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Objectives: To investigate OCD symptom structurein children and adolescents in order to identify OCDsubtypes.A few studies have tried to identify symptom basedsubtypes of OCD in Children and Adolescents, andfound it to contain 4-5 factors. There are severalreasons for the different number of factors foundsuch as different methods and limited sample sizes.Therefore, this study based on a large sample will bea valuable addition to the previous studies.Methods: Exploratory factor analysis will be appliedto the Children’s Yale-Brown Obsessive-CompulsiveScale (CY-BOCS) symptom checklist items in orderto reveal any latent factor structure. The relationbetween specific factors and co-morbid disorders willbe examined. Data for 696 children and adolescentswith OCD is already collected and the final sample isexpected to be around 850 subjects, collected from24 different research units in Europe and USA. Thisstudy is a part of the Nordic Long-Term OCDTreatment Study (NordLOTS).Results: Work in progress. Preliminary results will beavailable at the time of presentation.Discussion: Our study is unique in that it includesindividual CY-BOCS checklist items and it is thuspossible that our results will refine or go beyond the“classical” factors in the original publication. Theimportance of our findings for studies on OCDgenetics and pathogenesis of symptoms will bediscussed.

Quality of life (QoL) is a well-established outcome measure. In contrast to adult obsessive-compulsive disorder (OCD), little is known about the effects of treatment on QoL in children with OCD. This study aimed to assess QoL after cognitive behavioural therapy (CBT) in children and adolescents with OCD compared with the general population and to explore factors associated with potential changes in QoL after treatment. QoL was assessed in 135 children and adolescents (ages 7-17; mean 13 [SD 2.7] years; 48.1 % female) before and after 14 CBT sessions, using self-report and a caregivers proxy report of the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R). QoL was compared with an age- and gender-matched sample from the general population. Before treatment, QoL was markedly lower in children with OCD compared with the general population. QoL improved significantly in CBT responders (mean score change 7.4), to the same range as QoL in the general population. Non-responders reported no QoL changes after treatment, except for one patient. Comorbidity, family accommodation and psychosocial functioning were not associated with changes in QoL after treatment. To our knowledge, this is the first study of the changes in QoL after treatment of paediatric OCD. The assessment of QoL beyond symptoms and function in children with OCD has been shown to be reliable and informative. The results of this study support the application of QoL assessment as an additional measure of treatment outcome in children and adolescents with OCD.

ADHD, affecting 2-3% of children, is characterised by problems with attention, hyperactivity and impulsivity. Co-morbid psychiatric problems are very frequent. Causal factors are primarily genetics but environmental influences such as smoking during pregnancy or preterm birth are contributing factors. For children and adults psychoeducation is essential, for younger children training of the parents are recommended. The most efficient psychopharmacological treatment is with central stimulants or atomoxetine.

PURPOSE: This study investigated whether interictal epileptiform discharges (IED) on a baseline routine EEG in children with ADHD was associated with the occurrence of epileptic seizures (Sz) or influenced the use of methylphenidate (MPH) during 2 years follow-up.METHODS: A retrospective chart-review of 517 ADHD children with EEG revealed IED in 39 cases. These patients (IED group) were matched on age and gender with 39 patients without IED (non-IED group). We measured at baseline, 1 year and 2 years Sz occurrence, the use of MPH and antiepileptic drug (AED).RESULTS: At baseline, 12 patients in the IED group had active epilepsy and three of them had Sz during the last year. 36 (92.3%) patients were treated with MPH. Initial positive response to MPH was achieved in 83.3% compared with 89.2% in the non-IED group. At 1 and 2 years follow-up, three patients who also had Sz at baseline and difficult to treat epilepsy, had Sz, without changes in seizure frequency. We found no statistically significant differences between the groups with respect to MPH use at 1 year and at 2 years. Ten patients from IED group, who did not have confirmed epilepsy diagnosis, temporarily used AEDs during the first year of follow-up.CONCLUSION: Despite the occurrence of IED, the use of MPH was safe during 2 years follow-up. IED predict the Sz occurrence in children with previous epilepsy, but does not necessarily suggest an increased seizure risk. A caution is warranted in order not to overestimate the significance of temporarily occurrence of IED.

