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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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

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.

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.

IntroductionPersistence of attention deficit hyperactivity disorder (ADHD) into adolescence is a significant burden to patients. Clinical guidelines recommend non-pharmacological therapies, but the evidence to support this recommendation is sparse. This study aims to evaluate the effect of a 12-week group cognitive–behavioural therapy (CBT) programme for adolescents with ADHD aged 14–18 years, who still have impairing symptoms after treatment with medication. We will study the effect of the treatment on ADHD symptoms and examine moderators and mediators of the effect of the treatment on ADHD.Methods and analysisWe conduct a randomised controlled trial of CBT group therapy in adolescents with ADHD recruited from child psychiatric outpatient units in Mid-Norway. 99 adolescents who met inclusion criteria and consented to participation have been randomised to a 12-week group intervention or to a control group receiving treatment as usual. Assessments are made at admission to the clinic, preintervention, postintervention and at a 9-month follow-up, obtaining adolescent, parent and teacher reports. Clinicians blinded to group allocation rate all participants as to their functioning preintervention and at the two postintervention assessment points. The primary outcome is change in symptom scores on the ADHD Rating Scale-IV.Ethics and disseminationThe Regional Committee for Medical and Health Research Ethics in South East Norway approved the study protocol (2015/2115). We will disseminate the findings in peer-reviewed publications and conference presentations, to user organisations and at courses attended by families and professionals. Two PhD students will publish and defend dissertations relating to the study. Planned publications include primary and secondary outcomes and patient satisfaction with the treatment. Furthermore, we plan to publish a manual of CBT group therapy in adolescent ADHD to benefit treatment of patients in Norway and elsewhere.Trial registration numberNCT02937142

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

Cognitive-behavioral therapy (CBT) is considered first-line treatment for childhood obsessive-compulsive disorder (OCD). Despite CBT's efficacy, too many children and adolescents do not fully respond to treatment, making the identification of predictors of treatment response highly relevant. Executive functions (EF) have been suggested to constitute such predictors, but studies with pediatric samples are scarce. In the present study, we investigated latent level EF test performance and ratings of daily life EF behavior as predictors of CBT response in pediatric OCD. We further examined the stability of EF from pre-to post-treatment and the association of EF changes with OCD severity change. EF test performance significantly predicted exposure-based CBT outcome. Patients with better EF test performance had significantly elevated risk of non-response relative to patients with poorer performance. Daily life EF behavior in OCD probands improved after treatment relative to controls. The findings suggest that EF performance impacts CBT outcome, and that exposure-based CBT is well-suited for children and adolescents with OCD and poorer EF test performance. This study supports the relevance of EF in CBT for childhood OCD and denotes a possible need for development of enhanced treatments for children and adolescents with OCD and superior EF performance.

© 2017, Springer-Verlag GmbH Germany. The risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) may be influenced by environmental factors such as maternal obesity before pregnancy. Previous studies investigating those associations have found divergent results. We aim to investigate in a large birth cohort this association further in children with ADHD, ASD and comorbid ADHD and ASD. Our study population consisted of 81,892 mother–child pairs participating in the Danish National Birth Cohort (DNBC). Information about pre-pregnancy weight and height was collected in week 16 of pregnancy; the analysis was divided into groups based on BMI. Children with a clinical diagnosis of ADHD and/or ASD were identified in the Danish health registries at an average age of 13.3 years. Hazard ratios (HRs) were estimated using time-to-event analysis. Compared to normal weight mothers, the risk of having a child with ADHD was significantly increased if the mother was overweight (HR = 1.28 [95% CI 1.15;1.48]), obese (HR = 1.47 [95% CI 1.26;1.71]) or severely obese (HR = 1.95 [95% CI 1.58;2.40]). The same pattern was seen for the combined ADHD and ASD group. Regarding ASD, an increased risk was observed in underweight (HR = 1.30 [95% CI 1.01;1.69]) and obese (HR = 1.39 [95% CI 1.11;1.75]) mothers. Subgroup analysis revealed that the association in the ADHD group could mostly be attributable to the hyperactive group. Maternal obesity before pregnancy is a risk factor for ADHD in children. Maternal obesity as well as underweight may also be associated with an increased risk for ASD.

