Evaluation of executive functions in children and adolescents with obesity.

The purpose of this study is to evaluation of executive functions of obese children and adolescents. Thirty children and adolescents with obesity between the ages of 11 and 18 and thirty age- and sex-matched healthy weight-peers were included. Participants with a body mass index (BMI) value of 5 to 85thpercentile and >95thpercentile were classified as normal and obese, respectively. Turkish Version of Kiddy Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-T) was applied for excluding participants with psychiatric diagnoses. All children and their parents were asked to fill out Strengths and Difficulties Questionnaire (SDQ), Wisconsin Card Sorting Test (WCST), and Stroop Color and Word Test (SCWT) to evaluate executive functions. Children with obesity tended to complete Part 4 and Part 5 of SCWT in longer time (p = 0.043 and p = 0.018, respectively). Rate of obesity was higher among nuclear family members (p = 0.001) with a higher number of relatives positive for history of a psychiatric disorder (p = 0.020). While children with obesity reported higher rates of peer problems as measured by SDQ (p = 0.030), there was no significant difference in parent forms. In conclusion, although children with obesity may have disruptions in their executive functions to some degree, this does not refer a generalized impairment.

The relationship between theory of mind and sluggish cognitive tempo in school-age children with attention deficit and hyperactivity disorder.

Sluggish cognitive tempo (SCT) is considered as a cognitive-emotional style. Theory of mind (ToM) skills form the basis of human cognition and social behavior. The aim of this study is to contribute to SCT literature by examining the relationship between SCT and cognitive and affective ToM in school-age children with attention deficit and hyperactivity disorder (ADHD). Fifty school-age children with ADHD (43 boys and seven girls) and 40 typically developing children (34 boys and six girls) were assessed using Parent-rated Barkley Child Attention Scale and Child Behavior Checklist/6-18, cognitive (first- and second-order ToM) and affective ToM (Reading Mind in the Eyes Test and Unexpected Outcomes Test (UOT)) tests. Multiple linear regression analysis was performed to determine the variables that may predict SCT levels in children with ADHD. Attention deficit and hyperactivity disorder-inattention (Exp(B) = .334, p = .027), internalization (Exp(B) = .305, p = .006), and UOT scores (Exp(B) = .933, p = .015) significantly predicted SCT severity in children with ADHD. SCT severity was significantly associated with impaired cognitive ToM skills as measured by second-order ToM (Exp(B) = 1.933, p = .045). Our findings may indicate that affective ToM developing with age, and impaired cognitive ToM skills are associated with increasing SCT severity.

Elevated Melatonin Levels in Children With Attention Deficit Hyperactivity Disorder: Relationship to Oxidative and Nitrosative Stress.

Objective: The aim of this article is to measure serum antioxidant melatonin, the oxidants of nitric oxide, and malondialdehyde levels to calculate the serum oxidant-antioxidant balance based on the nitric oxide/melatonin and malondialdehyde/melatonin ratios in children with ADHD. Method: The serum melatonin, nitric oxide, malondialdehyde, and the nitric oxide/melatonin and malondialdehyde/melatonin ratios were calculated and compared between the children with ADHD (n = 103) and healthy control participants (n = 73). Results: Serum melatonin and nitric oxide levels were higher, and the nitric oxide/melatonin and malondialdehyde/melatonin ratios were lower in ADHD children than the control group. Melatonin was found to be significantly high, and the malondialdehyde/melatonin ratio was found to be significantly low in children with a positive ADHD family history. Conclusion: The serum oxidant-antioxidant balance was impaired in children with ADHD. Within the ADHD group, higher melatonin levels were determined in the children with a positive family history.

Mothers' emotional states and attitudes regarding their children with asthma.

OBJECTIVES: The aim of this study was to investigate the associations of asthma with the psychological profile (depression and anxiety) of children with asthma and their mothers as well as the attitudes of these mothers toward their children and their family relationships. METHODS: Sixty-four children with asthma, 60 healthy children and their mothers were included in the study. The Children's Depression Inventory (CDI) and Childhood Anxiety Sensitivity Index (CASI) were applied to the children. All mothers completed the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Parental Attitude Research Instrument and the Family Assessment Device. RESULTS: CASI scores were significantly higher in children with asthma (p < 0.001) than in healthy children. The increasing duration and severity of asthma were associated with increasing anxiety levels in children with asthma. Depression and anxiety scores were significantly higher in the mothers of children with asthma than in the comparison group. The mothers of children with asthma did not have supportive and friendly relationships with their children. In addition, these mothers had significantly higher Attitude of Hostility and Rejection, Attitude of Over-parenting and Authoritarian Attitude scores than those of the comparison group. Increasing duration and severity of asthma influenced family functions and the attitude of the mothers of children with asthma. There was a correlation between an increasing number of emergency department visits and increasing depression in the mothers of children with asthma. CONCLUSIONS: This cross-sectional study revealed that the disease may negatively affect the lives of children with asthma and their mothers and their family relationships.