Restless legs syndrome (RLS) and attention deficit hyperactivity disorder (ADHD) have consistently been found to coexist frequently. The cause for the relationship of these co-morbid disorders is contradicting, but both disorders are associated with a common dopaminergic dysfunction, low iron status, sleep disruptions and genetic linking. Well-known diagnostic criteria are necessary for early diagnosis and optimal treatment. Further investigation is needed to identify the pathogenesis, the genetic background and better validated treatment options. So far, oral iron treatment can reduce RLS symptoms, while treatment with e.g. central stimulants can reduce ADHD symptoms.

Objective: Little systematic information is available regarding how sleep problems influence daytime functioning in children with ADHD, as the role of ADHD presentations and comorbidity is unclear. Method: In total, 397 children were assessed with the Children’s Sleep Habits Questionnaire, the Weiss Functional Impairment Rating Scale, and the ADHD Rating Scale. Results: We found a moderate, positive correlation between sleep problems and impaired functioning in both children with ADHD and in typically developed children. ADHD presentations did not differ significantly with respect to sleep problem profile, but having a comorbid internalizing or autistic disorder lead to higher sleep problem score. Conclusion: Sleep problems and impaired daily functioning were more common in children with ADHD, but the overall association between sleep problems and impaired daily functioning was similar in clinical and nonclinical children. Internalizing or autistic comorbid disorders added significantly to the sleep problems.

BACKGROUND: The evidence for choices between antipsychotics for children and adolescents with schizophrenia and other psychotic disorders is limited. The main objective of the Tolerability and Efficacy of Antipsychotics (TEA) trial is to compare the benefits and harms of quetiapine versus aripiprazole in children and adolescents with psychosis in order to inform rational, effective and safe treatment selections.METHODS/DESIGN: The TEA trial is a Danish investigator-initiated, independently funded, multi-centre, randomised, blinded clinical trial. Based on sample size estimation, 112 patients aged 12-17 years with psychosis, antipsychotic-naïve or treated for a limited period are, 1:1 randomised to a 12- week, double-blind intervention with quetiapine versus aripiprazole. Effects on psychopathology, cognition, health-related quality of life, and adverse events are assessed 2, 4, and 12 weeks after randomisation. The primary outcome is change in the positive symptom score of the Positive and Negative Syndrome Scale. The recruitment period is 2010-2014.DISCUSSION: Antipsychotics are currently the only available pharmacologic treatments for psychotic disorders. However, information about head-to-head differences in efficacy and tolerability of antipsychotics are scarce in children and adolescents. The TEA trial aims at expanding the evidence base for the use of antipsychotics in early onset psychosis in order to inform more rational treatment decisions in this vulnerable population. Here, we account for the trial design, address methodological challenges, and discuss the estimation of sample size.TRIAL REGISTRATION: ClinicalTrials.gov: NCT01119014.

The current study introduces the Parental Emotional Response to Children Index (PERCI), a new questionnaire specifically designed to measure parents' emotional response to ADHD and related behaviors (delay discounting and delay aversion).The PERCI was completed by parents of 6- to 14-year-old children with ( n = 126) and without ( n = 160) ADHD.Factor analysis confirmed five separate subscales with acceptable psychometric properties. Parents of children with ADHD reported a stronger emotional response to ADHD behaviors than parents of typically developing children and inattention symptoms evoked the strongest emotional response in parents regardless of child diagnostic status.Parents' emotional responses appear to be differentiated in terms of specific ADHD-related triggers mapping onto the different domains of ADHD and delay-related responses. Further research is required to understand changes in parental emotional responses over time and their impact on children's developmental trajectories.

Psychiatric classifications have traditionally recognized a number of conditions as representing impulse control disorders. These have included pathological gambling, intermittent explosive disorder, kleptomania, pyromania, and trichotillomania.

