Chronic fatigue syndromes: real illnesses that people can recover from.

The 'Oslo Chronic Fatigue Consortium' consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brain's response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.

Effect of Music Therapy on Parent-Infant Bonding Among Infants Born Preterm: A Randomized Clinical Trial.

Importance: Parent-infant bonding contributes to long-term infant health but may be disrupted by preterm birth. Objective: To determine if parent-led, infant-directed singing, supported by a music therapist and initiated in the neonatal intensive care unit (NICU), improves parent-infant bonding at 6 and 12 months. Design, Setting, and Participants: This randomized clinical trial was conducted in level III and IV NICUs in 5 countries between 2018 and 2022. Eligible participants were preterm infants (under 35 weeks' gestation) and their parents. Follow-up was conducted across 12 months (as part of the LongSTEP study) at home or in clinics. Final follow-up was conducted at 12 months' infant-corrected age. Data were analyzed from August 2022 to November 2022. Intervention: Participants randomized to music therapy (MT) plus standard care or standard care alone during NICU admission, or to MT plus standard care or standard care alone postdischarge, using computer-generated randomization (ratio 1:1, block sizes of 2 or 4 varying randomly), stratified by site (51 allocated to MT NICU, 53 to MT postdischarge, 52 to both, and 50 to neither). MT consisted of parent-led, infant-directed singing tailored to infant responses and supported by a music therapist 3 times per week throughout hospitalization or 7 sessions across 6 months' postdischarge. Main Outcome and Measure: Primary outcome was mother-infant bonding at 6 months' corrected age, measured by the Postpartum Bonding Questionnaire (PBQ), with follow-up at 12 months' corrected age, and analyzed intention-to-treat as group differences. Results: Of 206 enrolled infants with 206 mothers (mean [SD] age, 33 [6] years) and 194 fathers (mean [SD] age, 36 [6] years) randomized at discharge, 196 (95.1%) completed assessments at 6 months and were analyzed. Estimated group effects for PBQ at 6 months' corrected age were 0.55 (95% CI, -2.20 to 3.30; P = .70) for MT in the NICU, 1.02 (95% CI, -1.72 to 3.76; P = .47) for MT postdischarge, and -0.20 (95% CI, -4.03 to 3.63; P = .92) for the interaction (12 months: MT in NICU, 0.17; 95% CI, -2.71 to 3.05; P = .91; MT postdischarge, 1.78; 95% CI, -1.13 to 4.70; P = .24; interaction, -1.68; 95% CI, -5.77 to 2.41; P = .42). There were no clinically important between-group differences for secondary variables. Conclusions and Relevance: In this randomized clinical trial, parent-led, infant-directed singing did not have clinically important effects on mother-infant bonding, but was safe and well-accepted. Trial Registration: ClinicalTrials.gov Identifier: NCT03564184.

Factors associated with quality of life for children affected by parental illness or substance abuse.

BACKGROUND: There have been inconsistent findings from studies examining factors associated with quality of life (QoL) for children affected by parental illness. AIM: The aim of this study was to explore factors associated with self-reported QoL in children affected by parental illness or parental substance abuse. DESIGN: A cross-sectional multicentre study. METHODS: The sample included 246 families with children 8-18 years recruited via ill parents who received treatment for severe physical illness, mental illness or substance abuse in specialised health services. We performed multiple linear regression analyses to examine factors associated with the children's self-reported QoL. MAIN OUTCOME MEASURE: KIDSCREEN-27. RESULTS: The children's self-reported QoL was positively associated with the ill parent's self-reported physical health, the children's self-reported social skills, the degree to which other adults took over the ill parent's responsibilities, provision of sibling care, provision of health care for the ill parent and positive outcome of caregiving. The children's QoL was negatively associated with the children's self-reported responsibilities due to parental illness, provision of emotional care for the ill parent, negative outcomes of caregiving and external locus of control. The model explained 63% of the variance (adjusted R2 ) in children's total QoL. STUDY LIMITATIONS: Sampling bias may have occurred during recruitment. CONCLUSIONS: The findings suggest factors of importance for the children's QoL. Clinicians should assess whether an ill parent's physical health may influence negatively on their ability to perform daily responsibilities at home and care for their children, and clinicians can use children's self-reported QoL to identify children who are most negatively affected.

