46 results on '"Möhler, Eva"'
Search Results
2. The impact of Internet pornography on children and adolescents: A systematic review
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Paulus, Frank W., Nouri, Foujan, Ohmann, Susanne, Möhler, Eva, and Popow, Christian
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- 2024
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3. Adolescent borderline personality traits and dyadic behavior shape mother-adolescent cortisol synchrony
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Fleck, Leonie, Fuchs, Anna, Lerch, Stefan, Möhler, Eva, Koenig, Julian, Resch, Franz, and Kaess, Michael
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- 2023
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4. Parents of Child Psychiatric Patients Report More Adverse Childhood Experiences Compared with Community Samples.
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Altpeter, Adriana, Dixius, Andrea, and Möhler, Eva
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Adverse childhood experiences (ACEs) have already been associated, in some studies, with various diverse psychosocial abnormalities in later life. However, it is still unclear whether ACEs reported by biological parents differ from ACE scores in community samples. Background/Objectives: The aim of this study was to investigate the extent to which parents of a patient sample differ from a community sample in terms of reporting childhood experiences. In addition, the connection between parental negative traumatic experiences and their children's reporting of these experiences should be examined in more detail. Methods: In total, 256 child psychiatric patients (73.8% female and 26.2% male) aged 4–18 years (mean [M] = 13.26 years, standard deviation [SD] = 2.73) were retrospectively examined for post-traumatic stress symptoms (using the CATS questionnaire). In addition, 391 caregivers, 316 of whom were biological parents, completed the ACE questionnaire on adverse childhood experiences. The frequencies of ACEs of the parents, the traumatic experiences of the patients and their cumulative occurrence were evaluated descriptively. Results: A total of 139 (73%) mothers reported at least one negative experience in childhood. In contrast, 65 fathers (52%) reported at least one negative experience in childhood. Mothers most frequently mentioned separation from a parent (38.7%), while fathers cited emotional abuse as the most frequent negative experience. These ACE scores were significantly higher than those reported from community samples. Post-traumatic stress disorder was diagnosed in 75 (29.3%) of the 256 patients. A total of 44.6% of children of mothers and 53.8% of children of fathers reporting at least one ACE showed a CATS score above the cut-off. Conclusions: Parents of child psychiatric patients show higher scores of adverse childhood experiences than a community sample with the same population background. Further empirical studies in parents of child psychiatric patients and a larger sample seem mandatory in the face of these results. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Effect of vaccinations and school restrictions on the spread of COVID-19 in different age groups in Germany.
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Dings, Christiane, Selzer, Dominik, Bragazzi, Nicola Luigi, Möhler, Eva, Wenning, Markus, Gehrke, Thomas, Richter, Ulf, Nonnenmacher, Alexandra, Brinkmann, Folke, Rothoeft, Tobias, Zemlin, Michael, Lücke, Thomas, and Lehr, Thorsten
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COVID-19 pandemic ,VACCINATION ,DISTANCE education ,AGE groups - Abstract
With the emergence of SARS-CoV-2, various non-pharmaceutical interventions were adopted to control virus transmission, including school closures. Subsequently, the introduction of vaccines mitigated not only disease severity but also the spread of SARSCoV- 2. This study leveraged an adapted SIR model and non-linear mixed-effects modeling to quantify the impact of remote learning, school holidays, the emergence of Variants of Concern (VOCs), and the role of vaccinations in controlling SARS-CoV-2 spread across 16 German federal states with an age-stratified approach. Findings highlight a significant inverse correlation (Spearman's r = -0.92, p < 0.001) between vaccination rates and peak incidence rates across all age groups. Model-parameter estimation using the observed number of cases stratified by federal state and age allowed to assess the effects of school closure and holidays, considering adjustments for vaccinations and spread of VOCs over time. Here, modeling revealed significant (p < 0.001) differences in the virus's spread among pre-school children (0-4), children (5-11), adolescents (12-17), adults (18 -59), and the elderly (60+). The transition to remote learning emerged as a critical measure in significantly reducing infection rates among children and adolescents (p < 0.001), whereas an increased infection risk was noted among the elderly during these periods, suggesting a shift in infection networks due to altered caregiving roles. Conversely, during school holiday periods, infection rates among adolescents mirrored those observed when schools were open. Simulation exercises based on the model provided evidence that COVID-19 vaccinations might serve a dual purpose: they protect the vaccinated individuals and contribute to the broader community's safety. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Early life maltreatment affects intrinsic neural function in mothers
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Schneider, Isabella, Neukel, Corinne, Bertsch, Katja, Fuchs, Anna, Möhler, Eva, Zietlow, Anna-Lena, Brunner, Romuald, Wolf, Robert Christian, and Herpertz, Sabine C.
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- 2021
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7. Hair cortisol moderates the association between obstetric complications and child wellbeing
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Fuchs, Anna, Dittrich, Katja, Neukel, Corinne, Winter, Sibylle, Zietlow, Anna-Lena, Kluczniok, Dorothea, Herpertz, Sabine C., Hindi Attar, Catherine, Möhler, Eva, Fydrich, Thomas, Bermpohl, Felix, Kaess, Michael, Resch, Franz, and Bödeker, Katja
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- 2020
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8. Link between children’s hair cortisol and psychopathology or quality of life moderated by childhood adversity risk
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Fuchs, Anna, Jaite, Charlotte, Neukel, Corinne, Dittrich, Katja, Bertsch, Katja, Kluczniok, Dorothea, Möhler, Eva, Attar, Catherine Hindi, Brunner, Romuald, Bödeker, Katja, Resch, Franz, Bermpohl, Felix, and Kaess, Michael
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- 2018
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9. Editorial on Asymptomatic Rib Fractures and Their Relationship to Child Abuse.
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Muensterer, Oliver J. and Möhler, Eva
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CHILD abuse & psychology ,SERIAL publications ,PSYCHOLOGY of adult child abuse victims ,RIB fractures ,CULTURAL pluralism ,ADVERSE childhood experiences ,CHILDREN - Published
- 2024
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10. Impact of Maternal Early Life Maltreatment and Maternal History of Depression on Child Psychopathology: Mediating Role of Maternal Sensitivity?