Objective Knowledge of factors associated with treatment dropout and missed appointments in adults with attention-deficit/hyperactivity disorder (ADHD) is very limited. On the basis of proposed hypotheses that past behavior patterns are more predictive of current behaviors of treatment dropout and missed appointments than are sociodemographic and clinical characteristics, we examined the associations of sociodemographic variables, clinical variables, risk-taking behavior, educational and occupational instability, and behaviors during mandatory schooling with the primary outcome measures of treatment dropout and missed appointments. Method In a naturalistic cohort study of 151 adult outpatients with ADHD initiating assessment in a Danish ADHD unit from September 1, 2010, to September 1, 2011, the Adult ADHD Self-Report Scale v1.1 symptom checklist (ASRS) and a thorough clinical interview were used to assess ADHD according to DSM-IV-TR criteria. Stepwise logistic regression analysis was used to estimate reported associations. Results A total of 27% of patients dropped out of treatment and a total of 42% had ≥ 3 missed appointments during treatment. Mood and anxiety disorders significantly lowered the odds of treatment dropout (odds ratio [OR] = 0.18; 95% confidence interval [CI], 0.05-0.65), whereas having started but not completed 2 or more educational programs apart from mandatory schooling significantly increased the odds of dropout (OR = 3.01; 95% CI, 1.32-6.89). Variables significantly associated with most missed appointments were low educational level (OR = 2.19; 95% CI, 1.12-4.31), 3 or more employments of less than 3 months' duration (OR = 2.86; 95% CI, 1.30-6.28), and having skipped class often/very often during mandatory schooling (OR = 2.65; 95% CI, 1.29-5.43). Additionally, the predominantly inattentive ADHD (ADHD-I) subtype lowered the odds of missed appointments (OR = 0.17; 95% CI, 0.05-0.62). Conclusion Our results suggest that past behavior in terms of highest dropout rates in the educational and occupational systems and highest rates of skipping class during mandatory schooling is equally associated with current behavior of treatment dropout and missed appointments as are sociodemographic and clinical factors. Trial registration ClinicalTrials.gov identifier: NCT02226445.

The purpose of the study was to estimate the risk of substance use disorder (SUD) and alcohol abuse in adulthood among children and adolescents with attention-deficit hyperactivity disorder (ADHD) compared to the background population. Furthermore, to examine whether the age at initiation and duration of stimulant treatment in childhood predicts SUD and alcohol abuse in adulthood. 208 youths with ADHD (183 boys; 25 girls) were followed prospectively. Diagnoses of SUD and alcohol abuse were obtained from The Danish Psychiatric Central Register. The relative risk (RR) of SUD and alcohol abuse for cases with ADHD, compared to the background population was 7.7 (4.3-13.9) and 5.2 (2.9-9.4), respectively. Female gender, conduct disorder in childhood and older age at initiation of stimulant treatment increased the risk of later SUD and alcohol abuse. Our results warrant increased focus on the possibly increased risk of substance abuse in females with ADHD compared to males with ADHD.

This article reflects discussion by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. After reviewing the historical classification of tic disorders, this article discusses their placement in ICD-11. Existing problems with diagnostic labels and criteria, appropriate placement of the tic disorders category within the ICD-11 system, and pragmatic factors affecting classification are reviewed. The article ends with recommendations to (a) maintain consistency with the DSM-5 diagnostic labels for tic disorders, (b) add a minimum duration guideline for a provisional tic disorder diagnosis, (c) remove the multiple motor tic guideline for the diagnosis of Tourette disorder, and (d) co-parent the tic disorder diagnoses in the disorders of the nervous system and the mental and behavioral disorders categories, with secondary co-parenting in the obsessive-compulsive and related disorders and neurodevelopmental disorders sections.

