Traumatic events and suicidality in a German adolescent community sample.

Exposure to traumatic events has been related to suicide attempts and suicidal ideation in adolescents. This study analyzes the association between suicidality and preceding traumatic life events in 665 German school students with an average age of 14.81 (SD = 0.66). Forty-three (6.5%) students reported suicide attempts and 239 (35.9%) reported suicidal ideation. Adolescents with a history of suicide attempts reported sexual abuse 6 months before their suicidal behavior significantly more often than students with only suicidal ideation. Sexual victimization seems to be especially linked to a risk for suicide attempts during adolescence. Screening for students at risk for developing suicidality should include assessment of traumatic events.

Report of an initial pilot study on the feasibility of using the MacArthur competence assessment tool for clinical research in children and adolescents with attention-deficit/hyperactivity disorder.

INTRODUCTION: The MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) was used in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and co-morbid oppositional defiant disorder (ODD) and in their parents. The aims were to test feasibility and to determine children's understanding of the elements of disclosure for a clinical drug trial and their competence to assent. METHOD: The contents and language of MacCAT-CR were adapted to be age appropriate for the children. Twelve children (mean age, 9.87 [7.7-12.2]; mean intelligence quotient [IQ], 97 [72-122]) and either the mother or father of each child were interviewed. Psychologists rated the interviews and, in addition to MacCAT-CR, competence was assessed by trained clinicians. RESULTS: The MacCAT-CR was practicable, and the time required was acceptable. Interrater reliability was excellent in children. Children performed less well than parents on this test (children;s vs. parents' scores: Understanding 5.86 vs. 9.08, appreciation 2.64 vs. 4.96, reasoning 3.05 vs. 4.63, respectively). Whereas clinicians assessed all children as competent, lack of competence became apparent in the MacCAT-CR. CONCLUSIONS: The practicability and the interrater reliability suggest that the MacCAT-CR is feasible in children, but the question of whether competence is assessed validly remains unsolved in the absence of external validation. The differences between assessment by clinicians and the low scores obtained in the MacCAT-CR suggest that children may give assent even if they do not understand completely. The results of this initial pilot study may help in the planning of further investigations intended to improve information about studies and assessment of assent/consent.

[Evaluation of pedagogic effects: adaptation of goal attainment scales to the needs of a juvenile penal system]. / Wirkungsmessung pädagogischer Interventionen: Anpassung eines Zielerreichungsinstruments an jugendforensische Anforderungen.

In youth welfare quality management increasingly gains in importance over the last decades. Tools used for quality assurance have to be broadly acceptable in everyday practical work. To meet that precondition it is essential that everyday practice and the different problem situations of children and adolescents are accordingly represented by these assessment scales. On the other hand they also require good methodical quality and generalization, thus, allowing to provide information about the effectiveness in a multiplicity of different residential institutions. Therefore, goal attainment scales have to be adapted to specific pedagogic settings as well as to the particular clientele. However, universal goals of pedagogic processes should be assessed as well. At the university hospital of Ulm, department child and adolescent psychiatry and psychotherapy, a scale was developed to measure the attainment of social competence and individual goals (PädZi). With the intention of an application of these scales in youth forensic context within a project (MAZ) in Switzerland the scales were adapted and expanded based on qualitative interviews with experts from the forensic and educational fields. Interrater agreement was shown to be good.

"...because I am something special" or "I think I will be something like a guinea pig": information and assent of legal minors in clinical trials--assessment of understanding, appreciation and reasoning.

BACKGROUND: The aim of this study is to assess and evaluate the capacities for understanding, appreciation and reasoning of legal minors with psychiatric disorders and their parents and their competence to consent or assent to participation in clinical trials. The beliefs, fears, motivation and influencing factors for decision-making of legal minors and parents were also examined. METHODS: Using the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), an instrument developed for adults whose capacities to consent are unclear, we provided information about clinical trials and assessed understanding, appreciation and reasoning. We adapted this tool for legal minors and examined 19 children and adolescents between the ages of 7 and 15 with attention deficit/hyperactivity disorder (ADHD) or ADHD combined with oppositional defiant disorder (DSM-IV 314.00/314.01/312.8) enrolled in clinical trials. Parents were also examined using the MacCAT-CR. RESULTS: Facts such as the procedures involved in trials or their duration were well understood by legal minors, but more abstract issues like the primary purpose of the trial were not understood by children and adolescents or by many parents. Legal minors also had difficulties understanding the nature of placebo and the probability of receiving placebo. Children's and adolescents' decisions were influenced by fears about their disorder worsening and by problems in their relationship with their parents. Parents wanted the best therapy for their children in order to minimize problems in school. CONCLUSION: Legal minors and parents need to be informed more precisely about specific issues like placebo and the primary purpose of trials. In general, the reasoning of children and adolescents was influenced by their experience with their disorder and decision making was based on reasonable arguments. Their fears were based on everyday experiences such as school performance or family relationships.