Social media addiction, escapism and coping strategies are associated with the problematic internet use of adolescents in Türkiye: a multi-center study.

Introduction: The literature highlighted that problematic internet use can have detrimental consequences on individuals' well-being. Social media addiction, escapism and coping skills are closely related to problematic internet use. However, no study has currently examined the relationship between problematic internet use and social media use, escapism and coping skills. Method: This multicenter cross-sectional designed study evaluated the relationships between problematic internet use and social media addiction, escapism, and coping skills in 508 adolescents (319 female) aged 14-18 years. In order to collect data, sociodemographic data form, Internet Addiction Scale, Social Media Addiction Scale, Escapism Scale and Kidcope Adolescent Version have been used. First, adolescents who scored ≥50 on the Internet Addiction Test were classified as the problematic internet use group; adolescents who scored <50 were classified as the control group. Then, the relationships between problematic internet use and social media addiction, escapism and coping skills were evaluated. Results: The results showed that problematic internet use was associated with duration of social media use, impairment in social media-related functionality, preferring virtual life, and virtual pleasure, escapism, avoidant and negative coping strategies. Conclusion: These findings may provide an empirical basis for problematic internet use prevention and intervention in adolescence.

Objective Parameters in Attention Deficit Hyperactivity Disorder: Eye and Head Movements.

OBJECTIVE: We aimed to evaluate eye and head movements, which are objective parameters in ADHD. Method: While the children were watching the course video task, which included the relevant (teacher and smart board) and irrelevant (any regions outside the relevant area) areas of interest, their eye movements were evaluated through eye tracking, and video recordings were made simultaneous. Head position estimation was made using through video recordings. The proportion of total fixation duration on areas of interest (PFDAOI) and saccade count, amplitude, velocity for eye movements, number of total head movements and angular change of head movement in x-y-z axes for head movements were compared. RESULTS: Children with ADHD had lower PFDAOI on the relevant area, and had more saccade and head movements The angular change of head movement in the x-axis was higher in the ADHD group. CONCLUSION: In the assessment of ADHD, the eye and head movements may be particulary useful.

Evaluation of Retinal Nerve Fiber Layer, Ganglion Cell Thickness, and Macular Thickness in Children With Comorbid Specific Learning Disorder and Attention-Deficit Hyperactivity Disorder.

PURPOSE: To investigate the changes in ocular optical coherence tomography (OCT) findings in the comorbidity of attention-deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD). METHODS: This study included 40 individuals diagnosed as having ADHD along with comorbid SLD, 40 individuals diagnosed as having only ADHD, and 40 individuals with no psychiatric disorders. OCT assessments were performed on eyes of the participants to obtain retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, and macular thickness measurements. RESULTS: In total, 240 eyes were evaluated. The right and left eyes were not significantly different in terms of RNFL, GCL, and macular thickness within groups (P > .05). RNFL thickness was measured and compared across four quadrants (superior, inferior, temporal, and nasal). Although these values were not significantly different between the groups (P > .05), RNFL was observed to be thinner in children with comorbid ADHD and SLD in all quadrants. Similarly, GCL and macular thickness measurements were also not different between the groups (P > .05). CONCLUSIONS: Considering that retinal nerve fibers can be seen as an extension of the brain in the embryologic context, the results showed that OCT findings alone are not sufficient to detect the changes in ADHD and SLD comorbidity. The authors suggest that OCT is more useful in the etiology and follow-up of neurodegenerative diseases rather than neurodevelopmental disorders. [J Pediatr Ophthalmol Strabismus. 2024;61(2):128-136.].

Psychometric Properties of the Turkish Version of the Children's Saving Inventory in a Clinical Sample.