Emotional and Behavioral Characteristics of Gifted Children and Their Families.

INTRODUCTION: To compare the quality of life, areas of social, emotional, behavioural and mental problems and family functionality of gifted children and children of normal intelligence. METHODS: The study included 49 gifted children aged 9-18 years and 56 age and gender-matched healthy children of normal intelligence. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), and the Children's Depression Rating Scale were applied to all the cases. The Quality of Life Scale for Children, the Depression Scale for Children, the Trait-State Anxiety Inventory, and the Strengths and Difficulties Questionnaire- Adolescent Form were completed by all the participants. All the parents completed the Family Evaluation Scale, the Strengths and Difficulties Questionnaire- Parents Form and the Parents Form of the Quality of Life Scale for Children. RESULTS: Compared to children of normal intelligence, gifted children described themselves as more inattentive and lively, social functionality was reported to be low and they had a worse perception of their physical health status. Gifted boys were determined to have more depressive symptoms than gifted girls. The parents of boys of normal intelligence reported lower academic performance than the parents of giftedboys. This difference was not determined for girls between the cases and comparative groups. CONCLUSION: All the findings obtained in this study suggest that gifted children are at risk in respect of mental health. Therefore, to be able to become healthy adults in a biopsychosocial aspect, it is important for the future of gifted children that this status can be identified at an early age, that they can receive appropriate education, that support and counselling are provided for emotional needs and that parents and teachers are fully informed.

Evaluation of the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volume as inflammatory markers in children with attention-deficit hyperactivity disorder.

AIM: The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), and mean platelet volume (MPV) have recently been used as indicators of a systemic inflammatory response. The aim of this study was to investigate the relations of the NLR, PLR, MLR, and MPV with attention-deficit hyperactivity disorder (ADHD). METHODS: The study group consisting of 82 children diagnosed with ADHD was compared with a healthy control (HC) group of 70 age-, sex-, and body-mass-index-matched subjects. The NLR, PLR, MLR, and MPV were measured according to the complete blood count. RESULTS: The NLR, PLR, MLR, MPV, and neutrophil count of the ADHD group were significantly higher than those of the HC group. The lymphocyte counts of the patients were significantly lower than those of the HC group. CONCLUSION: Inflammation might play a role in the etiopathogenesis of ADHD. The NLR, PLR, MLR, and MPV may be potential inflammation markers for ADHD in children.

Association between altered lipid profiles and attention deficit hyperactivity disorder in boys.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, which is multifactorial, complex, and seen most commonly in childhood. AIMS: The aim of this study was to examine the hypothesis that altered serum lipid profiles are associated with ADHD. METHODS: The study inluded 32 boys diagnosed with ADHD according to DSM-IV-R criteria and a control group of 29 healthy subjects. All patients were assessed with The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version, the Turgay DSM-IV-based Disruptive Behavior Disorders Child and Adolescent Rating and Screening Scale, the Conners Parent Rating Scale-Revised Long Form, and the Conners Teacher Rating Scale. Measurements were taken of fasting plasma total cholesterol (T-Chol), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and 1-day food intake levels, and the groups were compared. RESULTS: The mean TC, LDL, and HDL levels were significantly lower in the ADHD group than the control group (p = .005, p < .001, p = .002, respectively). There was no significant difference between the groups' TG levels (p = .295). No significant differences were determined between the combined-type ADHD patients and the predominantly inattentive subtype of ADHD in respect to the lipid profile. CONCLUSION: The results of this study add to the growing body of evidence indicating an association between serum cholesterol and ADHD in boys. Further genetic and molecular studies are required to elucidate the biochemical mechanisms underlying this relationship.

Vitamin D Deficiency and a Blunted Parathyroid Hormone Response in Children with Attention-Deficit/Hyperactivity Disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is the most frequently diagnosed neuropsychiatric disorder of childhood. The etiopathogenesis of ADHD has not been fully defined. Recent evidence has suggested a pathophysiological role of vitamin D deficiency in ADHD. In this study, we evaluated the serum levels of 25-hydroxy vitamin D (25(OH)D), parathyroid hormone (PTH), calcium (Ca), phosphate (P), and alkaline phosphatase (ALP) in children with ADHD. METHODS: The study group consisted of 105 children diagnosed with ADHD according to DSM-IV-TR criteria. A control group, matched for age and gender, was composed of 95 healthy children. Venous blood samples were collected, and 25(OH)D, PTH, Ca, P, and ALP levels were measured. RESULTS: The mean serum 25(OH)D, Ca, and P levels of the children with ADHD were significantly lower than those of the healthy controls. There were no significant differences between the groups regarding PTH and ALP. Serum PTH levels were found to be normal, but vitamin D deficiency, hypocalcemia, and hypophosphatemia were observed in children with ADHD. There was no correlation between serum PTH and Ca levels in children with ADHD, whereas, there was a negative correlation between serum PTH and Ca levels in healthy controls. There was no correlation between serum 25(OH)D and PTH levels in children with ADHD, whereas, there was a negative correlation between serum 25(OH)D and PTH levels in healthy controls. There were no significant differences in all parameters' levels among the subtypes of ADHD. CONCLUSIONS: The findings suggest that ADHD is associated with vitamin D deficiency, blunted PTH response, and impaired Ca homeostasis in children.