Cognitive-behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a randomised controlled trial.

BACKGROUND: Cognitive-behavioural therapy (CBT) is effective in chronic fatigue (CF) syndrome. However, CBT has not been investigated in postinfectious CF, nor is it known whether addition of therapeutic elements from other disciplines might be useful. We explored combined CBT and music therapy intervention for CF following Epstein-Barr virus (EBV) infection in adolescents. METHODS: Adolescents (12-20 years old) participating in a postinfectious cohort study who developed CF 6 months after an acute EBV infection were eligible for the present study. A combined CBT and music therapy programme (10 therapy sessions and related homework) was compared with care as usual in a randomised controlled design. Therapists and participants were blinded to outcome evaluation. Endpoints included physical activity (steps/day), symptom scores, recovery rate and possible harmful effects, but the study was underpowered regarding efficacy. Total follow-up time was 15 months. Power analyses suggested that 120 participants would be needed in order to detect a moderate effect size. RESULTS: A total of 91 individuals with postinfectious CF were eligible, and a total of 43 were included (21 intervention group, 22 control group). Concern regarding school absence due to therapy sessions was the main reason for declining participation. Seven individuals left the study during the first 3 months, leaving 15 in the intervention group and 21 in the control group at 3 months follow-up. No harmful effects were recorded, and compliance with appointment was high. In intention-to-treat analyses, the primary endpoint (number of steps/day) did not differ significantly between the intervention group and the control group (difference (95% CI) =-1298 (-4874 to 2278)). Secondary outcome measures were also not significantly different among the two groups. CONCLUSION: An intervention study of combined CBT and music therapy in postinfectious CF is feasible. A fully powered trial is needed to evaluate efficacy; participants' concern regarding school absence should be properly addressed to secure recruitment. TRIAL REGISTRATION NUMBER: ClinicalTrials ID: NCT02499302, registered July 2015.

Cognitive-behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a feasibility study.

​BACKGROUND: Cognitive-behavioural therapy (CBT) is effective in chronic fatigue syndrome. However, CBT has not been investigated in postinfectious chronic fatigue (CF), nor is it known whether addition of therapeutic elements from other disciplines might be feasible. We studied the feasibility of a combined CBT and music therapy intervention for CF following Epstein-Barr virus (EBV) infection in adolescents. ​METHODS: Adolescents (12-20 years old) participating in a postinfectious cohort study who developed CF 6 months after an acute EBV infection were eligible for the present feasibility study. A combined CBT and music therapy programme (10 therapy sessions and related homework) was compared with care as usual in a randomised controlled design. Therapists and participants were blinded to outcome evaluation. Endpoints included physical activity (steps/day), symptom scores, recovery rate and possible harmful effects, but the study was underpowered regarding efficacy. Total follow-up time was 15 months. ​RESULTS: A total of 43 individuals with postinfectious CF were included (21 intervention group, 22 control group). Seven individuals left the study during the first 3 months, leaving 15 in the intervention group and 21 in the control group at 3 months' follow-up. No harmful effects were recorded, and compliance with appointment was high. In intention-to-treat analyses, number of steps/day tended to decrease (difference=-1158, 95% CI -2642 to 325), whereas postexertional malaise tended to improve (difference=-0.4, 95% CI -0.9 to 0.1) in the intervention group at 3 months. At 15 months' follow-up, there was a trend towards higher recovery rate in the intervention group (62% vs 37%). ​CONCLUSION: An intervention study of combined CBT and music therapy in postinfectious CF is feasible, and appears acceptable to the participants. The tendencies towards positive effects on patients' symptoms and recovery might justify a full-scale clinical trial. ​TRIAL REGISTRATION NUMBER: NCT02499302.

Children with ill parents: extent and nature of caring activities.