OBJECTIVE: The Children's Saving Inventory (CSI) is a measurement tool developed to assess hoarding behavior in children. This study aims to investigate the psychometric properties of the Turkish version of the CSI in a clinical sample of children and adolescents. MATERIALS AND METHODS: The study sample consisted of 52 children and adolescents diagnosed with obsessive-compulsive disorder in the 8-17 age group and their families. As a structured diagnostic interview, the Development and Well-Being Assessment (DAWBA) was applied to all participants included in the research. Hoarding disorder (HD) diagnosis was made clinically by considering the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria. The Children's Yale-Brown Obsessive- Compulsive Scale Symptom Checklist (CY-BOCS) was administered by an experienced clinician. The parents and children filled out the Obsessive-Compulsive Inventory-Child Version (OCI-CV) and CSI scales independently. RESULTS: The 20-item CSI Turkish version demonstrated good internal consistency. This 4-factor structure of the scale was confirmed by confirmatory factor analysis. Children's Saving Inventory showed convergent and discriminant validity with the OCI-CV and CY-BOCS subscales, and the higher CSI total scores in children and adolescents diagnosed with HD confirmed the construct validity. CONCLUSION: These findings support the use of the CSI Turkish version as a valid and reliable scale to investigate the hoarding behavior of children and adolescents in a clinical sample. In addition, the CSI Turkish version is currently the only validated instrument to evaluate hoarding behavior in children and adolescents, as rated by parents in Türkiye.

Psychometric properties of Turkish Orthorexia Nervosa Inventory in a clinical adolescent sample.

PURPOSE: Orthorexic tendencies are increasingly prevalent among children and adolescents. This study set out to investigate the reliability and validity of the Turkish version of the Orthorexia Nervosa Inventory (ONI) in a clinical adolescent sample. METHODS: 266 adolescents aged 12-18 years, who applied to the Department of Child and Adolescents Psychiatry were included in the study. Participants completed sociodemographic data form, ONI, Eating Attitude Test, Revised Child Anxiety and Depression Scale-Child Version and ORTO-15. RESULTS: The Cronbach's alpha coefficient for the ONI reached 0.92, indicating very good internal consistency. Total factor scores and Cronbach alpha values for behaviors, impairments, and emotions were found to be 0.84, 0.84, and 0.83, respectively. The CFA performed supported the three-factor structure of the ONI obtained in the first sample. The minimum discrepancy per degree of freedom = 1.89 and the model generally fit well to the structure (RMSEA = 0.058, SRMR = 0.033, CFI = 0.92, TLI = 0.91). DISCUSSION: This study has shown that the Turkish version of the ONI is a valid and reliable scale for specifying the tendency for Orthorexia Nervosa in a Turkish adolescent population. These findings contribute in several ways to our understanding of orthorexic tendencies and provide a basis for more concrete research data that can be obtained by using the ONI, which is a reliable scale in studies to be conducted among adolescents. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Toward the detection of reduced emotion expression intensity: an autism sibling study.

INTRODUCTION: Expressing emotions through spontaneous facial expression is an important nonverbal social communication skill. In our study, we aimed to demonstrate that both children with autism spectrum disorder (ASD) and the non-ASD siblings of children with ASD have deficits in this skill. METHOD: In this study, we analyzed the six core facial emotion expressions of three distinct groups of children - those diagnosed with ASD (n = 60), non-ASD siblings (n = 60), and typically developed children (n = 60). To analyze facial expressions, we employed a computer vision program that uses machine learning algorithms to detect facial features and conducted an evidence-based task that involved assessing participants' ability to recognize facial emotion expressions. RESULTS: Deficits in spontaneous emotion expression were shown in the children with ASD and in non-ASD siblings when compared with typically developed children. Interestingly, it was determined that these deficits were not related to the severity of the autism symptoms in the ASD group. CONCLUSIONS: The results of the study suggest that computer-based automated analysis of facial expressions with contextual social scenes task holds potential for measuring limitations in the ability to express emotions, and they supplement the traditional clinical assessment of social phenotypical behavior deficits. This applies both to children with ASD and especially, to the non-ASD siblings of children with ASD. This study adds a novel approach to previous literature examining the emotion expression skills.

Changing Trends of Diagnoses in a Child and Adolescent Psychiatry Outpatient Clinic Before and During COVID-19: An Analysis of Registered Data.

