Cognitive Disengagement Syndrome in Mothers of Children With Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: To examine the cognitive disengagement syndrome (CDS) symptoms of mothers of children with attention-deficit/hyperactivity disorder (ADHD). METHOD: The participants consisted of 223 mothers of children with ADHD, and data were collected using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5-CV), the Stroop Test (ST), the Barkley Adult SCT Scale (CDS), and the Adult ADHD Self-Report Scale (ASRS). RESULTS: The participants were divided into four groups based on psychopathology: the group without any psychiatric disorder, the group with only ADHD, the group with a psychiatric disorder other than ADHD, and the group with another psychiatric disorder along with ADHD. The group with any psychiatric disorder along with ADHD had the highest CDS scores, while the group without any psychopathology had the lowest CDS scores. CONCLUSION: CDS seems to be a construct associated with both ADHD and other internalizing disorders. Further studies are needed to shed more light on these relationships.

Cognitive disengagement syndrome in children with type 1 diabetes: important implications for clinical outcomes.

AIMS: Children with type 1 diabetes (T1D) are prone to a variety of psychiatric disorders, however, to date, no study has examined cognitive disengagement syndrome (CDS) in children with T1D. The present study aimed to evaluate the frequency of CDS symptoms in children with T1D and whether it is related to glycemic control. METHODS: This cross-sectional study included 74 children with T1D and 88 healthy (control) children, aged 8-14 years. All children were evaluated through a semi-structured psychiatric interview, the Kent-EGY test, porteus maze test, stroop test TBAG form, Barkley child attention scale, and Conners' parent rating scale-revised-short form. RESULT: Children with T1D had considerably higher rates of elevated CDS symptoms than control children (35.1% vs. 10.2%, p < 0.001). Children with T1D performed poorly on attention and cognitive tests. High levels of CDS symptomatology were strongly associated with earlier diabetes onset age, longer disease duration, a higher percentage of diabetic ketoacidosis at diagnosis, higher HbA1c levels, and higher daily insulin dosages. Also, T1D patients with elevated CDS symptoms had lower IQ and attention scores and worse cognitive function performance compared to participants with low levels of CDS symptomatology. CONCLUSIONS: Elevated CDS symptoms are significantly higher in children with T1D and are associated with poorer diabetes control. The routine psychiatric examination of children with T1D should also include a screening for CDS, particularly in patients with poor glycemic control.

Emotional Dysregulation and Temperament-Character Traits in Adolescents With Functional Neurological Symptom Disorder (Conversion Disorder).

ABSTRACT: The purpose of this study was to evaluate emotion dysregulation and temperament-character traits in adolescents with functional neurological symptom disorder (FNSD). Forty adolescents with FNSD and 40 healthy adolescents were evaluated by a semiconstructed diagnosis interview, Temperament and Character Inventory (TCI), Difficulties in Emotion Regulation Scale (DERS), Regulation of Emotions Questionnaire (REQ), and Children's Somatization Inventory-24 (CSI-24). The external and internal dysfunctional emotion regulation scores of REQ, all subscales of DERS, except the awareness subscale, and CSI-24 scores were significantly higher in FNSD patients compared with healthy controls. There were significant differences between the groups in terms of harm avoidance and reward dependence subscale scores of TCI. Multiple logistic regression analysis showed that the external dysfunctional emotion regulation strategy, somatization, and reward dependence are significant predictors of FNSD. Our results provide evidence that adolescents with FNSD experience emotional dysregulation and that the differential value of some temperament-character traits in the diagnosis of FNSD.

The Effect of Methylphenidate Treatment on Olfactory Function in Children and Adolescents With ADHD.

OBJECTIVE: This study aimed to research whether there is an olfactory disorder in ADHD, and if so, what is the effect of methylphenidate on this condition. METHOD: This is a cross-sectional study aiming to evaluate olfactory threshold, identification, discrimination and threshold, discrimination, and identification (TDI) scores in 109 children and adolescents, 33 of whom have ADHD without medication, 29 with ADHD with medication and 47 control groups. RESULT: In the post hoc tests, the mean odor discrimination test, the mean odor identification test, and the mean TDI scores of the unmedicated ADHD group were significantly lower than those of the other two groups, and that the mean odor threshold test scores of the medicated ADHD group were significantly lower than those of the control and unmedicated groups. CONCLUSION: Olfactory function could be a useful tool to monitor treatment effects and may be a promising candidate as a biomarker in ADHD.

