167 results on '"Per Hove Thomsen"'
Search Results
2. Group Based Cognitive Behavioural Therapy for Anxiety in Children with Autism Spectrum Disorder:A Randomised Controlled Trial in a General Child Psychiatric Hospital Setting
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Tina R. Kilburn, Merete Juul Sørensen, Mikael Thastum, Ronald M. Rapee, Charlotte Ulrikka Rask, Per Hove Thomsen, Kristian Arendt, and Anders Helles Carlsen
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medicine.medical_specialty ,CBT ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Developmental and Educational Psychology ,medicine ,Psychiatric hospital ,0501 psychology and cognitive sciences ,Autism spectrum disorder ,Psychiatry ,Children ,Public health ,05 social sciences ,Cognition ,medicine.disease ,Anxiety disorder ,Autism ,Anxiety ,medicine.symptom ,Psychology ,030217 neurology & neurosurgery ,050104 developmental & child psychology - Abstract
Cognitive Behavioural Therapy (CBT) programs adapted to children with Autism Spectrum Disorder (ASD) effectively reduce anxiety when run in university clinics. Forty-nine children aged 8-14 years participated in a waitlist controlled study in a general child psychiatric hospital setting. Post-treatment 30% of the children were free of their primary anxiety diagnoses and 5% were free of all anxiety diagnoses. No statistically significant difference between the two trial conditions were found on primary outcomes. However, statistically significant differences were found on secondary outcomes indicating clinically meaningful treatment responses. Together with high program satisfaction this study shows the CBT program to be feasible and potentially efficacious in treating anxiety in children with ASD in a general child psychiatric hospital setting.
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- 2023
3. Motor impairments in early onset schizophrenia
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Loa Clausen, Pernille Byrial, Lene Nyboe, and Per Hove Thomsen
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Motor disorder ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Motor Disorders ,Psychological intervention ,Correlation ,Physical medicine and rehabilitation ,medicine ,Humans ,adolescents ,Antipsychotic ,Biological Psychiatry ,Motor skill ,child ,motor skills ,business.industry ,Cognition ,Stepwise regression ,medicine.disease ,schizophrenia ,Psychiatry and Mental health ,Schizophrenia ,Schizophrenic Psychology ,motor disorder ,Pshychiatric Mental Health ,Cognition Disorders ,business ,Antipsychotic Agents - Abstract
AIM: Motor impairments are frequent both at and before diagnosis. In childhood, impairments in general fine and gross motor function are among others identified using test batteries, and while elements of coordination are assessed in onset schizophrenia, the assessment of general motor functions is absent. Thus, we aimed to assess general motor function including childhood motor function in adolescents with schizophrenia in comparison with healthy controls and examine clinical correlates to general motor function.METHOD: General fine and gross motor function was assessed using two standardized age-normed test batteries and a questionnaire in 25 adolescents with schizophrenia compared with age and gender-matched controls using t-test and χ2 -test. Stepwise linear regression assessed potential developmental predictors on motor function including complications during childbirth, reported childhood motor function, executive function including false discovery rate q-values. Associations with schizophrenia symptom severity, executive function, cognitive function were assessed using Pearson's correlation and the impact of antipsychotic medication using t-test.RESULT: All measures of motor function but one significantly differentiated adolescents with schizophrenia from healthy controls. The presence of schizophrenia (β =4.41, β = 10.96), explained the main part of the variance however, childhood motor function (β = .08) also added significantly to motor function. Executive function (β = -.45) was important for childhood motor function. Severity of schizophrenia was associated with strength (p CONCLUSION: The documentation of significant differences in general motor function in early onset schizophrenia compared with healthy controls highlights the need for general motor assessments and potential interventions.
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- 2021
4. Health anxiety symptoms in pediatric obsessive–compulsive disorder:patient characteristics and effect on treatment outcome
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Charlotte Ulrikka Rask, Per Hove Thomsen, Davíð R.M.A. Højgaard, Charlotte Steen Duholm, and Gudmundur Skarphedinsson
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medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Treatment outcome ,Patient characteristics ,Comorbidity ,Affect (psychology) ,behavioral disciplines and activities ,Obsessive–compulsive disorder ,Obsessive-Compulsive Disorder/complications ,mental disorders ,Health anxiety ,Developmental and Educational Psychology ,Child and adolescent psychiatry ,medicine ,Obsessive-compulsive disorder ,Humans ,Child ,Pediatric ,business.industry ,Anxiety/therapy ,Cognitive Behavioral Therapy/methods ,General Medicine ,medicine.disease ,humanities ,Cognitive behavioral therapy ,Hypochondriasis ,Clinical trial ,Treatment ,Psychiatry and Mental health ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Anxiety ,medicine.symptom ,business ,Clinical psychology - Abstract
The aim was to explore the potential clinical role of health anxiety (HA) symptoms in children and adolescents diagnosed with obsessive–compulsive disorder (OCD). The study investigated differences in demographic and various clinical variables between young people with OCD, with and without HA symptoms, and the effect of HA symptoms on overall OCD treatment outcome. The study sample comprised 269 children and adolescents with OCD (aged 7–17 years) from the large Nordic Long-term OCD Treatment Study. OCD symptoms and severity were assessed with The Children’s Yale-Brown Obsessive–Compulsive Scale (CY-BOCS), which includes one item regarding HA-like obsessions and one item regarding HA-like compulsions that were used to define the HA group. Several other instruments were used to assess comorbidity and other clinical aspects. All participants were treated with 14 weekly protocolled sessions of exposure-based cognitive behavioral therapy (CBT). HA symptoms were present in 31% of participants. Other anxiety symptoms and comorbid anxiety disorders were more prevalent among those with HA symptoms. These patients also presented with significantly more types of OCD symptoms. HA symptoms were reduced following OCD treatment with CBT and having HA symptoms did not affect CBT outcome. Results suggest that pediatric OCD with HA symptoms is characterized by more anxiety symptoms and a more heterogeneous OCD symptom profile. Standardized CBT seems equally effective in treating child and adolescent OCD with or without HA symptoms. Clinical trials registration: Nordic Long-term Obsessive–Compulsive Disorder Treatment Study: www.controlled-trials.com ; ISRCTN66385119.
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- 2022
5. Quality of life in pediatric patients with obsessive–compulsive disorder during and 3 years after stepped-care treatment
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Karin Melin, Davíð R.M.A. Højgaard, Anders Helles Carlsen, Katja A. Hybel, Scott N. Compton, Bernhard Weidle, Nor Christian Torp, Sanne Skov Jensen, Tord Ivarsson, Judith Becker Nissen, Erik Lykke Mortensen, Per Hove Thomsen, Fabian Lenhard, and Gudmundur Skarphedinsson
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Quality of life ,medicine.medical_specialty ,Pediatrics ,Children and adolescents ,SYMPTOMS ,TERM OCD TREATMENT ,Norm (group) ,Population ,QUESTIONNAIRE ,SCHOOL-CHILDREN ,Obsessive–compulsive disorder ,03 medical and health sciences ,0302 clinical medicine ,Long-term ,Obsessive compulsive ,ADOLESCENTS ,Obsessive-compulsive disorder ,Developmental and Educational Psychology ,Child and adolescent psychiatry ,Medicine ,0501 psychology and cognitive sciences ,Clinical significance ,Stepped care ,Treatment outcome ,education ,education.field_of_study ,business.industry ,FUNCTIONAL IMPAIRMENT ,05 social sciences ,General Medicine ,Stepped-care treatment ,COGNITIVE-BEHAVIOR THERAPY ,humanities ,030227 psychiatry ,Psychiatry and Mental health ,PSYCHOMETRIC PROPERTIES ,GLOBAL ASSESSMENT SCALE ,Pediatrics, Perinatology and Child Health ,business ,MENTAL-HEALTH ,After treatment ,050104 developmental & child psychology - Abstract
The present study aimed to investigate the long-term quality of life (QoL) in a large sample of pediatric obsessive–compulsive disorder (OCD) patients. The study included 220 pediatric OCD patients from the Nordic Long-term OCD Treatment Study (NordLOTS) who were evaluated at seven time points before, during, and after stepped-care treatment over a 3-year follow-up period. Data from three symptom severity trajectory classes formed the basis of the QoL evaluation: acute (n = 127, N = 147), slow (n = 46, N = 63), and limited responders (n = 47, N = 59). Patients’ QoL was assessed using parent and child ratings of the revised Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R). QoL was analyzed by trajectory class using a random mixed effects model. The association between pre-treatment factors and long-term QoL was investigated across classes in a multivariate model. Three years after treatment, the acute responder class had reached QoL levels from a general population, whereas the limited responder class had not. The slow responder class reached norm levels for the child-rated QoL only. Higher levels of co-occurring externalizing symptoms before treatment were associated with lower parent-rated QoL during follow-up, while adolescence and higher levels of co-occurring internalizing symptoms were associated with lower child-rated QoL during follow-up. For some patients, residual OCD symptoms in the years after treatment, even at levels below assumed clinical significance, are associated with compromised QoL. Co-occurring symptoms could be part of the explanation. Assessing QoL after OCD treatment, beyond the clinician-rated symptom severity, could detect patients in need of further treatment and/or assessment. Trial registry: Nordic Long-term Obsessive–Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com ; ISRCTN66385119.
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- 2021
6. The factor structure of attention-deficit/hyperactivity disorder in schoolchildren
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Trine Wigh Arildskov, Anne Virring, Edmund J.S. Sonuga-Barke, Søren Dinesen Østergaard, Rikke Lambek, Anders Helles Carlsen, and Per Hove Thomsen
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Population ,Bifactor model ,Sample (statistics) ,Models, Psychological ,Factor structure ,Impulsivity ,Parent ratings ,Confirmatory factor analysis ,Child and adolescent ,Attention Deficit Disorder with Hyperactivity/diagnosis ,Developmental and Educational Psychology ,medicine ,Attention deficit hyperactivity disorder ,Psychiatric hospital ,ADHD ,Humans ,education ,Child ,Children ,ADHD-RS ,education.field_of_study ,medicine.disease ,Clinical Psychology ,Attention-deficit/hyperactivity disorder ,Attention Deficit Disorder with Hyperactivity ,Impulsive Behavior ,medicine.symptom ,Psychology ,Factor Analysis, Statistical ,Clinical psychology - Abstract
This study investigated the factor structure of attention-deficit/hyperactivity disorder (ADHD) by comparing the fit of a single-factor model, a correlated model with two or three factors, and a bifactor model with one general and two or three specific factors. Different three-factor solutions that varied with regard to the specification of the item “talks excessively” as impulsivity or hyperactivity were also tested. Parent ratings on the ADHD-Rating Scale (ADHD-RS-IV) were collected in a sample of 2044 schoolchildren (1st to 3rd grade) from the general population and in a clinical sample of 165 children and adolescents with ADHD referred to a public regional child and adolescent psychiatric hospital. Confirmatory factor analyses found a satisfactory fit for most models in both samples. However, a correlated three-factor model where “talks excessively” was included as an indicator of impulsivity and especially the bifactor version of this model with one general and three specific factors fit the data slightly better in the general population. In the clinical sample, a number of models performed equally well (the same version of the correlated three-factor model and all the bifactor models). Overall, the factor structure of ADHD seems to be better characterized by a bifactor model with a strong general factor and two or three weaker specific factors. Due to the strong general factor, we suggest emphasizing the ADHD-RS-IV total score rather than the subscale scores in clinical practice.
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- 2022
7. Systematic Review and Meta-analysis:An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder
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Jessica A. Johnson, Fernando R. Asbahr, Michael H. Bloch, Wayne K. Goodman, Michelle Rozenman, Brent J. Small, Eva Serlachius, Divya Ramakrishnan, Cynthia Turner, Adam B. Lewin, Eric A. Storch, Luis C. Farhat, Edoardo F.Q. Vattimo, David Mataix-Cols, Jennifer B. Freeman, John Piacentini, Mohammad Shabani, Gudmundur Skarphedinsson, Angeli Landeros-Weisenberger, Fenghua Li, Daniel Fatori, Fabian Lenhard, Jessica L.S. Levine, Tara S. Peris, Paul Grant, Lisa J. Merlo, Tord Ivarsson, Roseli G. Shavitt, Martin E. Franklin, Daniel A. Geller, Per Hove Thomsen, Bekir B. Artukoglu, Isobel Heyman, Ana I. Rosa-Alcázar, Sandra L. Cepeda, Jonathan S. Comer, Ángel Rosa-Alcázar, Bernhard Weidle, Euripedes Constantino Miguel, Susan E. Swedo, Hamid Mohsenabadi, and Jeffrey Sapyta
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medicine.medical_specialty ,Treatment response ,Obsessive-Compulsive Disorder ,Youden's J statistic ,CY-BOCS ,PsycINFO ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Developmental and Educational Psychology ,medicine ,Raw score ,Humans ,Child ,business.industry ,Area under the curve ,diagnostic test accuracy ,Clinical trial ,meta-analysis ,obsessive-compulsive disorder ,Psychiatry and Mental health ,Research Design ,Meta-analysis ,randomized controlled trials ,business - Abstract
Objective A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children’s Yale−Brown Obsessive-Compulsive Scale (CY-BOCS) in determining response and remission. We also aimed to generate empirically derived cutoffs on the CY-BOCS for these outcomes. Method A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references; 42 randomized controlled clinical trials were considered eligible, and 21 provided data for inclusion (N 1,234). Scores of ≤2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A 2-stage, random-effects meta-analysis model was established. The area under the curve (AUC) and the Youden Index were computed to indicate the discriminative ability of the CY-BOCS and to guide for the optimal cutoff, respectively. Results The CY-BOCS had sufficient discriminative ability to determine response (AUC = 0.89) and remission (AUC = 0.92). The optimal cutoff for response was a ≥35% reduction from baseline to posttreatment (sensitivity = 83.9, 95% CI = 83.7−84.1; specificity = 81.7, 95% CI = 81.5−81.9). The optimal cutoff for remission was a posttreatment raw score of ≤12 (sensitivity = 82.0, 95% CI = 81.8−82.2; specificity = 84.6, 95% CI = 84.4−84.8). Conclusion Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD randomized controlled clinical trials. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD.