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Bödeker, Katja, Fuchs, Anna, Führer, Daniel, Kluczniok, Dorothea, Dittrich, Katja, Reichl, Corinna, Reck, Corinna, Kaess, Michael, Hindi Attar, Catherine, Möhler, Eva, Neukel, Corinne, Bierbaum, Anna-Lena, Zietlow, Anna-Lena, Jaite, Charlotte, Lehmkuhl, Ulrike, Winter, Sibylle Maria, Herpertz, Sabine, Brunner, Romuald, Bermpohl, Felix, and Resch, Franz
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- 2019
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11. Effects of maternal history of depression and early life maltreatment on children's health-related quality of life
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Dittrich, Katja, Fuchs, Anna, Bermpohl, Felix, Meyer, Justus, Führer, Daniel, Reichl, Corinna, Reck, Corinna, Kluczniok, Dorothea, Kaess, Michael, Hindi Attar, Catherine, Möhler, Eva, Bierbaum, Anna-Lena, Zietlow, Anna-Lena, Jaite, Charlotte, Winter, Sibylle Maria, Herpertz, Sabine C., Brunner, Romuald, Bödeker, Katja, and Resch, Franz
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- 2018
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12. Alterations of brain volumes in women with early life maltreatment and their associations with oxytocin
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Mielke, Emilia L., Neukel, Corinne, Bertsch, Katja, Reck, Corinna, Möhler, Eva, and Herpertz, Sabine C.
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- 2018
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13. Premorbid body weight predicts weight loss in both anorexia nervosa and atypical anorexia nervosa: Further support for a single underlying disorder.
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Hebebrand, Johannes, Seitz, Jochen, Föcker, Manuel, Viersen, Hanna Preuss‐van, Huss, Michael, Bühren, Katharina, Dahmen, Brigitte, Becker, Katja, Weber, Linda, Correll, Christoph U., Jaite, Charlotte, Egberts, Karin, Romanos, Marcel, Ehrlich, Stefan, Seidel, Maria, Roessner, Veit, Fleischhaker, Christian, Möhler, Eva, Hahn, Freia, and Kaess, Michael
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PREVENTION of weight loss ,STATISTICAL correlation ,BODY mass index ,LEANNESS ,T-test (Statistics) ,BODY weight ,CLASSIFICATION of mental disorders ,DESCRIPTIVE statistics ,ANOREXIA nervosa ,RESEARCH ,CONCEPTS ,COMPARATIVE studies ,REGRESSION analysis ,STARVATION - Abstract
Objective: For adolescents, DSM‐5 differentiates anorexia nervosa (AN) and atypical AN with the 5th BMI‐centile‐for‐age. We hypothesized that the diagnostic weight cut‐off yields (i) lower weight loss in atypical AN and (ii) discrepant premorbid BMI distributions between the two disorders. Prior studies demonstrate that premorbid BMI predicts admission BMI and weight loss in patients with AN. We explore these relationships in atypical AN. Method: Based on admission BMI‐centile < or ≥5th, participants included 411 female adolescent inpatients with AN and 49 with atypical AN from our registry study. Regression analysis and t‐tests statistically addressed our hypotheses and exploratory correlation analyses compared interrelationships between weight loss, admission BMI, and premorbid BMI in both disorders. Results: Weight loss in atypical AN was 5.6 kg lower than in AN upon adjustment for admission age, admission height, premorbid weight and duration of illness. Premorbid BMI‐standard deviation scores differed by almost one between both disorders. Premorbid BMI and weight loss were strongly correlated in both AN and atypical AN. Discussion: Whereas the weight cut‐off induces discrepancies in premorbid weight and adjusted weight loss, AN and atypical AN overall share strong weight‐specific interrelationships that merit etiological consideration. Epidemiological and genetic associations between AN and low body weight may reflect a skewed premorbid BMI distribution. In combination with prior findings for similar psychological and medical characteristics in AN and atypical AN, our findings support a homogenous illness conceptualization. We propose that diagnostic subcategorization based on premorbid BMI, rather than admission BMI, may improve clinical validity. Public significance: Because body weights of patients with AN must drop below the 5th BMI‐centile per DSM‐5, they will inherently require greater weight loss than their counterparts with atypical AN of the same sex, age, height and premorbid weight. Indeed, patients with atypical AN had a 5.6 kg lower weight loss after controlling for these variables. In comparison to the reference population, we found a lower and higher mean premorbid weight in patients with AN and atypical AN, respectively. Considering previous psychological and medical comparisons showing little differences between AN and atypical AN, we view a single disorder as the most parsimonious explanation. Etiological models need to particularly account for the strong relationship between weight loss and premorbid body weight. [ABSTRACT FROM AUTHOR]
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- 2024
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14. Maternal sensitivity and the empathic brain: Influences of early life maltreatment
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Mielke, Emilia L., Neukel, Corinne, Bertsch, Katja, Reck, Corinna, Möhler, Eva, and Herpertz, Sabine C.
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- 2016
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15. Familial context influences media usage in 0- to 4-year old children.
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Paulus, Frank W., Joas, Jens, Friedmann, Anna, Fuschlberger, Tamara, Möhler, Eva, and Mall, Volker
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- 2024
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16. Mental health and quality of life in children and adolescents during the COVID-19 pandemic: a systematic review of longitudinal studies.
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Orban, Ester, Yao Li, Lydia, Gilbert, Martha, Napp, Ann-Kathrin, Kaman, Anne, Topf, Sabine, Boecker, Maren, Devine, Janine, Reiß, Franziska, Wendel, Flora, Jung-Sievers, Caroline, Ernst, Vanessa Sophie, Franze, Marco, Möhler, Eva, Breitinger, Eva, Bender, Stephan, and Ravens-Sieberer, Ulrike
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- 2024
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17. Motivations for Adolescent COVID-19 Vaccination: A Comparative Study of Adolescent and Caregiver Perspectives in Germany.
