Executive Functions, Psychiatric Symptoms and ADHD in Child Psychiatric Patients-Concurrent and Longitudinal Associations from Preschool to School Age.

We investigated in a child psychiatric sample whether preschool age executive functions (EFs) associate with concurrent and school age psychiatric symptoms and ADHD diagnosis. At baseline the children (n = 172) were 4-7 years old, at follow-up (n = 65) 8-13 years. EFs were measured at baseline with Attention and Executive Function Rating Inventory-Preschool Version, psychiatric symptoms were measured at both timepoints by Child Behavior Checklist. Information on diagnoses was collected from medical records. Deficits in EFs were associated with more concurrent externalizing and attention symptoms, but less internalizing symptoms. Preschool EFs predicted only school age attention symptoms. Preschool EFs were associated with both concurrent and school age ADHD diagnosis. Our results emphasize the importance of recognizing EF deficits early to arrange appropriate support to reduce later problems. More research is needed to understand the role of EFs over time in the manifestation of psychiatric symptoms in child psychiatric patients.

Sleep and psychiatric symptoms in young child psychiatric outpatients - a Follow-up study.

BACKGROUND: Knowledge of the continuity of sleep problems and the associations between sleep and psychiatric symptoms in child psychiatric patients is scarce. OBJECTIVES: To investigate the persistency of sleep problems and how sleep at preschool age predicts sleep problems and psychiatric symptoms at school age in child psychiatric patients. METHODS: Participants (n = 68) were child psychiatry outpatients at Helsinki University Hospital in 2015-2017. Caregivers evaluated sleep with the Sleep Disturbance Scale for Children (SDSC) and psychiatric symptoms with the Child Behavior Checklist (CBCL) at baseline (age 4-7 years) and again at follow-up (age 8-13 years). Family background information was collected at both time points. RESULTS: Sleep problems at preschool age predicted sleep problems at school age (R2Adjusted = .48, p < .001). Persistent sleep problems associated strongly with the intensity of psychiatric symptoms (p = .001). Internalizing symptoms were predicted by sleep problems (p = .038) even after controlling for age, sex, and psychiatric symptoms at preschool age. CONCLUSION: Sleep problems are prevalent and persistent and relate to psychiatric symptoms in children treated at child psychiatry clinics. These results emphasize the need for identification and treatment of sleep problems in these children.

Longitudinal associations between inhibitory control and externalizing and internalizing symptoms in school-aged children.

Inhibitory control (IC) deficits have been associated with psychiatric symptoms in all ages. However, longitudinal studies testing the direction of the associations in childhood are scarce. We used a sample of 2,874 children (7 to 9 years old) to test the following three hypotheses: (a) IC deficits are an underlying risk factor with a potentially causal role for psychopathology, (b) IC deficits are a complication of psychopathology, and (c) IC deficits and psychopathology are associated at the trait level but not necessarily causally related. We used the go/no-go task to assess IC, the parent-rated Strengths and Difficulties Questionnaire to evaluate externalizing/internalizing symptoms, and the random intercepts cross-lagged panel model to test the hypotheses. The results showed no support for the underlying risk factor hypothesis, suggesting that IC unlikely has a causal role in this age group's psychopathology. The complication hypothesis received support for externalizing symptoms, suggesting that externalizing symptoms may hamper the normal development of IC. IC deficits and both externalizing and internalizing symptoms were correlated at the trait level, indicating a possible common origin. We suggest that it may be useful to support children with externalizing symptoms to promote and protect their IC development.

Low mood in a sample of 5-12 year-old child psychiatric patients: a cross-sectional study.

BACKGROUND: Not much is known about low mood and its associates in child psychiatric patients. In this study, we examined the prevalence of low mood, how it associates with disruptive behaviour, and affects clinician-rated global functioning in child psychiatric outpatients. METHODS: The study population consisted of 862 5-12 year-old child psychiatric patients. The study sample was a subsample of all 1251 patients attending a child psychiatric outpatient clinic at Helsinki University Hospital in 2013-2015 formed by excluding 4 year-old and 13 year-old patients and those with missing or incomplete data. The parent-rated Strengths and Difficulties Questionnaire, collected as part of the routine clinical baseline measure, was used as a measure of psychiatric symptoms. The diagnoses were set according to ICD-10 by the clinician in charge after an initial evaluation period. The Children's Global Assessment Scale (CGAS) score set by clinicians provided the measure of the patients' global functioning. All information for the study was collected from hospital registers. Associations between emotional symptoms and conduct problems/hyperactivity scores were examined using ordinal regression in univariate and multivariate models, controlling for age and sex. The independent samples T test was used to compare the CGAS values of patient groups with low/normal mood. RESULTS: In our sample, 512 children (59.4%) showed low mood. In multivariate ordinal regression analysis, low mood associated with conduct problems (OR 1.93, 95% CI 1.39-2.67), but no association was found between low mood and hyperactivity. Low mood was prevalent among children with oppositional defiant disorder or conduct disorder (51.8%). The global functioning score CGAS was lower among children with parent-reported low mood (52.21) than among children with normal mood (54.62, p < 0.001). The same was true in the subgroup of patients with no depression diagnosis (54.85 vs. 52.82, p = 0.001). CONCLUSIONS: Low mood is prevalent in child psychiatric outpatients regardless of depression diagnosis and it has a negative effect on global functioning. Low mood and behavioural problems are often associated. It is important to pay attention to low mood in all child psychiatric patients. We recommend prevention measures and low-threshold services for children with low mood.