Objective This study describes 1-year treatment outcomes from a large sample of cognitive-behavioral therapy (CBT) responders, investigates age as a possible moderator of these treatment outcomes, and evaluates clinical relapse at the 1-year follow-up. Method This study is the planned follow-up to the Nordic Long-term OCD [obsessive-compulsive disorder] Treatment Study (NordLOTS), which included 177 children and adolescents who were rated as treatment responders following CBT for OCD. Participants were assessed with the Children’s Yale−Brown Obsessive-Compulsive Scale (CY-BOCS) at 6- and 12-month follow-up. Treatment response and remission were defined as CY-BOCS total scores ≤15 and ≤10, respectively. Linear mixed-effects models were used to analyze all outcomes. Results At 1 year, a total of 155 children and adolescents (87.6%) were available for follow-up assessment, with 142 of these (91.6%) rated below a total score of ≤15 on the CY-BOCS. At 1-year follow-up, 121 (78.1%) were in remission. On average, CY-BOCS total scores dropped by 1.72 points during the first year after terminating treatment (p = .001). A total of 28 participants (15.8%) relapsed (CY-BOCS ≥ 16) at either the 6- or 12-month assessment; only 2 patients required additional CBT. Conclusion Results suggest that manualized CBT in a community setting for pediatric OCD has durable effects for those who respond to an initial course of treatment; children and adolescents who respond to such treatment can be expected to maintain their treatment gains for at least 1 year following acute care. Clinical trial registration information– Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com ; ISRCTN66385119.

Obsessive-compulsive disorder (OCD) often becomes manifest in childhood. It has been suggested that the symptom heterogeneity of the disorder could mask subgroups associated with executive function (EF) impairment. Though supported in adult studies, this is scarcely investigated in children. The aims of the present study were to: (i) investigate OCD symptom subgroups using an empirically supported and age-appropriate definition of symptom dimensions (SD) as well as latent profile analysis (LPA); (ii) compare the identified subgroups with respect to EFs, demographic, and clinical descriptives; and (iii) explore the associations between SDs and EFs. The study included 50 pediatric OCD patients and 50 matched controls. Patients were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale from which three SD factor scores were generated. Participants were assessed with EF tasks from which latent variables measuring working memory, set shifting and response inhibition were derived. Parents rated executive function behaviors in their children. Three subgroups were identified, each predominantly characterized by one of the SDs. Subgroups differed with respect to parent-rated working memory and several demographic and basic clinical characteristics. The findings suggest the presence of clinically relevant child and adolescent OCD SD subgroups, but do not support the relevance of EFs in distinguishing SDs.

BACKGROUND: Knowledge on psychiatric emergencies in children and adolescents is limited. The Psychiatric Emergency Departments (PED) in Copenhagen enable the acute examination of children and adolescents 24 h a day, 7 days a week. However, very little is known about who presents to the PED, and the reason for their visit.AIM: To describe the prevalence and characteristics of presentations in PED and treatment provided.METHODS: A retrospective population based study comprising data of more than 4000 visitors presenting to PED from 2001-2010. In 2003 and 2006, two randomly chosen years, a more thorough analysis was performed, based on the individual emergency charts. Inter-rater reliability was high.RESULTS: Visits increased nearly threefold during the period. Symptom score for 2003 and 2006 revealed that more than one third of the visitors had suicidal ideation. Depressive and anxiety symptoms together with suicidal ideation rose significantly (P < 0.001). Psychoses and suicidal attempts remained unchanged. In one third of the visits, the discharge diagnosis was anxiety and stress-related disorders, followed by personality, behavioural and emotional disorders. Between 15% and 20% of the visits resulted in admission and more than 50% in referral for outpatient follow-up.CONCLUSIONS: The number of presenting psychiatric emergencies has increased over the last 10 years. Comparing symptoms from 2003 and 2006 showed a significant rise in their severity. This study highlights the need for 24-h access for acute evaluation by physicians skilled in child and adolescent psychiatry, and raises concern that the severity could increase.

