Turid Suzanne Berg-Nielsen

Prevalence of psychiatric disorders in preschoolers

BACKGROUND   Many disorders in childhood and adolescence were already present in the preschool years. However, there is little empirical research on the prevalence of psychiatric disorders in young children. A true community study using structured diagnostic tools has yet to be published. METHODS   All children born in 2003 or 2004 in the city of Trondheim, Norway, who attended the regular community health check-up for 4-year-olds (97.2% of eligible children) whose parents consented to take part in the study (N = 2,475, 82.0%) were screened for behavioral and emotional problems with the Strengths and Difficulties Questionnaire (SDQ). A screen-stratified subsample of 1,250 children took part in a furthermore comprehensive study including a structured diagnostic interview (the Preschool Age Psychiatric Assessment, PAPA), which 995 parents (79.6%) completed. RESULTS   The estimated population rate for any psychiatric disorder (excluding encopresis - 6.4%) was 7.1%. The most common disorders were attention deficit hyperactivity disorder (1.9%), oppositional defiant disorder (1.8%), conduct disorder (0.7%), anxiety disorders (1.5%), and depressive disorders (2.0%). Comorbidity among disorders was common. More emotional and behavioral disorders were seen in children whose parents did not live together and in those of low socioeconomic status. Boys more often had attention-deficit/hyperactivity disorder (ADHD) and depressive disorders than girls. CONCLUSIONS   The prevalence of disorders among preschoolers was lower than in previous studies from the USA. Comorbidity was frequent and there was a male preponderance in ADHD and depression at this early age. These results underscore the fact that the most common disorders of childhood can already be diagnosed in preschoolers. However, rates of disorder in Norway may be lower than in the USA.

Parenting Related to Child and Parental Psychopathology: A Descriptive Review of the Literature

Two areas of recent research on parenting are examined: (i) Parenting problems in families with parental psychopathology, and (ii) parenting problems when children have psychiatric disorders. Review of literature showed that parental, as well as child, psychopathology represents major stressors for a family and substantially impacts parenting abilities. Two main dimensions of dysfunctional parenting occur in families with child or parental psychopathology: (i) Parental negativity, and (ii) various forms of ineffective discipline practices. For parents, the level of parental social functioning and responsiveness may be more crucial for parenting skills than psychiatric symptoms per se. For children, the impact of dysfunctional parenting seems to be non-specific for child outcome, related to both internalizing and externalizing disorders. However, evidence does point to links among parental negative, affectionless control and depression/anxiety in children, whereas inconsistent, disruptive parenting with insufficient monitoring is more characteristic of parents with conduct-disordered children.

Preschoolers’ Psychosocial Problems: In the Eyes of the Beholder? Adding Teacher Characteristics as Determinants of Discrepant Parent–Teacher Reports

In this study, we explored informant characteristics as determinants of parent–teacher disagreement on preschoolers’ psychosocial problems. Teacher characteristics were included in the analyses, in addition to child and parent factors. Psychosocial problems of 732 4-year olds from a Norwegian community sample were assessed by parents and teachers (CBCL-TRF). Furthermore, teachers reported on their education, experience and relationship to the child. Parental stress and psychopathology were also measured. Teachers rated children considerably lower than their parents did, especially on internalizing problems. When teachers rated more child problems, this was strongly associated with conflict in the teacher–child relationship, which predicted disagreement more than other factors. The highest agreement was on boys’ externalizing problems. Girls’ behavior was rated much lower by teachers than boys’ behavior compared to parents’ ratings. Possible teacher perception biases are discussed, such as teacher–child conflict, non-identification of internalizing problems, and same-gender child preference.

Predicting Service Use for Mental Health Problems Among Young Children

OBJECTIVE: To identify sociodemographic, child, parent, and day care provider factors at age 4 that predict Norwegian children’s service use for mental health problems at age 7. METHOD: Two birth cohorts of 4-year-old children and their parents living in the city of Trondheim, Norway, were invited (82% consented). We successfully interviewed 995 parents among 1250 drawn to participate using the Preschool Age Psychiatric Assessment to set diagnoses and record parental burden and service use. Information concerning sociodemographics, child impairment, parental social support, and child need for mental health services according to parents, day care teacher, and health nurse were obtained. RESULTS: Rate of service use among those with a behavioral or emotional disorder was 10.7% at age 4 and 25.2% at age 7. Behavioral disorders (odds ratio [OR] 2.6, confidence interval [CI] 1.3–5.3), but not emotional disorders, predicted service use. When adjusted for incapacity (OR 1.3, CI 1.2–1.6), disorders were no longer predictive. Incapacity, in turn, was not predictive once parental burden (OR 1.1, CI 1.0–1.1) and parents’ (OR 2.7, CI 1.0–7.9) and day care teachers’ (OR 2.1, CI 1.4–3.2) judgment of child need of help were included. Lower socioeconomic status predicted more service use over and beyond these factors (OR 3.0, CI 1.5–6.1). CONCLUSIONS: Behavioral disorders may instigate service use if they result in impairment, and such impairment may operate via increased parental burden and parent and caregiver problem recognition. Service use may be increased through effective screening programs and efforts to increase day care teachers’ recognition of emotional problems.