RATIONALE: Previous studies have shown that children may take on higher extents of caring activities if their parents are affected by severe illness or disability, especially when their parents lack access to formal and informal care. AIMS AND OBJECTIVES: This study examined the extent and nature of caring activities done by patients' children; differences in caring activities between different types of parental illness; factors associated with caring activities. DESIGN: An explorative cross-sectional multicentre study. METHODS: Parents as patients in specialised healthcare services, and their children, were recruited from five health trusts in Norway. The sample included 246 children aged 8-17 years and their 238 parents with severe physical illness (neurological disease or cancer) (n = 135), mental illness (n = 75) or substance abuse (n = 28). MAIN OUTCOME MEASURE: Multidimensional Assessment of Caring Activities (MACA-YC18). RESULTS: A large number of children with ill parents are performing various caring activities. Increased caring activities among children due to their parent's illness were confirmed by their parents, especially with regard to personal care. We found no significant differences in the extent of caring activities between illness types, but there were some differences in the nature of these activities. Factors significantly associated with the extent and nature of caring activities were as follows: better social skills and higher external locus of control among the children; and poorer physical parental health. Parent's access to home-based services was limited. STUDY LIMITATIONS: In recruitment of participants for the study, a sampling bias may have occurred. CONCLUSION: To promote coping and to prevent inappropriate or extensive caring activities among children with ill parents, there is a need for increased access to flexible home-based services adapted to the type of parental illness.

Sleep problems in children and adolescents with epilepsy: Associations with psychiatric comorbidity.

Sleep problems are common in pediatric epilepsy and may influence seizure control, daytime functioning, and overall quality of life. Knowledge of factors contributing to sleep problems is likely to improve treatment. The aim of this study was to investigate associations between psychiatric comorbidity and parent-reported and self-reported sleep problems in a sample of children and adolescents with epilepsy. Participants were children and adolescents (N=94), aged 10-19years, with generalized or focal epilepsy who had been referred to a tertiary epilepsy treatment center in Norway. Participants underwent a thorough clinical assessment and 24h of EEG registration. Information on sleep problems was obtained from parents using the Children's Sleep Habit Questionnaire (CSHQ) and from self-reporting using the Sleep Self-Report (SSR) questionnaire. Psychiatric diagnoses were established using the semistructured psychiatric interview Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (Kiddie-SADS-PL). Both the total and subdomain CSHQ and SSR scores were high in comparison with scores from population-based samples. Having one or more psychiatric disorder(s) was significantly associated with elevated scores on both the CSHQ and the SSR. With the exception of parent-reported parasomnias, associations between sleep problems and psychiatric disorders remained significant after adjusting for relevant epilepsy variables. Psychiatric comorbidity explained about one-third of the variance of the reported sleep problems in children and adolescents with epilepsy.

Psychiatric comorbidity in children and youth with epilepsy: An association with executive dysfunction?

OBJECTIVES: Psychopathology in children and youth with epilepsy has previously been related to executive dysfunction, but the nature of the association is uncertain. We sought to explore risk factors for psychiatric disorders in children and youth with epilepsy, with emphasis on executive dysfunction, along with seizure-related and psychosocial factors. METHODS: The cohort consisted of one hundred and one consecutive patients aged 10-19 years with focal (n=52) or genetic generalized (n=49) epilepsy. All were screened for psychiatric symptoms, using part of an extensive questionnaire, the Strengths and Difficulties Questionnaire (SDQ) for both patients and their parents. Participants scoring in the borderline or abnormal range on the SDQ received a psychiatric interview (Kiddie-SADS-PL). All participants underwent a neuropsychological examination, and those with general cognitive abilities (IQ)<70 were excluded. RESULTS: Forty-seven of 101 participants (46.5%) had a SDQ score in the borderline or abnormal range and underwent a psychiatric evaluation. Of these, 44 (93.6%) met the criteria for a psychiatric diagnosis, the most common being ADHD and anxiety. An executive deficit was identified in 26.8% of the participants with a psychiatric diagnosis, but in only 5.4% of those without such a diagnosis (p=0.003). Multivariate logistic regression analysis showed that executive dysfunction was an independent risk factor for having a psychiatric disorder (OR 8.2, CI 1.8-37.2, p=0.006), along with male gender (OR 2.9, CI 1.2-7.3, p=0.02), and early seizure onset (0.86-that is one year older equals risk of psychiatric disorder reduced by 14%-CI 0.77-0.96, p=0.01). Other epilepsy-related or psychosocial factors were not significantly associated with psychiatric disorders. CONCLUSIONS: Multiple factors are associated with psychiatric problems in children and youth with epilepsy. In this study, executive dysfunction, male gender, and early epilepsy onset were independent risk factors for having a psychiatric disorder. An evaluation of psychiatric and cognitive problems is important to enable a positive long-term outcome in childhood epilepsy.