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Rothoeft, Tobias, Brinkmann, Folke, Maier, Christoph, Selzer, Dominik, Dings, Christiane, Kuehn, Anna, Möhler, Eva, Grote, Hanna, Nonnenmacher, Alexandra, Wenning, Markus, Zemlin, Michael, Richter, Ulf, Lehr, Thorsten, and Lücke, Thomas
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VACCINATION ,PARENT attitudes ,STATISTICAL power analysis ,LEISURE ,COVID-19 ,SCIENTIFIC observation ,PSYCHOLOGY of parents ,CONFIDENCE intervals ,COVID-19 vaccines ,ATTITUDE (Psychology) ,MOTIVATION (Psychology) ,ONE-way analysis of variance ,FISHER exact test ,EMIGRATION & immigration ,FAMILY attitudes ,COMPARATIVE studies ,T-test (Statistics) ,GUARDIAN & ward ,QUESTIONNAIRES ,DATA analysis software ,LOGISTIC regression analysis ,ODDS ratio ,ADOLESCENCE - Abstract
Given the crucial role of vaccination in halting the COVID-19 pandemic, it is imperative to understand the factors that motivate adolescents to get vaccinated. We surveyed adolescents and their accompanying guardians scheduled to receive a COVID-19 vaccination (Comirnaty) in an urban region in Germany in mid-2021 regarding their motivation for getting vaccinated and collected data on their sociodemographic characteristics, medical history, vaccination status, and any history of COVID-19 infection in the family. We also queried information strategies related to the SARS-CoV-2 pandemic. Motivations for getting vaccinated were similar among adolescents and their parents. The primary reasons for vaccination were protection against SARS-CoV-2-related illness and gaining access to leisure facilities. This was not influenced by gender, health status, migration background, or the presence of chronic or acute diseases. The percentage of parents who had received SARS-CoV-2 immunization and the proportion of parents with a high level of education were higher among study participants than in the general population. Adolescents were especially willing to be vaccinated if they came from a better educational environment and had a high vaccination rate in the family. Emphasizing the importance of vaccination among all segments of the population and removing barriers to vaccines may lead to an ameliorated acceptance of COVID-19 vaccines. [ABSTRACT FROM AUTHOR]
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- 2023
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18. Assessment and Diagnostic Classification Using DC:0-5 in Early Childhood Mental Health Clinics: The Protocol for the Developmental Psychiatry Diagnostic Challenges Study (DePsy).
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Bödeker, Katja, Watrin-Avino, Laura M., Martin, Annick, Schlensog-Schuster, Franziska, Janssen, Marius, Friese, Lennart, Licata-Dandel, Maria, Mall, Volker, Teich-Bělohradský, Juliane, Izat, Yonca, Correll, Christoph U., Möhler, Eva, and Paulus, Frank W.
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RESEARCH ,CAREGIVERS ,TREATMENT effectiveness ,CHILD psychopathology ,PATIENT-family relations ,SENSITIVITY & specificity (Statistics) ,PSYCHIATRIC hospitals ,LONGITUDINAL method ,EVALUATION - Abstract
Mental health problems in early childhood are common, but there is a lack of psychiatric research on this age group. DC:0-5 is a multiaxial classification system for mental disorders in early childhood, providing a framework for standardizing clinical practice and research. However, research on the validity of DC:0-5 is scarce. The Developmental Psychiatry Diagnostic Challenges Study (DePsy) is a multi-site, prospective clinical study including six German early childhood mental health (ECMH) clinics. The main objective of the study is to contribute to the validation of Axis I and Axis II of DC:0-5. A second aim of the study is to describe the population of the participating clinics regarding diagnoses, family context, and treatment outcomes. Additionally, the impact of environmental risk factors, including parental Adverse Childhood Experiences (ACEs) and media use, on child psychopathology and caregiver–child relationships will be examined. Over two years, patients aged 0.0–5.9 years old will be enrolled in the study. Assessments include ICD-10 and DC:0-5 diagnoses, developmental tests, video-based observations of caregiver—child interactions, and questionnaires on child psychopathology, media use, parental stress, and treatment satisfaction. Study results will promote the standardization of assessment and treatment in ECMH clinics aiming to improve the development of patients and their families. [ABSTRACT FROM AUTHOR]
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- 2023
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19. Impact of a maternal history of childhood abuse on the development of mother–infant interaction during the first year of life
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Fuchs, Anna, Möhler, Eva, Resch, Franz, and Kaess, Michael
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- 2015
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20. Observational Context of Mother-Child Interaction: Impact of a stress Context on Emotional Availability
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Dittrich, Katja, Fuchs, Anna, Führer, Daniel, Bermpohl, Felix, Kluczniok, Dorothea, Attar, Catherine Hindi, Jaite, Charlotte, Zietlow, Anna-Lena, Licata, Maria, Reck, Corinna, Herpertz, Sabine C., Brunner, Romuald, Möhler, Eva, Resch, Franz, Winter, Sibylle Maria, Lehmkuhl, Ulrike, and Bödeker, Katja
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- 2017
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21. Misjudgement of One's Own Performance? Exploring Attention Deficit (Hyperactivity) Disorder (ADHD) and Individual Difference in Complex Music and Foreign Language Perception.
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Groß, Christine, Bernhofs, Valdis, Möhler, Eva, and Christiner, Markus
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- 2023
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22. Effects of a Standardized DBT—A Program on Identity Development in Adolescents.
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Dixius, Andrea and Möhler, Eva
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IDENTITY (Psychology) , *ADOLESCENT development , *BEHAVIOR therapy , *EMOTION regulation , *BORDERLINE personality disorder - Abstract
Background: Identity diffusion plays a central role in the onset of borderline personality disorders. Dialectical Behavioral Therapy for Adolescents (DBT-A) is a treatment program for adolescents with emotional instability and dysregulation. The interest of this study is to examine the potential effects of a standardized and certified DBT-A therapy program on the identity development of adolescents in an inpatient setting. Methods: A total of 138 adolescents aged 13 to 18 years with symptoms of severe emotional instability were assessed before and after a certified and standardized 12-week in-patient DBT-A program targeting emotional regulation with the following standardized instruments: the Assessment of Identity Development in Adolescence (AIDA), Scale of the Experience of Emotions (SEE), and Symptom Checklist (SCL-90-R). Results: The results indicate a significant change in identity development, emotion regulation, and general symptoms of psychopathology after treatment with DBT-A. Conclusions: In this large sample of adolescents, DBT-A significantly improved identity development and reduced identity diffusion, however, without a treatment-as-usual control group as a limitation. Nevertheless, our results may become clinically relevant for the prevention of chronic impairment in emotionally unstable adolescents. [ABSTRACT FROM AUTHOR]
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- 2023
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23. Infant distress to novelty is associated with maternal anxiety disorder and especially with maternal avoidance behavior
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Reck, Corinna, Müller, Mitho, Tietz, Alexandra, and Möhler, Eva
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- 2013
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24. Self-Control and Child Abuse Potential in Mothers with an Abuse History and Their Preschool Children
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Henschel, Saskia, de Bruin, Marijn, and Möhler, Eva
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- 2014
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25. Problematic Internet Use among Adolescents 18 Months after the Onset of the COVID-19 Pandemic.
