Search

In the process of the Cologne Children’s Sleep Study, we assessed whether the occurrence of symptoms indicative of sleep onset and maintenance problems, daytime sleepiness, sleep disordered breathing (SDB), and restless legs syndrome (RLS) is related to an increased risk for the presence of symptoms of hyperactivity (ADHD). A total of 8,599 parents and 4th grade public school children were surveyed in a cross-sectional study concerning sleep habits, sleep problems, and environmental factors with a parental sleep questionnaire. Relative risks were calculated to examine the relationship between various sleep problems and ADHD symptoms. Frequent snoring was reported in 3.7% of the children, apneas in 0.6% and restless legs in 1.0%. Of the children, 8.9% were reported to be frequently hyperactive. Symptoms of sleep onset and maintenance problems were related to an increased risk of hyperactivity in contrast to daytime sleepiness that was not related to hyperactivity. Moreover, a significantly elevated risk for the symptom hyperactivity could be calculated for children presenting restless legs, snoring, and apneas. For apneas, however, this relationship only existed in children with moderate symptoms of hyperactivity but not in children with frequent hyperactivity. Our results clearly demonstrate that symptoms of hyperactivity are related to sleep onset and maintenance problems. In contrast, no indication was found for hyperactivity in children presenting increased daytime sleepiness. Our study results further support the hypothesis of significant correlations between ADHD, RLS, and SDB. [ABSTRACT FROM AUTHOR]

This study examined the discriminant validity of the German version of CBCL in two large samples of referred and non-referred children and adolescents which were matched for age, sex and socio-economic status. The combined sample that was used for statistical analysis consists of 2,058 referred and 2,058 non-referred boys and girls between 4 and 18 years of age (mean age: referred boys=10.9 years, non-referred boys=10.9 years, referred girls=11.3 years, non-referred girls=11.1 years). Referral status was used as validity criterion. Statistical procedures included Odds Ratios, Total Predictive Values, ROC analyses and discriminant analyses. Results indicated that the discriminant validity of the German version of CBCL is comparable to the original English version. With the use of CBCL Total Problem Score as predictor (cut-off T≥ 60) 83.8 % of children and adolescents could correctly be classified (sensitivity 83.6 %, specificity 83.9 %). Symptoms of the “Attention Problems Scale” show the highest discriminative power to distinguish between disturbed and undisturbed children and adolescents. [ABSTRACT FROM AUTHOR]

Although the use of psychotropic medications in child and adolescent psychiatry in Germany is on the increase, most compounds are in fact prescribed "off-label" because of a lack of regulatory approval in these age groups. In 2007, the European Parliament introduced Regulation 1901/2006 concerning medicinal products in pediatric populations, with a subsequent amendment in the form of Regulation 1902/2006. The main aim of this legislation was to encourage research and clinical trials in children and adolescents, and thus promote the availability of medications with marketing authorization for these age groups. Furthermore, initiatives such as the European 7th Framework Program of the European Union now offer substantial funding for pediatric pharmacological research. At a recent Congress of the German Society for Child and Adolescent Psychiatry and Psychotherapy (DGKJP), experts from the field and the pharmaceutical industry held a symposium with lay representatives in order to discuss attitudes toward, and experience with, pediatric psychopharmacology research in Germany since 2007. Several areas of concern were identified. The present paper derives from that symposium and provides an overview of these opinions, which remain crucial to the field. A wider discussion of how to facilitate psychopharmacological research in Germany in order to optimize the treatment and welfare of children and adolescents with psychiatric disorders is now warranted.

On the basis of the high prevalence for behavioural problems and mental disorders in adolescence and its persistence into adulthood it is tested whether and based upon which emphasis this topic is considered in the recent discussion on psychotherapy. Therefore, a bibliometric analysis is given that summarizes the issue in the 2011 and 2012 volumes of representative German child and adolescent psychological and psychiatric journals. The focus lies on conduct disorder, depression, deliberate self-harm, dissociative disorder, and post traumatic stress disorder.