BACKGROUND: Investigating the outpatient clinic admissions of children and adolescents significantly affected by the pandemic is crucial in developing policy and intervention methods in the future. The aim of this study is to analyze the admissions of child and adolescent psychiatry outpatient clinics, during the first year since the imposed rearrangements of the COVID-19 pandemic, compared to the one year before. SUBJECTS AND METHODS: This study was conducted between March 2019 and March 2021 and the total number of 5833 patients referred to the hospital was 3168 in the pre-pandemic period (Pre-P) and 2665 in the pandemic (In-P) period. After excluding 78 not fulfilling inclusion criteria, these screened cases were randomized for 700 patients for Pre-P and 700 for In-P within each group. RESULTS: Externalization Disorders and Neurodevelopmental Disorders were the most represented diagnoses categories between the two time periods and showed a statistically significant decrease in admission during the pandemic (p=0.002, p=0.024, respectively). Internalization disorders and the undiagnosed group showed a statistically significant increase during the pandemic (p=0.024, p<0.001, respectively). Significant differences were also shown in the treatment plan (need for pharmacological and psychotherapy) has increased. CONCLUSIONS: This study stands out by providing data on the trend of diagnosis in a child and adolescent psychiatry outpatient clinic before and during the pandemic period. To dominate these trends would be important to provide a basis for policymakers to plan appropriate management methods and levels of support for children and adolescents with different mental disorders.

Determinants of Leaky Gut and Gut Microbiota Differences in Children With Autism Spectrum Disorder and Their Siblings.

Leaky gut hypothesis is one of the well-known theory which tries to explain etiology of Autism Spectrum Disorder (ASD). Unfortunately there is still a gap of evidence to investigate the corner points of the hypothesis. The aim of this study was to investigate the determinants of leaky gut in children with ASD, their siblings and healthy controls. Intestinal microbiota was found to be similar between ASD and sibling groups. Biological markers of bacterial translocation showed a significant difference in the sibling group, whereas the marker indicating local inflammation was not different between the groups. The findings from this study did not support the role of Gut microbiota or leaky gut on the etiology of autism.

Voluntary imitation of dynamic facial expressions in attention deficit hyperactivity disorder: a facial-behavior analysis.

OBJECTIVE: The difficulties involved in social interaction among children with attention deficit hyperactivity disorder (ADHD) have been shown in many studies. Based on the knowledge that the imitation of facial expressions is a key factor in social interaction and functionality, the focus of prior studies has been on the evaluation of facial expressions in individuals with ADHD. However, little is known about voluntary facial mimicry in individuals with ADHD. In this context, we aimed to evaluate the voluntary-facial-imitation intensity of dynamic facial expressions in children with ADHD. METHOD: Forty-one children with ADHD and 53 typically developing children were included in the study. Participants were presented with a video of six basic emotions and neutral facial expressions selected from the EU-Emotion Stimulus Set via a screen. After each emotion, the instruction "now imitate it" was given. While the children watched the video, their faces were recorded with a webcam. The intensity of the children's voluntary facial imitations was examined with a computer vision program (Openface) that performs facial analysis on recorded videos. RESULTS: There was no significant difference between the groups in terms of facial emotion recognition accuracy. In group comparisons of voluntary facial mimicry, children with ADHD showed a significantly higher imitation intensity after emotional expressions of sadness, surprise and fear. There was no difference between the groups after the emotions of happiness, anger and disgust. CONCLUSION: This non-obtrusive, noninvasive, and cost-effective method allowed us to measure the quantitative differences in facial mimicry between children with ADHD and typically developing children. Our results contribute new information to the literature by indicating which emotions can be used in the evaluation of social communication skills, as well as intervention targets for these skills, in children with ADHD.

Assessing sustained attention of children with ADHD in a class flow video task.

