Parent rated bedtime resistance and comorbidity may predict levels of attention among Turkish children diagnosed with ADHD in on-line education classes during the COVID-19 outbreak.

OBJECTIVE: This study aimed to compare the attention levels, of Turkish children and adolescents with Attention Deficit/ Hyperactivity Disorder (ADHD) in on-line education classes with healthy controls. METHODS: This study is a cross-sectional, internet-based, case-control study that recruited 6-18 years old patients diagnosed with ADHD and receving treatment and healthy controls from eight centers. The measurements used in the study were prepared in the google survey and delivered to the participants via Whatsapp application. RESULTS: Within the study period, 510 children with ADHD and 893 controls were enrolled. Parent- rated attention decreased significantly in both groups during on-line education classes due to COVID-19 outbreak (p<0.001; for each). Children and adolescents with ADHD had significantly elevated bedtime resistance, problems in family functioning difficulties than control children according to parental reports (p=0.003; p<0.001; p<0.001, respectively). Furthermore, bedtime resistance and comorbidity significantly predicted attention levels in on-line education. CONCLUSION: Our findings may underline the need to augment student engagement in on-line education both for children without attention problems and those with ADHD. Interventions shown to be effective in the management of sleep difficulties in children as well as parent management interventions should continue during on-line education.

Processed meat products and snacks consumption in ADHD: A case-control study.

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) has been linked to "unhealthy" food consumption, but the studies in this area are insufficient. The aim of this study is to investigate the relationship between ADHD/related symptoms and processed meat products and snack consumption. METHODS: This study was conducted on 390 children aged between 6 and 17 with 169 ADHD (38 Girls, 131 Boys) and 221 healthy controls (93 Girls, 128 Boys). Food consumption was evaluated by a modified food frequency questionnaire, including 18 food containing processed meat products and snacks. ADHD symptoms were evaluated by the teacher and parent Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-Scale) and Conners' Rating Scale (CPRS, CTRS). RESULTS: Children with ADHD consumed more processed meat products, milk-based desserts, and chocolate-sweets than controls (p<0.05). A positive correlation was observed between the ADHD symptom scores and the consumption amount of all snacks, the amount of chocolate-sweets consumption, the frequency of consumption of sujuk, chocolate, jelly beans, sweets, cakes, and chocolate spread (p<0.05). CONCLUSION: Children with ADHD consume more foods rich in saturated fat and sugar than their healthy peers. Processed food consumption of children with ADHD may be associated with ADHD symptoms.

Parent-reported sleep problems in children and adolescents with sickle cell disease: relationship to health-related quality of life.

Introduction: Children with sickle cell disease (SCD) can present a variety of clinical symptoms that may affect their sleep and health-related quality of life (HRQOL). This study aims to investigate the relation between sleep problems and HRQOL in children and adolescents with SCD. Material and methods: The sample included 86 children and adolescents in the SCD patient group and 82 healthy controls, with an age range of 8-16 years. Subjects for the study were recruited from the Sickle Cell and Thalassemia Center of Hatay State Hospital, Hatay, Turkey. The Children's Sleep Habits Questionnaire (CSHQ) was used to evaluate sleep problems and Kinder Lebensqualitätsfragebogen: Children's Quality of Life Questionnaire - revised (KINDL-R) was used to examine HRQOL. Results: Total score, bedtime resistance, and night waking subscores of CSHQ were significantly higher in children with SCD when compared to healthy children. Total score, physical well-being, emotional well-being, social, and school subscores of KINDL-R were significantly lower in the patient group. Among SCD children, total score, bedtime resistance, sleep onset delay, daytime sleepiness, and parasomnias subscores of CSHQ were negatively correlated with KINDL-R total score. In the regression model, disease severity and CSHQ total score had significant negative associations with KINDL-R total score. Conclusions: Sleep problems in SCD children appear to be negatively linked with HRQOL. Disease severity and sleep problems may be predictors of overall HRQOL in children and adolescents with SCD.