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Paulus, Frank W., Joas, Jens, Gerstner, Ida, Kühn, Anna, Wenning, Markus, Gehrke, Thomas, Burckhart, Holger, Richter, Ulf, Nonnenmacher, Alexandra, Zemlin, Michael, Lücke, Thomas, Brinkmann, Folke, Rothoeft, Tobias, Lehr, Thorsten, and Möhler, Eva
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ADDICTIONS -- Risk factors ,PSYCHOLOGY of college students ,DIGITAL technology ,AGE distribution ,MULTIPLE regression analysis ,RESEARCH methodology evaluation ,MANN Whitney U Test ,RISK assessment ,SEX distribution ,PEARSON correlation (Statistics) ,PSYCHOLOGY of high school students ,DESCRIPTIVE statistics ,INTERNET addiction ,EMOTION regulation ,COVID-19 pandemic ,CHILDREN ,ADOLESCENCE - Abstract
Studies in recent years and especially since the beginning of the COVID-19 pandemic have shown a significant increase in the problematic use of computer games and social media. Adolescents having difficulties in regulating their unpleasant emotions are especially prone to Problematic Internet Use (PIU), which is why emotion dysregulation has been considered a risk factor for PIU. The aim of the present study was to assess problematic internet use (PIU) in adolescents after the third wave (nearly 1.5 years after the onset in Europe) of the COVID-19 pandemic. In the German region of Siegen-Wittgenstein, all students 12 years and older from secondary-level schools, vocational schools and universities were offered a prioritized vaccination in August 2021 with an approved vaccine against COVID-19. In this context, the participants filled out the Short Compulsive Internet Use Scale (SCIUS) and two additional items to capture a possible change in digital media usage time and regulation of negative affect due to the COVID-19 pandemic. A multiple regression analysis was performed to identify predictors of PIU. The original sample consisted of 1477 participants, and after excluding invalid cases the final sample size amounted to 1268 adolescents aged 12–17 (x = 14.37 years, SD = 1.64). The average prevalence of PIU was 43.69%. Gender, age, digital media usage time and the intensity of negative emotions during the COVID-19 pandemic were all found to be significant predictors of PIU: female gender, increasing age, longer digital media usage time and higher intensity of negative emotions during the COVID-19 pandemic were associated with higher SCIUS total scores. This study found a very high prevalence of PIU among 12- to 17-year-olds for the period after the third wave of the COVID-19 pandemic, which has increased significantly compared to pre-pandemic prevalence rates. PIU is emerging as a serious problem among young people in the pandemic. Besides gender and age, pandemic-associated time of digital media use and emotion regulation have an impact on PIU, which provides starting points for preventive interventions. [ABSTRACT FROM AUTHOR]
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- 2022
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26. Personality Disorders and Development.
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Möhler, Eva
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PERSONALITY disorders , *PERSONALITY development , *BORDERLINE personality disorder , *SELF-injurious behavior , *MENTAL health services , *STRESS tolerance (Psychology) , *CONTROL (Psychology) - Abstract
Patients with lesions in the orbitofrontal cortex were reported to show a significantly higher degree of impulsivity and a higher frequency of inadequate behaviour compared to patients in the healthy control group accordingly [[9]]. Together with review articles on state of the art advancements in personality disorders, research in this issue also explores the adverse childhood experiences framework and aims to describe empirical research on neurobiological associations between trauma and personality disorders. On another important note, research on personality disorders has stressed the importance of trauma and abusive experiences, as well as adverse childhood experiences for the development of personality disorders. Personality disorders constitute a major challenge for society, as well as psychiatry and psychotherapy. [Extracted from the article]
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- 2022
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27. Behavioral Inhibition in the Second Year of Life Is Predicted by Prenatal Maternal Anxiety, Overprotective Parenting and Infant Temperament in Early Infancy.
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Mudra, Susanne, Göbel, Ariane, Möhler, Eva, Stuhrmann, Lydia Yao, Schulte-Markwort, Michael, Arck, Petra, Hecher, Kurt, and Diemert, Anke
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RESPONSE inhibition ,PARENTAL overprotection ,PRENATAL depression ,BASHFULNESS ,PARENT-infant relationships ,SOCIAL anxiety ,THIRD trimester of pregnancy - Abstract
Background: Behavioral inhibition, characterized by shyness, fear and avoidance of novel stimuli, has been linked with internalizing personality traits in childhood, adolescence and early adulthood, and particularly later social anxiety disorder. Little is known about the relevance of potential prenatal precursors and early predictors for the development of inhibited behavior, such as infant vulnerability and family risk factors like parental anxiety and overprotection. Pregnancy-related anxiety has been associated with both infant temperament and maternal overprotective parenting. Thus, the aim of this study was investigating the predictive relevance of prenatal pregnancy-related anxiety for behavioral inhibition in toddlerhood, by considering the mediating role of maternal overprotection and infant distress to novelty. Materials and Methods: As part of a longitudinal pregnancy cohort, behavioral inhibition at 24 months postpartum was assessed in N = 170 mother-child pairs. Maternal pregnancy-related anxiety was examined in the third trimester of pregnancy, and maternal overprotection and infant distress to novelty at 12 months postpartum. Results: Mediation analysis with two parallel mediators showed that the significant direct effect of pregnancy-related anxiety on child behavioral inhibition was fully mediated by infant distress to novelty p < 0.001 and maternal overprotection (p < 0.05). The included variables explained 26% of variance in behavioral inhibition. A subsequent explorative mediation analysis with serial mediators further showed a significant positive association between distress to novelty and maternal overprotective parenting (p < 0.05). Conclusion: Results indicate a predictive relevance of both infant and maternal factors for the development of behavioral inhibition in toddlerhood. Mothers who perceived more pregnancy-related anxiety showed more overprotective parenting and had infants with more distress to novelty. Further, mothers being more overprotective reported their child to be more inhibited in toddlerhood. Our findings also indicate the stability of reported infant distress to novelty as one aspect of later behavioral inhibition. Addressing specific forms of parental anxiety from pregnancy on and in interaction with child-related variables seems to be a promising approach for future studies and clinical interventions. [ABSTRACT FROM AUTHOR]
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- 2022
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28. Preschool Temperament as a Factor of Risk and Protection for Later Childhood Psychopathology.