OBJECTIVE: The aim of the study was to evaluate sustained attention performance of children with ADHD and effect of distractors on sustained attention through an eye-tracking during a class-flow video task. METHOD: Data were collected using an eye-tracking during a class-flow task conducted with 60 children (ADHD and control groups). Two areas of interest were determined in the task, these are relevant (teacher and whiteboard) and irrelevant (any regions outside the relevant area) areas. The task also included distractors in relevant and irrelevant areas, comprising a brief conversation and dropping of a pencil, respectively. Proportion of total fixation duration on areas of interest (PFDAOI) was used to assess sustained attention. RESULTS: Children with ADHD had lower PFDAOI in the relevant area during the whole class than children in the control group. After the relevant area distractor, PFDAOI increased in relevant area in ADHD group, indicating these children may have better attention after the distractor. However, children with ADHD also showed increased PFDAOI in the irrelevant area following the irrelevant area distractor, indicating that it negatively affected them. There was no significant change in the control group following the distractors. CONCLUSION: These findings indicate that children with ADHD have poor sustained attention performance during the whole class. Moreover, distractors in distinct areas could affect children with ADHD differently. Thus, students with ADHD could benefit from increased stimuli in the relevant area and this can be a guide for classroom arrangements to improve the academic functionality of these children.

A clinical follow-up study of dialectical behavior therapy skills groups among female adolescents diagnosed with depressive disorder.

Our aim was to evaluate longitudinal data for adolescents who were treated with Dialectical Behavior therapy (DBT) skills groups having been previously diagnosed with depressive disorder. Intervention with an observational cross-sectional design was implemented to evaluate the treatment outcome of a 10-week DBT skills groups with female adolescents with depression. After the patients were identified for enrollment, parents and adolescents were evaluated with psychometric measurements pre-, post-intervention, and at one-year follow-up. Repeated measures analysis was undertaken with the Child Depression Inventory (CDI), Pediatric Quality of Life Inventory (PedsQL) and Strengths and Difficulties Questionnaire (SDQ) for participants. Statistical significance was detected for self-report CDI scores and both self-report and parent SDQ and PedsQL scores. This study is the first DBT intervention in Turkish children, shows that a group DBT skills groups training can be adapted and put into practice successfully with depressed Turkish adolescents.

Prevalence and correlates of hoarding behavior and hoarding disorder in children and adolescents.

Although hoarding symptoms are reported to begin in childhood and adolescence, the true prevalence of the disorder in this age group is unknown. This study aims to estimate the prevalence of hoarding disorder (HD) in children and adolescents. The present study was planned as a two-stage epidemiological research. In the first stage, the Children's Saving Inventory (CSI) and informed consent forms were delivered to a group of students' parents. In the second stage, one-on-one psychiatric interviews with a physician were planned with the families and children who had hoarding behavior (HB), as described by their parents. The DSM-5-based HD interview and the Development and Well-Being Assessment (DAWBA) diagnostic tool were used to detect prevalence of HD and comorbid psychiatric disorders. A total of 3249 children were included in the study, and 318 children and their parents were evaluated in the second stage. As a result of the second assessment, 32 out of 318 children met the HD diagnostic criteria. The estimated prevalence of HD was 0.98% (95% CI 0.7-1.4). Hoarding disorder was found more frequently in females (F/M = 3/1). After a logistic regression analysis, variables such as female sex and the presence of any psychopathology were identified as independent correlates of HD. More than half (56.2%) of the children diagnosed as having HD also had a comorbid psychiatric disorder. In the present study, the two-stage evaluation method was used in a large pediatric sample to determine the estimated prevalence of HD, as well as the factors associated with the disorder and comorbid psychiatric disorders.

A Closer Look at Familial Dysautonomia from a Social Communication Perspective: A Case Report and Review of Literature.

Familial dysautonomia (Riley-Day syndrome) is a rare but fatal autosomal recessive peripheral neuropathy caused by a point mutation in I-κ-B kinase complex-associated protein gene. The disease, which affects primarily people of Ashkenazi Jewish origin, prejudices the development of primary sensory neurons determining the depletion of autonomic and sensory neurons. In this study, we report a 5-year-old girl with familial dysautonomia, and how her different psychiatric aspects may lead to genetic vulnerability. Obviously, the gene, the reason for this syndrome, and overreactions to different kinds of emotions, maybe a risk factor for having any mood disorders. From another perspective, this "genetic vulnerability" may be protective or related to the syndromes that affect social communication like autism.