Psychological disturbances play an increasingly important role in the pediatric practice. Since the efficacy of early interventions is well proven, screening instruments are of interest that could help pediatrists with the diagnostic procedure. The authors report on the prevalence of psychological disorders and/or somatoform symptoms with their effects on the psychological and health related quality of life in a consecutive representative pediatric population in a rural area. Altogether 511 children, juveniles and their parents participated in the study. The Strengths and Difficulties Questionnaire (SDQ), the Health Survey (SF-36) and the Children's Somatization Inventory (CSI) were administered. The results showed that a great percentage of the children and juveniles who did not primarily attend a pediatrist due to behavior problems did exhibit psychological and emotional disturbances. Among the 11- to 17-year-old children the boys were significantly more disturbed than the girls, based on parent ratings. Furthermore, 49% of the children and juveniles reported indications for somatoform disorders, in 7.2% the DSM-IV criteria for a somatization disorder were fulfilled. Girls met the criteria significantly more often than boys. The subjectively perceived quality of life of the children and juveniles was found to be reduced with the degree of the psychological problems and the degree of somatization.

The heritability of attention deficit hyperactivity disorder (ADHD) is approximately 0.8. Despite several larger scale attempts, genome-wide association studies (GWAS) have not led to the identification of significant results. We performed a GWAS based on 495 German young patients with ADHD (according to DSM-IV criteria; Human660W-Quadv1; Illumina, San Diego, CA) and on 1,300 population-based adult controls (HumanHap550v3; Illumina). Some genes neighboring the single nucleotide polymorphisms (SNPs) with the lowest P-values (best P-value: 8.38 × 10(-7)) have potential relevance for ADHD (e.g., glutamate receptor, metabotropic 5 gene, GRM5). After quality control, the 30 independent SNPs with the lowest P-values (P-values ≤ 7.57 × 10(-5) ) were chosen for confirmation. Genotyping of these SNPs in up to 320 independent German families comprising at least one child with ADHD revealed directionally consistent effect-size point estimates for 19 (10 not consistent) of the SNPs. In silico analyses of the 30 SNPs in the largest meta-analysis so far (2,064 trios, 896 cases, and 2,455 controls) revealed directionally consistent effect-size point estimates for 16 SNPs (11 not consistent). None of the combined analyses revealed a genome-wide significant result. SNPs in previously described autosomal candidate genes did not show significantly lower P-values compared to SNPs within random sets of genes of the same size. We did not find genome-wide significant results in a GWAS of German children with ADHD compared to controls. The second best SNP is located in an intron of GRM5, a gene located within a recently described region with an infrequent copy number variation in patients with ADHD., (Copyright © 2011 Wiley Periodicals, Inc.)

Objectives: The primary objective of this study was to evaluate the efficacy of atomoxetine (ATX, target dose 1.2 mg/kg daily) on symptoms of oppositional defiant disorder (ODD) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). A secondary objective was to compare fast versus slow up-titration of ATX., Methods: This was a 3-arm, 9-week, randomized, placebo-controlled, double-blind study in ADHD patients (6-17 years) with comorbid ODD (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV] criteria A-C) or conduct disorder (CD). ATX-treatment arms were as follows-ATX-fast: 7 days 0.5 mg/kg, then 1.2 mg/kg; ATX-slow: 7 days each at 0.5 and 0.8 mg/kg, then 1.2 mg/kg. Primary outcome was the Swanson, Nolan, and Pelham Rating Scale-Revised (SNAP-IV) ODD-score after 9 weeks (Mixed Effects Model for Repeated Measures, ATX-up-titration groups pooled)., Results: In total, 181 patients were randomized, and 180 evaluated (ATX-fast/ATX-slow/placebo: 60/61/59). Baseline characteristics were comparable (84.4% boys; mean age 11.0 years; DSM-IV: 100% ADHD, 75.6% with combined type, 74.4% ODD, 24.4% CD; SNAP-IV ODD-scores, mean ± standard deviation 15.5 ± 4.35). At week 9, SNAP-IV ODD scores were significantly lower versus placebo in both ATX-groups (least square mean [95% confidence interval]: ATX-fast 8.6 [7.2;9.9]; ATX-slow 9.0 [7.7;10.3]; placebo 12.0 [10.6;13.5]; least square mean, ATX-pooled minus placebo: -3.2 [-5.0, -1.5], effect size: -0.69, p < 0.001). SNAP-IV ADHD-scores, CD symptoms (investigator-rated Attention-Deficit and Disruptive Behavior Disorders Instrument, disruptive behavior), Clinical Global Impressions-Severity, and individual treatment behaviors showed corresponding results. Post-hoc analyses indicated interrelationships between the medication effects on ADHD, ODD, and CD symptom scores. For ATX-slow, time to early dropout was significantly longer versus placebo (Hazard Ratio [95% confidence interval]: 3.57 [1.42;8.94]; p = 0.007). Clinically relevant adverse effects (fatigue, sleep disorders, nausea, and gastrointestinal complaints; weeks 1-3) were reported in 60.0% of ATX-fast, 44.3% of ATX-slow, and 18.6% of placebo group patients., Conclusions: ATX for 9 weeks significantly reduced symptoms of ODD/CD and ADHD; slower ATX-up-titration may be better tolerated.