BACKGROUND: Long-term outcome studies of child psychiatric populations are often limited by attrition. Our study uses the Danish National Crime Register to report on the largest and most complete prospective study of adult criminality as an outcome for children with socioeconomic status attention deficit hyperactivity disorder (ADHD) and is the first to report on the adult criminal outcome of girls with ADHD. AIMS: To estimate the relative risk (RR) of adult criminal convictions of children with ADHD compared with the rate in the general population. METHODS: A clinical sample of 206 children who had attended a regional child and adolescent psychiatric clinic in Denmark between 1968 and 1989 and received a diagnosis of ADHD was identified. Official criminal conviction data were collected for all of them up to the year 2000 when their mean age was 31 years. Their rate of sustaining at least one criminal conviction was compared with that in an age-matched general population sample. RESULTS: Ninety-seven (47%) of the children with ADHD had criminal convictions in adulthood. Children with ADHD were about five times more likely to sustain convictions than their peers in the general population (rate ratio (RR) 5.6, 95% confidence interval 5.2-6.1) and twelve times more likely to have violent convictions (RR 12.0, 95% confidence interval 9.9-14.5). Fifty-four (26%) of the children with ADHD without any conduct problems in childhood were convicted in adulthood. Girls with ADHD were also at increased risk of criminal convictions. CONCLUSIONS: Children with ADHD have a higher risk of criminal convictions in adulthood than previously documented, and both girls and boys are at increased risk. Co-morbid conduct problems in childhood are highly predictive of criminal convictions in adulthood. Even in the absence of conduct problems, however, childhood ADHD is associated with increased risk of criminality. Copyright © 2013 John Wiley & Sons, Ltd. Language: en

Three major changes will probably be introduced in the DSM-5 regarding obsessive-compulsive disorder: OCD will be classified in the diagnostic category 'obsessive-compulsive and related disorders', the clinician should consider the degree of insight into a symptomatology (good to poor insight) and a subtype of tic-related OCD will be introduced. The recommended treatment for OCD is CBT, in severe cases with addition of SSRI treatment.

Some studies have shown that children and adolescents with obsessive–compulsive disorder (OCD) and co-morbid tics differ from those without co-morbid tics in terms of several demographic and clinical characteristics. However, not all studies have confirmed these differences. This study examined children and adolescents with OCD and with possible or definite tic specifiers according to the DSM-5 in order to see whether they differ from patients without any tic symptoms regarding clinical presentation and outcome of cognitive behavioral therapy (CBT). The full sample included 269 patients (aged 7–17) with primary DSM-IV OCD who had participated in the Nordic Long-term Treatment Study (NordLOTS). Symptoms of tics were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). One or more tic symptoms were found in 29.9% of participants. Those with OCD and co-morbid tic symptoms were more likely male, more likely to have onset of OCD at an earlier age, and differed in terms of OCD symptom presentation. More specifically, such participants also showed more symptoms of OCD-related impairment, externalization, autism spectrum disorder (ASD), social anxiety, and attention-deficit/hyperactivity disorder (ADHD). However, the two groups showed no difference in terms of OCD severity or outcome of CBT. Children and adolescents with OCD and co-morbid tic symptoms differ from those without tic symptoms in several aspects of clinical presentation, but not in their response to CBT. Our results underscore the effectiveness of CBT for tic-related OCD. Clinical trials registration: Nordic Long-term Obsessive–Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com ; ISRCTN66385119.

OBJECTIVE: The aim of this study was to characterise the association between the cognitive profile and weight restoration in children and adolescents with anorexia nervosa.METHODS: The study was a longitudinal, matched case-control, multicentre study. An assessment of cognitive functions was conducted by using the Wechsler Intelligence Scale for Children-III/the Wechsler Adult Intelligence Scale-III, the Test of Memory and Learning-second edition, Trail Making Tests A and B, the Rey-Osterrieth Complex Figure Test and the Cambridge Neuropsychological Test Automated Battery.RESULTS: One hundred twenty individuals, 60 patients with anorexia nervosa with mean age of 14.65 (SD 1.820) years and 60 healthy controls with mean age of 14.76 (SD 1.704) years, participated. No association was found between weight recovery and cognitive functions. However, a significant increase in motor speed was found in Trail Making Test A (p = 0.004), Reaction Time (RTI) five-choice movement time (p = 0.002) and RTI simple movement time (p = 0.011), resulting in a normalisation corresponding to that found in healthy controls. Furthermore, a significantly lower score in the perceptual organization index (p = 0.029) was found at follow-up.CONCLUSIONS: Weight recovery appears not to be associated with cognition. Copyright © 2016 The Authors European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.