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- 2022
8. Testing the evolutionary advantage theory of attention-deficit/hyperactivity disorder traits
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Trine Wigh Arildskov, Anne Virring, Per Hove Thomsen, and Søren Dinesen Østergaard
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SELECTION ,Persistence (psychology) ,medicine.medical_specialty ,Population ,HYPERACTIVITY ,CHILDREN ,03 medical and health sciences ,Natural selection-based theories of ADHD ,0302 clinical medicine ,Attention Deficit Disorder with Hyperactivity/diagnosis ,Linear regression ,Adaptive advantages ,Developmental and Educational Psychology ,medicine ,Child and adolescent psychiatry ,ADHD ,Humans ,Attention deficit hyperactivity disorder ,0501 psychology and cognitive sciences ,Central Nervous System Stimulants/therapeutic use ,Child ,education ,Response inhibition ,education.field_of_study ,Working memory ,05 social sciences ,Regression analysis ,General Medicine ,medicine.disease ,GENE ,030227 psychiatry ,Psychiatry and Mental health ,Phenotype ,ADAPTATIONISM ,PARADOX ,Pediatrics, Perinatology and Child Health ,Dimensionality ,Psychology ,BEHAVIOR ,050104 developmental & child psychology ,Clinical psychology - Abstract
To reconcile the strong secular persistence of attention-deficit/hyperactivity disorder (ADHD) despite its impairing effects, ADHD traits have been postulated to offer an evolutionary advantage. It has been proposed that such advantages should in particular be observable under time-critical, novel, and resource-depleted conditions requiring response-readiness and high levels of scanning and exploration/foraging. Our objective was to provide the first behavioral test of this hypothesis. Schoolchildren from the general population with no/few (n = 56), mild (n = 50), moderate (n = 48), and severe (n = 48) ADHD traits, defined according to their ADHD-Rating Scale IV (ADHD-RS-IV) total score, participated in an exploratory foraging and response-readiness laboratory test. Here, children searched for coins hidden in locations of varying obscurity in an unfamiliar room for 1 min. Test-performance (number of coins found) adjusted for age, sex, and estimated IQ was analyzed categorically using multiple linear regression analyses and dimensionally by fitting a regression model including the ADHD-RS-IV score as a continuous measure. There were no differences in the mean number of coins between the No/Few (Mean = 7.82), Mild (Mean = 7.76), Moderate (Mean = 7.58), and Severe (Mean = 7.88) groups [F(3,195) = 0.24, p = 0.871]. Furthermore, excluding children with functional impairment, adjusting for verbal working memory and response inhibition, and stratifying for sex did not change these findings. Finally, continuous ADHD traits were not found to be related to test-performance [F(3,195) = 0.73, p = 0.536]. While our results do generally not support the evolutionary advantage theory (i.e., ADHD traits neither conferred an advantage nor a disadvantage), this does not disprove that ADHD traits may have offered advantages via other mechanisms.
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- 2021
9. How much impairment is required for ADHD? No evidence of a discrete threshold
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Søren Dinesen Østergaard, Per Hove Thomsen, Anne Virring, Trine Wigh Arildskov, and Edmund J.S. Sonuga-Barke
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medicine.medical_specialty ,DIMENSIONS ,Functional impairment ,SYMPTOMS ,Population sample ,diagnosis ,DEFICIT HYPERACTIVITY DISORDER ,IMPACT ,CHILDHOOD ,CHILDREN ,Comorbidity ,Audiology ,03 medical and health sciences ,0302 clinical medicine ,Rating scale ,Developmental and Educational Psychology ,medicine ,Cutoff ,Attention deficit hyperactivity disorder ,Humans ,0501 psychology and cognitive sciences ,ATTENTION-DEFICIT/HYPERACTIVITY DISORDER ,05 social sciences ,FUNCTIONAL IMPAIRMENT ,Parent reports ,schoolchildren ,Strengths and Difficulties Questionnaire ,medicine.disease ,continuity ,Rate of increase ,Psychiatry and Mental health ,Attention Deficit Disorder with Hyperactivity ,symptomatology ,Pediatrics, Perinatology and Child Health ,STRENGTHS ,Psychology ,030217 neurology & neurosurgery ,050104 developmental & child psychology - Abstract
Background: A diagnosis of attention-deficit/hyperactivity disorder (ADHD) requires the presence of impairment alongside symptoms above a specific frequency and severity threshold. However, the question of whether that symptom threshold represents anything more than an arbitrary cutoff on a continuum of impairment requires further empirical study. Therefore, we present the first study investigating if the relationship between ADHD symptom severity and functional impairment is nonlinear in a way that suggests a discrete, nonarbitrary symptom level threshold associated with a marked step increase in impairment. Methods: Parent reports on the ADHD-Rating Scale (ADHD-RS-IV), the Weiss Functional Impairment Rating Scale (WFIRS-P), and the Strengths and Difficulties Questionnaire were collected in a general population sample of 1st, 2nd, and 3rd graders (N = 1,914–2,044). Results: Piecewise linear regression analyses and nonlinear regression modeling both demonstrated that the relationship between symptom severity (ADHD-RS-IV total score) and impairment (WFIRS-P mean score) was characterized by a gradual linear increase in impairment with higher symptom severity and no apparent step increase or changing rate of increase in impairment at a certain high ADHD-RS-IV total score level. Controlling for socioeconomic status, sex, and co-occurring conduct and emotional symptoms did not alter these results, though comorbid symptoms had a significant effect on impairment. Conclusions: There was no clear evidence for a discrete, nonarbitrary symptom severity threshold with regard to impairment. The results highlight the continued need to consider both symptoms and impairment in the diagnosis of ADHD.
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- 2022
10. The Association between Sleep Problems and Neuropsychological Deficits in Medication-naïve Children with ADHD
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Poul Jennum, Rikke Lambek, Anne Virring Sørensen, Edmund J.S. Sonuga-Barke, and Per Hove Thomsen
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Multiple Sleep Latency Test ,Male ,Sleep Wake Disorders ,ADHD, søvn, eksekutive funktioner, delay aversion ,Adolescent ,Polysomnography ,Neuroscience (miscellaneous) ,Medicine (miscellaneous) ,Neuropsychological Tests ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Medicine ,Humans ,Association (psychology) ,Child ,Sleep Stages ,medicine.diagnostic_test ,business.industry ,Gold standard ,Neuropsychology ,Sleep in non-human animals ,Behavior Rating Inventory of Executive Function ,030228 respiratory system ,Attention Deficit Disorder with Hyperactivity ,Female ,Neurology (clinical) ,Psychology (miscellaneous) ,business ,Sleep ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Background: Children with ADHD are reported to have sleep problems and neuropsychological deficits, but studies examining a potential association between the two are scarce and the use of varying methodology can complicate conclusions. Participants: A clinical sample of 59 medication-naïve children with ADHD between the ages of 6 and 14 years (71% male). Methods: Children underwent polysomnography and multiple sleep latency test, and parent rated sleep habits on the Children’s Sleep Habits Questionnaire. Children also completed an extensive neuropsychological battery of executive function and delay aversion tasks, and parents and teachers rated executive function behavior on the Behavior Rating Inventory of Executive Function. Linear regression analyses were conducted with each of the neuropsychological outcomes included as the outcome variable and the sleep parameters as the predictor variables. Results: The correlations between sleep and neuropsychological outcomes were generally modest, but some sleep parameters (primarily sleep stages and sleep latencies) were associated with objectively and subjectively measured executive function and delay aversion. Conclusions: Using objective and subjective gold standard assessment procedures this study supports a (modest) association between sleep and neuropsychological function in children with ADHD.
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- 2022
11. Accuracy of diagnostic judgments using ICD-11 vs. ICD-10 diagnostic guidelines for obsessive-compulsive and related disorders
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Geoffrey M. Reed, Tahilia J. Rebello, Naomi A. Fineberg, Anne Claire Stona, Cary S. Kogan, Chihiro Matsumoto, Zhen Wang, Dan J. Stein, Odile A. van den Heuvel, Per Hove Thomsen, Jon E. Grant, Hisato Matsunaga, Jean Grenier, Tecelli Domínguez-Martínez, Leonardo F. Fontenelle, Mayya Kulygina, K. Jacky Chan, Jared W. Keeley, David Veale, H. Blair Simpson, Psychiatry, and Amsterdam Neuroscience - Compulsivity, Impulsivity & Attention
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Obsessive-Compulsive Disorder ,Compulsive Personality Disorder ,Case vignette ,Diagnostic accuracy ,Obsessive-compulsive and related disorders ,World health ,Russia ,Judgment ,03 medical and health sciences ,0302 clinical medicine ,International Classification of Diseases ,Obsessive compulsive ,ICD-11 ,Diagnosis ,Humans ,Medicine ,Routine clinical practice ,business.industry ,ICD-10 ,Field study ,International classification of diseases and related health problems ,Classification ,Mental health ,030227 psychiatry ,Clinical Practice ,Psychiatry and Mental health ,Clinical Psychology ,business ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
BACKGROUND: We report results of an internet-based field study evaluating the diagnostic guidelines for the newly introduced ICD-11 grouping of obsessive-compulsive and related disorders (OCRD). We examined accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 diagnostic guidelines to standardized case vignettes.METHODS: 1,717 mental health professionals who are members of the World Health Organization's Global Clinical Practice Network completed the study in Chinese, English, French, Japanese, Russian or Spanish. Participants were randomly assigned to apply ICD-11 or ICD-10 guidelines to one of nine pairs of case vignettes.RESULTS: Participants using ICD-11 outperformed those using ICD-10 in correctly identifying newly introduced OCRD, although results were mixed for differentiating OCRD from disorders in other groupings largely due to clinicians having difficulty differentiating challenging presentations of OCD. Clinicians had difficulty applying a three-level insight qualifier, although the 'poor to absent' level assisted with differentiating OCRD from psychotic disorders. Brief training on the rationale for an OCRD grouping did not improve diagnostic accuracy suggesting sufficient detail of the proposed guidelines.LIMITATIONS: Standardized case vignettes were manipulated to include specific characteristics; the degree of accuracy of clinicians' diagnostic judgments about these vignettes may not generalize to application in routine clinical practice.CONCLUSIONS: Overall, use of the ICD-11 guidelines resulted in more accurate diagnosis of case vignettes compared to the ICD-10 guidelines, particularly in differentiating OCRD presentations from one another. Specific areas in which the ICD-11 guidelines did not perform as intended provided the basis for further revisions to the guidelines.
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- 2020
12. The use of diet interventions to treat symptoms of ADHD in children and adolescents – a systematic review of randomized controlled trials
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Nanna Maria Uldall Torp and Per Hove Thomsen
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medicine.medical_specialty ,Adolescent ,diet-intervention ,Psychological intervention ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,children ,Randomized controlled trial ,law ,Elimination diet ,mental disorders ,ADHD ,Humans ,Medicine ,adolescents ,Child ,Psychiatry ,Randomized Controlled Trials as Topic ,business.industry ,Brain ,Diet ,030227 psychiatry ,Psychiatry and Mental health ,Attention Deficit Disorder with Hyperactivity ,Systematic review ,business ,030217 neurology & neurosurgery ,Systematic search - Abstract
Background: For over forty years diet interventions have been investigated as a treatment of ADHD in children and adolescents and, with the new discoveries of the microbiota-gut-brain axis, this research becomes more relevant than ever. The aim of this systematic review was therefore to investigate the current knowledge of diet interventions as a treatment of ADHD in children and adolescents Methods: A systematic literature search in PubMed was conducted, identifying randomized controlled trials investigating diet interventions to treat ADHD in children and adolescents. Results: The study populations were generally small and the studies varied in duration and nature of the exposure. Overall 10 out of 12 studies spoke in favour of an elimination diet, 2 out of 6 of eliminating artificial food colourings from the diet and none in favour of eliminating sucrose or aspartame from the diet to treat ADHD. Conclusion: The current evidence is not enough to recommend treating ADHD with diet interventions, but a subgroup of children and adolescents might warrant from elimination of certain food-items. Further investigations of the mechanism and effect of diet interventions to treat ADHD is needed.
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- 2020
13. Time Trends in Diagnostics and Clinical Features of Young Children Referred on Suspicion of Autism: A Population-Based Clinical Cohort Study, 2000–2010
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Diana Schendel, Sara Højslev Avlund, Meta Jørgensen, Per Hove Thomsen, and Loa Clausen
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medicine.medical_specialty ,Pediatrics ,Clinical cohort ,Referral ,Young children ,UNITED-STATES ,Population based ,behavioral disciplines and activities ,Ambiguous autism symptoms ,Autism Diagnostic Observation Schedule ,03 medical and health sciences ,0302 clinical medicine ,ADOLESCENTS ,mental disorders ,Developmental and Educational Psychology ,medicine ,0501 psychology and cognitive sciences ,Autism spectrum disorder ,SPECTRUM DISORDER ,ADOS ,SITES ,STABILITY ,Time trends ,Public health ,05 social sciences ,medicine.disease ,DISABILITIES MONITORING NETWORK ,PREVALENCE ,OBSERVATION SCHEDULE ,Autism ,Repetitive ritualistic stereotyped behaviors ,Psychology ,030217 neurology & neurosurgery ,050104 developmental & child psychology - Abstract
The present study aimed to explore clinical trends in the period 2000-2010, along with discriminating clinical factors for autism spectrum disorder (ASD), in young children suspected of ASD. The following trends were observed: (1) a rise in referrals including an increase in referrals among language-abled children, (2) an increase in children assigned an ASD diagnosis after assessment, and (3) a decrease in Autism Diagnostic Observation Schedule total score. The distribution of ASD subtypes and IQ level did not change. Results suggest that a higher proportion of children with less severe autism symptoms were referred and diagnosed. Further, restricted and repetitive behaviors seemed to be a key discriminating factor when distinguishing between ASD and no-ASD children with a discordant symptom profile.
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- 2020
14. Treatment Gains Are Sustainable in Pediatric Obsessive-Compulsive Disorder: Three-Year Follow-Up From the NordLOTS
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Katja A. Hybel, Davíð R.M.A. Højgaard, Sanne Skov Jensen, Tord Ivarsson, Bente Storm Mowatt Haugland, Nor Christian Torp, Robert Valderhaug, Gudmundur Skarphedinsson, Kitty Dahl, Karin Melin, Bernhard Weidle, Per Hove Thomsen, Judith Becker Nissen, and Ingela Skärsäter
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Obsessive-Compulsive Disorder ,Pediatrics ,medicine.medical_specialty ,Adolescent ,cognitive-behavioral therapy ,medicine.medical_treatment ,behavioral disciplines and activities ,Pharmacotherapy ,Obsessive compulsive ,Sertraline ,mental disorders ,follow-up ,Developmental and Educational Psychology ,medicine ,Humans ,0501 psychology and cognitive sciences ,Child ,Cognitive Behavioral Therapy ,sertraline ,business.industry ,05 social sciences ,Significant difference ,obsessive-compulsive disorder ,Cognitive behavioral therapy ,Clinical trial ,Psychiatry and Mental health ,Treatment Outcome ,pediatric ,Treatment study ,business ,After treatment ,Follow-Up Studies ,050104 developmental & child psychology ,medicine.drug - Abstract
Objective This study evaluated the long-term outcomes of a stepped care treatment for pediatric obsessive-compulsive disorder (OCD) and investigated whether response to first-step cognitive-behavioral therapy (CBT) is an important indicator of 3-year outcomes. Method This study is a part of the Nordic Long-term OCD Treatment Study (NordLOTS), in which 269 children and adolescents were treated with CBT. Nonresponders to CBT were randomized to extended treatment with continued CBT or pharmacotherapy with sertraline. Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores no higher than 15 and no higher than 10 were defined as treatment response and remission, respectively. Participants were assessed 2 and 3 years after first-step CBT. Linear mixed-effects models were used to analyze the outcomes. Results Intent-to-treat analyses showed a significant decrease in CY-BOCS total score from baseline (24.6) to 3-year follow-up (5.0; p = .001), with a mean decrease of 5.9 from after treatment to 3-year follow-up. Three years after treatment, 90% (n = 242) of participants were rated as responders and 73% were in clinical remission. The duration of treatment did not influence the symptom level at 3-year follow-up (p = .998) and no significant difference was found (p = .169) between the extended treatment conditions. Conclusion The results suggest that evidence-based treatment for pediatric OCD has long-term positive effects, whether a first step of manual-based CBT or extended treatment with CBT or sertraline. The improvements were maintained, and the symptoms decreased further during follow-up and were, after 3 years, similarly independent of treatment duration and form of extended treatment. Clinical trial registration information Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.