Separation anxiety in children with severe school refusal evokes often worry about the future with regard to professional career and social integration. This study highlights the native outcome of inpatient children with separation anxiety disorder. 18 of 24 children, who required at the age of 6-13 years between 1996-2002 inpatient treatment because of separation anxiety disorder were assessed at follow up. Diagnostic Interview for Mental Disorders in Children and Adolescents (Unnewehr et al. 2005) was used and academic and social outcome was explored. The follow-up time ranged from 4.3 to 11.1 years (average 7.1 years). Mean age was 18.4 years at time of follow-up. We found at least one clinical psychiatric diagnosis in one third of all patients at follow-up. Even more of the formerly inpatients reported subthreshold psychic symptoms (55%). The mental outcome was strongly related to comorbid diagnosis at time of inpatient care. Estimated remission rate for separation anxiety disorder was high (89%). The results revealed an important shift of diagnosis to social phobia in one third of cases. There was no incidence of agoraphobic or panic disorders. The majority of young people considered academic outcome satisfactory but reported pronounced problems in social integration. The mental stress of young people with a former severe separation anxiety after an average time of seven years was high, especially for social phobic symptoms. The results are discussed in view of further therapeutic implications.

Objective: This paper evaluates epidemiological data on psychopathy dimensions among adolescents., Method: The Psychopathy Checklist Youth Version (PCL:YV) was administered to a forensic sample of 169 boys and 172 girls, to a clinical sample of 30 boys and 63 girls, and to a community sample of 119 male and 116 female pupils. Analysis was based on three different conceptualizations of psychopathy. In total 669 youths between 14 to 19 years were included in the study., Results: Depending on the cutoff used, we found a psychopathy prevalence between 27 % and 63 % among the incarcerated boys, and from 7 % and 24 % among the incarcerated girls. The clinical and the community samples showed higher scores on the behavior and lower scores on the core personality dimensions. All samples indicated significantly more psychopathy dimensions in boys than in girls., Conclusions: Varying rates of prevalence are found when using different models for analyzing the PCL:YV. The extent of age-typical adolescent and antisocial behavioral dimensions represented by the Lifestyle and the Antisocial Factor inflates the total PCL:YV score without presenting increased scores in the psychopathy core dimensions. Prospectively, the two core personality dimensions of psychopathy should be studied more closely.

Objective: The diagnosis and classification of personality disorders in adolescence remains a controversially discussed topic., Method: This review reports recent research findings on the comorbidity and the diagnosis of personality disorders in adolescence and on their neurobiological and neuropsychological correlates., Results: On the one hand, the latest research findings refer to the implication that personality disorders in adolescence can be reliably diagnosed with the existing instruments used in the diagnosis of adults. On the other hand, researchers criticize the lack of a youth-specific concept of assessment, which could be used as a common foundation to study this clinically so relevant disorder., Conclusions: Diagnostic as well as longitudinal studies within the scope of networks are required in order to differentiate personality disorders in adolescence from other youth-related disorders.

Background: The goal of this study is to assess changes in the prevalence of attention-deficit/hyperactivity disorder (ADHD) and methylphenidate prescriptions over the period 2000 to 2007 on the basis of data from a German statutory health insurance carrier., Methods: In a cross-sectional study, we analyzed data from a random sample of insurees of the AOK health insurance company in the German state of Hesse for the years 2000 to 2007. Per calender year, 50,000 to 63,000 children and adolescents were retrospectively observed with respect to the documentation of ADHD diagnosis (ICD-10 diagnosis F90) and the prescribing of methylphenidate (ATC: N06BA04)., Results: In 2007, the overall prevalence of ADHD in all age groups (0-18 years) was 2.21% (95% CI: 2.09-2.34). This figure was 45% greater than the corresponding figure for the year 2000. The prevalence increased by a larger amount among girls aged 6 to 18 years than among boys in the same age group (+69% vs. +53%). In 2007, 1.06% (95% CI: 0.98-1.16) of the children/adolescents received at least one prescription for methylphenidate; this was a 96% increase over the prescription rate for 2000. A comparison of the two years 2000 and 2007 reveals a clear prevalence shift towards the older age groups, as well as an 82% increase in the average number of daily doses per recipient. Outpatient departments of child and adolescent psychiatry initiated more treatments in 2007 than in 2000., Conclusion: The 1% prevalence of methylphenidate use among children and adolescents that was found in this study is the same as that reported in other European countries, such as Switzerland, the Netherlands, and Norway. A drawback of our study is its limitation to a single insurance carrier in a single region. Nonetheless, data of this type are useful for monitoring. The findings suggest further issues worth studying, e.g., off-label use or the indications for treatment in older age groups.