Sluggish cognitive tempo is associated with autistic traits and anxiety disorder symptoms in children with attention-deficit/hyperactivity disorder

Objective: To investigate the association of sluggish cognitive tempo (SCT) with autistic traits (ATs) and anxiety disorder symptoms among children with attention-deficit/hyperactivity disorder (ADHD). Methods: A total of 195 children with a DSM-5 diagnosis of ADHD were included. The Barkley Sluggish Cognitive Tempo Scale (BSCTS) was used to measure SCT symptoms. Other study measures included the Autism Spectrum Quotient (AQ), Screen for Child Anxiety and Related Disorders (SCARED), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners' Teacher Rating Scale (CTRS-R). Results: The frequency of SCT was 30.3% (n=59) in the whole group. Those with SCT had higher total AQ and SCARED scores. Significant associations and correlations were also found between SCT and certain subscores of AQ and SCARED. According to the linear regression model, the total score and social skills, attention switching, and imagination scores of AQ, as well as generalized anxiety and panic/somatic scores of SCARED and the total and inattention scores of parent T-DSM-IV, were predictive of SCT total score (p < 0.05). Conclusions: SCT is associated with ATs and anxiety disorders. Children with ADHD and SCT symptoms should be screened for such conditions.

Parental psychological distress associated with COVID-19 outbreak: A large-scale multicenter survey from Turkey.

AIMS: Pandemics can cause substantial psychological distress; however, we do not know the impact of the COVID-19 related lockdown and mental health burden on the parents of school age children. We aimed to comparatively examine the COVID-19 related the stress and psychological burden of the parents with different occupational, locational, and mental health status related backgrounds. METHODS: A large-scale multicenter online survey was completed by the parents (n = 3,278) of children aged 6 to 18 years, parents with different occupational (health care workers-HCW [18.2%] vs. others), geographical (Istanbul [38.2%] vs. others), and psychiatric (child with a mental disorder [37.8%]) backgrounds. RESULTS: Multivariable logistic regression analysis showed that being a HCW parent (odds ratio 1.79, p < .001), a mother (odds ratio 1.67, p < .001), and a younger parent (odds ratio 0.98, p = .012); living with an adult with a chronic physical illness (odds ratio 1.38, p < .001), having an acquaintance diagnosed with COVID-19 (odds ratio 1.22, p = .043), positive psychiatric history (odds ratio 1.29, p < .001), and living with a child with moderate or high emotional distress (odds ratio 1.29, p < .001; vs. odds ratio 2.61, p < .001) were independently associated with significant parental distress. CONCLUSIONS: Parents report significant psychological distress associated with COVID-19 pandemic and further research is needed to investigate its wider impact including on the whole family unit.

Sluggish cognitive tempo is associated with autistic traits and anxiety disorder symptoms in children with attention-deficit/hyperactivity disorder.

OBJECTIVE: To investigate the association of sluggish cognitive tempo (SCT) with autistic traits (ATs) and anxiety disorder symptoms among children with attention-deficit/hyperactivity disorder (ADHD). METHODS: A total of 195 children with a DSM-5 diagnosis of ADHD were included. The Barkley Sluggish Cognitive Tempo Scale (BSCTS) was used to measure SCT symptoms. Other study measures included the Autism Spectrum Quotient (AQ), Screen for Child Anxiety and Related Disorders (SCARED), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners' Teacher Rating Scale (CTRS-R). RESULTS: The frequency of SCT was 30.3% (n=59) in the whole group. Those with SCT had higher total AQ and SCARED scores. Significant associations and correlations were also found between SCT and certain subscores of AQ and SCARED. According to the linear regression model, the total score and social skills, attention switching, and imagination scores of AQ, as well as generalized anxiety and panic/somatic scores of SCARED and the total and inattention scores of parent T-DSM-IV, were predictive of SCT total score (p < 0.05). CONCLUSIONS: SCT is associated with ATs and anxiety disorders. Children with ADHD and SCT symptoms should be screened for such conditions.