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- 2020
15. Factors Associated with a Delayed Autism Spectrum Disorder Diagnosis in Children Previously Assessed on Suspicion of Autism
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Sara Højslev Avlund, Loa Clausen, Per Hove Thomsen, Meta Jørgensen, Diana Schendel, and Anders Helles Carlsen
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Pediatrics ,medicine.medical_specialty ,genetic structures ,Age at diagnosis ,autism spectrum disorder ,Delayed diagnosis ,behavioral disciplines and activities ,Autism Diagnostic Observation Schedule ,03 medical and health sciences ,0302 clinical medicine ,Parental education ,mental disorders ,Developmental and Educational Psychology ,medicine ,0501 psychology and cognitive sciences ,delayed diagnosis ,ADOS ,05 social sciences ,Cognition ,medicine.disease ,Autism spectrum disorder ,age at diagnosis ,Autism ,Psychology ,030217 neurology & neurosurgery ,050104 developmental & child psychology - Abstract
This study aimed to investigate factors associated with a delayed autism spectrum (ASD) diagnosis when compared to children with either no or early ASD diagnosis. Among 893 children assessed for ASD before age 8, 39% had no ASD at baseline, of which 21% received a later ASD diagnosis. Autism symptoms, diagnostic history of other developmental disorders, cognitive ability, and socioeconomic factors were associated with delayed ASD. Autism Diagnostic Observation Schedule (ADOS) scores in delayed ASD fell between early and no ASD. Other developmental disorders, time and clinical trends like ADOS use and low parental education distinguished delayed and early ASD, whereas higher frequency of IQ
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- 2021
16. Immediate reactions to the covid-19 pandemic in adults with obsessive-compulsive disorder: a self-report survey
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Charlotte Steen Duholm, Sanne Skov Jensen, Judith Becker Nissen, Davíð R.M.A. Højgaard, and Per Hove Thomsen
- Subjects
Adult ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,Obsessive compulsive ,Self-report study ,obsessive compulsive disorder ,Surveys and Questionnaires ,mental disorders ,Pandemic ,adults ,Medicine ,Humans ,survey ,Psychiatry ,Pandemics ,Retrospective Studies ,business.industry ,SARS-CoV-2 ,pandemic ,COVID-19 ,030227 psychiatry ,Psychiatry and Mental health ,Quality of Life ,Female ,Self Report ,business ,030217 neurology & neurosurgery - Abstract
Background: Limited studies are available that investigate the reactions to COVID-19 pandemic by people suffering from obsessive-compulsive disorder (OCD). Due to the nature of the pandemic and the heightened focus on contamination, cleaning, and social distancing, it is likely that a deterioration of OCD symptoms and severity will be seen. Aims: Our aims were to evaluate (1) self-reported changes in OCD symptom severity of adults with OCD during the COVID-19 pandemic outbreak, (2) whether the COVID-19 pandemic would trigger self-reported contamination symptoms in persons with no history of such symptoms, (3) self-reported variables associated with OCD symptom severity change, and 4) self-reported changes in quality of life. Method: A 47-item self-report questionnaire was sent to all members of the Danish OCD Association and the final sample comprised 201 adult participants. The association of OCD severity change with demographic and clinical variables was analyzed using linear regression. Results: 61.2% of participants reported an increase in OCD severity, based on the retrospective self-report. Female gender, self-reported contamination symptoms, and self-reported psychiatric comorbidity were found to have a significant association with increasing OCD severity. Five participants reported the emergence of contamination symptoms and two of harm related symptoms. Thirty participants reported a severe reduction in quality of life (≥80). Conclusions: A large group of people suffering from OCD may require special attention and care during a pandemic like COVID-19 in order to lessen the deterioration of OCD symptoms and also to minimize the reduction in quality of life evident in this group.
- Published
- 2021
17. Younger versus older children with obsessive-compulsive disorder:Symptoms, severity and impairment
- Author
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Judith Becker Nissen, David R.M.A. Højgaard, Tord Ivarsson, Bernhard Weidle, Gudmundur Skarphedinsson, Per Hove Thomsen, Orri Smárason, and Nor Christian Torp
- Subjects
050103 clinical psychology ,Cultural context ,CYBOCS ,Child and adolescent ,03 medical and health sciences ,0302 clinical medicine ,Age groups ,NordLOTS ,Symptom profile ,Obsessive compulsive ,mental disorders ,medicine ,Obsessive-compulsive disorder ,0501 psychology and cognitive sciences ,Age differences ,05 social sciences ,Pediatric OCD ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Functional impairment ,Treatment study ,Anxiety ,medicine.symptom ,Age of onset ,Psychology ,Clinical psychology - Abstract
Studies on child and adolescent obsessive-compulsive disorder (OCD) indicate that symptom severity is similar across age, but significant age differences of symptom profile and comorbid disorders have been observed. The current study examines these differences in one of the largest samples to date, and the first sample outside of an English-speaking cultural context. We compared children aged 11 years and younger to adolescents aged 12 years and older from the Nordic Long-Term Obsessive-Compulsive Disorder Treatment Study that included 269 children and adolescents with a primary diagnosis of OCD. The two groups were compared on measures of OCD severity, symptom profile, comorbid symptoms, and functional impairment. Results showed that the younger group had a poorer level of insight, higher rates of ADHD, and disruptive disorders. The older group had higher levels of mental compulsions, miscellaneous obsessions and compulsions, and self-rated functional impairment. No differences were found on the prevalence of anxiety, tic or depressive disorders between the age groups, nor on overall OCD severity. Overall, differences between the age groups were found to be less than in previous research. Defining groups by age of onset and duration of illness rather than age at evaluation did not change results.
- Published
- 2021
18. Convergent and divergent validity of the schedule for affective disorders and schizophrenia for school-age children – present and lifetime version diagnoses in a sample of children and adolescents with obsessive–compulsive disorder
- Author
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Karin Melin, Marie Husby, Per Hove Thomsen, Nor Christian Torp, Davíð R.M.A. Højgaard, Kristin Kragh, Gudmundur Skarphedinsson, Judith Becker Nissen, Katja A. Hybel, and Bernhard Weidle
- Subjects
Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Adolescent ,Psychometrics ,K-SADS-PL ,Comorbidity ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,Convergent validity ,mental disorders ,medicine ,Humans ,Attention deficit hyperactivity disorder ,Longitudinal Studies ,Medical diagnosis ,divergent validity ,Child ,Psychiatry ,Depression (differential diagnoses) ,Psychiatric Status Rating Scales ,Mood Disorders ,Discriminant validity ,Reproducibility of Results ,Schedule for Affective Disorders and Schizophrenia ,medicine.disease ,paediatric OCD ,030227 psychiatry ,comorbidity ,Psychiatry and Mental health ,Schizophrenia ,Anxiety ,Female ,Schizophrenic Psychology ,medicine.symptom ,Psychology ,030217 neurology & neurosurgery - Abstract
The presence of comorbid conditions associated with paediatric obsessive–compulsive disorder (OCD) is reported to range from 50 to 80% and to have an impact on treatment outcome. Accurate identification of comorbid psychiatric disorders is necessary in order to provide personalised care. Reliable and valid diagnostic interviews are essential in the process of establishing the correct diagnoses. The objective of this study was to evaluate the convergent and divergent validity of four diagnose categories generated by the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL). The diagnose categories were: anxiety, depression, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The K-SADS-PL was applied in a clinical sample of youth aged 7–17 years (N = 269), who were participants in the Nordic long-term OCD-treatment study (NordLOTS). Youth and parents completed measures to evaluate symptoms of anxiety, depression, ADHD, and ODD. Convergent and divergent validity of K-SADS-PL anxiety diagnosis was supported based on both anxiety self- and parent-reports. Similarly, support was found for convergent and divergent validity of ADHD and ODD diagnoses. For depressive disorder, support for convergent validity was found based on the depression self-report. Support for divergent validity of depression was found based on both the depression self- and parent-reports. Results of the present study suggest that the K-SADS-PL generates valid diagnoses of comorbid anxiety disorders, depression disorders, ODD, and ADHD in children and adolescents with OCD.
- Published
- 2019
19. Hoarding in children and adolescents with obsessive–compulsive disorder: prevalence, clinical correlates, and cognitive behavioral therapy outcome
- Author
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Nor Christian Torp, Gudmundur Skarphedinsson, Katja A. Hybel, Tord Ivarsson, Davíð R.M.A. Højgaard, Per Hove Thomsen, Karin Melin, Judith Becker Nissen, and Bernhard Weidle
- Subjects
Male ,Obsessive-Compulsive Disorder ,Obsessive-Compulsive Disorder/psychology ,medicine.medical_treatment ,Treatment outcome ,AUTISM SPECTRUM DISORDERS ,Hoarding ,SYMPTOM DIMENSIONS ,0302 clinical medicine ,NordLOTS ,QUALITY-OF-LIFE ,Obsessive-compulsive disorder ,Prevalence ,Developmental and Educational Psychology ,Child and adolescent psychiatry ,PREDICTORS ,Child ,Pediatric ,ASPERGER-SYNDROME ,FUNCTIONAL IMPAIRMENT ,05 social sciences ,General Medicine ,Cognitive behavioral therapy ,Psychiatry and Mental health ,Treatment Outcome ,Treatment study ,Female ,050104 developmental & child psychology ,Clinical psychology ,medicine.medical_specialty ,Clinical variables ,Adolescent ,IMPACT SCALE ,QUESTIONNAIRE ,Affect (psychology) ,behavioral disciplines and activities ,03 medical and health sciences ,Obsessive compulsive ,Hoarding/psychology ,mental disorders ,medicine ,Humans ,0501 psychology and cognitive sciences ,VALIDITY ,OCD ,Cognitive Behavioral Therapy ,business.industry ,Cognitive Behavioral Therapy/methods ,030227 psychiatry ,Treatment ,Pediatrics, Perinatology and Child Health ,business - Abstract
Hoarding, common in pediatric obsessive–compulsive disorder (OCD), has specific clinical correlates and is associated with poor prognosis. However, there are few studies of hoarding in pediatric OCD. This study estimates the occurrence of hoarding symptoms in a sample of children and adolescents with OCD, investigating possible differences in demographic and clinical variables between pediatric OCD with and without hoarding symptoms. Furthermore, the study investigates whether hoarding symptoms predict poorer treatment outcomes after cognitive behavioral therapy (CBT). The study sample comprised 269 children and adolescents with OCD, aged 7–17 years, from Denmark, Sweden, and Norway, who were all included in the Nordic long-term obsessive–compulsive disorder Treatment Study. All had an OCD diagnosis according to the DSM-IV and were treated with 14 weekly sessions of manualized, exposure-based CBT. Hoarding symptoms and OCD severity were assessed with the Children’s Yale–Brown Obsessive–Compulsive Scale and group differences in treatment outcome were analyzed using linear mixed-effect modelling. Seventy-two patients (26.8%) had one or more symptoms of hoarding. Comorbid tic disorders (p = 0.005) and indecision (p = 0.024) were more prevalent among those with hoarding symptoms than those without hoarding symptoms. In addition, youth with hoarding symptoms had a different OCD symptom profile. Having symptoms of hoarding did not affect CBT outcome (p = 0.933). Results from the study suggest that CBT is equally effective for those with and without hoarding-related OCD.
- Published
- 2019
20. The QTc interval and risk of cardiac events in bulimia nervosa: A long-term follow-up study
- Author
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Pernille Charmoth Østergaard, Claus Graff, Henrik Jensen, Per Hove Thomsen, Morten Krogh Christiansen, Loa Clausen, and Tanja Charlotte Frederiksen
- Subjects
Adult ,Male ,medicine.medical_specialty ,cardiac event ,Population ,QTc interval ,bulimia nervosa ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,QT interval ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Bulimia Nervosa ,education ,education.field_of_study ,Bulimia nervosa ,business.industry ,Hazard ratio ,medicine.disease ,mortality ,Long QT Syndrome ,Psychiatry and Mental health ,eating disorder ,Relative risk ,Cohort ,cardiovascular system ,Cardiology ,Female ,business ,Follow-Up Studies ,circulatory and respiratory physiology - Abstract
OBJECTIVE: An association between bulimia nervosa (BN) and prolonged corrected QT interval (QTc) in the electrocardiogram has been suggested, but results of previous studies are conflicting, and the risk of cardiac events in patients with BN has yet to be investigated.METHOD: We estimated mean QTc interval and relative risk of borderline (QTc >440 ms) and prolonged QTc (QTc >460 ms) between adult women with BN (N = 531) and healthy controls (N = 123). In follow-up analyses, we investigated the risk of a primary endpoint (syncope, ventricular tachycardia, and cardiac arrest) and all-cause mortality in patients with BN (N = 702) compared with a population-based cohort derived from the Danish Civil Register (N = 7,020).RESULTS: Mean QTc did not differ between patients with BN and controls. Relative risk of borderline prolonged QTc was 2.3 (p = 0.28). The number of patients and controls with prolonged QTc was small, and the risk did not differ between patients with BN and controls. Median follow-up was 10.6 years. Although there appeared to be increased risks after 5 years of follow-up, long-term risks of the primary endpoint (Hazard ratio [HR] = 1.4, p = 0.37) and all-cause mortality (HR = 1.7, p = .28), respectively, were not increased in patients with BN compared to a population-based cohort.DISCUSSION: Mean QTc did not differ between patients with BN and healthy controls, and the risk of prolonged QTc was not increased in patients with BN. There was no difference in the long-term risk of cardiac events, and long-term all-cause mortality did not differ significantly between patients with BN and a population-based cohort.