Early sexual debut in Norwegian youth with epilepsy: A population-based study.

OBJECTIVES: In comparison with controls, youth with epilepsy (YWE) have greater psychosocial problems. However, information about their sexual behavior is sparse. We have performed a large, population-based questionnaire study to examine differences in sexual behavior between YWE and controls. METHODS: A randomly chosen cohort of youth (13-19 years) from Akershus county, Norway (n=19,995) was asked to complete a questionnaire anonymously with questions on epilepsy and sexual activity. RESULTS: The response rate was 85%. Two hundred forty-seven participants reported having or having had epilepsy, i.e., a lifetime epilepsy prevalence of 1.2%. Compared with controls, a higher proportion of YWE reported having had sexual intercourse (43.6% vs. 35.3%, p=0.009). The mean age at sexual debut was significantly lower in YWE than in controls (14.0 years vs. 15.0 years, p<0.001), and this was particularly marked among boys. A higher proportion of YWE reported not having used contraceptives at their last sexual intercourse compared with controls (31.6% vs. 22.3%, p=0.03). Ten percent of YWE, compared with 2% of the controls, reported that they had been forced into their first sexual intercourse. CONCLUSION: In YWE, some aspects of sexual behavior differ from those of their peers, with earlier sexual debut and less frequent use of contraceptives. More attention should be directed toward this subject, aiming at avoiding unwanted pregnancies and potential emotional traumas in this already vulnerable patient group.

Paediatric functional abdominal pain: significance of child and maternal health. A prospective study.

AIM: First, to what extent do general paediatric outpatients with functional abdominal pain experience other somatic and mental health symptoms compared with children in a population-based sample? Second, to what extent are such symptoms in both patients and their mothers associated with persistent child abdominal pain and functional disability? METHODS: Ninety-four referred patients [mean age (SD) 11.1 (1.9) years, 62% girls] were assessed by questionnaires and a paediatric consultation at baseline and at follow-up after 6-9 months (94% follow-up participation). At baseline, somatic and mental health symptoms in the patients were compared with a population-based sample of 14,000 school children. Outcome at follow-up was patient self-reported abdominal pain and disability. Prognostic factors explored included patient and maternal somatic and mental health symptoms. RESULTS: The patients experienced significantly more somatic [e.g. headache (OR: 9.2; 95% CI: 5.9-14.6)] and emotional symptoms than the school children. Patient's older age and peer problems at baseline were significantly associated with more abdominal pain at follow-up, whereas patient's older age, emotional symptoms, prosocial behaviour and maternal somatic symptoms were associated with disability. CONCLUSION: Our results highlight the importance of focusing wider than just the patient's symptoms of abdominal pain in clinical practice and research.

Psychiatric symptoms in Norwegian children with epilepsy aged 8-13 years: effects of age and gender?