Evaluation of cognitive disengagement syndrome in children with obsessive-compulsive disorder: Clinical implications.

Cognitive disengagement syndrome (CDS) has been found to be associated with internalizing symptoms. Yet, no study thus far has focused on whether there is an association between obsessive-compulsive disorder (OCD) and CDS. The purpose of this study is to examine the symptom frequency and clinical implications of CDS in children with OCD. The study included sixty-one children with OCD and sixty-six typically developing children. Children were evaluated by a semi-constructed diagnosis interview, Obsessive-Compulsive Inventory, Barkley Child Attention Scale, and Stroop test. The frequency of elevated symptoms of CDS, and total time, total error, and total correction scores of the Stroop test were significantly higher in the OCD group compared to the controls. Elevated CDS symptoms were significantly associated with higher OCD symptom prevalence and poorer performance on the Stroop Test. Moreover, poor insight, hoarding symptoms, mental compulsions, and ADHD comorbidity were significantly higher in those with elevated CDS symptoms than in those without CDS in the OCD group. The findings of this study provide clinical implications that CDS symptoms may contribute to deficits in attentional orientation, conceptual flexibility, and cognitive processing speed in OCD.

Sociodemographic variables, clinical characteristics, and treatments in children with trichotillomania in terms of age and gender: a multicenter study.

OBJECTIVE: Although trichotillomania (TTM) is a common, typically pediatric-onset disorder, data on the phenomenology of TTM in children, accompanying comorbid psychiatric disorders, and treatment options are extremely limited. In our study, it was aimed to investigate these variables and related factors in patients undergoing psychiatric evaluation and follow-up. METHOD: The study included 79 children and adolescents between the ages of 4 and 17 who were diagnosed with TTM and followed up in four different Child and Adolescent Psychiatry outpatient clinics between 2015 and 2020. The sociodemographic characteristics of these patients, clinical features of the disease, comorbid psychiatric disorders, and treatment approaches have been studied. RESULTS: Our results showed that TTM was more common in girls, hair and eyebrow plucking was the most common, and symptoms and features accompanying TTM changed with age, but not with gender. Again, 79.7% of these children had at least one psychiatric comorbid disorder (most common being anxiety disorders and Attention Deficit/Hyperactivity Disorder), comorbidity was closely related to TTM severity, 93.7% used at least one pharmacotherapeutic agent, and positive response rates to treatment were found to be low. Moreover, TTM severity was found to increase with age and disease duration. CONCLUSION: Study findings support that clinical presentation, disease severity and comorbidity rates may change with age in children and adolescents with TTM, and early intervention is important to prevent clinical progression/worsening and mental health sequela.

Does Involvement in Peer Bullying Invite Self-Injury?: The Association Between Peer Bullying and Self-Injury in a Clinical Sample.

ABSTRACT: Previous studies have linked peer bullying to nonsuicidal self-injury (NSSI). However, the evidence is largely limited to population-based groups. This study examined whether there is a relationship between NSSI and being a victim of peer bullying among adolescents in a clinical sample and how this may be influenced by types of bullying. The sample consisted of 96 outpatients with NSSI and 107 healthy adolescents. The Inventory of Statements About Self-Injury, Peer Bullying Scale, and Rosenberg Self-Esteem Scale were applied. Whereas the scores of each bullying type of adolescents with NSSI were significantly higher, their self-esteem scores were significantly lower. Each victimization score of bullying had a negative correlation with NSSI-onset age and self-esteem scores and a positive correlation with self-injury scores. This study demonstrated that being a victim of any type of bullying is strongly associated with self-injury. It would be advisable to screen adolescents with self-injury for exposure to bullying, and vice versa.

The Role of Childhood Trauma on Prenatal Attachment: A Cross-Sectional Study.

ABSTRACT: Although the quality of prenatal attachment is a strong predictor of the quality of postnatal mother-infant attachment and mother-child interaction, little is known about the specific impacts of maternal exposure to childhood traumas, and it deserves more attention. This study was conducted to determine whether there is a relationship between childhood traumas and pren1atal attachment levels. Prenatal attachment and childhood trauma were evaluated in 104 pregnant women using the Prenatal Attachment Scale and Childhood Trauma Questionnaire. Our results showed that all kinds of childhood traumatic experiences were associated with lower prenatal attachment scores. Also, more severe childhood traumas were strongly associated with weaker prenatal attachment. This study contributes to the very limited literature on the prenatal attachment of expectant mothers with childhood traumas by emphasizing the importance of pregnant women's exposure to childhood traumas as a risk factor for low prenatal attachment.