Objective: This study addresses the question whether temperament and character differ between antisocial incarcerated girls with and without psychopathy. Furthermore, it enquires whether this model discriminates between groups with varied psychopathy symptoms., Method: 170 incarcerated girls aged 14 to 17 years were examined using the German version of the Junior Temperament and Character Inventory (JTCI 12-18) and the Psychopathy Checklist Youth Version (PCL:YV). On the basis of the PCL:YV scores the girls were divided into three high-scoring psychopathy groups and compared to a group without psychopathy., Results: Three-quarters of the juvenile criminals did not show psychopathy; the percentage of those scoring high on the psychopathy core dimensions was only 7%. With the aid of Cloninger's model of personality, differences in the psychopathy groups as compared to the nonpsychopathy group were identified regarding the dimensions novelty seeking, reward dependence, cooperativeness and self-transcendence. However, specific relationships between individual psychopathy dimensions and the JTCI-factors could not be identified., Conclusions: The results confirm the existence of the psychopathy construct in female delinquents, though the percentage of girls with core psychopathy dimensions is very small. The differentiating temperament factors found among girls scoring high on psychopathy dimensions as opposed to girls without psychopathy indicate that psychopathy is a valid construct that can identify a specific subgroup of antisocial girls with core psychopathy symptoms.

We tested the psychometric properties of the Hypomania Checklist (HCL-32) in a sample of nonclinical adolescents, examined the association with current psychopathology, and tested if "hypomanic" adolescents differ from other participants regarding HCL-scores and psychopathology. A total of 294 students completed the HCL-32 and the SDQ, a screening for psychopathology. In adolescence, the internal structure of hypomania seems to be represented by a triple structure. The first factor "active-elated" is an indicator of symptoms related to energy and activity. The adult factor "irritable-risk taking" is better reflected by two separate factors ("disinhibited/stimulation-seeking" and "irritable-erratic"). These factors were associated with externalizing problems. "Hypomanic" adolescents showed higher HCL total and disinhibited/stimulation-seeking scores and reported more conduct problems than "non-hypomanic" youngsters. The internal structure of the HCL in adolescents mirrors the association of juvenile bipolarity with substance use and symptoms of ADHD and conduct disorder and presents preliminary evidence for its validity.

Nightmares are defined as dreams with strong negative emotions which awaken the dreamer and are common during childhood: cross-sectional data shows the highest prevalence rates between the ages of five and ten. The present longitudinal study was designed to study the stability of nightmares over the course of 2 years. Sleep questionnaires and Strengths and Difficulties Questionnaires were completed by 851 10-years-old children and their parents, separately. In the total sample, nightmares occurred often in 2.5% (parental estimates) to 3.5% (self estimates of the children). The findings indicate that nightmare stability is considerably high, i.e., nightmare occurrence was predicted by the prevalence the year before (in addition to the concurrent amount of emotional symptoms). Children with 'chronic' nightmares showed more psychopathological symptoms. It would be interesting to follow-up these children in order to investigate whether childhood nightmares are also predictive for adult psychopathology.

Objective is the promotion of the international recognition of research in child and adolescent psychiatry which is published in German language. There is a necessity for change of the strategy of publication in these scientific journals. The goal is to increase the impact factor. The length of the review and publication process has to be shortened, citations should be relevant to the present, interdisciplinarity and the cooperation of the editorial boards of different disciplines should be reinforced. These efforts are necessary for a better international recognition of publications in German language.