- Published
- 2018
21. Obsessive-compulsive symptom dimensions: Association with comorbidity profiles and cognitive-behavioral therapy outcome in pediatric obsessive-compulsive disorder
- Author
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Tord Ivarsson, Gudmundur Skarphedinsson, Nor Christian Torp, Katja A. Hybel, Robert Valderhaug, Eric A. Storch, Judith Becker Nissen, Davíö R.M.A. Højgaard, Kitty Dahl, Karin Melin, Per Hove Thomsen, Bernhard Weidle, and Erik Lykke Mortensen
- Subjects
Male ,Obsessive-Compulsive Disorder ,Adolescent ,Sexual Behavior ,medicine.medical_treatment ,Comorbidity ,Hoarding ,Affect (psychology) ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,mental disorders ,Odds Ratio ,Humans ,Medicine ,0501 psychology and cognitive sciences ,Child ,Association (psychology) ,Biological Psychiatry ,Cognitive Behavioral Therapy ,business.industry ,05 social sciences ,Schedule for Affective Disorders and Schizophrenia ,Odds ratio ,Prognosis ,medicine.disease ,Outcome (probability) ,Latent class model ,030227 psychiatry ,Cognitive behavioral therapy ,Psychiatry and Mental health ,Logistic Models ,Treatment Outcome ,Female ,business ,050104 developmental & child psychology ,Clinical psychology - Abstract
Our aims were to examine: (1) classes of comorbid disorders in a sample of children and adolescents with Obsessive-Compulsive Disorder (OCD), (2) how these classes relate to obsessive-compulsive symptom dimensions, and (3) the extent to which obsessive-compulsive symptom dimensions predict Cognitive-Behavioral Therapy (CBT) outcome. Participants (N = 269) were assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) and the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Latent Class Analysis (LCA) was used to identify comorbidity classes. Regression analyses were used to evaluate symptom dimensions as predictors of treatment outcome and their relation to comorbidity classes. Comorbidity was included in the treatment outcome analyses as it can affect outcome. Comorbidity was best categorized by a three-class model and each class was distinctively correlated with the OCD symptom dimensions. Higher scores on the symmetry/hoarding factor increased the chance of responding to CBT by an odds ratio of 1.56 (p = 0.020) when controlled for age, gender, and comorbidity class. The harm/sexual factor (p = 0.675) and contamination/cleaning factor (p = 0.122) did not predict CBT outcome. Three clinically relevant comorbidity subgroups in pediatric OCD were identified. Patients who exhibited higher levels of symmetry/hoarding dimension were more prone to respond to CBT.
- Published
- 2018
22. Psychometric validation of a Danish version of the Obsessive Beliefs Questionnaire - Child Version (OBQ-CV)
- Author
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Katja A. Hybel, Ingrid Söchting, Rikke Lambek, David R.M.A. Højgaard, Per Hove Thomsen, Cecilie Schultz, and Mikael Thastum
- Subjects
Male ,Obsessive-Compulsive Disorder ,050103 clinical psychology ,medicine.medical_specialty ,Adolescent ,Psychometrics ,Denmark ,Dysfunctional family ,Danish ,03 medical and health sciences ,0302 clinical medicine ,Dysfunctional beliefs ,children ,Surveys and Questionnaires ,Obsessive-compulsive disorder ,medicine ,Humans ,Translations ,0501 psychology and cognitive sciences ,adolescents ,Child ,Psychiatry ,OBQ-CV ,05 social sciences ,Reproducibility of Results ,humanities ,language.human_language ,030227 psychiatry ,Psychiatry and Mental health ,language ,Female ,Obsessive Behavior ,Factor Analysis, Statistical ,Psychology - Abstract
AIM: The aim of the study was to examine the psychometric properties of a Danish version of the Obsessive Beliefs Questionnaire - Child Version (OBQ-CV). The OBQ-CV assesses dysfunctional beliefs concerning responsibility/threat estimation, perfectionism/uncertainty, and importance/control of thoughts, which according to cognitive theories are important in the development and maintenance of obsessive-compulsive disorder (OCD).METHODS: The study included a pediatric sample (age 7-17 years) consisting of 57 children and adolescents with OCD, 49 children and adolescents with an anxiety disorder (AD), and 58 typically developing (TD) children and adolescents without a psychiatric diagnosis. All participants completed the OBQ-CV and the Child Behavior Checklist - the School Age Scales (CBCL/6-18). The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was used to assess OCD symptom severity in the OCD group.RESULTS: Confirmatory factor analyses supported the three-factor structure and thereby the construct validity of the OBQ-CV. Gender was not associated with subscale scores, whereas age influenced the subscale scores differently in the three groups. Reliability analyses showed acceptable to excellent internal consistency and acceptable test-retest reliability of the instrument. There were significant differences between the OCD group and the TD group, supporting the criterion validity. Results on convergent validity were mixed.CONCLUSIONS: Overall, results supported the reliability and validity of the Danish OBQ-CV and thus the use of the questionnaire for future clinical and research purposes.
- Published
- 2018
23. One-year outcome of manualised behavior therapy of chronic tic disorders in children and adolescents
- Author
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Judith Becker Nissen, Anders Helles Carlsen, and Per Hove Thomsen
- Subjects
medicine.medical_specialty ,Pediatrics ,Adolescent ,Tics ,lcsh:RC435-571 ,Chronic tics disorder ,Habit reversal training ,Outcome (game theory) ,Tourette syndrome ,Danish ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Psychiatry ,Forensic psychiatry ,Child and adolescent psychiatry ,Medicine ,Children ,business.industry ,lcsh:RJ1-570 ,lcsh:Pediatrics ,medicine.disease ,Long-term outcome ,language.human_language ,030227 psychiatry ,Psychiatry and Mental health ,Pediatrics, Perinatology and Child Health ,language ,Chronic Tic Disorder ,Therapy ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Chronic tic disorders are neurodevelopmental disorders that can be treated with Habit Reversal Training (HRT) and Exposure Response Prevention (ERP). Intermediate and long-term effects have been examined after individual treatment with HRT, whereas evaluation of long-term outcome after an initial treatment with ERP, or a combination of HRT and ERP is lacking. The present study examines the long-term effect after a combined treatment with HRT and ERP delivered in an individual or a group setting Methods Fifty-nine children and adolescents diagnosed with a chronic tic disorder were randomised to manualised treatment combining HRT and ERP as individual or group training. Forty-seven were re-examined 1 year after acute outcome. Outcome measures included Total Tic Severity score (TTS) measured by the Yale Global Tic Severity Scale (YGTSS) and Beliefs About Tics Scale (BATS) Results In a mixed model, it was shown that the initial improvement with both individual and group treatment was maintained throughout the follow-up period. There were no significant differences between the two methods of treatment delivery. Of all participants completing the 12 months evaluation, 74.4% were considered responders. There was a significant positive association between the reduction of TTS and the reduction in BATS. In a latent class post-treatment trajectory analysis, two classes were identified, where high baseline severity increased the likelihood of being in the lesser responder class. Similar, but only as a trend, having ADHD, planning difficulties or hypersensitivity increased the risk of a lesser response. Conclusions The present study compares the efficacy in individualised and group treatment of providing manualised therapy for child and adolescent tic disorders using two behavioural methods (combined HRT and ERP) both of which have been shown to have acute benefits but only one of which has been validated for longer term effectiveness. In the present study, both individualised and group treatments showed benefit throughout a 1-year follow-up period with several potential confounds affecting outcomes, while the relative benefits of either HRT and ERP were not addressed. Trial registration NCT04594044, 1-10-72-216-15, registered 19th October 2020, retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/Home.vm?uid=U0005BW2&ts=9&sid=S000ABEY&cx=-wlx7vb The study is approved by the National Ethical Committee (1-10-72-216-15) and the Danish Data Protection Agency (1–16-02-490-15), registered 12 October 2015.
- Published
- 2021
24. Food preferences, food neophobia and chemosensation among adolescents with ADHD
- Author
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Jelena Stankovic, Therese Ovesen, and Per Hove Thomsen
- Subjects
Taste ,Adolescent ,Food item ,Lower score ,Olfaction ,behavioral disciplines and activities ,03 medical and health sciences ,Food Preferences ,0302 clinical medicine ,030225 pediatrics ,mental disorders ,medicine ,Humans ,030212 general & internal medicine ,Association (psychology) ,Avoidant Restrictive Food Intake Disorder ,business.industry ,digestive, oral, and skin physiology ,Neophobia ,General Medicine ,medicine.disease ,Unhealthy food ,Diet ,nutrition ,Attention Deficit Disorder with Hyperactivity ,Pediatrics, Perinatology and Child Health ,attention-deficit hyperactivity disorder adolescent ,diet ,business ,olfaction ,Clinical psychology - Abstract
Aim: It has been suggested that adolescents diagnosed with ADHD have an unhealthier diet compared to their peers without ADHD. The association between chemosensation (smell and taste) and dietary patterns remains unknown. The aim is to investigate unhealthy food preferences and food neophobic behaviour among adolescents diagnosed with ADHD. Additionally, it is to investigate the relationship between dietary patterns and chemosensory function. Methods: We enrolled 36 adolescents with and without ADHD to complete a food item and a food neophobia questionnaire and to undergo chemosensory testing. Results: Adolescents with ADHD performed significantly worse on both chemosensory tests compared to the non-ADHD group. No difference in food preferences nor food neophobia was found between the two groups. Conclusion: Adolescents with ADHD have a lower score on chemosensory tests compared to their peers, suggesting impaired chemosensory function. No differences in dietary preferences nor food neophobia were seen between the two groups.
- Published
- 2021
25. Effect of Parent Training on Health-Related Quality of Life in Preschool Children With Attention-Deficit/Hyperactivity Disorder:A Secondary Analysis of Data From a Randomized Controlled Trial
- Author
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Per Hove Thomsen, Edmund J.S. Sonuga-Barke, Anne-Mette Lange, Liva Bundgaard Larsen, Charlotte Ulrikka Rask, and David Daley
- Subjects
Parents ,Mediation (statistics) ,preschool children ,Population ,attention-deficit/hyperactivity disorder ,law.invention ,Randomized controlled trial ,Quality of life ,law ,mental disorders ,Developmental and Educational Psychology ,medicine ,Humans ,Attention deficit hyperactivity disorder ,0501 psychology and cognitive sciences ,Early childhood ,Child ,education ,education.field_of_study ,Parenting ,business.industry ,05 social sciences ,medicine.disease ,humanities ,health-related quality of life ,Psychiatry and Mental health ,Treatment Outcome ,Attention Deficit Disorder with Hyperactivity ,Research Design ,Child, Preschool ,parent training ,Quality of Life ,Parent training ,business ,Psychosocial ,050104 developmental & child psychology ,Clinical psychology - Abstract
Objective School-age children with attention-deficit/hyperactivity disorder (ADHD) have reduced health-related quality of life (HRQoL), but it is unclear whether this is also true for preschool children. It is unknown whether parent training (PT) improves HRQoL. This study compared HRQoL in preschool children with ADHD with age-matched children from the general population; examined whether PT improves HRQoL; and tested if treatment-related changes in HRQoL were mediated by improvements in ADHD, parent efficacy, and family stress. Method Parents of 164 children age 3–7 years with an ADHD diagnosis participated in a randomized controlled trial comparing the New Forest Parenting Programme and treatment as usual. Measures of HRQoL, ADHD, parent efficacy, and family stress were completed at baseline, posttreatment, and 36-week follow-up. Child baseline HRQoL was compared with 2 general population-based reference groups. PT effects were analyzed using linear models and mediation analyses. Results Preschoolers with ADHD had lower HRQoL than the reference groups. The New Forest Parenting Programme, but not treatment as usual, was associated with improvement in psychosocial HRQoL at posttreatment (change 2.28, 95% CI [0.78, 3.77]) and at 36-week follow-up (change 2.05, 95% CI [0.56, 3.54]). This difference between treatment arms was not statistically significant. Parent efficacy and family stress scores at posttreatment significantly mediated improvements in HRQoL at 36-week follow-up; ADHD scores at posttreatment did not. Conclusion ADHD negatively impacts HRQoL in early childhood. PT for ADHD has the potential to improve HRQoL independently of its effects on ADHD symptoms. Clinical trial registration information A Controlled Study of Parent Training in the Treatment of ADHD in Young Children (D’SNAPP); http://clinicaltrial.gov/ ; NCT01684644.