Clinical characteristics according to sex and symptom severity in children with selective mutism: a four-center study.

INTRODUCTION: Clinical information regarding selective mutism (SM), a persistent and debilitating psychiatric disorder, in children is extremely limited. We aimed to examine sociodemographic characteristics and comorbid psychiatric conditions and identify clinical variables associated with sex and SM severity among children with SM. METHODS: We analyzed the medical records of 49 children who received treatment for SM in four different tertiary hospitals in Turkey between 2016 and 2021. Children's charts were reviewed to examine clinical characteristics, comorbidities, and response to treatment. RESULTS: Thirty-one children were female, and 18 were male (female:male ratio is 1.7:1). Most children (73.5%) with SM displayed onset of SM in 3-6 years. However, most children (57.1%) were diagnosed between the ages of 7-11. The mean time from onset to diagnosis was 1.69 ± 1.37 years. Females displayed a later onset of SM (6.42 ± 2.40 vs. 4.89 ± 0.96; p= 0.013) and higher comorbidity rates (71% vs. 38.9%, p= 0.039) than males. The vast majority of children received two or more psychiatric diagnoses. Children in the severe group had a longer duration of illness, higher rates of psychiatric comorbidity, speech delay, and treatment resistance. CONCLUSION: Our study suggests that SM may have different clinical features according to sex and symptom severity of SM. More information about children with SM is needed to understand the development and maintenance of SM.

SIRT1, MMP-9 and TIMP-1 levels in children with specific learning disorder.

BACKGROUND: Specific Learning Disorder (SLD) is a common developmental and neurobiological disorder of childhood characterized by impairment of functionality in one or more areas such as reading, writing, mathematics, listening, speaking, and reasoning. The etiology of SLD is still not fully understood. The aim of this study was to evaluate children with SLD to investigate the potential role of MMP-9, TIMP-1 and SIRT-1, which have important roles in synaptic plasticity, cognitive functions, learning and memory, and are known to be associated with various psychiatric disorders. METHODS: The study was conducted with 44 outpatients aged 8-14 years who were diagnosed with SLD according to DSM-5 in the outpatient clinic and a control group of 44 age, gender and education level-matched healthy children. The groups were compared in respect of serum levels of MMP-9, TIMP-1 and SIRT-1, evaluated using the ELISA method. RESULTS: Serum MMP-9 levels were significantly lower in children in the SLD group than in the control group, while TIMP-1 was higher. No difference was determined between the groups in respect of the SIRT1 levels. SLD severity was negatively correlated with MMP-9 levels and positively correlated with TIMP-1 levels. CONCLUSIONS: MMP-9 appear to contribute to hippocampal-dependent memory and learning by modulating long-term synaptic plasticity. The findings of this study also reinforce the idea that deregulation of the MMP-9/TIMP-1 ratio may impact learning and play a role in SLD. These findings will help to elucidate the etiology of SLD. Furthermore, understanding molecular pathways can contribute to the discovery of certain biomarkers in SLD pathogenesis and the development of new treatment possibilities.

Risk of autism spectrum disorder in children with a history of hospitalization for neonatal jaundice.

BACKGROUND: Limited research has focused explicitly on the association between neonatal jaundice and autism spectrum disorder (ASD), and inconclusive evidence exists in the literature within this framework. This study aimed specifically to investigate whether neonatal jaundice is a potential risk factor for ASD and whether there is a connection between the types of neonatal jaundice and the severity of ASD. METHODS: This study involved 119 children with ASD [90 males (75.6%), 29 females (24.4%), mean age: 45.39 ± 11.29 months] and 133 healthy controls [100 males (75.2%), 33 females (24.8%), mean age: 46.92 ± 11.42 months]. Psychiatric disorders were diagnosed through the Diagnostic and Statistical Manual of Mental Disorders criteria. Childhood Autism Rating Scale (CARS) was used to assess the screening and diagnosis of autism. A specially prepared personal information sheet was employed to investigate sociodemographic characteristics and birth and clinical histories. RESULTS: The rate of the history of jaundice and pathological jaundice requiring hospitalization and phototherapy were significantly higher in the ASD group compared to the controls. CARS total score and the mean scores of nearly all items were statistically higher in children with a history of pathological jaundice than those with a history of physiological jaundice. DISCUSSION: Neonatal jaundice, depends on its severity, seems to be one of the possible biological factors associated with subsequent development of and the severity of ASD. Establishing a causal relationship between neonatal jaundice and ASD by more comprehensive studies may contribute to alleviating of the severity of ASD for individuals at risk.