Aim: This study was performed to investigate relations between psychopathology and psychopathy in adolescent female and male detainees., Method: We examined 91 male and 123 female adolescent detainees (aged 14-19) for psychopathology -using the Youth Self Report, the Overt Aggression Scale-Modified and a Conduct Disorder Self Report Scale- and for psychopathic dimensions using the psychopathy checklist youth version (PCL:YV). Based on a linear regression analysis we compared the specific associations between psychopathology and psychopathy in both male and female delinquent juveniles., Results: Our results revealed higher scores for externalizing behavior and psychopathic dimensions in delinquent males, and higher internalizing problem scores in delinquent females. Furthermore, we found a positive relationship between suicidal behavior and the psychopathy total score as well as the affective, the lifestyle and the antisocial dimension only in girls. No association was found for suicidal behavior in boys. Regarding anxious-depressive behavior, we found a negative relation to the psychopathy total score and to the affective psychopathy factor for the boys., Conclusion: Expectedly, the population of incarcerated adolescents exhibited a high prevalence of psychopathology. At the same time our results referred to meaningful gender-related differences with respect to associations with psychopathy. The gender-related differences in psychopathological symptoms could indicate varied subtypes of psychopathy in boys and girls.

Background: Family studies of anorexia (AN) and bulimia (BN) nervosa in relatives of patients with eating disorders compared to control subjects are rare in German-speaking countries., Methods: A German multicenter study compared first-, second- and third-degree relatives of 65 adolescent AN subjects (n = 746), 21 adolescent BN subjects (n = 265) and relatives of 11 adolescent depressive control subjects (n = 157), as well as those of 37 adolescent healthy control subjects (n = 480). Assessments included the Diagnostic Interview for Genetic Studies (DIGS), the short form of the Family Interview of Genetic Studies (FIGS), and the Eating Disorder Family History Interview., Results: Rates of anorexia nervosa and major depressive disorder (trend) were significantly (p < .01) higher among the first- and second-degree relatives of anorexic and bulimic subjects than among the relatives of healthy controls. Most results were more prominent among relatives of bulimic index patients. Nevertheless, the frequencies were lower in this sample than in comparable US-American samples., Conclusions: The data confirm the hypothesis of familial vulnerability to anorexia and bulimia nervosa. The observed differences in comorbidity patterns among eating-disordered relatives may be due to an age effect of the index patients.

Prevalence and comorbidity of attention-deficit hyperactivity disorder (ADHD) and personality disorders (PD) were studied in a sample of juvenile in-patients (n = 43) and a sample of detained adolescents. The prevalence of ADHD showed no difference between detainees and in-patients, but significantly more incarcerated girls than boys reported ADHD-symptoms. PD and comorbid PDs were significantly more prevalent in the detained sample: whereas the in-patient juveniles fulfilled more often criteria for passive-avoidant and obsessive-compulsive PD, the detainees showed more antisocial PD (ASPD) and narcissistic PD. Incarcerated boys showed more paranoid, narcissistic and antisocial PD, detained girls more borderline PD (BPD). The incarcerated adolescents with BPD reported significantly more ADHD during childhood and current hyperactivity; the detainees with ASPD had more often hyperactivity during childhood. Furthermore, for both genders most and greatest correlations were found for ADHD and psychopathy. Moreover, there were significant relations between BPD and hyperactivity as well as impulsive behaviour. The incarcerated boys showed correlations between ASPD and ADHD and early impulsivity; in detained girls BPD and hyperactivity were associated and PD-dimensions and ADHD. This study indicates that ADHD and PD are often found disorders in juvenile at-risk populations which show on the one hand gender related prevalence differences and on the other hand significant overlap. This result contributes to the ongoing discussion on the conceptual handling of both diagnoses on the basis of current classification systems.

A developmental perspective implies similar personality pathology dimensions for adolescents and adults. The present study examined the applicability of a dimensional approach in incarcerated delinquent female and male juveniles using the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). A sample of detained adolescents (n = 146) was compared to adolescent students (n = 98) and a healthy control group of adults (n = 82). Additionally, psychopathology was assessed in the incarcerated juveniles using the Youth Self Report (YSR). Analyses of variance revealed higher scores on personality disorder traits for juveniles compared to adult controls; the highest scores were observed in criminal juveniles. Hypothesized relationships could be confirmed within the criminal sample between the DAPP factor Emotional Dysregulation and the YSR Internalization syndrome scale, and between the DAPP factor Dissocial Behavior and the YSR Externalization syndrome scale. Moreover, gender differences in the criminal sample are discussed. Results indicate that the DAPP-BQ can assess personality disorder traits in delinquent and nondetained juveniles with sufficient group and criterion validity.

