The significance of nonverbal performance in children with developmental language disorder.

Nonverbal deficits are frequently reported in children with developmental language disorder (DLD). In the new diagnostic criteria of DLD, the previous requirement of normal nonverbal performance has been removed and children with below average and even weak nonverbal skills now fit under the DLD definition. However, the significance of the nonverbal cognitive level, and the connection between nonverbal and verbal skills in these children diagnosed according to the new DLD classification is unclear. In the present study, the significance of nonverbal cognitive level on verbal performance was investigated among preschool-aged children with remarkable deficits in language development. Verbal skills were compared between average, below average, and weak nonverbal cognitive level groups. The connection between nonverbal and verbal skills was evaluated with Pearson correlations, and the covariance structure of the subtests used was modeled with Structural Modelling. The connection between nonverbal cognitive level and verbal skills was clear; weaker nonverbal cognitive levels were associated with lower verbal skills. While receptive language skills and verbal short-term-memory (STM) were the most profound weaknesses, relative strengths emerged for each nonverbal cognitive level group in fluid intelligence, especially in nonverbal reasoning tasks without time limits. In addition, fluid intelligence was strongly linked to verbal understanding and reasoning. These results suggest that the relative strength in nonverbal fluid intelligence with specific weaknesses in receptive language, verbal understanding, and verbal STM could be used as basic factors differentiating children with DLD from those with intellectual disability.

Cognitive Profiles of Finnish Preschool Children With Expressive and Receptive Language Impairment.

Purpose: The aim of this study was to compare the verbal and nonverbal cognitive profiles of children with specific language impairment (SLI) with problems predominantly in expressive (SLI-E) or receptive (SLI-R) language skills. These diagnostic subgroups have not been compared before in psychological studies. Method: Participants were preschool-age Finnish-speaking children with SLI diagnosed by a multidisciplinary team. Cognitive profile differences between the diagnostic subgroups and the relationship between verbal and nonverbal reasoning skills were evaluated. Results: Performance was worse for the SLI-R subgroup than for the SLI-E subgroup not only in verbal reasoning and short-term memory but also in nonverbal reasoning, and several nonverbal subtests correlated significantly with the composite verbal index. However, weaknesses and strengths in the cognitive profiles of the subgroups were parallel. Conclusions: Poor verbal comprehension and reasoning skills seem to be associated with lower nonverbal performance in children with SLI. Performance index (Performance Intelligence Quotient) may not always represent the intact nonverbal capacity assumed in SLI diagnostics, and a broader assessment is recommended when a child fails any of the compulsory Performance Intelligence Quotient subtests. Differences between the SLI subgroups appear quantitative rather than qualitative, in line with the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) classification (American Psychiatric Association, 2013).

Suicidal ideation, suicide attempts, and psychological distress among intoxicated adolescents in the pediatric emergency department.

BACKGROUND: Studies have emphasized screening for psychiatric disorders, especially suicide risk in emergency departments. Psychiatric disorders and experimentation with alcohol increase in adolescence and intoxications among patients challenge the staff in emergency departments. AIMS: This study examined the degree of suicidal ideation (SI) and suicidal behavior in adolescents, and the extent to which they differed from non-suicidal patients in terms of alcohol use, psychological distress, self-esteem, and perceived social support. METHODS: The study comprised 120 adolescents, a mean age of 14.2 years. Of them 60% were females. We collected data on the clinical characteristics and assessed the patient's psychiatric status using self-report scales and analyzed blood samples for alcohol. A consulting psychiatrist interviewed each patient before discharge to evaluate potential SI or suicide attempt (SA) using structured and semi-structured scales. RESULTS: Of the 120 patients 20% had SI or had made a SA. High psychological distress in girls, low blood alcohol levels (BALs), as well as low scores on self-esteem, on social support and on familial support were associated with patients with SI/SA. Logistic regression showed that the most significant variables with suicidal patients included low BAL and low self-esteem and high alcohol consumption. Psychological distress had a direct and mediational role in the suicidal patients. CONCLUSIONS: Adolescents referred to the pediatric emergency department with intoxication displaying high psychological distress and low self-esteem represent a high-risk group of teens. In this group, careful assessment of mental health status, screening for suicidal ideation, and SAs seems warranted.

Development of self-image and its components during a one-year follow-up in non-referred adolescents with excess and normal weight.