Online challenges that emerge as a public health issue for adolescents: Assessment of psychiatric comorbidity and the importance of parenting

ABSTRACT Background: Online Challenge is neither an application nor an internet-based game; instead, users receive a link to it via chat groups on social media. Our aim is to identify the potential differences between the normal population and youth drawn to online challenges. These potential differences are the examining the parenting skills of parents of children who participate in the challenges and determining underlying psychopathologies through structured clinical interviews. Method: A questionnaire-based cross-sectional study was used to obtain further in-depth information on the comorbid psychopathology of children who play the BWC and on the parenting skills. The Development and Well Being Assessment and Alabama Parenting Questionnaire was applied to the children and their families in both the control and case groups. Results: Two groups of children and parents were recruited: a clinical sample (case) group (n = 34) and a community sample (control) group (n = 141). Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), specific phobia and CD (conduct disorder) were significantly more frequent in the clinical sample than in the community sample. The median scores for the Alabama Parenting Questionnaire (APQ) parental involvement, positive parenting, and poor monitoring/supervision subscales were significantly lower in the clinical sample than in the community sample. Conclusion: As far as we know, this study is the first to examine comorbid psychopathologies of online challenge-style games and parenting skills. We believe that as research into these subject increases, it will assist mental health professionals to develop prevention strategies and to manage cases resulting from the Blue Whale Challenge (BWC) and other online challenges that pose a serious threat to mental health and that have driven many young people to suicide worldwide.

Integrating Telepsychiatric Services into the Conventional Systems for Psychiatric Support to Health Care Workers and Their Children During COVID-19 Pandemics: Results from A National Experience.

Background:A system presented here was established to provide psychiatric help for health care workers (HCWs) that combined telehealth applications with local psychosocial support teams, allowing services from video calls to emergency interventions.Introduction:The aim of this study was to determine the effectiveness of a system that combined telehealth applications with local psychosocial support teams.Materials and Methods:A mobile application-based approach supported by the conventional local units was used. A three-step approach including contacting live operators followed by video calls from psychiatrists or child and adolescent psychiatrists and if necessary local unit support was used to provide support.Results:In addition to system records covering sociodemographic variables and initial complaints, a telephone survey, questioning the effectiveness and satisfaction of the system, was used as the main outcome. The number of individuals who asked for a psychiatrist appointment from operators after downloading the application was 1,076 (n = 879 [81.6%] support for self) (n = 197 [18.4%] support for child). Four hundred forty-nine (n = 449) HCWs (41.7%) replied video calls and received psychiatric help from psychiatrists on the time of appointment (n = 351 [78.1%] support for self) (n = 98 [21.8%] support for child). The overall satisfaction level of HCWs for the service they received was 8.1/10 (8.1/10 for support for self, 8.4/10 for support for the child. 86.6% (n = 389).Discussion:The findings of this study suggest that although telepsychiatry may be useful in public health emergencies such as COVID-19 pandemics should not be consisted of only telephone lines or video calls.Conclusions:Systems combining telehealth applications and local intervention teams may be more effective and establishing such organizations is possible in short intervals.

Caring for the Most Vulnerable: A Model for Managing Maladaptive Behavior in Children with Mental Special Needs During the COVID-19 Pandemic.

Background: This article presents the results of a comprehensive national model developed for managing maladaptive behaviors (MBs) in children with mental special needs (CMSNs) during the coronavirus disease 2019 (COVID-19) pandemic that combines telehealth-based Applied Behavioral Analyses, psychiatric interventions, and support from local psychosocial teams. This study aims to determine the effectiveness of a system that combined telehealth applications with local psychosocial support teams, allowing services from video calls to emergency interventions. Materials and Methods: The system combines the telehealth applications with the services from local psychosocial intervention teams. In addition to system records covering sociodemographic variables and initial complaints, a telephone survey questioning the effectiveness and satisfaction of the system was used as the main outcome. Results: In total, 347 individuals used the system with mothers constituting the majority of applicants (88.7%, n = 332). The overall satisfaction of the system was 8.8/10. In terms of effectiveness, 63.3% (n = 237) of caregivers reported an improvement in the reason of application. Counselors decided on a need for follow-up visits for 36.6% (n = 137) of applications. A referral to a psychiatrist was asked for 40 patients (10.6%). Discussion: To our best knowledge, this is the first study presenting a model for managing MBs of CMSNs during the COVID-19 outbreak. In general, therefore, it seems that there is a need for unique systems to handle behavioral problems of CMSNs. Conclusions: The findings of this study suggest that it is possible to establish an integrative multistep multidisciplinary telehealth-based approach in a short while.