Background: In children with pediatric bipolar disorder (PBD), a consistent pattern of elevations in inattention/hyperactivity, depression/anxiety, and aggression has been identified on the Child Behavior Checklist (CBCL-PBD profile). In Germany, no epidemiological study has included PBD to date., Objectives: To estimate the six-month prevalence of the CBCL-PBD profile in Germany in a large normative general population sample, and to examine subjects with CBCL-PBD profile with regard to symptoms assumed to coexist with PBD (e.g., suicidality, decreased need for sleep, and hypersexuality)., Methods: We studied a nationwide representative general population sample of 2,856 children and adolescents aged 4-18 years., Results: A total of 21 subjects [0.7% of the sample; 95% confidence interval (CI) = 0.5-1.1] met the criteria for the CBCL-PBD phenotype. CBCL-PBD subjects were more pervasively disturbed than clinical controls (n = 118; 4.1% of total sample; 95% CI = 3.4-4.9), demonstrated in significantly more social problems and delinquent behavior, and showed significantly higher rates of suicidality, decreased need for sleep and hypersexual behavior., Conclusions: The prevalence of CBCL-PBD subjects in the general German population compares to rates of PBD in US and Dutch epidemiological samples. Regardless of whether these subjects are affected by 'real' PBD or 'severe, pervasive ADHD' with pronounced emotional dysregulation, they constitute a group of seriously disturbed children and adolescents. The high rate of suicidality among CBCL-PBD subjects emphasizes the need for the identification and adequate treatment of children meeting this profile.

Study Objectives: The Cologne Children's Sleep Study intended to provide information on prevalence and course of difficulties of initiating and maintaining sleep in childhood., Design: Longitudinal study., Setting: Children of the fourth grade of elementary schools in Cologne., Participants: 832 children and their parents; the mean age of the children was 9.4, 10.7, and 11.7 years at the 3 assessments., Measurements and Results: Children and parents were surveyed using questionnaires 3 times on an annual basis. In self- and parental reports, about 30%-40% of the children of the longitudinal sample had problems falling asleep at the first assessment. One year later, about 30% to 40% of these children did not describe any difficulties initiating sleep, whereas about 60% did report continuing difficulties initiating sleep. Difficulties maintaining sleep are less common in childhood. The analysis of self- and parental reports revealed that in general children described significantly more difficulties initiating and maintaining sleep than their parents report., Conclusions: Difficulties initiating and maintaining sleep may be transient or persistent. In practice, children and adolescents should be included in the diagnostic and therapeutic process.

In accordance with Robert Hare's concept, the term psychopathy was operationalized in 1985 when the revised form of the psychopathy checklist (PCL-R) was published. Since then, the PCL-R has been used internationally. For several years in North America and now even in England and the Netherlands, personality traits of psychopathy have also been studied in children and juveniles. Based on the PCL-R, a checklist for adolescents (PCL-YV) was developed that takes the special conditions of adolescents into account. The goal of this paper was to test the applicability of the PCL-YV retrospectively in a sample of forensic psychiatric evaluations of delinquent juveniles that were assigned to the Clinic for Child and Adolescent Psychiatry at the University of Cologne, Germany. Based on results collected with the PCL-YV, data on groups of low- and medium-scoring juveniles were classified which partially differed significantly in relation to sociodemographic and anamnestic data. Furthermore, factor analyses showed a three-factor model solution. Associations with legal issues such as the question of criminal responsibility could not be found. In summary, the results indicate the applicability of the PCL-YV for adolescents but show the difficulties of retrospective design without conducting PCL interviews.

Objectives: The objective of this study was to analyze aggressive behaviour towards others by schizophrenic as opposed to antisocial adolescents, and the influence of substance abuse before, during and after their hospitalization., Methods: We analyzed 21 schizophrenic adolescents and compared their aggressive behaviour and their substance abuse to that of 21 antisocial juveniles before and during their hospitalization and again at the time of a follow-up interview. The two samples were matched for age, sex and intelligence. In a first step, data were gathered from the hospital records, in a second step, for follow-up data we conducted standardized telephone interview with the patient and his or her parent or caregiver. Within the analysis we focused on aggressive behaviour towards other people and objects, as well as on criminal acts and regular substance abuse., Results: We found less aggressive behaviour among psychotic patients during and post-hospitalization than among their antisocial counterparts. As inpatients, the acutely psychotic juveniles were at higher risk for aggressive acts, but adequate treatment subdued their offensive behaviour. In the long term, there were fewer criminal arrests among psychotic patients. Only in connection with their substance abuse, their aggressive misconduct towards others increased., Conclusions: Our results suggest that drug treatment during adolescence might help to lessen the risk of aggressive behaviour towards others.