- Published
- 2021
26. Effectiveness of transdiagnostic cognitive and behavioral psychotherapy compared to management as usual for youth with common mental health problems. A randomized clinical trial
- Author
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Mikael Thastum, Kerstin J. Plessen, Simon Peter Neumer, Sabrina Mai Nielsen, Louise Berg Puggaard, Mette Maria Agner Pedersen, Wendy K. Silverman, Anne Katrine Pagsberg, Robin Christensen, Rasmus Trap Wolf, Per Hove Thomsen, Christoph U. Correll, Pia Jeppesen, and Niels Bilenberg
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Referral ,Denmark ,medicine.medical_treatment ,Population ,Psychological intervention ,VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Psychiatry, child psychiatry: 757 ,Behavioral Symptoms ,Anxiety ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Outcome Assessment, Health Care ,Humans ,Online First ,Medicine ,Child ,education ,Original Investigation ,education.field_of_study ,Cognitive Behavioral Therapy ,Depression ,business.industry ,Research ,Disease Management ,Strengths and Difficulties Questionnaire ,Mental health ,030227 psychiatry ,Cognitive behavioral therapy ,Psychiatry and Mental health ,VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Psykiatri, barnepsykiatri: 757 ,Physical therapy ,Female ,medicine.symptom ,business ,Comments ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Key Points Question Can a transdiagnostic modular cognitive-behavioral therapy (CBT) program outperform management as usual for youth with emotional and behavioral problems? Findings In this randomized clinical trial of 396 youths aged 6 to 16 years, the parent-reported functional impairment was significantly reduced for youth allocated to transdiagnostic modular CBT compared with management as usual. Key secondary outcomes also indicated a broad range of benefits. Meaning This pragmatic study adds to the growing evidence that the wide-scale implementation of transdiagnostic modular CBT in nonspecialist care settings provides timely indicated prevention and quality care for help-seeking youth., This randomized clinical trial assesses the effectiveness of a new transdiagnostic cognitive-behavioral therapy program compared with management as usual in youths with emotional and behavioral problems below the threshold for referral to mental health care., Importance Behavioral therapy and cognitive-behavioral therapy (CBT) programs targeting a single class of problems have not been widely implemented. The population of youths with common mental health problems is markedly undertreated. Objective To determine the effectiveness of a new transdiagnostic CBT program (Mind My Mind [MMM]) compared with management as usual (MAU) in youths with emotional and behavioral problems below the threshold for referral to mental health care. Design, Setting, and Participants This pragmatic, multisite, randomized clinical trial of MMM vs MAU was conducted from September 7, 2017, to August 28, 2019, including 8 weeks of postintervention follow-up, in 4 municipalities in Denmark. Consecutive help-seeking youths were randomized (1:1) to the MMM or the MAU group. Main inclusion criteria were age 6 to 16 years and anxiety, depressive symptoms, and/or behavioral disturbances as a primary problem. Data were analyzed from August 12 to October 25, 2019. Interventions The MMM intervention consisted of 9 to 13 weekly, individually adapted sessions of manualized CBT delivered by local psychologists. The MAU group received 2 care coordination visits to enhance usual care. Main Outcomes and Measures The primary outcome was change in mental health problems reported by parents at week 18, using the Strengths and Difficulties Questionnaire (SDQ) Impact scale (range, 0-10 points, with higher scores indicating greater severity of distress and impairment). Primary and secondary outcomes were assessed in the intention-to-treat population at week 18. Maintenance effects were assessed at week 26. Results A total of 396 youths (mean [SD] age, 10.3 [2.4] years; 206 [52.0%] boys) were randomized to MMM (n = 197) or MAU (n = 199), with primary outcome data available in 177 (89.8%) and 167 (83.9%), respectively, at 18 weeks. The SDQ Impact score decreased by 2.34 points with MMM and 1.23 with MAU, from initial scores of 4.12 and 4.21, respectively (between-group difference, 1.10 [95% CI, 0.75-1.45]; P
- Published
- 2020
27. The Immediate Effect of COVID-19 Pandemic on Children and Adolescents with Obsessive Compulsive Disorder
- Author
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Judith Becker Nissen, Per Hove Thomsen, and David R.M.A. Højgaard
- Subjects
Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Adolescent ,Coronavirus disease 2019 (COVID-19) ,lcsh:RC435-571 ,Denmark ,Pneumonia, Viral ,Adolescents ,Trauma ,behavioral disciplines and activities ,Danish ,03 medical and health sciences ,0302 clinical medicine ,Obsessive compulsive ,lcsh:Psychiatry ,Pandemic ,mental disorders ,medicine ,Humans ,Attention deficit hyperactivity disorder ,Family history ,Child ,Psychiatry ,Pandemics ,Children ,OCD ,business.industry ,COVID-19 ,medicine.disease ,Health Surveys ,language.human_language ,030227 psychiatry ,Psychiatry and Mental health ,Obsessive compulsive disorder ,language ,Anxiety ,Age of onset ,medicine.symptom ,Coronavirus Infections ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Obsessive compulsive disorder (OCD) is a distressing psychiatric disorder. Traumas may trigger or aggravate OCD symptoms. COVID-19 pandemic has coursed a global crisis and has been associated with onset of psychiatric disorders in adults. Little is known about children/adolescents with OCD. The present study aimed to examine how children/adolescents with OCD react towards COVID-19 crisis. Methods A questionnaire was distributed to two separate groups of children/adolescents. One group was a clinical group newly diagnosed at a specialized OCD clinic. All the children/adolescents had a current close contact to a therapist or doctor. The other group was a survey group identified through the Danish OCD Association. Most of these children/adolescents were diagnosed years ago, and their primary treatment was completed. For the clinical group, data from patient files was available. Results In both groups, but most pronounced in the survey group, participants experienced a worsening of their OCD, anxiety, and depressive symptoms. The aggravation of OCD correlated with the worsening of anxiety, depressive symptoms, and the extent of avoidance behavior. For both groups, OCD aggressive symptoms predicted a significant worsening. Poor baseline insight showed a trend to predict a symptom worsening. The worsening was most pronounced in children with early age of onset and a family history of attention deficit hyperactivity disorder. Conclusions To our knowledge, this is one of the first studies examining the effect of COVID-19 in children/adolescents with OCD. The effect was examined in two separate populations strengthening the findings. The study points towards an influence of the OCD phenotype, baseline insight suggesting a continued vulnerability, and a family history of psychiatric disorders. Trial registration The study is approved by the Danish Data Protection Agency (1–16–02-147-20) registered 1st of April 2020. Oral and written information was given to parents and patients and written consent from patients over 15 years and parents were received.
- Published
- 2020
28. Treatment of ADHD in adults - prevalence of discontinuation and associated factors - results from a cross-sectional analysis of Danish register data
- Author
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Anne Mette Lange, Per Hove Thomsen, David Daley, and Christina Mohr-Jensen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Cross-sectional study ,Denmark ,compliance ,Pharmacological treatment ,Danish ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,mental disorders ,Prevalence ,ADHD ,Medicine ,Humans ,Patient compliance ,Psychiatry ,treatment ,business.industry ,stability ,Middle Aged ,language.human_language ,030227 psychiatry ,Discontinuation ,Psychiatry and Mental health ,Cross-Sectional Studies ,Register data ,Attention Deficit Disorder with Hyperactivity ,language ,Central Nervous System Stimulants ,business ,030217 neurology & neurosurgery ,discontinuation - Abstract
BACKGROUND: A growing number of adults are receiving pharmacological treatment for ADHD but a sizable proportion also discontinues or have gaps in treatment. The primary aims of this study were to identify how many patients treated for ADHD in adulthood, have at least one event of discontinuation in treatment and to identify possible associated variables.METHODS: Within the Danish population aged 18-60 years on the 1st of January 2013, we identified the number of individuals who had been prescribed ADHD-medication at least once during the 1st of January 2002-31st of December 2013 using Danish register data. Among those who filed more than one prescription, treatment discontinuation was defined as having more than 211 days between two prescriptions. In crude and adjusted logistic regression analysis, we explored potential associations to discontinuation for variables such as gender and age at treatment initiation.RESULTS: In a population, if N = 3,165,844 individuals, n = 42,892 had received at least one prescription for ADHD medication. Among those with more than one prescription ( N = 38,289), 29.4% had discontinued their treatment at least once, according to our definition of treatment discontinuation. ADHD treatment discontinuation was associated with being male, unemployment, lower educational attainment, receiving incapacity benefits and younger age at treatment initiation ( p CONCLUSIONS: A large proportion of individuals treated for ADHD had at least one discontinuation of treatment according to our definition. Although the present study does not allow for investigating the direction of these effects, nor whether some patients later resumed treatment, having at least one discontinuation was associated with a range of variables relating to e.g. age and gender, and provides an emerging profile for clinicians of patients more likely to discontinue.
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- 2020
29. Systematic identification and stratification of help-seeking school-aged youth with mental health problems: a novel approach to stage-based stepped-care
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Louise Berg Puggaard, Pia Jeppesen, Niels Bilenberg, Anne Katrine Pagsberg, Mikael Thastum, Dorte Gyrd-Hansen, Per Hove Thomsen, Simon Peter Neumer, Mette Maria Agner Pedersen, Wendy K. Silverman, Rasmus Trap Wolf, Kerstin J. Plessen, and Christoph U. Correll
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Mental Health Services ,medicine.medical_specialty ,Youth ,Children and adolescents ,Adolescent ,VDP::Social science: 200::Psychology: 260 ,Population ,Context (language use) ,Mental health problem ,Anxiety Disorders ,Child ,Humans ,Mental Disorders/diagnosis ,Mental Disorders/epidemiology ,Mental Disorders/therapy ,Mental Health ,Psychotic Disorders ,Schools ,Mental health problems ,Mental health services ,Stage-based stepped-care ,Visitation ,03 medical and health sciences ,0302 clinical medicine ,Developmental and Educational Psychology ,Child and adolescent psychiatry ,medicine ,030212 general & internal medicine ,Psychiatry ,education ,Socioeconomic status ,education.field_of_study ,Mental Disorders ,General Medicine ,Mental health ,Help-seeking ,030227 psychiatry ,Psychiatry and Mental health ,Pediatrics, Perinatology and Child Health ,VDP::Samfunnsvitenskap: 200::Psykologi: 260 ,Anxiety ,medicine.symptom ,Psychology ,Psychopathology - Abstract
We investigated whether a novel visitation model for school-aged youth with mental health problems based on a stage-based stepped-care approach facilitated a systematic identification and stratification process without problems with equity in access. The visitation model was developed within the context of evaluating a new transdiagnostic early treatment for youth with anxiety, depressive symptoms, and/or behavioural problems. The model aimed to identify youth with mental health problems requiring an intervention, and to stratify the youth into three groups with increasing severity of problems. This was accomplished using a two-phase stratification process involving a web-based assessment and a semi-structured psychopathological interview of the youth and parents. To assess problems with inequity in access, individual-level socioeconomic data were obtained from national registers with data on both the youth participating in the visitation and the background population. Altogether, 573 youth and their parents took part in the visitation process. Seventy-five (13%) youth had mental health problems below the intervention threshold, 396 (69%) were deemed eligible for the early treatment, and 52 (9%) had symptoms of severe mental health problems. Fifty (9%) youth were excluded for other reasons. Eighty percent of the 396 youth eligible for early treatment fulfilled criteria of a mental disorder. The severity of mental health problems highlights the urgent need for a systematic approach. Potential problems in reaching youth of less resourceful parents, and older youth were identified. These findings can help ensure that actions are taken to avoid equity problems in future mental health care implementations.
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- 2020
30. Psychometric properties of the Weiss Functional Impairment Rating Scale parent and self-reports in a Norwegian clinical sample of adolescents treated for ADHD
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Anne Mari Sund, Anne-Lise Juul Haugan, Stian Lydersen, Per Hove Thomsen, and Torunn Stene Nøvik
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Parents ,medicine.medical_specialty ,Functional impairment ,Adolescent ,Psychometrics ,DEFICIT HYPERACTIVITY DISORDER ,Sample (statistics) ,Weiss Functional Impairment Rating Scale ,CHILDREN ,Norwegian ,psychometric properties ,03 medical and health sciences ,0302 clinical medicine ,Rating scale ,QUALITY-OF-LIFE ,LISDEXAMFETAMINE DIMESYLATE ,medicine ,Humans ,ADHD ,adolescents ,VALIDITY ,Psychiatry ,Child ,Psychiatric Status Rating Scales ,OUTCOMES ,ATTENTION-DEFICIT/HYPERACTIVITY DISORDER ,Reproducibility of Results ,language.human_language ,030227 psychiatry ,PREVALENCE ,Psychiatry and Mental health ,functional impairment ,Attention Deficit Disorder with Hyperactivity ,RELIABILITY ,language ,Self Report ,Psychology ,FOLLOW-UP ,030217 neurology & neurosurgery - Abstract
Objective To analyze the psychometric properties of the Norwegian version of the Weiss Functional Impairment Rating Scale parent and self-reports (WFIRS-P and WFIRS-S) in adolescents with ADHD. Methods 102 clinically referred patients, of which 86% were enrolled in an ongoing RCT program (Clinical trials NCT02937142), were diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV). The conceptual framework of the WFIRS-P and the WFIRS-S was evaluated using confirmatory factor analysis (CFA), reliability was estimated using Cronbach’s alpha, convergent and divergent validity was assessed using correlations with the Children’s Global Assessment Scale (C-GAS) and the ADHD Rating Scale-IV (ADHD-RS-IV). Results CFA supported the original factor structure of the questionnaires, both a first-order and a second-order model revealed acceptable model fit. Internal consistency was satisfactory across domains. The parent-adolescent agreement was moderate. The correlations between the C-GAS and the total scores of the WFIRS-P and WFIRS-S were low to moderate (r = –0.29 to −0.38). The ADHD-RS-IV correlated moderately (r = 0.49) with WFIRS-P, the correlation with WFIRS-S was weak (r = 0.28) supporting divergent validity. In multiple regression analyses, the ADHD-RS total score was the strongest predictor of the total score in both the WFIRS questionnaires, with internalizing disorder showing an additional small contribution. Age, gender and full-scale IQ gave no additional contribution in explaining the variance. Conclusions The findings support the use of the Norwegian version of the WFIRS-S and the WFIRS-P in the evaluation of functional impairment in adolescents with ADHD. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
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- 2020
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31. Rationale and design for cognitive behavioral therapy for anxiety disorders in children with autism spectrum disorder: a study protocol of a randomized controlled trial
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Kristian Arendt, Merete Juul Sørensen, Ronald M. Rapee, Mikael Thastum, Per Hove Thomsen, Charlotte Ulrikka Rask, and Tina R. Kilburn
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Male ,050103 clinical psychology ,Time Factors ,Adolescent ,medicine.medical_treatment ,Denmark ,Population ,Medicine (miscellaneous) ,Child Behavior ,behavioral disciplines and activities ,law.invention ,Manuals as Topic ,Study Protocol ,Quality of life (healthcare) ,Randomized controlled trial ,anxiety disorders ,children ,law ,mental disorders ,Medicine ,Humans ,0501 psychology and cognitive sciences ,Pharmacology (medical) ,Prospective Studies ,Autism spectrum disorder ,education ,Child ,Randomized Controlled Trials as Topic ,education.field_of_study ,lcsh:R5-920 ,business.industry ,05 social sciences ,Age Factors ,medicine.disease ,Mental health ,cognitive behavioral therapy ,Cognitive behavioral therapy ,Mental Health ,Treatment Outcome ,Adolescent Behavior ,Anxiety ,Female ,medicine.symptom ,business ,lcsh:Medicine (General) ,Anxiety disorder ,050104 developmental & child psychology ,Clinical psychology - Abstract
Background Autism spectrum disorder (ASD) is found in approximately 1% of the population and includes core symptoms that affect general and social development. Beside these core symptoms, it is suggested that up to 60% of children with ASD suffer from comorbid anxiety disorders which may further affect educational, social and general development as well as quality of life. The main goal of this study is to examine the effectiveness of a manualized cognitive behavioral therapy (CBT) anxiety program adapted for children with ASD. Methods This study is a randomized controlled trial (RCT). Fifty children with ASD and anxiety, aged 7 to 13 years, will be randomly assigned to group CBT or a wait-list control (WL) condition. The design will follow a two (CBT and WL) by two (pre–post assessment) mixed between–within design. The control group will receive intervention after the waitlist period of 13 weeks. Primary outcomes are diagnostic status and severity of the anxiety disorders, measured with The Anxiety Disorder Interview Schedule for DSM-IV, Parent and Child Versions. Secondary outcomes are parent and child ratings on questionnaires on the child’s level of anxiety and impact on everyday life. Additional outcomes entail information gathered from parents, child and teachers on the child’s behavior and negative self-statements, together with social and adaptive skills. Follow-up data will be collected 3 months after intervention. Discussion This study aims to evaluate the effectiveness of a manualized CBT program in Danish children with ASD and anxiety within a mental health clinic setting. The hypothesis is that training anxiety reduction skills will decrease anxiety in children, as well as ensure better psychosocial development for the child in general. Trial registration https://ClinicalTrials.gov (NCT02908321). Registered 19th of September 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2591-x) contains supplementary material, which is available to authorized users.