Can Temperament and Character Traits Be Used in the Diagnostic Differentiation of Children With ADHD?

ABSTRACT: In this study, it was aimed to determine the contributions of temperament and character traits to the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Thirty-six patients between the ages of 9 and 14 with a diagnosis of combined type ADHD and 39 healthy children were included in the study. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Version and the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale parent form were used to assess hyperactivity/impulsivity and inattentiveness, and comorbid disorders. The Junior Temperament and Character Inventory-Revised form was used to evaluate temperament-character traits. The classification-based association rules (CBARs) method was used for finding rules predicting ADHD accurately. Low persistence and self-directedness scores, and higher disorderliness and fatigability subgroup scores were found in the ADHD group. In CBARs, the separation of children with ADHD from healthy controls could be made with 0.83 accuracy, 0.80 sensitivity, and 0.86 specificity. The results of our study support the view that temperament-character traits can help clinical diagnosis of ADHD.

Effects of agmatine, glutamate, arginine, and nitric oxide on executive functions in children with attention deficit hyperactivity disorder.

In this study, we aimed to investigate the effects of agmatine, nitric oxide (NO), arginine, and glutamate, which are the metabolites in the polyamine pathway,  on the performance of executive functions (EF) in attention deficit hyperactivity disorder (ADHD). The ADHD group included 35 treatment-naive children (6-14 years old) who were ewly diagnosed with ADHD. The control group consisted of 35 healthy children with the same age and sex, having no previous psychiatric disorders. In the study groups, Stroop test (ST) and trail making test (TMT) were used to monitor EF, and blood samples were collected to measure agmatine with ultra-high-performance liquid chromatography and NO, glutamate, and arginine with enzyme-linked immunosorbent assay (ELISA). The EFs were significantly impaired in the ADHD group. The agmatine and arginine levels of the ADHD group were significantly higher than their peers. The NO and glutamate levels were also higher in the ADHD group compared to the control group, but these differences did not reach statistical significance. Children with ADHD had more difficulties during EF tasks compared to healthy children. The elevated NO and glutamate levels may be related with the impairment during EF tasks. Therefore, agmatine and arginine may increase to improve EF tasks through its inhibitory effect on the synthesis of NO and glutamate. Further studies are needed about polyamine pathway molecules to shed light on the pathophysiology of ADHD.

Body Perception, Self-Esteem, and Comorbid Psychiatric Disorders in Adolescents Diagnosed with Polycystic Ovary Syndrome.

STUDY OBJECTIVE: To investigate adolescents with polycystic ovary syndrome (PCOS) in terms of body perception, self-esteem, and comorbid psychiatric diseases by comparing them with their healthy peers. DESIGN: Cross-sectional design. SETTING: The Department of Child and Adolescent Psychiatry and the Department of Pediatric Endocrinology outpatient clinic of Cumhuriyet University in Sivas, Turkey. PARTICIPANTS: Fifty female adolescents aged 12-18 years who were diagnosed as having PCOS and 37 healthy adolescents aged 12-18 years. INTERVENTIONS AND MAIN OUTCOME MEASURES: All adolescents were evaluated by a child and adolescent psychiatrist using a semistructured interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children) and asked to complete the Rosenberg Self-Esteem Scale, Children's Depression Inventory, and Body Image Scale. RESULTS: The rate of psychiatric disorders in the PCOS group was significantly higher than in the control participants (16/50 (32%) vs 5/37 (13.5%), respectively; P = .046). The most common disorder was major depressive disorder. The Rosenberg Self-Esteem Scale and Body Image Scale scores of the PCOS group were lower (P = .03; P < .001, respectively), and Children's Depression Inventory scores were higher (P = .03) than in the control group. There was no significant relationship between obesity, hirsutism, and insulin resistance with any psychiatric disorders in the PCOS group. CONCLUSION: Adolescents with PCOS had more psychopathology than their peers. Moreover, their self-esteem was lower and their body perceptions were more dissatisfied compared with their peers.