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Paulus, Frank W., Möhler, Eva, Festag, Lisa, and Joas, Jens
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CHILD psychopathology ,RESPONSE inhibition ,TEMPERAMENT ,MULTIPLE regression analysis ,PRESCHOOL children ,PRESCHOOLS ,SENSORY disorders - Abstract
Background: Temperament might be considered as a risk factor as well as a resilience factor for later externalizing and internalizing disorders. Therefore, this study examines different dimensions of temperament in preschool age with regard to their predictive value for psychopathology later in childhood. Methods: A total of 76 patients (63.2% male) were assessed in a special psychiatric consultation for preschool age at measuring point time t1 (x = 4.2) and measuring point time t2 (x = 9.2). At t1, the Integrative Child Temperament Inventory (ICTI) was used for assessment. At t2, parents completed the Strengths and Difficulties Questionnaire SDQ. Multiple regression analyses were used to test if the temperament factors of the ICTI predicted clinical abnormalities in the SDQ subscales or total difficulties score. Results: SDQ total difficulties score as an indicator of total psychiatric disturbance in childhood appears to be good predicted by the temperament factor frustration/anger. Sensory sensitivity in preschoolers serves as a risk factor for later emotional symptoms, whereas high activity levels appear to prevent later emotional symptoms. Behavioral inhibition appears to protect against hyperactivity/inattention. Conclusion: Our data suggests that preschool temperament contributes differently to the development of externalizing and internalizing problems in childhood. The temperament factor frustration/anger in preschool children might be a strong predictor of the general mental condition in childhood at nine years of age and can therefore be used as a target for prevention of psychopathology in children. On one hand, high sensory sensitivity can be a predictor to identify preschool children at risk for later emotional symptoms, on the other hand, activity level acts as a protective factor against later emotional symptoms. An increased level of behavioral inhibition might be protective against the development of hyperactivity/inattention symptoms. Overall, this study illustrates the complexity and ambiguity of temperament in child development. [ABSTRACT FROM AUTHOR]
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- 2022
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29. Mental Health and Health-Related Quality of Life in German Adolescents after the Third Wave of the COVID-19 Pandemic.
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Hussong, Justine, Möhler, Eva, Kühn, Anna, Wenning, Markus, Gehrke, Thomas, Burckhart, Holger, Richter, Ulf, Nonnenmacher, Alexandra, Zemlin, Michael, Lücke, Thomas, Brinkmann, Folke, Rothoeft, Tobias, and Lehr, Thorsten
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COVID-19 ,QUALITY of life ,QUESTIONNAIRES ,DESCRIPTIVE statistics ,CHI-squared test ,DATA analysis software ,COVID-19 pandemic ,PARENTS - Abstract
Evaluations after the first and second waves of the COVID-19 pandemic in Germany showed an increase in mental health problems and a reduction in health-related quality of life (HRQoL). The aim of the study was to assess those aspects after the third wave of COVID-19 in adolescents who decided to receive a vaccination. In students aged 12–17 years recruited from schools in one German region, mental health (by the strengths and difficulties questionnaire, SDQ) and HRQoL (by KIDSCREEN-10) were assessed by both a self- and parental report. Data from 1412 adolescents (mean age 14.3 years, SD = 1.64) and 908 parents were collected. The mean self-reported HRQoL was T = 53.7 (SD = 11.2), significantly higher in boys than in girls and higher in younger (12–14 years) than in older (15–17 years) adolescents. In total, 18.7% of adolescents reported clinically relevant psychological symptoms, especially peer problems (23.5%), emotional problems (17.4%), and hyperactivity (17.1%). Comparing the present data to evaluations after the first and second waves of COVID-19, adolescents rated a higher HRQoL and reported less mental health problems after the third wave. After 1.5 years of living with the pandemic, adolescents have adapted to the changes in everyday life. Further, the relaxation of restrictions, better school organization, and the prospect of the vaccination may have increased optimism, wellbeing, and contentment, leading to declining but still alarming rates of psychological symptoms. [ABSTRACT FROM AUTHOR]
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- 2022
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30. Relation of behavioral inhibition to neonatal and infant cardiac activity, reactivity and habituation
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Moehler, Eva, Kagan, Jerome, Parzer, Peter, Wiebel, Angelika, Brunner, Romuald, and Resch, Franz
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- 2006
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31. Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review.
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Paulus, Frank W., Ohmann, Susanne, Möhler, Eva, Plener, Paul, and Popow, Christian
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MENTAL illness ,OPPOSITIONAL defiant disorder in children ,SELF-injurious behavior ,EATING disorders ,EMOTIONAL trauma ,AUTISM spectrum disorders - Abstract
Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2–17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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32. Maternal Bonding in Early Infancy Predicts Childrens' Social Competences in Preschool Age.