BACKGROUND: The proportion of overweight and obese youths is high. The present study aimed to investigate the development of self-image and its components during a one-year follow-up among non-referred adolescents with excess and normal weight. Furthermore, we separately analyzed the data for girls and boys. METHODS: Altogether 86 8(th) grades (41 girls and 45 boys) with a relative weight of 26% or more above the median and 91 controls (43 girls and 48 boys) with normal weight participated the follow-up. The Offer Self-Image Questionnaire, Revised (OSIQ-R) was used to assess self-image at baseline and on follow-up. In the OSIQ-R, a low total raw score implies positive adjustment, while a high raw score implies poor adjustment and a negative self-image. The study design was doubly correlated (pairs and time), and a linear mixed model was used in the statistical analysis. RESULTS: In OSIQ-R total scores, a comparative improvement was observed in girls with normal weight. Among these girls, significant change scores compared to zero were seen in impulse control, social functioning, vocational attitudes, self-confidence, self-reliance, body image, sexuality, and ethical values. In girls with excess weight, none of the change scores compared to zero were statistically significant. When the girls with normal and excess weight were compared, the difference in change scores was largest in sexuality and vocational attitudes. Change scores compared to zero were significant in sexuality and idealism for boys with excess weight, and in impulse control, mental health, self-reliance, and sexuality for normal weight boys. When the boys with excess and normal weight were compared, no statistically significant differences emerged in change scores. CONCLUSION: In mid-adolescent girls, the influence of overweight and obesity on the development of self-image is substantial. Weight management programs directed at overweight adolescent girls should include psychological interventions aiming to diminish self-image distress, especially that associated with feelings, attitudes, and behavior towards the opposite sex, as well as future career plans.

Psychological well-being in adolescents with excess weight.

BACKGROUND: Self-esteem, perceived health, weight satisfaction, eating habits, physical activity, friendships, intimate relationships, smoking and substance use habits can be regarded as important correlates of psychological well-being in adolescence. AIM: The present study aimed to determine whether problems in the above-mentioned elements of psychological well-being were more prevalent among mid-adolescent pupils with excess weight than among their healthy-weight peers. METHODS: The study participants comprised 178 adolescents with excess weight and 1087 healthy-weight peers with a mean age of 14.7 years attending the 8th grade at secondary school. The Rosenberg Self-Esteem Scale, the Eating Disorder Inventory and a questionnaire assessing health- and food-related attitudes and habits were used. RESULTS: The adolescents with excess weight more often reported weight dissatisfaction, abnormal eating habits and signs of eating disorder pathology than those with healthy weight. No significant difference in self-esteem was observed between weight groups. The proportion of adolescents who were non-smokers, did not use alcohol and had one or more close friends did not differ between those with excess and healthy weight. However, a lower proportion of excess-weight adolescents had dating experience. Inadequate physical activity was highly prevalent among adolescents in both weight groups. CONCLUSIONS: Despite the high prevalence of eating pathology and weight dissatisfaction, most mid-adolescent pupils with excess weight expressed good psychological health. Targeted psychological interventions should be offered to some adolescents with overweight problems.

Spoken language skills and educational placement in Finnish children with cochlear implants.

OBJECTIVE: This study reports the demographics, and the auditory and spoken language development as well as educational settings, for a total of 164 Finnish children with cochlear implants. METHODS: Two questionnaires were employed: the first, concerning day care and educational placement, was filled in by professionals for rehabilitation guidance, and the second, evaluating language development (categories of auditory performance, spoken language skills, and main mode of communication), by speech and language therapists in audiology departments. RESULTS: Nearly half of the children were enrolled in normal kindergartens and 43% of school-aged children in mainstream schools. Categories of auditory performance were observed to grow in relation to age at cochlear implantation (p < 0.001) as well as in relation to proportional hearing age (p < 0.001). The composite scores for language development moved to more diversified ones in relation to increasing age at cochlear implantation and proportional hearing age (p < 0.001). Children without additional disorders outperformed those with additional disorders. CONCLUSION: The results indicate that the most favorable age for cochlear implantation could be earlier than 2. Compared to other children, spoken language evaluation scores of those with additional disabilities were significantly lower; however, these children showed gradual improvements in their auditory perception and language scores.

Students' approaches to learning and their experiences of the teaching-learning environment in different disciplines.

BACKGROUND: There is evidence of disciplinary variation in students' approaches to learning. Furthermore, previous research has shown that students' approaches are related to their perceptions of the learning environment. AIM: The overall objective of the study was to analyse combinations of approaches to learning among undergraduates in different disciplines. More precisely, the aim was to cluster students on the basis of their scores on different items measuring approaches to learning, and to explore the relationship between the clusters and both the disciplines of the students and their perceptions of the teaching-learning environment. SAMPLE: A total of 2,509 students participated in the study. METHODS: The students were asked to complete an on-line questionnaire, which was a revised version of the Experience of Teaching and Learning Questionnaire. It included items covering approaches to learning and perceptions of the teaching-learning environment. RESULTS: The students were classified in four clusters. There were significant differences in how the respondents from the 10 faculties were represented in these clusters. There were also differences in their perceptions of the teaching-learning environment in the different faculties. CONCLUSIONS: It appears that there is disciplinary variation in approaches to learning. Furthermore, the results indicate that both approaches to learning and the discipline have an effect on students' experiences of the teaching-learning environment.

The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms.