Risperidone-induced bruise-like rash in a child.

Adverse cutaneous reactions are rarely seen with antipsychotics. Exanthematous eruptions, skin pigmentation changes, photosensitivity, urticaria, and pruritus have been previously reported. We report a bruise-like rash in a 4-year-old boy with risperidone use. The rash disappeared on discontinuation and then reappeared after re-initiating the medication. Clinicians should be aware of a bruise-like skin rash as a rare adverse effect of risperidone. This is especially important for pediatric cases where physical abuse may be suspected. SIMILAR CASES PUBLISHED: None.

Methylphenidate-induced Exacerbation of Chorea in a Child Resolved with Switching to Atomoxetine.

Choreiform movements have been reported with stimulant medications, especially in adults. There is only limited evidence on the management of such reactions in children with attention deficit hyperactivity disorder. Hereby, we present the exacerbation of chorea with long-acting methylphenidate use in a 6-year-old child with acute rheumatic fever which resolved with switching to atomoxetine.

Priapism With Methylphenidate Use in a Preschool-Aged Boy Resolved With Switching to Atomoxetine.

BACKGROUND: Priapism is a persistent unwanted erection that is not linked with sexual stimulation. A number of previous case reports have shown priapism with methylphenidate (MPH) use, especially in adolescence and preadolescence period. In all of these cases, the unwanted erections ceased after the medication was discontinued and no further attention-deficit hyperactivity disorder medication was initiated. Hereby, we present the case of a boy who had priapism episodes with MPH, which resolved with switching to atomoxetine (ATX). CASE REPORT: A 5-year, 10-month-old medically healthy boy was diagnosed with attention-deficit hyperactivity disorder and was prescribed methylphenidate immediate-release (10 mg/d). Two weeks later, his family communicated and reported penile erection episodes since the initiation of MPH. With the suspect of a medication-induced adverse reaction, MPH was discontinued and priapism resolved within a week. Thereafter, 10 mg/d of ATX was initiated. Four-week follow-up with ATX treatment revealed that the medication was tolerated well, and priapism or any other adverse effect was not reported. CONCLUSIONS: This case report suggests that ATX may be safely used in some children who experienced priapism with MPH. Future studies are needed to clarify the risk factors and etiologic mechanisms of this adverse reaction.

Sleep problems in children with autism spectrum disorder: clinical correlates and the impact of attention deficit hyperactivity disorder.

PURPOSE: High prevalence of sleep problems has been reported in children with autism spectrum disorder (ASD). However, there is limited literature about the types and clinical correlates of sleep problems. This study aims to compare sleep disturbances between children with ASD and healthy children and investigate the relationship between sleep difficulties and clinical symptoms of ASD. MATERIALS AND METHODS: The sample consisted of 112 children in ASD patient group and 112 healthy controls, with an age range of 2-18 years. The Children's Sleep Habits Questionnaire (CSHQ) was used for sleep problems; Turgay DSM-IV Disruptive Behavior Disorders Rating Scale parent form (T-DSM-IV-S) was used to assess hyperactivity/impulsivity and inattentiveness; Childhood Autism Rating Scale (CARS), Autism Behavior Checklist, and Aberrant Behavior Checklist were used to evaluate the severity of autistic symptoms and behav-ioral problems. RESULTS: Total score, bedtime resistance, and sleep anxiety subscores of CSHQ were significantly higher in children with ASD than the control group. Among ASD children, intellectual capacity was not found to be associated with CSHQ scores. Bedtime resistance and night waking sub-scores of CSHQ were found to be positively correlated with CARS total score. Inattentiveness subscore of Parent T-DSM-IV-S was significantly higher in children with moderate-to-severe sleep problems. CONCLUSION: Sleep difficulties in ASD patients may occur independently of intellectual disability. Bedtime resistance and night waking appear to be linked with ASD symptoms. Inattentiveness in ASD children may be associated with moderate-to-severe sleep problems.