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Joas, Jens and Möhler, Eva
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MATERNAL love ,SOCIAL skills ,INFANTS ,SOCIAL influence ,CHILD development - Abstract
Background: There are many studies on mother-child-bonding with little theoretical doubt that better bonding may have a positive effect on further social development. However, there is hardly any empirical evidence. In particular, there is a lack prospective longitudinal studies. Methods: As part of a longitudinal study, bonding was assessed in a community sample of 97 healthy mothers using the Postpartum Bonding Questionnaire (PBQ) 6 weeks after birth of their child. Social competencies in the offspring were assessed using the Self- and Other-oriented Social Competencies (SOCOMP) at 5.5 years of age. A potential correlation between bonding and social competencies was tested using Spearman Rank Correlation. Results: Retention rate over 5.5 years was 77.23%. Lower Maternal Bonding Impairment Scores 6 weeks postnatally were positively related to childrens' social competences at 5.5 years of age. Conclusion: The present data confirm a positive and long-term influence of bonding on social skills and provide further evidence of the importance of parent child bonding for child development in general. This result should give reason to further investigate this relationship in depth, causally and at later points in time. [ABSTRACT FROM AUTHOR]
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- 2021
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33. Electronic Media and Early Childhood: A Review.
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Paulus, Frank W., Möhler, Eva, Recktenwald, Franziska, Albert, Amélie, and Mall, Volker
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- 2021
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34. Early Detection of Temperament Risk Factors: A Comparison of Clinically Referred and General Population Children.
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Zentner, Marcel, Biedermann, Vivienne, Taferner, Christina, da Cudan, Hannah, Möhler, Eva, Strauß, Hannah, and Sevecke, Kathrin
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CHILD Behavior Checklist ,TEMPERAMENT - Abstract
Despite an extensive literature on associations between early childhood temperament and behavior problems, most of this evidence is based on general population samples. Hence, relatively little is known about the temperament characteristics of children who have been referred for in- or outpatient treatment of emotional and/or behavioral problems. Whether temperament-to-behavior problems identified in community samples would also be found in samples of clinically referred children is poorly understood. To redress this limitation, we compared temperament attributes of a predominantly preschool-aged sample of children referred for treatment of emotional and/or behavioral disorders (N = 87) with those from a similarly-aged general population sample (N = 85) by using the Integrative Child Temperament Screener (ICTS)—a new nine-item scale to identify clinically significant temperament attributes. Behavioral symptoms in the clinical sample were assessed through diagnostic interviews in combination with the Child Behavior Checklist (CBCL), which was also administered to the general population children. Compared with general population children, referred children exhibited substantially higher scores on all ICTS subscales except behavioral inhibition. Furthermore, areas under the curve analyses showed that discrimination of both groups based on CBCL scales could be improved by adding the ICTS. Overall, the findings fill a long-standing gap in evidence regarding temperament characteristics of children with serious emotional and/or behavioral symptoms and suggest a useful role for the ICTS in assessment, screening, and prevention. [ABSTRACT FROM AUTHOR]
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- 2021
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35. Emotional Dysregulation in Preschool Age Predicts Later Media Use and Gaming Disorder Symptoms in Childhood.
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Paulus, Frank W., Hübler, Karen, Mink, Fabienne, and Möhler, Eva
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CHILD Behavior Checklist ,PRESCHOOL children ,PRESCHOOLS ,AGE ,BEHAVIOR disorders - Abstract
Background: The aim of this study was to evaluate the role of early Emotional Dysregulation (ED) at preschool age as a risk factor or predictor of later media use behavior and Gaming Disorder (GD) in school age. Methods: 80 patients (63.7% male; mean age = 4.2, SD = 1.23) who had attended a special outpatient program for preschoolers at measuring point time t1 were contacted at measuring point time t2 (mean age = 9.2, SD = 2.03). At t1, the comprehensive clinical assessment comprised Child Behavior Checklist—Dysregulation Profile (CBCL-DP). At t2, parents completed a questionnaire on their children's media availability, usage times, and GD. Results: ED predicts a more intense use of digital media in the future. The daily average screen-use time at t2 varies significantly between the groups (148 min for children with ED at t1 and 85 min for children without ED at t1). The intensity of media use can be considered a significant predictor for the presence of a GD in dimensional assessment. When GD is classified categorically, according to the DSM-5 criteria, there is no significant correlation between ED and later GD diagnosis, neither between screen-use time and GD diagnosis. However, at dimensional level, preschool children with ED show significantly higher GD symptom scores at 9 years of age. Conclusion: ED at preschool age is strongly associated with time spent video gaming and GD symptoms 5 years later. Our results strongly indicate that emotion dysregulation in preschool children is a risk factor for later problematic video game playing behavior. This strengthens the concept of ED in the etiology of media use and provides potential targets for early GD prevention. [ABSTRACT FROM AUTHOR]
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- 2021
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36. Editorial: Low threshold interventions and preventive approaches in child mental health care.
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Möhler, Eva
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- 2023
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37. Maternal early life maltreatment and psychopathology affect the next generation: Alterations in post‐awakening cortisol levels of primary school‐aged children.
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Hillmann, Karen, Neukel, Corinne, Zimmermann, Johannes, Fuchs, Anna, Zietlow, Anna‐Lena, Möhler, Eva, Herpertz, Sabine C., Kaess, Michael, and Bertsch, Katja
- Abstract
Early life maltreatment (ELM) has severe and lasting effects on the individual, which might also impact the next generation. On an endocrine level, the hypothalamus–pituitary–adrenal axis has been suggested to play an important role in the interplay between ELM and the development of mental disorders. Several studies have revealed that maternal post‐awakening cortisol concentration, maternal sensitivity, maternal ELM and psychopathology are associated with children's cortisol levels. We investigated the post‐awakening cortisol concentrations in 6‐ to 11‐year‐old children (N = 53) whose mothers either had experienced ELM and had developed a lifetime mental disorder (N = 15 ELM and disorder group), had experienced ELM without developing a mental disorder (N = 12 ELM‐only group), or had neither experienced ELM nor developed a mental disorder (N = 26 HC‐group). Furthermore, we assessed maternal post‐awakening cortisol concentrations, maternal psychopathology, and sensitivity. Multilevel analysis revealed higher cortisol at awakening (S1) levels in children of mothers with ELM and disorder. Maternal cortisol at awakening (S1) also predicted the child's cortisol at awakening (S1), and no effect of maternal sensitivity could be found. The current results replicate an attunement of cortisol levels (S1) between mothers and children and suggest an association between the children's endocrine stress system and maternal factors such as ELM and psychopathology. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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38. The Cycle of Abuse: Emotional Availability in Resilient and Non-Resilient Mothers with Early Life Maltreatment.