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- 2018
32. EARLY REGULATION IN CHILDREN WHO ARE LATER DIAGNOSED WITH AUTISM SPECTRUM DISORDER. A LONGITUDINAL STUDY WITHIN THE DANISH NATIONAL BIRTH COHORT
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Merete Bjerrum, Erik T. Parner, Sanne Lemcke, Marlene Briciet Lauritsen, and Per Hove Thomsen
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Longitudinal study ,medicine.medical_specialty ,business.industry ,05 social sciences ,medicine.disease ,language.human_language ,Danish ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Autism spectrum disorder ,Pediatrics, Perinatology and Child Health ,Intellectual disability ,Developmental and Educational Psychology ,language ,medicine ,Autism ,0501 psychology and cognitive sciences ,business ,Psychiatry ,Birth cohort ,030217 neurology & neurosurgery ,050104 developmental & child psychology - Abstract
Studies have shown that children later diagnosed with autism spectrum disorders (ASD) in their first years of life might show symptoms in main developmental areas and that these signs might be sensed by the parents. The present study investigated in a large birth cohort if children later diagnosed with ASD had deviations at 6 and 18 months in areas such as the ability to self-regulate emotions, feeding, and sleeping. The study was based on prospective information collected from 76,322 mothers who participated in the Danish National Birth Cohort. When the children reached an average age of 11 years, 973 children with ASD and a control group of 300 children with intellectual disability (IDnoASD) were identified via Danish health registries. Associations were found between short periods of breast-feeding and the children later diagnosed with ASD and IDnoASD as well as associations at 18 months to deviations in regulation of emotions and activity. The similarities in these associations emphasize how difficult it is to distinguish between diagnoses early in life.
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- 2018
33. Predictors of therapeutic treatment outcome in adolescent chronic tic disorders
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Per Hove Thomsen, Erik T. Parner, and Judith Becker Nissen
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exposure response prevention ,paediatric ,Comorbid anxiety ,Tics ,habit reversal training ,medicine.medical_treatment ,Therapeutic treatment ,Habit reversal training ,predictor ,CHILDREN ,Outcome (game theory) ,Tourette syndrome ,Group psychotherapy ,HABITUATION ,03 medical and health sciences ,0302 clinical medicine ,QUALITY-OF-LIFE ,Intervention (counseling) ,Medicine ,ANXIETY ,business.industry ,SUPPORTIVE PSYCHOTHERAPY ,HABIT REVERSAL ,ADULTS ,medicine.disease ,030227 psychiatry ,Psychiatry and Mental health ,BEHAVIOR-THERAPY ,Papers ,business ,030217 neurology & neurosurgery ,Clinical psychology ,PREMONITORY URGES - Abstract
Background Chronic tic disorders may have a major impact on a child's function. A significant effect has been shown for combined habit reversal training (HRT) and exposure response prevention (ERP) treatment delivered in an individual and group setting. Aims The present study examines predictors and moderators of treatment outcome after an acute therapeutic intervention. Method Fifty-nine children and adolescents were randomised to manualised treatment combining HRT and ERP as individual or group training. Age, gender, baseline tic severity, Premonitory Urge for Tics Scale (PUTS) scores, Beliefs about Tic Scale (BATS) scores, hypersensitivity and comorbid psychiatric symptoms were analysed as predictors of outcome. The same characteristics were examined as moderators for individual versus group treatment. Outcome measures included the change in total tic severity (TTS) score and functional impairment score (as measured by the Yale Global Tic Severity Scale (YGTSS)). Results Internalising symptoms predicted a lesser decrease in functional impairment. The occurrence of obsessive–compulsive symptoms predicted a larger decrease in TTS. Baseline hypersensitivity and high scores on depressive symptoms favoured individual treatment. High baseline PUTS scores favoured group therapy. Conclusions This is the first study examining factors predicting and moderating perceived functional impairment following a therapeutic intervention. The study adds to the knowledge on predictors and moderators of TTS. Furthermore, this is the first study examining the effect of the BATS score. The study points towards factors that may influence treatment outcome and that require consideration when choosing supplemental treatment. This applies to comorbid anxiety and depressive symptoms, and to the child's belief about their tics and premonitory urge. Declaration of interest None.
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- 2019
34. Avoidance, Insight, Impairment Recognition Concordance, and Cognitive Behavioral Therapy Outcomes in Pediatric Obsessive Compulsive Disorder
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Allison M. Waters, Tord Ivarsson, Sharna L. Mathieu, Lara J. Farrell, Robert R. Selles, S. Evelyn Stewart, Eric A. Storch, Per Hove Thomsen, Daniel A. Geller, Davíð R.M.A. Højgaard, Nicole M. McBride, and Sabine Wilhelm
- Subjects
mega-analysis ,Adult ,symptom recognition ,Treatment response ,Obsessive-Compulsive Disorder ,Adolescent ,medicine.medical_treatment ,Concordance ,Logistic regression ,behavioral disciplines and activities ,Parent ratings ,Article ,Cognition ,Obsessive compulsive ,mental disorders ,Developmental and Educational Psychology ,medicine ,Humans ,0501 psychology and cognitive sciences ,Family ,Child ,Aged ,Cognitive Behavioral Therapy ,business.industry ,05 social sciences ,treatment response ,Recognition, Psychology ,exposure and response prevention ,Large sample ,Exposure and response prevention ,Cognitive behavioral therapy ,Psychiatry and Mental health ,predictors ,Treatment Outcome ,business ,050104 developmental & child psychology ,Clinical psychology - Abstract
Objective Insight and avoidance are commonly discussed factors in obsessive-compulsive disorder (OCD) that have demonstrated associations with increased severity as well as reduced treatment response in adults, but these factors have not been sufficiently examined in pediatric OCD. This study examined the impacts of avoidance, insight, and impairment recognition concordance on cognitive-behavioral therapy (CBT) outcomes as well as impacts of CBT on insight and avoidance in a large sample of youths affected by OCD. Method Data from 573 OCD-affected youths enrolled in CBT trials were aggregated. Children’s Yale-Brown Obsessive-Compulsive Scale items measured treatment response, insight, and avoidance. Standardized differences between child and parent ratings of impairment were used to calculate impairment recognition concordance. Binary logistic regression was used to identify variables associated with treatment response. Results Greater avoidance, limited child recognition of impairment, older age, and lower baseline severity predicted reduced likelihood of treatment response, but insight did not. Both insight and avoidance improved significantly following CBT. Response rates were lower when posttreatment insight and avoidance were worse. Conclusion Contrasting with prevailing belief, poor insight does not appear to limit CBT response potential in pediatric OCD. Avoidance and impairment recognition are understudied CBT response predictors and warrant further consideration in pediatric OCD. Clinicians should attend to these factors to optimize outcomes for children affected by this common, debilitating illness.
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- 2019
35. Group-based Cognitive Behavioural Therapy for Anxiety Disorder in Children with Autism Spectrum Disorder:a feasibility study
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Tina R. Kilburn, Mikael Thastum, Ronald M. Rapee, Charlotte Ulrikka Rask, Kristian Arendt, Per Hove Thomsen, and Merete Juul Sørensen
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Male ,Parents ,medicine.medical_specialty ,Adolescent ,Autism Spectrum Disorder ,CBT ,Affect (psychology) ,VALIDATION ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,DSM-IV ,children ,Surveys and Questionnaires ,ADOLESCENTS ,medicine ,Humans ,anxiety disorder ,Medical diagnosis ,Autism spectrum disorder ,Child ,Psychiatry ,SCALE ,Cognitive Behavioral Therapy ,business.industry ,PSYCHIATRIC-DISORDERS ,Cognition ,medicine.disease ,Anxiety Disorders ,Comorbidity ,030227 psychiatry ,PREVALENCE ,Psychiatry and Mental health ,PSYCHOMETRIC PROPERTIES ,RELIABILITY ,Psychotherapy, Group ,Quality of Life ,Feasibility Studies ,Anxiety ,Female ,medicine.symptom ,business ,COMORBIDITY ,030217 neurology & neurosurgery ,Anxiety disorder ,INTERVIEW SCHEDULE - Abstract
Purpose: Autism spectrum disorder (ASD) includes core symptoms that affect general and social development. High risk of developing comorbid disorders such as anxiety is prominent. Up to 60% of children with ASD suffer from anxiety disorders which can negatively influence educational, social and general development together with quality of life. This study is the first to investigate the feasibility of the manualised cognitive behavioural therapy (CBT) group programme 'Cool Kids ASD' for anxiety adapted for children with ASD in a general hospital setting. Methods: Nine children, aged 9–13 years, with ASD and anxiety recruited from a public child psychiatric health clinic were enrolled in the study. Outcome measures were collected from both child and parent pre- and post-treatment and at 3-month follow-up and included scores from a semi-structured anxiety interview, together with questionnaires on anxiety symptoms, life interference, children's automatic thoughts and satisfaction with the programme. Results: Eight out of nine families found the programme useful and would recommend it to other families in a similar situation. Six families attended all 12 sessions in the programme, two missed one session and one family only managed to attend eight sessions. At follow-up, five children were free of all anxiety diagnoses and a further two out of the nine children no longer met the criteria for their primary anxiety diagnosis. Conclusions: This study suggests that the transition of the group programme 'Cool Kids ASD' from University Clinics to standard child psychiatric clinical settings is feasible. Further randomised studies are needed to confirm the efficacy of the programme in a larger sample.
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- 2019
36. The Children's Yale-Brown Obsessive-Compulsive Scale's auxiliary items: Long-term outcome
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Katja A. Hybel, Tord Ivarsson, Davíð R.M.A. Højgaard, Nor Christian Torp, Bernhard Weidle, Per Hove Thomsen, Karin Melin, Scott N. Compton, Erik Lykke Mortensen, Gudmundur Skarphedinsson, Judith Becker Nissen, Anders Helles Carlsen, and Sanne Skov Jensen
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050103 clinical psychology ,Treatment response ,Children and adolescents ,medicine.diagnostic_test ,05 social sciences ,Symptom severity ,Outcome (probability) ,030227 psychiatry ,Term (time) ,03 medical and health sciences ,Psychiatry and Mental health ,Clinical Psychology ,0302 clinical medicine ,Yale–Brown Obsessive Compulsive Scale ,Children's Yale-Brown Obsessive-Compulsive Scale ,Obsessive-compulsive disorder ,medicine ,0501 psychology and cognitive sciences ,In patient ,Longitudinal study ,Slowness ,Psychology ,Pathological ,Outcome ,Clinical psychology - Abstract
Objective Standard assessment of pediatric obsessive-compulsive disorder (OCD) patients includes ratings of insight, avoidance, indecisiveness, sense of responsibility, pervasive slowness, pathological doubting, and obsession-free intervals. The present study aims to identify pre-treatment associations of these clinical features to symptom severity and symptom dimensions as well as to describe and analyze the long-term levels and distribution in different treatment responder groups. Method: Severity ratings as well as clinical feature ratings were evaluated in 268 pediatric OCD patients using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) at seven time points before, during, and up to three years after first-line cognitive-behavioral therapy. The CY-BOCS auxiliary items were evaluated on the basis of three symptom severity trajectory classes: acute, slow, and limited responders. Results: Insight, avoidance, pervasive slowness, and obsession-free intervals were positively associated with pre-treatment symptom severity. Symptom dimensions were associated with different auxiliary items. At three-year follow-up, the limited responder class had higher scores than the acute and slow responder classes on all items except for responsibility. Conclusion: The CY-BOCS auxiliary items are closely related to symptom dimensions and partly to symptom severity. The features appear to be dynamic concepts prone to change, yet, less so in patients showing limited long-term treatment response.
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- 2020
37. Associations of Age, Gender, and Subtypes With ADHD Symptoms and Related Comorbidity in a Danish Sample of Clinically Referred Adults
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Berit Rungoe, Lars Winther, Per Hove Thomsen, Pernille Pedersen, Jette Moeskjaer Nielsen, Agnethe Elkjaer Poulsen, Helle Moeller Soendergaard, Erik Morre Pedersen, Anne Henriksen, and Hans Joergen Soegaard
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Adult ,Male ,Cross-sectional study ,Denmark ,Comorbidity ,Hyperkinesis ,Logistic regression ,behavioral disciplines and activities ,Danish ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,mental disorders ,Odds Ratio ,Developmental and Educational Psychology ,medicine ,Humans ,Adhd symptoms ,Sex Distribution ,Mental Disorders ,Age Factors ,Odds ratio ,medicine.disease ,Personality disorders ,language.human_language ,030227 psychiatry ,Diagnostic and Statistical Manual of Mental Disorders ,Clinical Psychology ,Cross-Sectional Studies ,Logistic Models ,Socioeconomic Factors ,Attention Deficit Disorder with Hyperactivity ,language ,Female ,Substance use ,Psychology ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Objective: The aim was to examine associations of age and gender with ADHD subtypes and subsequently to examine associations of age, gender, and subtypes with comorbid psychiatric disorders. Method: Odds ratios were calculated and logistic regression performed using information from a clinical sample of 155 ADHD adults referred to a Danish specialized ADHD unit from 2010 to 2011. Results: A majority of men (65%) was found in the sample. Most patients were subtyped ADHD combined (78%), followed by ADHD inattentive (18%), and ADHD hyperactive-impulsive (4%). No significant differences were found in gender and age across subtypes. Current comorbid disorders were found in 57% of the ADHD patients. Significantly more comorbidity was found in the ADHD combined type and in patients ≥25 years. Significantly more men had substance use disorders and significantly more women had personality disorders. Conclusion: When assessing adult ADHD patients' age, gender, subtype, and related comorbid symptom profiles should be taken into account. (J. of Att. Dis. XXXX; XX(X) XX-XX).
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- 2016
38. Familial occurrence of tic disorder, anxiety and depression is associated with the clinical presentation of obsessive compulsive disorder (OCD) in children and adolescents
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Davíð R.M.A. Højgaard, Robert Valderhaug, Gudmundur Skarphedinsson, Bernhard Weidle, Karin Melin, Nor Christian Torp, Per Hove Thomsen, Tord Ivarsson, Fabian Lenhard, Judith Becker Nissen, and Kitty Dahl
- Subjects
Proband ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Tic disorder ,Tics ,Adolescents ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,mental disorders ,Obsessive-compulsive disorder ,medicine ,Family ,Family history ,Psychiatry ,Children ,Obsessive-compulsive disorder (OCD) ,Depression (differential diagnoses) ,Inheritance ,medicine.disease ,humanities ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Etiology ,Anxiety ,medicine.symptom ,Psychology ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Obsessive compulsive disorder (OCD) is a neuropsychiatric entity. The aim was to explore the association of familial OCD, tics, anxiety, and depression with the presentation of OCD in offspring. To our knowledge, this is the first study examining the association of other familial psychiatric disorders with OCD in offspring. A total of 198 families recruited to a Scandinavian multicenter treatment study participated. Characteristics of the child were assessed with standard measures. Family psychiatric disorders were assessed with two methods: a parent interview with open questions and a parent interview with specific questions concerning tics, depression, anxiety, and OCD. A family history of OCD was described in 6% of the probands. No differences were observed between children who had relatives with OCD and children without familial occurrence of OCD. Familial tic disorder was associated with comorbid tics, externalizing disorders, repeating compulsions, and hoarding in the child proband. Familial anxiety was associated with internalizing disorders and comorbid tics, whereas familial depression was associated with somatic obsessions and hoarding in the proband. Our study shows that familial occurrence of other psychiatric disorders is associated with differences in the clinical presentation. Identifying subtypes may have implications for our understanding of the etiology of OCD.