PURPOSE: In this population-based study we wanted to assess the prevalence and impact of psychiatric symptoms in children with epilepsy compared to controls, and investigate possible age and gender differences. METHODS: Data were collected using the Strengths and Difficulties Questionnaire-Parent report (SDQ-P) as part of a more extensive questionnaire. A total of 14,699 parents of children aged 8-13 years (response rate 78%) participated. Associations between SDQ scores and epilepsy, other chronic disease, age, gender, and socioeconomic factors were explored using logistic regression analysis. KEY FINDINGS: Children with epilepsy (CWE) (n=110) had a significantly higher frequency of psychiatric symptoms (37.8% vs. 17.0% in controls, p<0.001). Gender differences were found in several subscales of the SDQ; girls had more emotional problems, whereas boys had higher scores regarding peer relationship and hyperactivity/inattention problems. Male gender, low socioeconomic status (family income below poverty limit and living in a single parent home), and other chronic disease (asthma/diabetes) were independent risk factors of developing psychiatric symptoms, along with epilepsy. Having or having had epilepsy was, however, a much stronger risk factor for developing psychiatric symptoms in girls than in boys [odds ratio (OR) 4.2 vs. OR 2.3]. A minor effect of age was seen only in girls with epilepsy, with an increased risk of psychiatric symptoms in age group 10-13 years (OR 1.28 for scoring borderline/abnormal on SDQ-total difficulties). Borderline/abnormal impact scores were found in 31.8% of CWE compared with 13.0% of controls (p<0.001). SIGNIFICANCE: Multiple risk factors contribute to the high prevalence of psychiatric symptoms in CWE, perhaps differently in boys and girls. Awareness of this complex interaction may help target intervention toward high risk groups and thus prevent more serious problems from arising.

Understanding discrepancies in parent-child reporting of emotional and behavioural problems: Effects of relational and socio-demographic factors.

BACKGROUND: Discrepancies between parents and children in their assessment of children's mental health affect the evaluation of need for services and must be taken seriously. This article presents the differences between parents' and children's reports of the children's symptoms and social impairment, based on the results of the Strengths and Difficulties Questionnaire (SDQ). The interrelationship between relational aspects and socio-demographic factors with patterns of disagreement are explored. METHODS: Differences in the prevalence and means of SDQ symptom and impact scores were obtained from 8,154 primary school children, aged between 10 and 13 years, and their parents. Agreement between matched pairs was measured using Pearson's and Spearman's rho correlations. Socio-demographic variables, communication patterns and parental engagement were analysed as possible correlates of informant discrepancies using bivariate and multivariate logistic regression models. RESULTS: In general, although children reported more symptoms, they reported less impact of perceived difficulties than parents. The parents were more consistent in their evaluation of symptoms and impact than were the children. Exploration of highly discrepant subgroups showed that, when children reported the most symptoms and impact, qualitative aspects of the parent-child relationship and family structure seemed to be more powerful predictors of disagreement than were gender of the child and socio-demographic variables. When parents reported the most symptoms and impact, low parental educational level, low income and male gender of the child played an additional role. CONCLUSIONS: Our findings underline the importance of paying attention to child reports of emotional-behavioural difficulties, particularly when parents do not identify these problems. Considerations on what meaning parent-child discrepancy might have in the context of the parent-child relationship or the family's psychosocial status should be integrated in the overall understanding of the child's situation and subsequent recommendations.

Prevalence and characteristics of significant social anxiety in children aged 8-13 years: a Norwegian cross-sectional population study.

BACKGROUND: Social anxiety has been frequently studied in both population- and clinical-based adult and adolescent samples. Corresponding research in children is scarce and is dominated by clinical studies. The aim of the present population-based study was to examine the prevalence of significant social anxiety (SSA) in preadolescent children and compare their characteristics with those of children without SSA. The spectrum of social anxiety is explored by comparing children with different levels of social anxiety, as defined by 1-2 versus 3-5 social situations feared. METHOD: The sample consisted of 14,497 parents and their 3rd-7th grade children (8-13 years old) who participated in a health profile study, including questions covering DSM-IV criteria A-D for social anxiety disorder (SAD). Socio-demographic data, social and school functioning, somatic complaints, parent-child relationships, and use of health services were added to a logistic regression model to explore characteristics associated with children with, and without SSA. Associated emotional and behavioural problems were measured by the Strengths and Difficulties Questionnaire (SDQ) using parent and self-report. RESULTS: Parents described 2.3% of all children as significantly socially anxious and 0.9% feared at least three social situations. The majority of children with SSA managed their everyday life well. However, compared with children without SSA, children with SSA struggled more often in different areas of life and showed a significantly higher prevalence of associated emotional and behavioural symptoms. Our findings also support the notion of social anxiety as a spectrum concept. CONCLUSIONS: Social anxiety problems start in childhood and can be impairing, even in non-clinical populations and in reasonably young age groups. Increased awareness of different aspects of social anxiety is needed to identify children who are at risk and to devise appropriate interventions to improve the immediate and long-term outcome.