Sleep Disorders in Preschoolers: Prevalence and Comorbidity with Psychiatric Symptoms

Objectives: This study provides data on the prevalence of diagnosable sleep disorders in preschoolers and examined the relationship between specific sleep disorders and a range of DSM-4–defined psychiatric symptoms. Methods: All children born in 2003 or 2004 in Trondheim, Norway, who attended regular community health checkups for 4 year olds were asked to participate (97.2% attendance; 82.0% consent rate, N = 2475). A screen-stratified subsample of 1250 children was recruited to participate in an additional comprehensive study that included a structured diagnostic interview (the Preschool-Age Psychiatric Assessment). Nine hundred ninety-five parents (79.6%) completed the interview. Results: The estimated sleep disorder rate was 19.2%. Rates of specific disorders were as follows: primary insomnia (16.6%), primary hypersomnia (0.8%), nightmare disorder (2.2%), and sleepwalking disorder (0.7%). When adjusted for a range of common psychiatric symptoms, primary insomnia was specifically related to symptoms of depression, generalized anxiety disorder, separation anxiety, and specific phobia. When sleep problems were excluded as a symptom of depression, the association between depression and primary insomnia was no longer significant. Nightmare disorder was significantly related to generalized anxiety disorder. Conclusions: This first study of the prevalence and comorbidity of diagnosable sleep disorders in preschoolers indicates that primary insomnia is common in young children, whereas other sleep disorders are rare. Sleep disorders are related to psychiatric symptoms, particularly symptoms of anxiety disorders.

The Three Dimensions of the Student-Teacher Relationship Scale : CFA Validation in a Preschool Sample

The validity of the Student–Teacher Relationship Scale (STRS) was examined in a preschool community sample (N = 925) using confirmatory factor analysis (CFA). Factorial invariance across genders was also investigated as was concurrent and discriminant validity. Indicators of validity were teacher-rated social competence, problem behavior, and mental health, as well as the children’s score on the Peabody Picture Vocabulary Test. Results showed that the original three-dimensional model of the STRS was not satisfactorily confirmed. However, a slightly modified 25 items, 3-factor version of the STRS showed an acceptable fit. Model fit was acceptable for both boys and girls. The modified three-factor model evidenced good concurrent validity. The discriminant validity of the dependency versus the conflict subscale was somewhat unsatisfactory, mainly due to imperfections in the dependency subscale.

Secure attachment promotes the development of effortful control in boys.

Although effortful control (EC), a regulatory aspect of temperament, is associated with a wide range of developmental outcomes, knowledge about EC promoters is scarce. This study explored whether secure attachment promoted the development of EC from preschool to school age in a community sample of 903 Norwegian children. EC was measured using the parent-reported Children’s Behavior Questionnaire at four (T1) and six (T2) years of age, and attachment was measured using the Manchester Child Attachment Story Task at T1. Previous research has indicated that a child’s gender and socioeconomic status are possible covariates of EC; hence, these factors were included in the analyses. Despite considerable rank-order stability in EC, secure attachment contributed to an increase in EC. Furthermore, gender moderated the effect of attachment: secure attachment promoted EC in boys only. These findings emphasize preschool boys’ need for emotional security to facilitate effortful capacities in their transition to school.