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Mielke, Emilia Louisa, Neukel, Corinne, Fuchs, Anna, Hillmann, Karen, Zietlow, Anna-Lena, Bertsch, Katja, Reck, Corinna, Möhler, Eva, and Herpertz, Sabine C.
- Subjects
PSYCHOLOGICAL abuse ,PSYCHOLOGICAL resilience ,MOTHERS ,MOTHER-child relationship ,CHILD abuse ,PSYCHOLOGICAL child abuse - Abstract
Background: Early life maltreatment (ELM) has a high risk of transmission across generations, known as "the cycle of abuse." ELM is also an important risk factor for developing mental disorders, and having a mental disorder increases the risk of child abuse. Both the abuse potential in mothers with ELM and in mothers with a history of mental disorders might be associated with a disturbed mother-child interaction. Objective: The current study examined differences in emotional availability between mothers with a history of ELM and previous or current mental disorders (non-resilient), mothers with ELM without mental disorders (resilient), and control mothers without ELM and without mental disorders. Methods: Thirty-three non-resilient mothers, 18 resilient mothers, and 37 control mothers and their 5- to 12-year-old children participated in a standardized mother-child interaction task. Videotaped interactions were rated by three independent, trained raters based on the Emotional Availability Scales (EA Scales) and compared between the groups. Results: The non-resilient mothers and their children showed reduced maternal sensitivity, structuring, non-intrusiveness, non-hostility, responsiveness, and involvement compared to the resilient mothers and their children and the control mothers and their children (p = 0.006, η
p 2 = 0.12). No differences on any of the EA Scales were found between resilient mothers and control mothers. Conclusions: These deficits in mother-child interaction in non-resilient mothers might contribute to mechanisms that could explain the cycle of abuse. Interestingly, resilient mothers, who did not develop a mental disorder despite having experienced ELM, did not show these deficits. Thus, prevention programs promoting resilience might be a key to break the cycle of abuse. [ABSTRACT FROM AUTHOR]- Published
- 2020
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39. The Early Mother-to-Child Bond and Its Unique Prospective Contribution to Child Behavior Evaluated by Mothers and Teachers.
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Fuchs, anna, Möhler, Eva, Reck, Corinna, Resch, Franz, and Kaess, Michael
- Subjects
- *
MOTHER-child relationship , *CHILD behavior , *CHILD development , *PATHOLOGICAL psychology , *STRENGTHS & Difficulties Questionnaire , *PSYCHOLOGICAL tests for children - Abstract
Maternal bonding has been described as the quality of the affective tie from a mother to her infant. This early bond's mental components and its longitudinal impact on child outcome have been markedly understudied. Although most researchers assume impaired maternal bonding to have a negative impact on child development, there is a lack of prospective studies evaluating this hypothesis. Since maternal mental health problems may negatively affect both bonding quality and child development, it is still to be determined whether there is a unique contribution of bonding quality to child behavior problems over and above maternal psychopathology. We examined a community sample of 101 mother-child dyads at the child's age of 2 weeks (t1) and 6 weeks (t2), 4 months (t3), 14 months (t4), and 5.5 years (t5). Maternal bonding and psychopathology were assessed at time points t1-t4 using the Postpartum Bonding Questionnaire (PBQ-16) and the Symptom Checklist Revised (SCL 90-R). Child behavior problems were rated in a multi-informant design by mothers and teachers at t5 using the Strengths and Difficulties Questionnaire (SDQ). In the case of maternal judgment of child behavior problems, bonding at 14 months (t4) proved to be a significant predictor (β = 0.30; p = 0.011). Teacher-rated child behavior problems were significantly predicted by maternal bonding at 2 weeks (t1; β = 0.48; p = 0.025). Our results indicate a prospective influence of the early mother-infant bond on child development and underline the unique contribution of bonding quality to child behavior problems over and above the impact of maternal psychopathology in a community sample. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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40. Association of behavioral inhibition with hair pigmentation in a European sample
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Moehler, Eva, Kagan, Jerome, Brunner, Romuald, Wiebel, Angelika, Kaufmann, Claudia, and Resch, Franz
- Published
- 2006
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41. Temperament.
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Möhler, Eva and Resch, Franz
- Published
- 2012
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42. Infant Psychiatry – frühe Eltern-Kind-Interaktion.
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Ziegenhain, Ute, Fegert, Jörg M., and Möhler, Eva
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- 2012
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43. Musical Performance in Adolescents with ADHD, ADD and Dyslexia—Behavioral and Neurophysiological Aspects.