We present the case of a 10-year-old boy, Sam, with congenital deafness and Gilles de la Tourette Syndrome (GTS). GTS is characterised by multiple motor tics and one or more vocal tics that wax and wane. Due to his deafness Sam never developed vocal language but instead used sign language from the age of four. His tic disorder rapidly accelerated from the age of seven over a six-month period and soon sign language was incorporated into tics as complex "vocal" tics. Bursting out "words" in sign language would also occur in front of people unfamiliar with sign language and often with an obscene content although this was not evident to someone not trained in sign language. To our knowledge this is the first reported case of a congenital deaf child with GTS. The case presented here supports previously published work that the intentional share of the tics in GTS is very small. This case also questions former theories on which regions and circuits of the brain are involved in GTS.

The purpose of the study was to assess the association of obstetric complications with risk for mental disorders resulting in hospitalization before the age of 15. Records from all births in Denmark from 1973 through 1993 were linked to records of all psychiatric hospitalizations. Diagnoses were grouped into seven broad categories. A reference population of 10% of births in Denmark from 1973 to 1990 was used for comparison. Obstetric complications were associated with the range of mental disorders occurring in childhood. The strongest predictors were a variable indicating the interaction of birth weight with speed of growth and the 5-minute Apgar score. There was no diagnostic group that stood out as different with respect to obstetric complications. These results are consistent with the hypothesis of the continuum of reproductive casualty.

Obsessive-compulsive disorder (OCD) is now recognized as a frequent and disabling disorder among children and adolescents. The phenomenology is similar to adult OCD, but several reports have indicated that compulsions are more prominent in children and that children are more inclined than adults to include their family surroundings in ritualistic behavior. It is also clear that young children engage in a significant amount of repetitive, ritualistic compulsive activity that appears to be a normal part of their behavioral repertoire.Although the cause of childhood-onset OCD is unknown, many factors are likely to contribute to the heterogenous clinical phenotypes, including both genetic and environmental factors. The neurobiological circuitry involved in childhood-onset OCD is likely to involve alterations to the same cortico-striatothalamic circuitry implicated in adult OCD, but the develop-mental differences have yet to be fully delineated. The treatment response patterns of adults and children are generally inconsis-tent with each other, and specific OCD subtypes may also respond differentially.Phenotypic characterization can be undertaken either categorically, as seen with traditional diagnostic categories, or dimensionally. Extended phenotypes can be defined in terms of symptoms and course of the illness, or neuroimaging and neurobiologic study findings, or treatment responses. Phenotypic characterization must also reflect an understanding of the rituals and repetitive behaviors that are associated with normal development. (A proposed categorization of OCD subtypes appears in the “Table library.”)

3 cases of early onset, severe eating disorder are described. These young children did not present a distorted body image even though they had suffered a great weight loss, were somatically distressed and in all other aspects fulfilled the criteria for anorexia nervosa. The criteria for anorexia nervosa are discussed for this group of young patients.

Genetic aspects of obsessive-compulsive disorder (OCD) are reviewed. The prevalence of OCD is higher than believed previously, probably affecting about 1-3% of the adult population, and the search for etiologic factors has increased. All family studies indicate that OCD in relatives of patients is much more common than the general risk for OCD in the population, and during the past decade some well-conducted family studies, using uniform diagnostic criteria, have been performed. There have been no good twin studies, specifically focusing on OCD. There is still a need for genetic research in the field of OCD and related disorders.

PurposeThe knowledge about possible relationships between ADHD and epilepsy is largely based on small samples of ADHD patients and on cohorts with epilepsy. There is insufficient information about the clinical characteristics of epilepsy among children diagnosed with ADHD. The aim of this study was to investigate the prevalence and characteristics of epilepsy in a large, unselected cohort of children with ADHD.MethodsWe conducted a retrospective chart-review of children with ADHD who were evaluated in our clinic between the years 2000 and 2005. We compared age, sex, disorders of psychological development, cognitive level, pharmacological treatment for ADHD, initial response to treatment and ADHD subtype with and without epilepsy. In addition, we compared our data with data from a Norwegian study in a large general pediatric population.ResultsOf 607 children with ADHD (age 6–14 years; 82.4% males); 14 (2.3%) had a history of epilepsy, and 13 of these had active epilepsy. This is a higher occurrence than expected in the general pediatric population (0.5%). The majority of our patients had mild (an easily treated) epilepsy and they were more likely to be seizure free (79%) compared to the patients with epilepsy in general pediatric population. The ADHD patients with and without epilepsy did not differ regarding age, gender, disorders of psychological development, IQ level