OBJECTIVE: The purpose of this study was to investigate therapy switching from methylphenidate (MPH) to atomoxetine (ATX) in a clinical sample of Danish children and adolescents with attention-deficit/hyperactivity disorder (ADHD); specifically, to determine the duration of MPH treatment before switching to ATX, and the reasons leading to a switch in therapy.METHODS: We included 55 patients with ADHD who switched from first-line MPH to second-line ATX during January 01, 2012 and May 15, 2014. Patient and treatment characteristics along with clinical reasons for switching therapy were extracted from individual patients' records.RESULTS: Mean duration of MPH treatment until switch to ATX was 11.2 months (range = 0.3-28.5 months); 36% of the patients switched within the first 6 months, 56% within the first year, and 76% within 1.5 years of initiating MPH; 24% continued MPH treatment for up to 2.5 years prior to switching. Most common reasons for switching were "adverse events" (AEs) (78%), "wish for more optimal day coverage" (24%), and "lack of efficacy" (16%). Other reasons for switching included "patient/parental request" (13%) and "noncompliance" (2%). Most common AEs leading to switch were psychiatric disorders (insomnia, aggression, tic, depression, anxiety) and decreased appetite.CONCLUSIONS: Our findings highlight the importance of continuous evaluation of the need for prescription switch to ATX in children and adolescents treated with MPH, taking into consideration various factors including potential AEs, non-optimal day coverage, lack of efficacy, patient/parental preferences, and noncompliance. These factors should be considered, not only at the initial stage of MPH treatment but throughout the whole treatment course.

BackgroundTo present the rationale for the new Obsessive–Compulsive and Related Disorders (OCRD) grouping in the Mental and Behavioural Disorders chapter of the Eleventh Revision of the World Health Organization’s International Classification of Diseases and Related Health Problems (ICD-11), including the conceptualization and essential features of disorders in this grouping.MethodsReview of the recommendations of the ICD-11 Working Group on the Classification for OCRD. These sought to maximize clinical utility, global applicability, and scientific validity.ResultsThe rationale for the grouping is based on common clinical features of included disorders including repetitive unwanted thoughts and associated behaviours, and is supported by emerging evidence from imaging, neurochemical, and genetic studies. The proposed grouping includes obsessive–compulsive disorder, body dysmorphic disorder, hypochondriasis, olfactory reference disorder, and hoarding disorder. Body-focused repetitive behaviour disorders, including trichotillomania and excoriation disorder are also included. Tourette disorder, a neurological disorder in ICD-11, and personality disorder with anankastic features, a personality disorder in ICD-11, are recommended for cross-referencing.LimitationsAlternative nosological conceptualizations have been described in the literature and have some merit and empirical basis. Further work is needed to determine whether the proposed ICD-11 OCRD grouping and diagnostic guidelines are mostly likely to achieve the goals of maximizing clinical utility and global applicability.ConclusionIt is anticipated that creation of an OCRD grouping will contribute to accurate identification and appropriate treatment of affected patients as well as research efforts aimed at improving our understanding of the prevalence, assessment, and management of its constituent disorders.

BackgroundMental disorders show varying degrees of continuity from childhood to adulthood. This study addresses the relationship of child and adolescent mental disorders to early adult psychiatric morbidity.MethodsFrom a population at risk of 830,819 children and adolescents aged 6-16 years, we selected all those (n = 6043) who were enrolled for the first time in the Danish Psychiatric Register with an ICD-10 F00-99 diagnosis in 1995-1997, and identified any mental disorder for which they received treatment up to 2009.ResultsNeurodevelopmental and conduct disorders were the principal diagnostic groups at 6-16 years and exhibited a characteristic male preponderance; while affective, eating, neurotic, stress-related and adjustment disorders were more common in girls. Over a mean follow-up period of 10.1 years, 1666 (27.6%) cases, mean age 23.4 years, were referred for treatment to mental health services, and they had a markedly higher risk than the general population (RR 5.1; 95% CI 4.9-5.4). Affective, eating, neurodevelopmental, obsessive-compulsive and psychotic disorders had the strongest continuity. Heterotypic transitions were observed for affective, eating, neurodevelopmental, personality and substance use disorders.ConclusionsThese findings suggest that individuals with psychiatric antecedents in childhood and adolescence had a high risk of being referred for treatment in early adulthood, and many mental disorders for which they required treatment revealed both homotypic and heterotypic continuity.

Attention-deficit hyperactivity disorder (ADHD) is a heterogeneous psychiatric disorder with three different presentations and high levels of psychiatric comorbidity. Serious sleep complaints are also common, but the role of the presentations and comorbidity in sleep is under-investigated in ADHD. Consequently, the goal of the study was to investigate sleep problems in medicine-naive school-aged children (mean age = 9.6 years) with ADHD compared to controls using objective methods and to examine the role of comorbidity and presentations. Ambulatory polysomnography results suggested that children with ADHD (n = 76) had significantly more sleep disturbances than controls (n = 25), including a larger percentage of rapid eye movement (REM) sleep and more sleep cycles, as well as lower mean sleep efficiency, mean non-REM (NREM) sleep stage 1 and mean NREM sleep stage 3. No significant between-group differences were found on the multiple sleep latency test. Stratifying for comorbidity in the ADHD group did not reveal major differences between groups, but mean sleep latency was significantly longer in children with ADHD and no comorbidity compared to controls (36.1 min; SD = 30.1 versus 22.6 min; SD = 15.2). No differences were found between ADHD presentations. Our results support the presence of night-time sleep disturbances in children with ADHD. Poor sleep does not appear to be attributable to comorbidity alone, nor do sleep disturbances differ within ADHD presentations.