School truancy is not a diagnostic entity. It is rather a conglomeration of symptoms with various causal factors. With a prevalence of about 5% of all children attending school, three typical groups of anxious school truants can be differentiated: children with separation anxiety, with simple and social phobia as well as anxious and/or depressive symptoms. Anxious truants show depressive symptoms and separation anxiety significantly above chance, while school truancy is closely associated with social disorders, depression and oppositional behaviour and mostly occurs in boys. Psychosocial risk factors such as contact problems with peers, familial and school problems often play an important part. The increased comorbidity as well as various associated stress factors demand multiple behaviour and psychological diagnostics. Sophisticated therapeutic measures should regard this and focus on cognitive behaviour therapy as well as educative and supportive interventions.

Epidemiological studies of sleep disturbances in preschool and school-aged children are under-represented in international clinical research. Based on this fact we investigated the prevalence of insomnia and parasomnia in a representative sample of school-novices in Cologne in 2002 (Cologne Children's Sleep Study). We have also considered the relationship between sleep problems on the one hand and sleep hygienic variables, physical and somatic healthy factors and behavioral problems on the other. A high prevalence of insomnia problems (15%) and repeated nightmares (14%) in children of this age were found in parent's report. Thereas sleep-walking, night terrors and daytime sleepiness were reported less frequently. Children having a solid sleep-wake-schedule show significant less problems to fall into sleep and feel sleepy during the day. Moreover we focused the correlation between disturbed sleep and multiple influencing, as light irritating and noise. We found a two- to three times elevated risk for hyperactive and emotional problems for children with insomnia or parasomnia complaints with regard to the comorbidity of behavioural difficulties. These findings underline the necessity for diagnostic clarifying of sleep disturbances and intervention programs for behavioural disturbed and isolated sleep impaired children.

Sleep disorders in children are very common and their impact on emotional and cognitive functions is considerable. Various pathogenetic factors have to be considered, especially a disturbed sleep-wake rhythm but also organic or psychiatric causes. Symptoms and pathogenetic factors for sleep disorders in children are quite different from adults. In children especially parent-child interactional factors and developmental aspects of the sleep architecture have to be taken into account what necessitates a different diagnostic approach. This article describes systematically typical sleep disorders in children and gives practical advices for an anamnestic and diagnostic access to the subject.

Spinal muscular atrophy (SMA) is a chronic illness characterized by loss of motor function. The aim of the study was to investigate behavioural adjustment in 96 children and adolescents with SMA (47 males, 49 females; mean age 11 years 2 months, range 6 to 18 years). Forty-five non-affected siblings (26 males, 19 females; mean age 11 years 6 months, range 6 to 18 years) and 59 normally developing children (33 males, 26 females; mean age 10 years 8 months, range 6 to 18 years) were recruited as control participants. Behavioural symptoms were measured with the Child Behaviour Checklist (CBCL) and disorders were assessed with a structured psychiatric interview (Kinder-DIPS). Of the patients with SMA, 12.5% fulfilled the criteria for an ICD-10 or DSM-IV diagnosis, with separation anxiety disorder being the most common diagnosis. The CBCL total score was in the clinical range for 11.5% of patients, 20% of the siblings, and 11.7% of the control children; the externalizing score rates were 2.1%, 22.2%, and 11.9% respectively; the internalizing score 18.9%, 24.4%, and 13.6% respectively. Comorbid psychopathology was not influenced by sex, IQ, nor severity of SMA, and only externalizing behaviour was correlated to age. In conclusion, children and adolescents with SMA are characterized by a low psychiatric comorbidity not different from control individuals. The group with the highest rate of behavioural problems and with the greatest need for intervention were the non-affected siblings who had a two- to threefold higher rate of behavioural problems than the normative population.