Sertraline-Related Amenorrhea in an Adolescent.

Amenorrhea is one of the clinical consequences of hyperprolactinemia. Although symptomatic hyperprolactinemia is among the well-described adverse reactions of antipsychotic agents, it may also be reported with the use of selective serotonin reuptake inhibitors. Hereby, we present a case of sertraline-related hyperprolactinemic amenorrhea in an adolescent. Amenorrhea occurred 2 months after starting sertraline, and menstrual cycle restored after stopping the treatment.

Levetiracetam-Related Mania-Like Symptoms: An Adolescent Case.

Levetiracetam is an antiepileptic agent that is used for partial and generalized epilepsy. Although it is well tolerated in most cases, behavioral and nonbehavioral adverse effects may be observed. Among behavioral symptoms, depression, hostility, and agitation have been frequently reported. However, mania or mania-like symptoms are relatively rare, especially in children and adolescents. Hereby, we report mania-like symptoms with levetiracetam use in a 15-year-old boy. Mania-like symptoms emerged 3 weeks after starting levetiracetam and disappeared after adding risperidone to ongoing levetiracetam treatment.

Autistic-Like Traits in Pena-Shokeir Syndrome.

Pena-Shokeir syndrome (PSS) is a rare, early lethal disease. PSS is characterized by fetal growth restriction, craniofacial deformities, multiple ankyloses and pulmonary hypoplasia. Because of the primary concern of physical health problems, psychiatric evaluation is frequently underestimated in PSS patients. Our case report describes a child with PSS who presented with autistic spectrum disorder symptoms.

Risperidone Related Raynaud's Phenomenon: An Adolescent Case.

Raynaud's phenomenon is a recurrent vasospastic condition with reducing in peripheral blood flow due to cold, or emotional stress. White, blue and red discolorations occur during the attacks. Serotonin reuptake inhibitors, psychostimulants, and aripiprazole are reported to be related with Raynaud's phenomenon. Risperidone is an atypical antipsychotic drug with dopaminergic and serotonergic effects. In children and adolescents, risperidone is used for bipolar disorder, tic disorders, conduct disorder, schizophrenia, symptoms of irritability and self-mutilation. Here we report a case of Raynaud's phenomenon associated with risperidone in a 12-year-old boy. Raynaud's phenomenon occurred two weeks after starting risperidone and disappeared after stopping risperidone.

Attention-Deficit Hyperactivity Disorder (ADHD) in Epilepsy and Primary ADHD: Differences in Symptom Dimensions and Quality of Life.

PURPOSE: We aimed to (1) compare quality of life (QOL) among children with epilepsy, epilepsy and attention-deficit hyperactivity disorder (ADHD), and primary ADHD and (2) compare ADHD symptom dimensions and subtypes between children with epilepsy-ADHD and primary ADHD. METHODS: A total of 140 children; 53 with epilepsy, 35 with epilepsy-ADHD, and 52 with primary ADHD were included. KINDL-R (quality of life measure), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners' Parent Rating Scale (CPRS) were completed. Neurology clinic charts were reviewed for epilepsy-related variables. RESULTS: Children with epilepsy-ADHD had the lowest (poorest) KINDL-R total scores. Epilepsy-ADHD group had more inattentiveness symptoms, whereas primary ADHD group had more hyperactivity/impulsivity symptoms. The frequencies of ADHD combined and inattentiveness subtypes were 60% and 40% in children with epilepsy-ADHD and 80.7% and 19.3% in children with primary ADHD, respectively ( P = .034). CONCLUSION: ADHD in epilepsy is associated with a significantly poor quality of life and predominantly inattentiveness symptoms.

Iron deficiency parameters in autism spectrum disorder: clinical correlates and associated factors.