Dynamic thiol/disulfide homeostasis in children with attention deficit hyperactivity disorder and its relation with disease subtypes.

BACKGROUND: The aim of this study was to evaluate a novel oxidative stress marker (thiol/disulfide homeostasis) in attention deficit hyperactivity disorder (ADHD) children for the first time in literature. METHODS: Ninety children with ADHD diagnosed according to DSM-V and as control group, 65 healthy children were included to the study. Native thiol, total thiol, disulfide, disulfide/native thiol, disulfide/total thiol were compared between the groups. RESULTS: Total and native thiol levels were significantly higher whereas the disulfide/native thiol ratios were significantly lower in children with ADHD. ADHD combined type appeared to have higher disulfide, disulfide/native thiol and disulfide/total thiol ratios compared to other subtypes. Disulfide levels of the males with ADHD were significantly higher than those of the females with ADHD. CONCLUSION: This study suggests that thiol/disulfide homeostasis is abnormal in children with ADHD. It may be used as a novel OS marker in ADHD children because it is easy, practical, fully automated and relatively inexpensive.

Evaluation of Oxidant-Antioxidant Balance in Children with Atopic Dermatitis: A Case-Control Study.

BACKGROUND: Increased reactive oxygen species (ROS) and oxidative stress (OS) has been reported in many allergic and inflammatory skin diseases, including urticaria, psoriasis, and atopic dermatitis (AD). Melatonin is a hormone secreted from the pineal gland and is a potent antioxidant. OBJECTIVE: The aim of the study was to measure serum antioxidant melatonin, oxidants of nitric oxide (NO), and malondialdehyde levels to calculate the serum oxidant-antioxidant balance based on the NO/melatonin and malondialdehyde/melatonin ratios and to determine the correlation with the disease severity in children with AD. METHODS: Seventy-three children with AD and 67 healthy controls were included in the study. The clinical diagnosis of AD was based on the diagnostic criteria of Hanifin-Rajka. The severity of AD was evaluated by the scoring AD (SCORAD) index, and atopy was determined by skin prick tests (SPTs) with commercial extracts. The OS-related parameters of serum melatonin, NO, malondialdehyde, and the NO/melatonin and malondialdehyde/melatonin ratios were calculated and compared with the results of healthy controls. RESULTS: Serum melatonin levels were higher (p < 0.0001) and serum NO levels and the NO/melatonin and malondialdehyde/melatonin ratios were lower in children with AD than in healthy controls (p = 0.045, p < 0.0001, p < 0.0001, respectively). There was no difference between children with AD and healthy controls in terms of serum malondialdehyde levels (p = 0.119). Serum melatonin levels were significantly lower in severe AD than in mild AD (p = 0.012). However, in terms of serum melatonin levels, there was no difference between mild and moderate AD (p = 0.742) and moderate to severe AD (p = 0.301). There was no significant difference in serum NO and malondialdehyde levels and NO/melatonin and malondialdehyde/melatonin ratios among children with mild, moderate, and severe AD (p > 0.05). A negative correlation was found between serum melatonin levels and the SCORAD index (r = -0.252, p = 0.031), and a positive correlation was found between NO/melatonin and malondialdehyde/melatonin ratios (r = 0.511, p < 0.0001). There was no statistically significant relationship between age (≤24 or >24 months), disease duration (≤6 or >6 months), and sex for the OS-related parameters (p > 0.05). CONCLUSION: The serum oxidant-antioxidant balance was impaired in children with AD. Serum melatonin levels were higher in children with AD; however, this was negatively correlated with disease severity. Serum NO levels and NO/melatonin and malondialdehyde/melatonin ratios were lower in children with AD than in healthy controls. Melatonin might be used as a promising antioxidant to evaluate disease severity in children with AD. Thus, further studies are needed to clarify the role of melatonin in AD pathogenesis.

High-dose anti-histamine use and risk factors in children with urticaria.