The mental health of preschoolers in a Norwegian population-based study when their parents have symptoms of borderline, antisocial, and narcissistic personality disorders: at the mercy of unpredictability

BackgroundClinical studies have shown that children of parents with mental health problems are most likely to develop psychiatric problems themselves when their parents have a Personality Disorder characterized by hostility. The Personality Disorders that appear most associated with hostility, with the potential to affect children, are Borderline Personality Disorder, Antisocial Personality Disorder and Narcissistic Personality Disorder. The question addressed in this study is whether the risk to children’s mental health extends to the normal population of parents who have subclinical symptomlevels of these disorders.MethodsThis inquiry used data from a Trondheim, Norway community sample of 922 preschoolers and one parent for each child. The mean age of the children was 53 months (SD 2.1). Parents reported symptoms of Borderline, Antisocial and Narcissistic Personality Disorders on the DSM-IV ICD-10 Personality Questionnaire, and the children’s symptoms of DSM-IV behavioral and emotional diagnoses were measured with the Preschool Age Psychiatric Assessment, a comprehensive interview. Multigroup Structural Equation Modeling was used to assess the effect of parents’ symptoms on their preschoolers’ behavioral and emotional problems.ResultsThe analyses yielded strongly significant values for the effect of parents’ Personality Disorder symptoms on child problems, explaining 13.2% of the variance of the children’s behavioral symptoms and 2.9% of the variance of internalizing symptoms. Biological parents’ cohabitation status, i.e., whether they were living together, emerged as a strong moderator on the associations between parental variables and child emotional symptoms; when parents were not cohabiting, the variance of the children’s emotional problems explained by the parents’ Personality Disorder symptoms increased from 2.9% to 19.1%.ConclusionsFor the first time, it is documented that parents’ self-reported symptoms of Borderline, Antisocial, and Narcissistic Personality Disorders at a predominantly subclinical level had a strong effect on their children’s psychiatric symptoms, especially when the biological parents were not living together. Child service providers need to be aware of these specific symptoms of parental Personality Disorders, which may represent a possible risk to children.

The Mother and Baby Interaction Scale: a valid broadband instrument for efficient screening of postpartum interaction? A preliminary validation in a Norwegian community sample

BACKGROUND AND AIMS The mother-infant relationship may represent a risk or a protective factor for child development. Hence, an early focus on the relationship may be a worthwhile preventive measure. A simple 10-item instrument, the Mother and Baby Interaction Scale, could be a convenient screening instrument for early bonding failure. In this pilot study, preliminary indications of the internal consistency, stability, principal components validity of the Mother and Baby Interaction Scale were investigated. METHODS Seventy-six postpartum women participated. The Mother and Baby Interaction Scale and Postpartum Bonding Questionnaire were completed together with the Edinburgh Postnatal Depression Scale. The internal reliability of the Mother and Baby Interaction Scale, and its correlations with the Postpartum Bonding Questionnaire and Edinburgh Postnatal Depression Scale, was examined. Principal component analysis of the Mother and Baby Interaction Scale was conducted, and the emerging subscales were compared with the Postpartum Bonding Questionnaire. RESULTS The principal component analysis yielded four subscales: Bonding problems, Worries about caretaking, Regulation and routine and Sensitivity and separation. We found acceptable internal consistency of the Mother and Baby Interaction Scale. The total score of the Mother and Baby Interaction Scale correlated better (r=0.72) with the Postpartum Bonding Questionnaire than the four subscales. The correlation between the total scores of the Edinburgh Postnatal Depression Scale and the Mother And Baby Interaction Scale was r=0.49. CONCLUSIONS The total score of the Mother and Baby Interaction Scale is a promising measure for early screening of the quality of the mother-infant relationship and is suitable for general practitioners, midwives and other health workers dealing with postpartum women and their children.

Catechol-O-methyltransferase Val158Met genotype moderates the effect of disorganized attachment on social development in young children

Children with histories of disorganized attachment exhibit diverse problems, possibly because disorganization takes at least two distinctive forms as children age: controlling-punitive and controlling-caregiving. This variation in the developmental legacy of disorganization has been attributed primarily to variations in childrens rearing experiences. Here an alternative explanation of these divergent sequelae of disorganization is evaluated: one focused on genotype. Structural equation modeling was applied to data on 704 Norwegian children to test whether the catechol-O-methyltransferase Val158Met genotype moderates the effect of disorganized attachment, which was measured dimensionally at 4 years of age using the Manchester Child Attachment Story Task, on changes in aggressive behavior and social competence from ages 4 to 6. Children who scored high on disorganization and were homozygous for the valine allele displayed significantly greater increases in aggression and decreases in self-oriented social skills (e.g., self-regulation and assertiveness) over time than did their disorganized counterparts carrying the methionine allele, whereas disorganized children carrying the methionine allele increased their other-oriented social skill (e.g., cooperation and responsibility) scores more than did valine-homozygous children. These results are consistent with the controlling-punitive and controlling-caregiving behaviors observed in disorganized children, suggesting that the childrens genotype contributed to variations in the social development of disorganized children.