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Groß, Christine, Serrallach, Bettina L., Möhler, Eva, Pousson, Jachin E., Schneider, Peter, Christiner, Markus, and Bernhofs, Valdis
- Subjects
MUSICAL performance ,DYSLEXIA ,ATTENTION-deficit hyperactivity disorder ,AUDITORY cortex ,MUSICAL interpretation - Abstract
Research has shown that dyslexia and attention deficit (hyperactivity) disorder (AD(H)D) are characterized by specific neuroanatomical and neurofunctional differences in the auditory cortex. These neurofunctional characteristics in children with ADHD, ADD and dyslexia are linked to distinct differences in music perception. Group-specific differences in the musical performance of patients with ADHD, ADD and dyslexia have not been investigated in detail so far. We investigated the musical performance and neurophysiological correlates of 21 adolescents with dyslexia, 19 with ADHD, 28 with ADD and 28 age-matched, unaffected controls using a music performance assessment scale and magnetoencephalography (MEG). Musical experts independently assessed pitch and rhythmic accuracy, intonation, improvisation skills and musical expression. Compared to dyslexic adolescents, controls as well as adolescents with ADHD and ADD performed better in rhythmic reproduction, rhythmic improvisation and musical expression. Controls were significantly better in rhythmic reproduction than adolescents with ADD and scored higher in rhythmic and pitch improvisation than adolescents with ADHD. Adolescents with ADD and controls scored better in pitch reproduction than dyslexic adolescents. In pitch improvisation, the ADD group performed better than the ADHD group, and controls scored better than dyslexic adolescents. Discriminant analysis revealed that rhythmic improvisation and musical expression discriminate the dyslexic group from controls and adolescents with ADHD and ADD. A second discriminant analysis based on MEG variables showed that absolute P1 latency asynchrony |R-L| distinguishes the control group from the disorder groups best, while P1 and N1 latencies averaged across hemispheres separate the control, ADD and ADHD groups from the dyslexic group. Furthermore, rhythmic improvisation was negatively correlated with auditory-evoked P1 and N1 latencies, pointing in the following direction: the earlier the P1 and N1 latencies (mean), the better the rhythmic improvisation. These findings provide novel insight into the differences between music processing and performance in adolescents with and without neurodevelopmental disorders. A better understanding of these differences may help to develop tailored preventions or therapeutic interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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44. Emotional stress in pregnancy predicts human infant reactivity
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Möhler, Eva, Parzer, Peter, Brunner, Romuald, Wiebel, Angelika, and Resch, Franz
- Subjects
- *
INFANT development , *ADOLESCENCE , *OBSTETRICS , *PREGNANCY - Abstract
Abstract: Background: Infant distress to novelty at 4 months of life has previously been identified as an important predictor of longer term emotional development in childhood and adolescence. Aim: To investigate the relationship between prenatal stress and infant reactivity to unfamiliar visual, auditory and olfactory stimuli. Study design: Maternal emotional stress, life events and medical adversities during pregnancy and maternal personality characteristics were assessed by interview, questionnaire and patient charts at 2 weeks postnatal age. Postnatal maternal psychopathology was assessed at 2 weeks and 4 months postnatal age. Infant outcome was examined 4 months postnatally. Subjects: 102 mother–infant pairs were recruited in local obstetric units, complete datasets were available for 96 mother–infant-pairs. Outcome measure: Infant reactivity to unfamiliar stimuli was assessed when the infants were 4 months postnatal age. Results: Maternal prenatal emotional stress was significantly associated with infant affective reactivity to novelty. Maternal postnatal psychopathology did not have an influence on affective infant reactivity. Conclusions: These data provide evidence for an impact of maternal emotional stress in pregnancy on early infant distress to novel stimuli, a behavioral trait whose stability throughout childhood and adolescence has previously been demonstrated. [Copyright &y& Elsevier]
- Published
- 2006
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45. The impact of the COVID-19 pandemic on administrative eating disorder prevalence in the outpatient sector and on severity of anorexia nervosa.
- Author
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Tam FI, Ochmann R, Marschall J, Leschzinski H, Seidel M, Klink L, Föcker M, Bühren K, Dahmen B, Jaite C, Herpertz-Dahlmann B, Seitz J, Gilsbach S, Correll CU, Müller AE, Hebebrand J, Bell R, Legenbauer T, Holtmann M, Becker K, Weber L, Romanos M, Egberts K, Kaess M, Fleischhaker C, Möhler E, Wessing I, Hagmann D, Hahn F, Thiemann U, Antony G, Gramatke K, Roessner V, and Ehrlich S
- Abstract
The COVID-19 pandemic appears to have had a considerable impact on the mental health of children and adolescents, particularly regarding eating disorders. However, it remains unclear whether the pandemic affected only the frequency or also the severity of eating disorders. We examined potential pandemic-related changes in the administrative prevalence of eating disorders in the outpatient sector compared with other mental disorders using German statutory health insurance data for the age group 10 to 16 years. We also examined disorder severity of anorexia nervosa using data from the multicenter German Registry of Children and Adolescents with Anorexia Nervosa in the same age group. Our results showed a marked increase in the administrative prevalence of eating disorders (based on documented diagnoses) in the outpatient sector among girls but not among boys. A similar pattern was found for internalizing disorders, whereas the administrative prevalences of externalizing disorders decreased. Regarding the severity of anorexia nervosa among inpatients, we found no pandemic-related changes in body mass index standard deviation score at admission, body weight loss before admission, psychiatric comorbidities and psychopharmacological medication. Given the administrative prevalence increase in the outpatient sector, the lack of impact of the pandemic on the inpatient sector may also be partly due to a shift in healthcare utilization towards outpatient services during the pandemic. Thus, the higher number of children and adolescents requiring specialized and timely outpatient care may be a major concern under pandemic conditions., (© 2024. The Author(s).)
- Published
- 2024
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46. Feasibility and Effectiveness of a New Short-Term Psychotherapy Concept for Adolescents With Emotional Dysregulation.
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Dixius A and Möhler E
- Abstract
Background: The 'Stress-Trauma-Symptoms-Regulation-Treatment' (START) is an innovative manualized short-term treatment program for stabilization and stress resilience in emotionally dysregulated adolescents, based on an approach of stress and management and emotional regulation. The current pilot trial aims to assess the feasibility and effectiveness of the START intervention program for improvement of emotion regulation. Methods: Sixty-six adolescents between the age of 13-18 years admitted to a psychiatric unit for acute emotional or behavioral dysregulation took part in the START program for 5 weeks in an open group setting with two sessions per week (70 min/session). Before treatment, we assessed a history of adverse experience with the Child and Adolescent Trauma Screen (CATS) and the Child Posttraumatic Cognitions Inventory (CPTCI). Before and after treatment, the participants completed the FEEL-KJ, a self-report screening instrument of emotional regulation and coping strategies. Results: A large proportion of this sample had experienced traumatic events based on the CATS (75%) and the CPTCI (82%). The mean FEEL-KJ score significantly decreased after the intervention ( d = -0.248, p = 0.037), while no difference was observed with regard to mean level of adaptive emotion regulation strategies ( d = 0.202, p = 0.207). A positive effect of the intervention was observed on three components of the adaptive FEEL-KJ scale: accepting (d = 0.289, p = 0.08), forgetting ( d = 0.271, p = 0.049) and dealing with anger ( d = 0.309, p = 0.034). Conclusion: START demonstrates preliminary evidence for improvement in emotional dysregulation after a 5-weeks course of treatment. Therefore, this short-term intervention can possibly be regarded as a tool to improve emotional stability in children with a high load of trauma-related psychopathology. The results are promising and warrant future studies, specifically randomized controlled trials on the effectiveness of START for strengthening resilience at-risk-populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dixius and Möhler.)
- Published
- 2021
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