Purpose:To estimate the risk of schizophrenia in adulthood among children and adolescents with ADHD compared to the background population.Subjects/materials and methods:Two hundred and eight youths with ADHD (183 boys; 25 girls) were followed prospectively. Diagnoses of schizophrenia were obtained from The Danish Psychiatric Central Register. The relative risk (RR) of schizophrenia for cases with ADHD, compared to the normal population, was calculated as risk ratios. Hazard ratios (HR's) by Cox regression were calculated in the predictor analyses.Results:Mean age for ADHD cases at follow-up was 31.1 years. Schizophrenia diagnoses were given to 3.8% of these cases. Compared to the general population, RR of schizophrenia in cases with ADHD was 4.3 (95% CI 1.9–8.57).Discussion and conclusion:This prospective follow-up study found children with ADHD to be at higher risk of later schizophrenia than controls. If replicated, these results warrant increased focus on the possible emergence symptoms of schizophrenia or schizophreniform psychosis during clinical follow-up of patients with ADHD.

BACKGROUND: This paper describes and discusses the methodology of the Nordic long-term OCD-treatment study (NordLOTS). The purpose of this effectiveness study was to study treatment outcome of CBT, to identify CBT non- or partial responders and to investigate whether an increased number of CBT-sessions or sertraline treatment gives the best outcome; to identify treatment refractory patients and to investigate the outcome of aripiprazole augmentation; to study the outcome over a three year period for each responder including the risk of relapse, and finally to study predictors, moderators and mediators of treatment response. METHODS: Step 1 was an open and uncontrolled clinical trial with CBT, step 2 was a controlled, randomised non-blinded study of CBT non-responders from step 1. Patients were randomized to receive either sertraline plus CBT-support or continued and modified CBT. In step 3 patients who did not respond to either CBT or sertraline were treated with aripiprazole augmentation to sertraline. CONCLUSIONS: This multicenter trial covering three Scandinavian countries is going to be the largest CBT-study for paediatric OCD to date. It is not funded by industry and tries in the short and long-term to answer the question whether further CBT or SSRI is better in CBT non-responders. © 2013 Thomsen et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

The ICD-8 diagnosis applicable to borderline psychosis in children is psychosis limitaris infantilis (299.02). Results from a register-based study referring to all Danish children admitted between 197

BACKGROUND: The choice between different attention-deficit/hyperactivity disorder (ADHD) medications depends on different drug attributes. Economic evaluations of drugs often disregard the utility of other attributes compare with the drugs' efficacy.AIMS: The aim of this study was to assess patient's preferences and elicit willingness-to-pay (WTP) for different drug attributes in the treatment of ADHD.METHODS: 285 patients (117 parents for children below 15 years, 52 adolescents 15-17 years and 116 adults aged 18 years and above) from Sweden, Denmark and Norway completed a questionnaire concerning their ADHD drug treatment, and answered questions on their preferences using a discrete choice experiment (DCE). Included attributes were effectiveness, side-effects, dosing and price.RESULTS: Effectiveness was the most important attribute, followed by side-effects and the number of dosings per day (all P < 0.001). The estimated monthly WTP for a drug generating full effectiveness, no side-effects and once-daily dosing was €790 for adolescents and €360 for adults. The estimated WTP for ADHD drugs with characteristics similar to existing drugs on the market was higher or in line with market prices (€37-180 for adolescents and €16-80 for adults). Regarding experience with current treatment, 19% of all patients in the study reported good functioning during the morning, day and evening.CONCLUSIONS: The gap between the monetary valuation of existing products and an optimally valued product suggest that there is room for improvements in the clinical management of ADHD. The results suggest that DCE is a method that can be used to value not only hypothetical scenarios but also can be used to value and distinguish between real-life scenarios.