Attention Deficit/Hyperactivity Disorder is one of the most common behavior disorders in child and adolescent psychiatry. The problems resulting from the core symptoms of the disorder often endure into adolescence and adulthood placing these children at significant long-term risk for academic psychological and social morbidity. Despite the importance of the school in this process relatively few teachers of regular schools have sufficient knowledge about the foundations and principles of treatment concerning ADHD nor do they receive adequate training how to deal with ADHD related problems in the classroom. Moreover there is a significant lack of cooperation between schools, parents and therapeutic institutions inhibiting a multimodal treatment. This article resumes the experiences of a 3 months ADHD intervention program for teachers in a Cologne elementary school. It gives informations and advices for appropriate measurements in the classroom setting that include: 1. intensive information of teachers about the disorder, 2. intensified involvement of teachers in the treatment process and 3. the implementation of distinct didactic elements and well structured principles of behavior therapy in the school lessons.

The article reviews the empirical research on the efficacy of pharmacological and psychological treatment of children and adolescents with attention deficit hyperactivity disorders (ADHD). The importance of evidence based treatment is stressed. Then the results of the internationally most important treatment study in this field, the US Multimodal Treatment Study of Children with ADHD (MTA-Study) are summarized. The study shows the efficacy of both pharmacological therapy (mainly stimulant treatment) and behaviour therapy. The combination of both interventions was not clearly superior to drug treatment plus counselling (medical management). However, Reanalyses show better effects of combined treatment. In the German speaking countries the Cologne Multimodal Interventions Study (COMIS) was conducted. Some main results of this study are summarised. Evidence based conclusions regarding the efficacy of different psychological and pharmacological interventions based on meta analyses, review articles and empirical studies are summarised.

Starting from race hygienic and eugenic ideas at the end of 19th and at the beginning of the 20th century the development and the execution of the "euthanasia of children" by the Nazis is described. Particularly the carrying out of the killing action is so-called "special children's departments" is dealt with in detail by the use of available investigations. Finally questions about the perpetrator profile and regarding the significance of ethical principles in child and adolescent psychiatry are raised.

Among a number of issues and disorder pictures neuropsychological diagnostics should occupy a solid position, both in the initial assessment, as well as in that of the course. With an eye towards its use in child and adolescent psychiatry, a descriptive definition of this area of psychological diagnostics must be provided. In so doing, several essentially different approaches arise, whose effects on psychometrics and interpretation must be examined. Regardless of the fact that the current availability of standardized neuropsychological diagnostics is satisfactory only in certain areas, the methods used in clinical practice and/or research are presented. In addition to the individual test batteries, individual test methods for the areas of visual and auditory memory functions, attention functions, functions associated with speech, and executive functions are discussed. The current status of neuropsychological diagnostics generates essential tasks towards its further development. This is true with regard to goals attainable in the short term, such as adaptation or standardization of available instruments, as well as for long-term research tasks.

This article describes experiences of parents of sexual abused children and their evaluations of institutional interventions on sexual child abuse. Results are presented of a study investigating 'individual and institutional reactions on sexual child abuse'. The number of contacted institutions, personnel experiences with these institutions and resulting requirements are described. The results are based on a sample of 47 (82.5%) girls and 10 (17.5%) boys (range 6-18 years) and interviews with their 'non-abusing' parents. 28 (49.1%) of these children were abused by a member of the family, 29 (50.9%) children by non-familiar persons. It could be shown that 70.2% of the children had contacted four or more different institutions soon after the sexual abuse had been revealed. In cases of sexual abuse by a family member the first contacted institution was the Youth-and-Health-Care-System whereas in cases of sexual abuse by non-familiar persons mostly the police was contacted. Nevertheless in most cases both judicial and supporting approach were chosen. Additionally to concrete advices and professional competences the interviewed parents reported that emotional warmth was a very helpful aspect of the professional intervention. Generally the perspective of the parents seems to give some interesting informations about 'consumer satisfaction'.

Objectives: To analyze the frequency of behavioral/emotional problems and somatic complaints of children aged four to ten as rated by their parents., Method: The analysis is based on the PAK-KID study on behavioural and emotional problems and psychosocial competencies of children and adolescents in Germany. In a nationally representative sample of N = 1030 children aged four to ten years the parents rated their child using the Child Behavior Checklist., Results: The prevalence rates of the symptoms are presented. Additionally global prevalence rates based on three different models were calculated and compared. They range from 13.1% to 28.3%. The issues of defining cutoffs necessary for the calculation of prevalence rates are discussed.