with CHMP2B mutation show cognitive changes dominated by executive dysfunctions, years before they fulfil diagnostic criteria of FTD. However, there is great heterogeneity in the individual cognitive trajectories.

Family matters: parental-acquired brain injury and child functioning.

OBJECTIVESnTo relate illness related to and family factors to emotional and behavioural problems in school-age children (7-14 years old) of parents with acquired brain injury and their healthy spouses.nnnPARTICIPANTS, MATERIALS/METHODSnMembers of 35 families in which a parent had been diagnosed with acquired brain injury participated. Family and brain injury characteristics were reported by the ill and healthy parents. Children self-reported post-traumatic stress symptoms (PSS) using the Child Impact of Events revised (CRIES). Emotional and behavioural problems among the children were also identified by the parents using the Achenbachs Child Behaviour Checklist (CBCL).nnnRESULTSnThe family stress variables relating to the healthy spouse in all six comparisons were significant (p <= 0.05) or nearly so (p = 0.07) in each case showing higher scores for spouses to be associated with higher CRIES and CBCL total scores for the children. For the adjusted associations, we again found the family stress variables in the healthy spouse to be related to the risk of emotional and behavioral problems in the children.nnnCONCLUSIONSnThe present results suggest that in ABI families, the childrens emotional functioning depends upon family factors and primarily on the level of parental stress in the healthy parent.

Cognitive behavioural treatment for the chronic post-traumatic headache patient: a randomized controlled trial

BackgroundChronic post-traumatic headache (CPTH) after mild head injury can be difficult to manage. Research is scarce and successful interventions are lacking.To evaluate the effect of a group-based Cognitive Behavioural Therapy (CBT) intervention in relation to headache, pain perception, psychological symptoms and quality of life in patients with CPTH.MethodsNinety patients with CPTH according to ICHD-2 criteria were enrolled from the Danish Headache Center into a randomized, controlled trial. Patients were randomly assigned to either a waiting list group or to a nine-week CBT group intervention. At baseline and after 26xa0weeks all patients completed the Rivermead Post Concussion Symptoms Questionnaire, SF-36, SCL-90-R and a headache diary.ResultsThe CBT had no effect on headache and pressure pain thresholds and only a minor impact on the CPTH patients’ quality of life, psychological distress, and the overall experience of symptoms. The waiting-list group experienced no change in headache but, opposed to the treatment group, a significant decrease in somatic and cognitive symptoms indicating a spontaneous remission over time.ConclusionsOur primarily negative findings confirm that management of patients with CPTH still remains a considerable challenge. Psychological group therapy with CBT might be effective in an earlier stage of CPTH and in less severely affected patients but our findings strongly underline the need for randomized controlled studies to test the efficacy of psychological therapy.