AIM: The drugs of choice in the treatment of urticaria in children are H1-antihistamines. The aim of the study was to evaluate children with urticaria and define risk factors for requirement of high-dose H1-antihistamines in children with urticaria. MATERIAL AND METHODS: The medical data of children who were diagnosed as having urticaria admitted to our outpatient clinic between January 2014 and January 2016 were searched. The medical histories, concomitant atopic diseases, parental atopy histories, medications, treatment responses, blood eosinophil and basophil counts, and serum total IgE levels were recorded. In addition, the urticaria activity score for seven days, autoimmune antibody tests, and skin prick test results were evaluated in children with chronic urticaria. RESULTS: The numbers of the children with acute and chronic urticaria were 138 and 92, respectively. The age of the children with chronic urticaria was higher than that of those with acute urticaria (p<0.0001). There was no difference between the two groups in terms of blood eosinophil and basophil counts, and serum total IgE levels (p>0.05). There was a negative correlation between blood eosinophil count and the UAS7 score in children with chronic urticaria (r=-0.276, p=0.011). Chronic urticaria and requirement of high dose H1-antihistamines were significant in children aged ≥10 years (p<0.001, p=0.015). High UAS7 score (OR: 1.09; CI 95%: [1.03-1.15]) and basopenia (OR: 6.77; CI 95%: [2.01-22.75]) were associated with the requirement of high-dose H1-AH in children with chronic urticaria. CONCLUSION: The requirement of high-dose H1-antihistamines was higher with children's increasing age. Disease severity and basopenia were risk factors for the requirement of high-dose H1-antihistamines.

[Validity and Reliability Analysis of Turkish Version of Childhood Autism Rating Scale]. / Çocukluk Otizmi Derecelendirme Ölçegi Türkçe Formunun Geçerlik ve Güvenilirlik Çalismasi.

OBJECTIVE: The purpose of this study is to expand validity and reliability analysis of Turkish Version of Childhood Autism Rating Scale (CARS), whose internal consistency,content validity and discriminant validity for a limited size of sample group were examined by Sucuoglu et al. METHOD: 96 children and adolescents aged between 4-18, (48 diagnosed with pervasive developmental disorder (PDD) and 48 diagnosed with mental disability (MD) and developmental delay based on DSM-IV-TR criteria,) were included in the study. Regarding reliability analysis of Turkish Version of the scale; Cronbach's alpha values as internal consistency indicator, inter-rater reliability, and test-retest reliability were calculated. Principal components analysis and Varimax rotation were used in order to determine factors. The scale was compared with Autism Behavior Checklist and Clinical Global Impression-Severity of Illness. The most appropriate cut-off point was determined for CARS by conducting ROC analysis. RESULTS: As a result of principal components analysis and Varimax rotation, one component factor was obtained. Correlations between CARS and the other scales were statistically significant. The Cronbach's alpha value of total score of the scale was determined as 0,95. Test-retest reliability (r=0,98, p<0,01), and inter-rater reliability (r=0,98, p<0,01) were determined for total score of the scale. The cut-off point of the scale was 29,5. CONCLUSION: All of these results support that the scale adapted into Turkish is a valid and reliable assessment instrument.

[The validity and reliability of the Social Communication Questionnaire- Turkish form in autistics aged 4-18 years]. / 4-18 Yas Araligindaki Otistik Bireylerde Sosyal Iletisim Ölçegi Türkçe Formunun Geçerlik ve Güvenilirlik Çalismasi.

OBJECTIVE: The Social Communication Questionnaire (SCQ) is a valid and reliable 40- item scale used to assess of pervasive developmental disorders (PDDs). The aim of this study was to determine the validity and reliability of the SCQ-Turkish Form (SCQ-TF). MATERIALS AND METHODS: The study included 100 children and adolescents aged 4-18 years 50 were diagnosed as PDD and 50 were diagnosed with intellectual disability (ID) based on DSM-IV-TR criteria. The consistency, test-retest reliability, content validity, and discriminant validity of SCQ-TF for the groups in the study sample were evaluated. SCQ-TF was compared to the Childhood Autism Rating Scale (CARS), Autism Behavioural Checklist (ABC), and Clinical Global Impression Severity of Illness (CGI-SI). The most appropriate SCQ-TF cut-off point was determined via ROC analysis. RESULTS: The 4-factor structure of SCQ-TF accounted for 43% of the observed total variance. Correlations between the Social Communication Questionnaire -Turkish Form and the other measures were significant. The Cronbach's alpha value for the SCQ-TF total score was 0.80. Intraclass correlation coefficient (ICC) varied between 0.87 and 0.96, and the cut-off point was 15. CONCLUSION: The findings show that SCQ-TF is valid and reliable for use in Turkey in those aged 4-18 years.