Construct validity of the five-factor Strengths and Difficulties Questionnaire (SDQ) in pre-, early, and late adolescence.

BACKGROUND: The Strengths and Difficulties Questionnaire (SDQ) is designed to measure psychological adjustment in children and adolescents. Psychometric evaluations of the instrument have shown satisfactory convergent and discriminant validity, while factor analysis studies have shown mixed results across countries. In the present study, the construct validity of the five-factor SDQ is evaluated in a large community sample of Norwegian pre-, early, and late adolescents. METHODS: The sample consisted of 26,269 children and adolescents (10-19 years) with valid answers on all 25 items of the SDQ self-report. Complete parent/proxy data of respective pre-adolescent children was available for 6,645 cases. A Lisrel approach to Confirmatory Factor Analysis (CFA) was used to evaluate the five-factor model and the presence of a positive construal factor. In the sample of pre-adolescents and their parents/proxies, convergent and discriminant validity was evaluated by a CFA approach to multitrait-multimethods (MTMM). RESULTS: Fit statistics for the hypothesized five-factor model were satisfactory, but introducing correlated error terms for some of the items led to significant model improvement in all age groups. All factor loadings were higher than .30, except for item 11 (good friend). The loadings differed across age groups and differed markedly between the parent/proxy and self-report measures. The MTMM showed that the source of ratings made a difference on the validity of all subscale ratings, with self-reports discriminating more on ratings of emotional and peer problems, and parents/proxies discriminating more on hyperactivity symptoms. A positive construal factor was identified but had a modest effect compared with the original five traits. Results suggested an unclear construct and meaning of the Prosocial behaviour subscale. CONCLUSION: The results of the present study indicated support for the proposed five-factor structure of the SDQ (Goodman, 2001) across a wide age range (10-19years), including older adolescents and different informants. However, some improvements should be considered to improve internal reliability and conceptual clarity.

Psychiatric symptoms in adolescents with epilepsy in junior high school in Norway: a population survey.

The aims of this study were to assess the frequency and impact of psychiatric symptoms among adolescents with epilepsy in a general population, and compare the findings with those for adolescents without epilepsy. The data were collected through the Health Profiles for Children and Youth in Akershus Study. The data were cross-sectional and based on self-reports from adolescents (13-16 years of age). To assess psychiatric symptoms, we used the Strengths and Difficulties Questionnaire-Self Report (SDQ-S). A total of 11,021 pupils were invited to participate, and 9424 responded to the questionnaire (response rate=86%). We found that adolescents with epilepsy (124) from an unselected group obtained a significantly higher symptom score on the SDQ-S than those without epilepsy, indicating a higher incidence of psychiatric symptoms. The adolescents with epilepsy also reported a greater impact of their perceived difficulties on their daily life than did adolescents without epilepsy. The study illustrates the need for developing better strategies to detect and prevent psychiatric problems in adolescents with epilepsy.

Self-reported strengths and difficulties in a large Norwegian population 10-19 years : age and gender specific results of the extended SDQ-questionnaire.

This study reports young people's assessment of own problems and strengths from a Norwegian survey (n=29,631, age range 10-19), based on the self-report version of the Strengths and Difficulties Questionnaire (response rate 84.3%). Differences according to the age and gender are illuminated. Girls reported most emotional problems and boys most conduct and peer problems. Compared to other countries, Norwegian adolescents reported more hyperactive behaviour. Total problem scores were highest in early-adolescence for boys (Mean=10.8, SD=6.1), and for girls it is in late adolescence (Mean 11.3, SD=5.2). One third of the subjects reported at least minor perceived difficulties. All symptom scales were strongly associated with perceived difficulties, impact and burden to others (P<0.001) with significant gender and age effects. Impact scores were included in the estimate of possible caseness. Combining symptom scores and impact scores, 3.7% of the sample was defined as a high risk group, while 8.8% needed special attention from mental health services. The results also suggested that SDQ could be a valuable screening instrument for older adolescents.