BACKGROUND: High prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) has been reported in children with autism spectrum disorder (ASD). However, there is a limited number of studies about the association between iron deficiency parameters and clinical symptoms of ASD. This study aims to compare hemoglobin, hematocrit, iron, ferritin, MCV, and RDW levels between ASD patients and healthy controls and to investigate the correlation between these values and clinical symptoms of ASD. METHODS: The sample consisted of 100 children in ASD patient group and 100 healthy controls, with an age range of 2-18 years. We used ferritin cutoff of < 10 ng/mL for preschoolers (< 6 years) and < 12 ng/mL for school-aged (> 6 years) children to evaluate ID. Anemia was defined as hemoglobin < 11.0 g/dL for preschoolers and < 12.0 g/dL for school-aged children. Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (AuBC), and Aberrant Behavior Checklist (AbBC) were used to evaluate the severity of autistic symptoms and behavioral problems. Categorical variables were compared by using chi-square test. Normally distributed parametric variables were compared between groups by using Independent Samples t test. Pearson's correlation analysis was used in order to examine the correlations. The p value < 0.05 was accepted to be statistically significant. RESULTS: Hemoglobin, hematocrit, iron, and MCV (p < 0.05) levels of children with ASD were lower than healthy controls. Hemoglobin, hematocrit, and MCV (p < 0.05) levels were found to be significantly lower in preschool ASD patients. Hemoglobin and hematocrit (p < 0.05) levels were significantly lower in ASD patients with intellectual disability. Hemoglobin (p < 0.05) levels were lower in patients with severe ASD. There was a significant negative correlation between hematocrit levels of children with ASD and CARS, AuBC, and AbBC total scores (p < 0.05). CONCLUSIONS: Hemoglobin levels of children with ASD were lower than healthy children, but this was not sufficient to result in anemia. IDA in children with ASD might be associated with intellectual disability instead of ASD symptom severity.

Galactorrhea Probably Related with Switching from Osmotic-release Oral System Methylphenidate (MPH) to Modified-release MPH: An Adolescent Case.

Galactorrhea, as an adverse effect of psychotropic medications, usually develops due to high dose of antipsychotics. Selective serotonin reuptake inhibitors (SSRIs) have also been reported to be related to galactorrhea. To the best of our knowledge, no previous study reported galactorrhea with methylphenidate (MPH) use. Hereby, we report a case of an adolescent girl who developed galactorrhea after increasing his modifed-release oral MPH to 50 mg/day while under treatment of sertraline and very low dose haloperidol.

Sleep and quality of life in children with traumatic brain injury and ADHD.

Objective Attention problems are common in children who sustain a traumatic brain injury (TBI). The differential features of TBI-related Attention Deficit Hyperactivity Disorder (ADHD) and primary ADHD are largely unknown. This study aimed to compare sleep problems and quality of life between children with TBI and ADHD and children with primary ADHD. Methods Twenty children with TBI (mean age = 12.7 ± 3.1 years) who had clinically significant ADHD symptoms according to the structured diagnostic interview and rating scales and a control group with primary ADHD (n = 20) were included. Parents completed Children's Sleep Habits Questionnaire (CSHQ) and Kinder Lebensqualitätsfragebogen: Children's Quality of Life Questionnaire-revised (KINDL-R). Neurology clinic charts were reviewed for TBI-related variables. Results When compared to children with primary ADHD, the Total Score and Sleep Onset Delay, Daytime Sleepiness, Parasomnias, and Sleep Disordered Breathing subscores of CSHQ were found to be higher in children with TBI and ADHD. The Total Score and Emotional Well-Being and Self-Esteem subscores of the KINDL-R were found to be low (poorer) in children with TBI and ADHD. The Total Score and certain subscores of KINDL-R were found to be lower in TBI patients with a CSHQ > 56 (corresponds to significant sleep problems) when compared to those with a CSHQ < 56. CSHQ Total Score was negatively correlated with age. Conclusion Children with TBI and ADHD symptoms were found to have a poorer sleep quality and quality of life than children with primary ADHD. ADHD in TBI may be considered as a highly impairing condition which must be early diagnosed and treated.