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- 2016
39. Subclinical autism spectrum symptoms in pediatric obsessive–compulsive disorder
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Katja A. Hybel, Tord Ivarsson, Bernhard Weidle, Karin Melin, David R.M.A. Højgaard, Gudmundur Skarphedinsson, Trine Wigh Arildskov, and Per Hove Thomsen
- Subjects
Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Adolescent ,Autism Spectrum Disorder ,Population ,Comorbidity ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,Obsessive compulsive ,mental disorders ,Prevalence ,Developmental and Educational Psychology ,medicine ,Child and adolescent psychiatry ,Humans ,Obsessive compulsive scale ,0501 psychology and cognitive sciences ,Child ,Psychiatry ,education ,Subclinical infection ,education.field_of_study ,05 social sciences ,subclinical symptoms ,General Medicine ,autism spectrum screening questionnaire ,medicine.disease ,humanities ,030227 psychiatry ,obsessive-compulsive disorder ,Psychiatry and Mental health ,Autism spectrum disorder ,Pediatrics, Perinatology and Child Health ,Autism ,Female ,autism spectrum symptoms ,Psychology ,050104 developmental & child psychology ,Clinical psychology - Abstract
The literature on subclinical autism spectrum (ASD) symptoms in pediatric obsessive-compulsive disorder (OCD) is scarce, and it remains unclear whether ASD symptoms are related to OCD severity. The aims of the present study were to assess the prevalence of ASD symptoms and age and sex differences in children and adolescents with OCD, and to explore the relation between ASD symptoms and OCD severity. This is the largest study of ASD symptoms in an OCD population to date, and the first directly aimed at elucidating sex and age differences in this matter. The study used baseline data from the Nordic Long-term OCD Treatment Study in which parents of 257 children and adolescents with OCD aged 7-17 completed the Autism Spectrum Screening Questionnaire. OCD severity was assessed with the Children's Yale-Brown Obsessive Compulsive Scale. Pediatric OCD patients were found to exhibit elevated rates of ASD symptoms compared to a norm group of school-age children. ASD symptoms were concentrated in a subgroup with a prevalence of 10-17 %. This subgroup was characterized by a male preponderance with a sex ratio of approximately 2.6:1, while children versus adolescents with OCD exhibited similar rates. Autism-specific social and communication difficulties were not related to OCD severity, while restricted repetitive behavior was positively related to OCD severity. The results indicate that clinicians need to be aware of ASD symptoms in children and adolescents with OCD since one out of ten exhibits such symptoms at a clinical sub-threshold.
- Published
- 2015
40. The early motor development in children diagnosed with ADHD: a systematic review
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Per Hove Thomsen, Sanne Lemcke, and Sine Ravn Havmoeller
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Gross motor skill ,Motor Activity ,03 medical and health sciences ,0302 clinical medicine ,Attention Problems ,Child Development ,medicine ,Humans ,0501 psychology and cognitive sciences ,Association (psychology) ,Motor skill ,School age child ,05 social sciences ,Infant ,General Medicine ,medicine.disease ,Child development ,Comorbidity ,General movements ,Psychiatry and Mental health ,Clinical Psychology ,Attention Deficit Disorder with Hyperactivity ,Psychology ,030217 neurology & neurosurgery ,050104 developmental & child psychology ,Clinical psychology - Abstract
Although there is limited knowledge about early signs of ADHD, deviations in motor development are suggested as a possible indicator of such early signs. The purpose of the present systematic review was to gather knowledge about motor development before three years of age in children later diagnosed with ADHD. A systematic search was completed in four research databases, and the quality of the identified studies was systematically assessed. Of 440 initial search results, only five studies met the inclusion criteria and were fully abstracted. Major methodological heterogeneity was found between the studies, and the results are pointing in various directions. One study found an association between delay in gross motor development and ADHD, while another did not. However, associations between both good early motor development as well as delayed were also found in one study. A study of premature infants showed no association between early motor development and attention problems at school age, and a study of high-risk children from a neonatal care unit found no association between abnormal general movements and later ADHD without comorbidity. The results of the studies are pointing in various directions. No firm conclusion can be drawn on early motor development in children with ADHD due to the very different results of the studies and the methodological heterogeneity.
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- 2018
41. Parent Training for Preschool ADHD in Routine, Specialist Care: A Randomized Controlled Trial
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Aparna Udupi, Edmund J.S. Sonuga-Barke, Per Hove Thomsen, Charlotte Ulrikka Rask, Anne-Mette Lange, David Daley, Signe Søndergaard-Baden, Tine Houmann, Morten Frydenberg, and Lene Kristensen
- Subjects
Male ,Parents ,psychosocial ,Denmark ,Psychological intervention ,Child Behavior ,routine care ,attention-deficit/hyperactivity disorder ,preschool ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Intervention (counseling) ,Surveys and Questionnaires ,mental disorders ,Developmental and Educational Psychology ,Medicine ,Attention deficit hyperactivity disorder ,Humans ,0501 psychology and cognitive sciences ,030212 general & internal medicine ,Child ,Schools ,business.industry ,05 social sciences ,Repeated measures design ,medicine.disease ,Mental health ,Psychiatry and Mental health ,Attention Deficit Disorder with Hyperactivity ,Child, Preschool ,Randomized Controlled Trial ,Parent training ,Female ,business ,Psychosocial ,050104 developmental & child psychology ,Clinical psychology - Abstract
Objective: Parent training is recommended for attention-deficit/hyperactivity disorder (ADHD) in preschool children. Evidence-based interventions are important, but only if they produce better outcomes than usual care. Method: The authors conducted a multicenter, 2-arm, parallel-group, randomized controlled trial in routine specialist ADHD clinics in the Danish Child and Adolescent Mental Health Services. Children (N = 164, 3–7 years old) with ADHD received a well-established parent training program (New Forest Parenting Programme; n = 88) or treatment as usual (n = 76). The primary outcome was parent ratings of child ADHD symptoms. Secondary outcomes included teacher ratings and direct observations of ADHD symptoms. Outcomes were measured at baseline, after treatment, and at follow-up (36 weeks later). Representativeness of participants was evaluated against the total national cohort of children (N = 1,378, 3–7 years old) diagnosed with ADHD during the same period using the Danish Civil Registration System. Statistical analysis used a repeated measure model. Results: After treatment, the parent training program was superior to treatment as usual on parent-rated ADHD symptoms (p =.009; effect size d = 0.30) and on parenting self-efficacy and family strain. Effects persisted to 36 weeks after treatment. There were no effects on teacher ratings or direct observations of ADHD or on ratings of conduct problems or parenting. The clinical sample was similar to the national cohort of young children with ADHD. Conclusion: Evidence-based parent training has value as an intervention for preschool ADHD in routine clinical settings. As in previous trials, effects were restricted to parent-reported outcomes. Surprisingly, there were no effects on child conduct problems. Clinical trial registration information: A Controlled Study of Parent Training in the Treatment of ADHD in Young Children (D'SNAPP). http://clinicaltrial.gov/; NCT01684644.
- Published
- 2018
42. Symptom Insight in Pediatric Obsessive-Compulsive Disorder: Outcomes of an International Aggregated Cross-Sectional Sample
- Author
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Sharna L. Mathieu, Lara J. Farrell, Sabine Wilhelm, Melissa Elgie, Eric A. Storch, Davíð R.M.A. Højgaard, Tord Ivarsson, S. Evelyn Stewart, Noam Soreni, Per Hove Thomsen, Eli R. Lebowitz, Allison M. Waters, Nicole M. McBride, Robert R. Selles, and Daniel A. Geller
- Subjects
Male ,050103 clinical psychology ,Obsessive-Compulsive Disorder ,Younger age ,Internationality ,Cross-sectional study ,Serotonin reuptake inhibitor ,medicine.medical_treatment ,Placebo ,behavioral disciplines and activities ,Severity of Illness Index ,Article ,03 medical and health sciences ,0302 clinical medicine ,Obsessive compulsive ,mental disorders ,Severity of illness ,Developmental and Educational Psychology ,Medicine ,Humans ,0501 psychology and cognitive sciences ,Child ,Psychiatric Status Rating Scales ,business.industry ,05 social sciences ,Awareness ,030227 psychiatry ,Cognitive behavioral therapy ,Psychiatry and Mental health ,Cross-Sectional Studies ,Pill ,Female ,business ,Clinical psychology - Abstract
Insight in obsessive-compulsive disorder (OCD) refers to patients' recognition that their obsessions and compulsions are symptoms rather than necessary or natural thoughts and behaviors.1 It has been estimated that 20% to 45% of youth with OCD exhibit poor or absent insight.2-4 Identified correlates of poor insight include younger age,2,3,5,6 increased OCD severity,2,4,7 impairment,4,7,8 and family accommodation2,4; lower intellectual and adaptive functioning3; and greater depressive symptoms.2,3 Poorer insight has also been associated with reduced response across treatment groups (ie, selective serotonin reuptake inhibitor [SSRI], cognitive behavioral therapy [CBT], combined SSRI plus CBT, or pill placebo).9.
- Published
- 2018
43. QTc Interval and Risk of Cardiac Events in Adults With Anorexia Nervosa
- Author
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Henrik Jensen, Pernille Charmoth Østergaard, Morten Krogh Christiansen, Loa Clausen, Tanja Charlotte Frederiksen, Claus Graff, and Per Hove Thomsen
- Subjects
Adult ,Pediatrics ,medicine.medical_specialty ,Anorexia Nervosa ,Time Factors ,Long term follow up ,Denmark ,Action Potentials ,030204 cardiovascular system & hematology ,Risk Assessment ,QT interval ,Electrocardiography ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Risk Factors ,Cause of Death ,Physiology (medical) ,Humans ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,medicine.diagnostic_test ,business.industry ,Incidence ,Incidence (epidemiology) ,Prolonged QTc interval ,Prognosis ,Heart Arrest ,Anorexia nervosa (differential diagnoses) ,Case-Control Studies ,cardiovascular system ,Tachycardia, Ventricular ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: The literature contains several cases of anorexia nervosa (AN) patients with prolonged QTc interval. However, the risk of prolonged QTc interval is controversial and the risk of cardiac events in AN patients has yet to be investigated. Methods: We estimated the difference in mean QTc interval and relative risk of borderline prolonged QTc (>440 ms) and prolonged QTc (>460 ms) between 430 adult women AN patients and 123 healthy controls using 3 correction formulas. In a follow-up study, we estimated the risk of a primary end point (a composite of ventricular tachycardia, aborted cardiac arrest, and cardiac arrest) in AN patients compared with a population-based cohort derived from the Danish Civil Register. Results: Mean QTc for AN patients was 408 ms (Hodges), 402 ms (Fridericia), and 399 ms (Bazett). Hodges’ found a slightly increased mean QTc (6.8 ms, 95% confidence interval, 1.6–12.0; P =0.01) and percentage with QTc >440 ms in AN patients (relative risk, 3.7, 95% confidence interval, 1.4–10.3; P =0.01), not observed with Fridericia’s and Bazett’s formulas. There was no difference in the risk of QTc >460 ms between AN patients and healthy controls. During a median follow-up of 10.1 years, AN patients had an increased risk of the primary end point compared with the population-based cohort (hazard ratio, 10.4, 95% confidence interval, 2.6–41.6; P =0.001). However, absolute numbers were small with cumulative incidences of 0.5% and 0.07%, respectively, after 10 years. No events occurred in any AN patient with QTc >440 ms. All-cause mortality was also significantly increased in AN patients compared with the population-based cohort (hazard ratio, 11.2, 95% confidence interval, 5.1–24.5; P Conclusions: Overall, there was no difference in mean QTc interval or risk of prolonged QTc between AN patients and healthy controls. However, AN patients had a notably increased all-cause mortality, as well as an increased risk of cardiac events, which was not related to the baseline QTc interval.
- Published
- 2018
44. Is it time to rethink standard dosage of exposure-based cognitive behavioral therapy for pediatric obsessive-compulsive disorder?
- Author
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Robert Valderhaug, Marianne Aalberg, Bernhard Weidle, Tord Ivarsson, Nor Christian Torp, Gudmundur Skarphedinsson, Per Hove Thomsen, Judith Becker Nissen, Karin Melin, and Kitty Dahl
- Subjects
Male ,Obsessive-Compulsive Disorder ,Treatment response ,Adolescent ,medicine.medical_treatment ,Cognitive-behavior therapy ,03 medical and health sciences ,0302 clinical medicine ,Obsessive compulsive ,Humans ,Medicine ,Prospective Studies ,Child ,Biological Psychiatry ,Retrospective Studies ,Characteristics of early responds ,Univariate analysis ,Cognitive Behavioral Therapy ,business.industry ,Cognition ,Combined Modality Therapy ,Response to treatment ,Pediatric OCD ,030227 psychiatry ,Cognitive behavioral therapy ,Psychiatry and Mental health ,Young age ,Treatment Outcome ,Baseline characteristics ,Health Resources ,Female ,business ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Objective Identifying factors associated with early treatment response is important, because it can help allocate limited resources in psychiatric care more appropriately. This study examined baseline characteristics of participants with early response to exposure-based cognitive behavior therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). Method 269 participants with OCD, aged 7–17 years, were enrolled in a 14-weeks CBT program. We identified participants with early response to treatment, (CY-BOCS total score of ≤15), by the seventh session. Results At week 7, 248 (92.2%) participants were assessed, 38.3% (95% CI 32.4–44.5%, n = 95) were identified as treatment responders. Univariate analyses showed that six baseline characteristics were significantly associated with early treatment response: young age, lower levels of symptom severity, functional impairment, internalizing- and externalizing problems, depressive symptoms, and family accommodation. Conclusions These results suggested that treatment plans for younger children with moderate OCD symptoms and no major comorbid disorder should include briefer and less resource demanding treatment formats than the commonly recommended and applied standard doses of 15 CBT sessions.