Nablus Mask-Like Facial Syndrome with Moderate Developmental Delay.

Nablus mask-like facial syndrome (NMLFS) is defined by distinctive craniofacial appearance including tight-appearing glistening facial skin, blepharophimosis, telecanthus, severe arched eyebrows, flat and broad nose, long philtrum, distinctive ears, unusual hair patterns, mild developmental delay and "happy" disposition. We aim to report a 7-year-old boy diagnosed with NMLFS and moderate developmental delay. Literature emphasis that Intellectual Disability is common in this syndrome though it has been diagnosed to only a few people worldwide.

Do we need to re-think on subthreshold childhood psychiatric cases? A follow-up study.

A remarkable number of children all over the world have psychiatric disorders, which cause severe impairments in functionality. In the development of future mental health planning, not only determining epidemiological data is sufficient, but also follow-up studies are needed. This study aimed to determine the course of subthreshold psychiatric disorders in three-year follow-up process, and whether there is a relationship between sociodemographic factors, parental attitudes and SDQ scores and the escalating escalation from SPD to psychopathology or the disappearance of SPD symptoms. This study included fifty-four children with age of 7-9 years. The Development and Well Being Assessment, structured diagnostic interview, was used to evaluate psychiatric disorders. Besides, parents were asked to fill out a socio-demographic form and the Parent Attitude Research Instrument. The mean age of children was 8.2 ± 0.8 years, and 59.3% of them were girls, and 40.7% of them were boys. At the beginning of the study, most common subthreshold psychiatric disorders were Specific Phobia with a prevalence of 3%, followed by Attention Deficit Hyperactivity Disorder 2.2%. After three-year of the follow-up period, 37% of subthreshold cases progress into psychiatric disorders. Living in a city centre in a slum and psychiatric disorder history of the family were independent risk factors for developing psychopathology. Living in a village was an effective protective factor in the disappearance of Subthreshold Psychiatric Disorder symptoms. In this study, besides the factors that may be effective in the development of psychiatric disorders, the factors that may be effective in the disappearance of Subthreshold Psychiatric Disorder symptoms were examined.

The prevalence of childhood mental disorders in different habitations: are we underestimating their prevalence in rural areas?

Background: Recently, the number of epidemiological studies of child psychiatry has increased, but most of these studies focus on children living in city centres. Unfortunately, one-third of the global population lives in rural areas, and various habitations exist in cities, including city centres and slums. Moreover, despite having a high risk for psychopathology development, individuals who have symptoms but fall outside the limits specified for diagnoses due to having fewer symptoms than those mentioned in diagnostic systems and individuals who do not fulfil the impairment criteria listed in diagnostic systems are not addressed in these studies.Aim: The purpose of this study was to understand the prevalence of DSM-IV childhood psychiatric disorders and subthreshold psychiatric problems from middle-class city centres, city centres in slums, towns and village areas of Turkey with a nationally representative sample using a state-of-the-art methodology.Methods: In total, 1080 children were randomly selected from second and third grades for the study's sample. A structured diagnostic interview was applied.Results: The overall prevalence of psychiatric disorders was 8.4% (n = 91); 7.2% (n = 78) of the children were subthreshold cases. The general prevalence of psychiatric disorders was higher among children living in villages with respect to all the other human settlement areas included in the study.Conclusions: Although global urbanisation foregrounds the mental health of children living in cities, children in rural areas may have a greater risk of developing a mental disorder. This study confirmed that an equal amount of children fell outside of the diagnosing limits.