Health anxiety (HA) is an overlooked area in paediatric research. Little is known about the occurrence of HA symptoms in a child and adolescent psychiatric setting, and there are no age-appropriate diagnostic criteria and only limited number of assessment tools. It is therefore likely that HA is seen as part of obsessive-compulsive disorder (OCD) due to construct overlap and the diagnostic uncertainty of HA in this age group. In the present study, the extent of HA symptoms was investigated in 94 children and adolescents with a primary ICD-10 diagnosis of OCD. Self-reported HA symptoms were assessed using the Childhood Illness Attitude Scales. Clinician-rated OCD symptoms and severity were measured using the Children's Yale Brown Obsessive Compulsive Scale. Information on socio-demographics was obtained from the child's/adolescent's medical record. The distribution of HA symptoms resembled a normal curve shifted to the right compared with a normal population of Danish children, and 30 % presented with high HA symptoms. Chi-squared tests were used to examine the proportion of children and adolescents with high HA symptoms in relation to various clinical characteristics. Clinician-rated illness worries and comorbid anxiety disorder were associated with high self-reported HA symptoms. The results contribute to the understanding of how HA and OCD overlap conceptually in young patients and bring attention to the need for improved recognition of OCD patients dominated by illness worries. Further research in the description of childhood HA is important in order to understand whether HA is a distinct disorder early in life.

Background: Neuropsychological and neuroimaging studies have documented that patients with obsessive – compulsive disorder (OCD) have cognitive diffi culties dependent upon fronto-striatal circuits in the brain. It is, however, unclear whether the cognitive diffi culties change after treatment. Answering this question could help establish whether cognitive diffi culties in OCD are state dependent or more trait-like. Aim: To determine whether cognitive functions in OCD change after treatment, based on a systematic literature review, supplemented by a double case report of monozygotic twins with OCD. Methods: For the literature review, systematic searches were conducted in PubMed, Embase and PsycINFO from the earliest dates available to September 2010. For the double case report, monozygotic twins underwent blood samples and magnetic resonance imaging before treatment with cognitive behavioral therapy (CBT), antidepressants and small doses of antipsychotic medication. Before and after CBT they were assessed with measures of content and severity of OCD symptoms, and with a comprehensive battery of neuropsychological tests to assess cognitive functions. Results: Results from the studies under review ( n 14) were so inconsistent that it could not be concluded whether cognitive functions in OCD change after treatment. The twins improved some of their cognitive functions after treatment. Conclusions: A better understanding of whether cognitive dysfunctions in OCD are state dependent or trait-like could bring important implications in understanding the pathology and future treatment of OCD. • Cognitive functions , OCD , Treatment , Twins.

The present study is an analysis of the sociodemographic background of children and adolescents with OCD and child psychiatric control patients. The case records of 61 children and adolescents with OCD and of 117 control patients aged 8-17 years, admitted to a Danish child psychiatric hospital during a 17-year period, were analyzed with regard to sociodemographic data. The OCD patients differed in many ways from their controls, regarding problems at school and family background. Significantly more parents of OCD patients belonged to the highest social classes, and significantly fewer OCD patients came from broken homes. Parents of OCD patients had fewer admissions to psychiatric hospitals and fewer abuse problems than in the control groups.

A recent study reported substantial differences concerning the use of medication for Attention-Deficit/Hyperactivity (ADHD) across the Nordic countries (1). More surprisingly, the variation across ...

To examine the prevalence, clinical characteristics and course of children with tics identified in a community sample. This was a three-stage study. At the age of 9 to 11, parents of 8,244 children born at Aarhus University Hospital Skejby between January 1990 and April 1992 were invited to complete a screening questionnaire about tics. One year later participating parents completed the Strengths and Difficulties Questionnaire (SDQ). From December 2004 to June 2005, when the cohort was 13-15 years of age, parents of the children who screened positive for tics were interviewed in detail about tic disorders. The prevalence of Tourette Syndrome (TS) was 0.6 and 0.6% of chronic motor tics (CMT). Approximately one-third of those with a chronic tic disorder [CTD (TS and CMT)] reported remission of tics by age 13-15. On the parent-rated SDQ children with a CTD were five times more likely (OR = 5.0, 95% CI = 2.6-9.2) to fall into the clinical range of hyperactivity, twice as likely (OR = 2.2, 95% CI = 2.1-7.5) to exhibit disruptive and defiant behavior and over four times more likely to have emotional difficulties (OR = 4.7, 95% CI = 2.5-8.6) compared to children without tic disorders. Children with hyperactivity and CTD were more impaired than subjects with CTD only. Children with CTD and hyperactivity show greater symptom severity across several domains of behavior and overall impairment. In the absence of hyperactivity, children with CTD are at increased risk for emotional difficulties, but not disruptive behavior problems.