International audience; The aim was to study the association between preschool behavioural problems and emotional symptoms in 10- to 12-year-old children. The study was based on the Aarhus Birth cohort, Denmark, and included 1,336 children. Based on the parent-administered preschool behaviour questionnaire (PBQ), we identified three not mutually exclusive preschool behavioural categories: anxious-fearful ( = 146), hyperactive-distractible ( = 98), and hostile-aggressive ( = 170). Children without any known symptoms were considered well adjusted ( = 1,000). Borderline emotional ( = 105) and emotional difficulties ( = 136) were measured at age 10-12 years with the parent-administered strength and difficulties questionnaire (SDQ). Multinomial logistic regression analyses were used to adjust for potential confounding factors. We found that anxious-fearful behaviour and hostile-aggressive preschool behaviour were associated with twice the risk of school-age emotional difficulties. Comorbidity or confounding failed to explain these results. Hyperactive-distractible preschool behaviour was not associated with school-age emotional difficulties. Preschool anxious-fearful behaviour was associated with school-age emotional difficulties, suggesting internalizing symptom stability in some children from early childhood. Preschool hostile-aggressive behaviour was also associated with school-age emotional difficulties, which suggests transformation of one behavioural dimension into another through childhood, and the need to focus on both early internalizing difficulties and hostile-aggressive behaviour as risk factors for later internalizing difficulties.

Objective: To evaluate 410 real-life patients treated with stimulants and assessed systematically over several years. Method: Naturalistic observational study. A database was compiled on the basis of a review of the medical charts of patients attending a specialized ADHD clinic. Results: The diversity of ADHD patients was evident from the comorbidity, age at start, comedication, and treatment needs over time. Dosages corresponded to guidelines in most patients, but some needed higher dosages or got along on lower dosages for long periods. Age at start and comorbidity influenced dosage, and dosage was associated to differential outcome groups. Conclusion: The study findings underscored the diversity of ADHD patients and that individual factors should be taken into account when tailoring individual treatment schedules. Findings further showed that stimulant dosages are dynamic over time and depend on individual factors, that individual factors influence outcome, and that patients with ADHD should be individually monitored and stimulant dosages adjusted continuously. (J. of Att. Dis. 2011; 15(6) 439-451)

Refugee children may encounter barriers to accessing mental health services. We conducted a case—control study based on a systematic review of clinic records to compare psychopathology and service utilization in refugee and Norwegian children referred to a child psychiatry department in a county in southern Norway. Sixty-one refugee children were compared with 61 Norwegian-born children matched for gender, age and time of referral to the clinic. There was no significant difference in rates of referral or level of service utilization, which were proportional to the population. Compared with Norwegian children, refugee children were diagnosed more frequently with post-traumatic stress disorder and other affective and emotional disorders, and less often with pervasive developmental disorders and attention deficit hyperactivity disorder. The results are discussed in terms of referral pathways and the need for culturally competent care for refugee children.

The purpose of this study was to investigate whether OPTAx, an objective measurement of hyperactivity, impulsivity and inattention can be used to measure the positive clinical effect of stimulants found in children with hyperkinetic disorder (HKD) or attention deficit disorder without hyperactivity.A total of 22 boys and one girl, with ages ranging between 7-12 years, diagnosed with HKD or attention deficit disorder without hyperactivity and receiving treatment with stimulants were tested with OPTAx, with and without stimulants. The main parameters investigated were: displacement, area, accuracy, variability, errors of commission and errors of omission.OPTAx showed a significant improvement on all parameters during stimulant treatment compared with no treatment. The improvement measured by OPTAx was supported by clinical assessment, which found that 95% of the children improved much or very much on the Clinical Global Assessment Scale during stimulant treatment.The objective parameters of the OPTAx reflected the clinical improvement found in children with HKD or attention deficit disorder without hyperactivity during stimulant treatment. This suggests a greater role for objective measurements such as OPTAx in daily clinical practise.