BACKGROUND: Adverse life events and social support may influence the outcome of major depressive disorder (MDD). We hypothesized that outcome would depend on the level of depressive symptoms present at the outset, with those in partial remission being particularly vulnerable. METHOD: In the Vantaa Depression Study (VDS), patients with DSM-IV MDD were interviewed at baseline, and at 6 and 18 months. Life events were investigated with the Interview for Recent Life Events (IRLE) and social support with the Interview Measure of Social Relationships (IMSR) and the Perceived Social Support Scale - Revised (PSSS-R). The patients were divided into three subgroups at 6 months, those in full remission (n = 68), partial remission (n = 75) or major depressive episode (MDE) (n = 50). The influence of social support and negative life events during the next 12 months on the level of depressive symptoms, measured by the Hamilton Rating Scale for Depression (HAMD), was investigated at endpoint. RESULTS: The severity of life events and perceived social support influenced the outcome of depression overall, even after adjusting for baseline level of depression and neuroticism. In the full remission subgroup, both severity of life events and subjective social support significantly predicted outcome. However, in the partial remission group, only the severity of events, and in the MDE group, the level of social support were significant predictors. CONCLUSIONS: Adverse life events and/or poor perceived social support influence the medium-term outcome of all psychiatric patients with MDD. These factors appear to have the strongest predictive value in the subgroup of patients currently in full remission.

Socioeconomic status as a cause and consequence of psychosomatic symptoms from adolescence to adulthood.

BACKGROUND: Few follow-up studies have investigated psychosomatic health and socioeconomic status (SES) and associations between them at different life stages. The aim of this study was to investigate differences in psychosomatic symptoms by SES in adolescence, early adulthood and adulthood and to examine whether lower SES leads to higher levels of symptoms (social causation) or higher levels of symptoms to lower SES (health selection) or both. METHODS: All 16-year-old ninth-grade school pupils of one Finnish city completed questionnaires at school. Subjects were followed up using postal questionnaires when aged 22 and 32 years. RESULTS: Females reported significantly higher scores of psychosomatic symptoms than males at 16, 22 and 32 years of age. Higher rates of psychosomatic symptoms were found among females of manual class origin at 16 years. In addition, at 22 years, both females and males with only comprehensive school education and, at 32 years, those who worked in manual jobs had higher scores of symptoms. When low SES both as a cause and consequence of symptoms was investigated, the findings supported both these paths among females and more the health selection among males. In both genders, especially the path from psychosomatic symptoms in adolescence to lower education in early adulthood was strong. CONCLUSIONS: The results highlight the need of greater consideration of psychosomatic symptoms, particularly in adolescence, in later socioeconomic outcomes.

Risk of repeat offending among violent female offenders with psychotic and personality disorders.

OBJECTIVE: The aim of this study was to examine the rate of criminal recidivism among female homicide offenders evaluated by forensic psychiatrists, to compare this rate with that of other violent female offenders, and to analyze the explanatory variables of recidivism. METHOD: This was a retrospective study of all women (N=132) sent for forensic psychiatric examination after being convicted of homicide or attempted homicide in Finland during 1982-1992; subjects were followed up until mid-1999. Data were collected from the national crime register, the prisoner record, and Statistics Finland. The authors compared the rate of violent repeat offending in this group with that of other violent women and analyzed the explanatory variables of recidivism. RESULTS: During the follow-up period, 23% of the study group committed a repeat offense, 15% of which were violent and 3% of which were homicides. Almost half of all repeat offenses occurred within the first 2 years after the index offense. There was no statistically significant difference in violent recidivism between the study group and other violent female offenders. Of those who committed repeat offenses, 81% were diagnosed with a personality disorder, and 10% were diagnosed with psychosis. Criminality prior to the index event, alcohol or drug dependency, and young age significantly raised the risk and rapidity of further offenses. CONCLUSIONS: The risk of recidivism was high in this study group yet was similar to that of other violent female offenders. The risk was high very early after release. It seems that women and men who are violent and have personality disorders are comparable in their risk of recidivism.

Emergence of penicillin resistance among Fusobacterium nucleatum populations of commensal oral flora during early childhood.

Penicillin resistance due to beta-lactamase production is surprisingly common among oral bacteria in childhood. Fusobacterium nucleatum, a Gram-negative anaerobic bacillus, is a member of the developing oral commensal flora. As part of the investigation on the emergence of oral bacterial resistance, the aim of the present study was to examine longitudinally the penicillin resistance among salivary F. nucleatum populations as related to age, day care attendance and sibling history, and exposure to antimicrobial agents. Altogether 1492 F. nucleatum isolates from saliva of 44 healthy infants followed at a study clinic at 2, 6, 12, 18 and 24 months of age were tested for beta-lactamase production. Furthermore, the 276 beta-lactamase-positive isolates were examined for their in vitro susceptibility to penicillin G by the NCCLS-approved agar dilution method. Statistical analysis of the associations between penicillin-resistant isolates and infants' age, day care attendance, number of siblings and their ear infections, and exposure to antimicrobial agents was performed by SPSS Windows Version 10. The prevalence of infants harbouring beta-lactamase-producing F. nucleatum strains increased from 2% to 49% during the follow-up time. In nearly all cases beta-lactamase-producing F. nucleatum isolates were found simultaneously with beta-lactamase-negative isolates. Most beta-lactamase-producing isolates (80%) showed an MIC of > or =8 mg/L. In conclusion, the prevalence of infants harbouring penicillin-resistant F. nucleatum due to beta-lactamase production increased with age and usage of antimicrobial agents during the first year of life.