Olfactory Impairment in Children and Adolescents With Obsessive-Compulsive Disorder.

In this study, we aimed to examine the olfactory function of adolescents with obsessive-compulsive disorder (OCD). We investigated olfactory function of 50 adolescents with OCD and 50 healthy controls (min-max, 12-17 years) by the "Sniffin' Sticks" extended test. OCD and depression symptomatology were assessed with the Maudsley Obsessive-Compulsive Inventory (MOCI) and the Children's Depression Inventory (CDI). Adolescents with OCD had lower olfactory performance than healthy controls. The patients who responded positively to the treatment exhibited performance superior to the patients with partial response and those untreated. All olfactory measurements were significantly inversely correlated with MOCI and CDI total scores and OCD duration. Our results show that OCD has a significant impact on all olfactory tests, and olfactory impairment is related to symptom severity, duration, and course of OCD. The decrease in olfactory function may be a noninvasive state marker for OCD. Further investigations in longitudinal studies are required to confirm our results.

Evidence supporting the role of telomerase, MMP-9, and SIRT1 in attention-deficit/hyperactivity disorder (ADHD).

Growing evidence suggests that telomeres, telomerase, matrix metalloproteinase-9 (MMP-9), and SIRT1 (sirtuin1) are involved in the pathophysiology of neuropsychiatric and neurodevelopmental disorders. However, whether these molecules are contributors to attention-deficit/hyperactivity disorder (ADHD) has been little explored and poorly understood. This study aimed to determine the potential role of telomerase, MMP-9, and SIRT1 in children with ADHD. The study was performed on 46 children with ADHD aged between 8 and 14 and 43 healthy children matching in age and gender. Children were evaluated by Kiddie-Sads-Present and Lifetime Version, Conners' Parent Rating Scale-Revised Short Form (CPRS-RS) and Stroop test. Serum telomerase, MMP-9, and SIRT1 levels were measured by a quantitative sandwich enzyme-linked immunosorbent assay. MMP-9 and telomerase levels were significantly higher and SIRT1 levels were significantly lower in patients with ADHD than those of controls. All three molecules were significantly associated with both the severity of ADHD symptoms and cognitive functions. This is the first attempt to indicate that the important role of telomerase, MMP-9, and SIRT1 in ADHD, and the association of all these molecules with the severity of ADHD and cognitive functions, but future studies are required to verify these results.

Olfactory Function in Depressed Adolescents.

Some researchers have suggested that olfactory deficits might be a sensitive marker for depression in adults. However, olfactory function has not been well studied in relation to depression among children and adolescents. The aim of this study was to evaluate the effect of depression on olfactory function of adolescents. The olfactory threshold, odor identification, and discrimination abilities of adolescents aged 12 to 17 (43 adolescents with major depressive disorder and 43 healthy controls) alongside their sum were evaluated using the Sniffin' Sticks extended test. Olfactory scores were similar between the groups. However, depressed adolescents perceived their own olfactory function scores significantly lower than the measured values. No correlation was found between olfactory scores and age, sex, severity of depression, and duration of depression. This study conducted with a small sample size revealed that olfactory function of the adolescents with depression was similar to olfactory function of the healthy adolescents. It is required to conduct further adequately powered, longitudinal studies in order to verify these results.

Sociodemographic Characteristics Associated With Speech and Language Delay and Disorders.

The aim of this study was to identify major risk factors and sociodemographic characteristics responsible for speech and language delay/disorders. Two hundred twenty-eight children (aged 24-72 months) with speech and language delay/disorders participated in this study. The Ankara Developmental Screening Inventory and The Peabody Picture Vocabulary Test were used to assess language profiles and developmental stages of children. Low income, nonattendance in preschool education, low maternal education, having two or more siblings, later birth order (order of siblings), family history of speech and language delay/disorders, preterm birth, low birth weight, and birth complications or the need for intensive care support during neonatal period were identified as risk factors (all p < 0.005). Both sociodemographic and biologic factors were associated with speech and language delay/disorders. Awareness of these factors may provide a chance for earlier diagnosis and intervention. Identification of risk factors of these children would contribute to our knowledge in this field.