Selective mutism in children and adolescents. / Selektiv mutisme hos barn og unge.

The diagnosis selective mutism describes children who are completely mute in situations where speech is expected (usually in day-care or school), whereas at home they do speak with close family members. Early intervention is essential, but often a long time may pass before these children are offered adequate help.

Children with neurodegenerative disease and obsessive-compulsive behaviour. / Barn med nevrodegenerativ sykdom og tvangshandlinger.

BACKGROUND: Children with neurodegenerative diseases progressively lose skills and develop somatic and psychiatric symptoms. Obsessive-compulsive disorder (OCD) may occur, a disorder for which effective medical and psychological treatments are available. However, whether these treatments are useful for children with neurodegenerative disease is unknown. CASE PRESENTATION: A child with an uncommon form of neurodegenerative disease (with loss of sight and incipient cognitive decline) had during the previous year developed time-consuming compulsive behaviours. The child spent much of the day at home (> 8 hours), turning on/off switches, opening/closing doors, repeating after others and so on. A diagnostic assessment concluded that the child fulfilled the criteria for OCD, with predominantly compulsive acts. The child began combined treatment with sertraline and exposure and response prevention therapy (ERP). It was necessary to adapt the ERP to the neurodegenerative disease, with strong parental involvement. After six months the compulsive acts were gone. INTERPRETATION: Children with neurodegenerative disease may have a high risk of psychiatric disorders, but the literature is sparse on phenomenology and treatments. The present case study documents that OCD can occur in a child with neurodegenerative disease and that the combined medical and psychological treatments were effective.

[Congenital hypothyroidism and the impact of thyroxine treatment]. / Medfødt hypotyreose og tyroksinbehandling.

BACKGROUND: We have studied the significance of the thyroxine treatment for neuropsychological functioning in young adults with congenital hypothyroidism. SUBJECTS AND METHODS: This is a neuropsychological follow-up study of a three-year cohort of early treated congenital hypothyroidism in Norway (N = 49) at age 20. Siblings comprise the control group (N = 41, 21 years). RESULTS: The patient group performed weaker than the control group on cognitive and motor measures. They reported somewhat more psychosocial problems; fewer completed high school. A more severe hypothyroidism at the time of diagnosis was associated with a larger motor deficit at age 20. Better cognitive function in young adulthood was associated with a higher thyroxine starting dose and serum thyroxine level in the first years of life. Blood samples in young adulthood showed elevated thyrotropin levels in 45% of the patients. INTERPRETATION: This study supports the new guidelines for treatment of congenital hypothyroidism with a higher starting dose of 10-15 microg thyroxine/kg/24 hours. The young adults are in need of better medical follow up.