- Published
- 2019
45. Obsessive-compulsive disorder in children and adolescents. A review of the literature
- Author
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Per Hove Thomsen
- Subjects
medicine.medical_specialty ,Neuropsychology ,General Medicine ,medicine.disease ,Anorexia nervosa ,behavioral disciplines and activities ,Comorbidity ,humanities ,Psychiatry and Mental health ,Eating disorders ,Asperger syndrome ,Schizophrenia ,mental disorders ,Pediatrics, Perinatology and Child Health ,Developmental and Educational Psychology ,medicine ,Child and adolescent psychiatry ,Anxiety ,medicine.symptom ,Psychology ,Psychiatry - Abstract
The literature on obsessive-compulsive disorder (OCD) in children and adolescents is reviewed. On the basis of the epidemiological data it is concluded that OCD is far more common among children and adolescents than was previously believed. However, good epidemiological studies in other parts of the world than the US are still needed. Follow-up studies of the course of OCD with a childhood onset are still very few in number. Recent studies show that OCD is a disabling disorder for many of the patients, also in adult life, but that a considerable proportion of the patients seems to "recover" from their obsessions and compulsions in adulthood. There are indications that treatment response in childhood, parental psychopathology, and severity of the OCD migh predict the outcome. The biological aspects of OCD are reviewed. The serotonin transmitter system seems to be involved in the pathogenesis of adult as well as childhood OCD. Additionally, most studies demonstrate a high degree of neuropsychological and neurological deficits in children with OCD. Comorbidity in childhood, and the concept of OCD spectrum disorders are presented. Childhood OCD seems to be associated with depression, eating disorders, anxiety disorders, and empathy disorder, whereas there seems to be no convincing relation between OCD and schizophrenia.
- Published
- 2018
46. Combined habit reversal training and exposure response prevention in a group setting compared to individual training: a randomized controlled clinical trial
- Author
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Martin Kærgaard, Erik T. Parner, Lisbeth Laursen, Per Hove Thomsen, and Judith Becker Nissen
- Subjects
Male ,medicine.medical_specialty ,Quality of Life/psychology ,Exposure response prevention ,Adolescent ,Tic Disorders/therapy ,medicine.medical_treatment ,Group setting ,Habit reversal training ,Tourette syndrome ,Group psychotherapy ,03 medical and health sciences ,0302 clinical medicine ,Tourette Syndrome/therapy ,Quality of life ,Behavior Therapy ,Developmental and Educational Psychology ,Child and adolescent psychiatry ,medicine ,Humans ,0501 psychology and cognitive sciences ,Child ,Pediatric ,business.industry ,05 social sciences ,Manual ,General Medicine ,Original Contribution ,medicine.disease ,030227 psychiatry ,Clinical trial ,Psychiatry and Mental health ,Behavior Therapy/methods ,Treatment Outcome ,Tic Disorders ,Pediatrics, Perinatology and Child Health ,Physical therapy ,Quality of Life ,Chronic Tic Disorder ,Female ,Group ,business ,human activities ,050104 developmental & child psychology - Abstract
Chronic tic disorders may have a huge influence on quality of life. Habit reversal training (HRT) and exposure response prevention (ERP) are effective treatments. In a blinded assessed, open trial, this study evaluates the effectiveness of a newly developed Scandinavian tic treating manual designed to treat adolescents with a chronic tic disorder, combining HRT and ERP. The study compared the efficacy of treatment based on the same manual delivered either individually or in groups. The study was an open randomized controlled clinical trial in which adolescents were randomized to either individual or group therapy. Both therapies included nine sessions. The parents were offered group-based psycho-education. The exclusion criteria were chosen to design a study that would be close to clinical practice. This is the first Scandinavian study that examines the effectiveness of a treatment manual combining HRT and ERP delivered in an individual and group setting. The study showed a significant reduction of the Total Tic score on the Yale Global Tic Severity Scale both in the individual (effect size 1.21) and group setting (effect size 1.38). A total of 66.7% of participants were considered responders. There was no statistical significant difference between the individual and group setting apart from the functional impairment score. The reductions were comparable with those shown in other studies. The participants applied both HRT and ERP, and the majority (36/59) reported an increased post-treatment experience of control. The newly designed Scandinavian manual was equally effective in the individual and group setting with effect sizes comparable with those shown in other studies.
- Published
- 2018
47. Are there distinct cognitive and motivational sub-groups of children with ADHD?
- Author
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Edmund J.S. Sonuga-Barke, Dorte Damm, Rosemary Tannock, Per Hove Thomsen, Anne Virring Sørensen, and Rikke Lambek
- Subjects
Male ,Adolescent ,Child Behavior ,Latent variable ,03 medical and health sciences ,Executive Function ,0302 clinical medicine ,medicine ,Journal Article ,Attention deficit hyperactivity disorder ,Humans ,0501 psychology and cognitive sciences ,Child ,Categorical variable ,Applied Psychology ,Working memory ,05 social sciences ,Neuropsychology ,Cognition ,medicine.disease ,Confirmatory factor analysis ,Psychiatry and Mental health ,Delay Discounting ,General level ,Adolescent Behavior ,Attention Deficit Disorder with Hyperactivity ,Female ,Psychology ,030217 neurology & neurosurgery ,Psychomotor Performance ,050104 developmental & child psychology ,Clinical psychology - Abstract
Attention-deficit/hyperactivity disorder (ADHD) is proposed to be a neuropsychologically heterogeneous disorder that encompasses two distinct sub-groups, one with executive function (EF) deficits and one with delay aversion (DA). However, such claims have often been based on studies that have operationalized neuropsychological deficits using a categorical approach – using intuitive but rather arbitrary, clinical cut-offs. The current study applied an alternative empirical approach to sub-grouping in ADHD, latent profile analysis (LPA), and attempted to validate emerging subgroups through clinically relevant correlates.One-hundred medication-naïve children with ADHD and 96 typically developing children (6–14 years) completed nine EF and three DA tasks as well as an odor identification test. Parents and teachers provided reports of the children's behavior (ADHD and EF). Models of the latent structure of scores on EF and DA tests were contrasted using confirmatory factor analysis (CFA). LPA was carried out based on factor scores from the CFA and sub-groups were compared in terms of odor identification and behavior.A model with one DA and two EF factors best fit the data. LPA resulted in four sub-groups that differed in terms of general level of neuropsychological performance (ranging from high to very low), odor identification, and behavior. The sub-groups did not differ in terms of the relative EF and DA performance. Results in the ADHD group were replicated in the control group.While EF and DA appear to be dissociable constructs; they do not yield distinct sub-groups when sub-grouping is BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is proposed to be a neuropsychologically heterogeneous disorder that encompasses two distinct sub-groups, one with executive function (EF) deficits and one with delay aversion (DA). However, such claims have often been based on studies that have operationalized neuropsychological deficits using a categorical approach - using intuitive but rather arbitrary, clinical cut-offs. The current study applied an alternative empirical approach to sub-grouping in ADHD, latent profile analysis (LPA), and attempted to validate emerging subgroups through clinically relevant correlates.METHODS: One-hundred medication-naïve children with ADHD and 96 typically developing children (6-14 years) completed nine EF and three DA tasks as well as an odor identification test. Parents and teachers provided reports of the children's behavior (ADHD and EF). Models of the latent structure of scores on EF and DA tests were contrasted using confirmatory factor analysis (CFA). LPA was carried out based on factor scores from the CFA and sub-groups were compared in terms of odor identification and behavior.RESULTS: A model with one DA and two EF factors best fit the data. LPA resulted in four sub-groups that differed in terms of general level of neuropsychological performance (ranging from high to very low), odor identification, and behavior. The sub-groups did not differ in terms of the relative EF and DA performance. Results in the ADHD group were replicated in the control group.CONCLUSIONS: While EF and DA appear to be dissociable constructs; they do not yield distinct sub-groups when sub-grouping is based on a statistical approach such as LPA.
- Published
- 2018
48. Developmental course of anxiety and depression from adolescence to young adulthood in a prospective Norwegian clinical cohort
- Author
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Jan L. Wallander, Stian Lydersen, Marit S. Indredavik, Norbert Skokauskas, Ingunn Ranøyen, Bernhard Weidle, Tricia L Larose, and Per Hove Thomsen
- Subjects
Male ,medicine.medical_specialty ,Generalized anxiety disorder ,Adolescent ,Comorbidity ,Anxiety ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Developmental and Educational Psychology ,medicine ,Child and adolescent psychiatry ,Prevalence ,Humans ,Prospective Studies ,Age of Onset ,Depression (differential diagnoses) ,Depressive Disorder ,business.industry ,Depression ,Norway ,Social anxiety ,General Medicine ,medicine.disease ,Mental illness ,Anxiety Disorders ,Adolescence ,030227 psychiatry ,Psychiatry and Mental health ,Phobic Disorders ,Pediatrics, Perinatology and Child Health ,Longitudinal ,Disease Progression ,Mental health ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Anxiety disorder ,Clinical psychology ,Follow-Up Studies - Abstract
Anxiety and depression are often co-occurring disorders, reflecting both homotypic and heterotypic continuity as possible developmental pathways. The present study aimed to examine homotypic and heterotypic continuities of anxiety and depression across 3 years in adolescence and young adulthood. Participants included patients presenting to psychiatric care with diagnoses of anxiety and/or depressive disorders aged 13-18 at T1 (N = 717, 44% initial participation rate) and aged 16-21 at T2 (N = 549, 80% follow-up participation rate). McNemar's mid-p test and ordinal proportional odds logistic regression analyses were used to assess changes in prevalence within and across diagnostic categories, respectively. More adolescents had an anxiety disorder (+ 11%), whereas fewer had a depressive disorder (- 11%), at T2 compared to T1. Of adolescents with anxiety and/or depression at T1, only 25% recovered or were non-symptomatic 3 years after referral to a psychiatric clinic. Homotypic continuity was observed for anxiety disorders in general (OR = 2.33), for phobic anxiety disorders (OR = 7.45), and for depressive disorders (OR = 2.15). For heterotypic continuity, depression predicted later anxiety (OR = 1.92), more specifically social anxiety (OR = 2.14) and phobic anxiety disorders (OR = 1.83). In addition, social anxiety predicted later generalized anxiety disorder (OR = 3.11). Heterotypic continuity was thus more common than homotypic continuity. For adolescents presenting with anxiety or depression, treatment should, therefore, target broad internalizing symptom clusters, rather than individual diagnoses. This may contribute to prevent future mental illness, particularly anxiety, in clinical samples.
- Published
- 2017
49. What Predicts a Good Adolescent to Adult Transition in ADHD? The Role of Self-Reported Resilience
- Author
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Torunn Stene Nøvik, Marit S. Indredavik, Thomas Jozefiak, Per Hove Thomsen, Stian Lydersen, and Jorun Schei
- Subjects
Male ,050103 clinical psychology ,Adolescent ,media_common.quotation_subject ,Developmental psychology ,Young Adult ,Developmental and Educational Psychology ,medicine ,Humans ,Interpersonal Relations ,0501 psychology and cognitive sciences ,Favorable outcome ,Young adult ,Depression (differential diagnoses) ,media_common ,Psychiatric Status Rating Scales ,Depressive Disorder ,05 social sciences ,Resilience, Psychological ,Anxiety Disorders ,Self Concept ,Clinical Psychology ,Attention Deficit Disorder with Hyperactivity ,Anxiety ,Female ,Self Report ,Psychological resilience ,medicine.symptom ,Psychology ,050104 developmental & child psychology ,Clinical psychology - Abstract
OBJECTIVE: ADHD is a disorder associated with impairment and comorbid psychiatric problems in young adulthood; therefore, factors that may imply a more favorable outcome among adolescents with ADHD are of interest.METHOD: This study used a longitudinal design to assess whether adolescent personal resilience characteristics during adolescence protected against psychosocial impairment, depression, and anxiety 3 years later. Self-reported protective factors were used as baseline measures in the assessment of 190 clinically referred adolescents with ADHD. A semi-structured diagnostic interview was performed at the follow-up.RESULTS: In a group of youth with ADHD, personal resilience characteristics were associated with better psychosocial functioning in young adulthood, and less depression and anxiety.CONCLUSION: Although further research is needed, these results indicate that personal resilience characteristics may be protective factors in the transitional period from adolescence to early adulthood.
- Published
- 2015
50. Effectiveness of cognitive behavior treatment for pediatric obsessive-compulsive disorder: Acute outcomes from the Nordic Long-term OCD Treatment Study (NordLOTS)
- Author
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Tord Ivarsson, Nor Christian Torp, Martin E. Franklin, Robert Valderhaug, Kitty Dahl, Katja A. Hybel, Tore Wentzel-Larsen, Bernhard Weidle, Karin Melin, Per Hove Thomsen, Fabian Lenhard, Gudmundur Skarphedinsson, and Judith Becker Nissen
- Subjects
Male ,Obsessive-Compulsive Disorder ,medicine.medical_specialty ,Cognitive-behavioral therapy ,Exposure and response prevention ,Adolescent ,Denmark ,medicine.medical_treatment ,Cognitive behavioural therapy ,Experimental and Cognitive Psychology ,Child and adolescent ,medicine ,Humans ,Outpatient clinic ,Longitudinal Studies ,Treatment outcome ,Child ,Psychiatry ,Sweden ,OCD ,Cognitive Behavioral Therapy ,Norway ,Cognition ,Mental health ,Clinical trial ,Cognitive behavioral therapy ,Psychiatry and Mental health ,Clinical Psychology ,Treatment Outcome ,Treatment study ,Physical therapy ,Family Therapy ,Female ,Psychology - Abstract
OBJECTIVE: The purpose of this study was to examine the acute effectiveness of manualized exposure-based CBT with a family-based treatment, as an initial treatment for pediatric OCD delivered in regular community child and adolescents outpatient clinics. The report summarizes outcome of the first treatment step in the NordLOTS, which was conducted in Denmark, Sweden and Norway.METHOD: 269 participants, age 7-17, with OCD, received treatment for 14 weekly sessions. Treatment response was defined as CY-BOCS score of ≤15 at post treatment.RESULTS: 241 participants (89.6%) completed all 14 weeks of treatment. Treatment response among the completers was 72.6% (95% CI 66.7%-77.9%). Mixed effects model revealed a statistically significant effect of time F(1,479) = 130.434. Mean symptom reduction on the CY-BOCS was 52.9% (SD = 30.9). The estimated within-group effect size between baseline and post treatment was 1.58 (95% CI: 1.37-1.80).CONCLUSION: This study found that manualized CBT can be applied effectively in community mental health clinics. These findings underscore the feasibility of implementing exposure-based CBT for pediatric OCD in a regular child and adolescent mental health setting.CLINICAL TRIALS REGISTRATION INFORMATION: This study was registered in Current Controlled Trials; Nordic Long-term Obsessive-compulsive disorder (OCD) Treatment Study (www.controlled-trials.com ISRCTN66385119).
- Published
- 2015
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