Obsessive compulsive disorder (OCD) is a frequent condition. First-choice psychopharmacological treatment includes SSRIs where the choice of drug depends on the occurrence of side effects. If remission is obtained, continued treatment is recommended for at minimum of one year. If only a partial or no response is obtained, augmentation treatment with atypical antipsychotics may be attempted. However, only few studies have examined the effect and side effects of augmentation treatment in children and adolescents. The aim was to provide a summary on the current knowledge on psychopharmacological treatment of children and adolescents with OCD.

Background Intergenerational transmission of trauma as a determinant of mental health has been studied in the offspring of Holocaust survivors and combat veterans, and in refugee families. Mainly negative effects on the children are reported, while a few studies also describe resilience and a possible positive transformation process. A longitudinal prospective cohort study of Vietnamese refugees arriving in Norway in 1982 reports a 23 years follow-up, including spouses and children born in Norway, to study the long-term effects of trauma, flight, and exile on the offspring of the refugees. Objectives of the study: 1.To study the association between the psychological distress of Vietnamese refugee parents and their children after 23 years resettlement.2.To analyse paternal predictors for their children's mental health. Methods Information from one or both parents at arrival in 1982 (T1), at follow-up in 1985 (T2), and 23 years after arrival (T3) was included. The mental health was assessed by the Global Severity Index (GSI) of the self-report Symptom Check List-90-R (SCL-90-R) for parents (n = 88) and older children (age 19-23 yrs, n = 12), while children aged 4-18 (n = 94) were assessed using the Strengths and Difficulties Questionnaire (SDQ). Results Thirty percent of the families had one parent with a high psychological distress score ("probable caseness" for a mental disorder), while only 4% of the children aged 10 - 23 years were considered as probable cases. In spite of this, there was an association between probable caseness in children and in fathers at T3. A significant negative paternal predictor for the children's mental health at T3 was the father's PTSD at arrival in Norway, while a positive predictor was the father's participation in a Norwegian network three years after arrival. Conclusions Children of refugees cannot be globally considered at risk for mental health problems. However, the preceding PTSD in their fathers may constitute a specific risk for them.

Background: Obsessive-compulsive disorder (OCD) is a frequent and clinically heterogeneous disorder. The complex clinical presentation can be summarized using a few consistent and temporally stable symptom dimensions. Only few studies in children and adolescents have examined the importance of symptom dimensions. Aims: This retrospective study was undertaken to describe the relation between symptom dimensions, pattern of comorbidity and family disposition, in a sample of Danish children and adolescents with OCD assessed in a naturalistic setting. Methods: A retrospective study of children and adolescents (n=83) diagnosed with OCD in the period 1998-2004, at the Psychiatric Hospital for Children and Adolescents, Risskov, Denmark. Information from clinical records was systematically collected and Children's Yale-Brown Obsessive-compulsive Scale (CY-BOCS) scores and symptom checklists were obtained. Results: High scores on the symmetry/ordering dimension were related to OCD in first-degree relatives and high scores on the aggressive/checking dimension were associated to comorbidity with tic disorders. We showed a correlation between limited insight and younger age. Conclusion: This is one of the first studies to examine symptom dimensions in children and adolescents in naturalistic settings. The results were comparable with those in adult studies, showing an association between the occurrence of the symmetry/ordering dimension and family OCD and the occurrence of the aggressive/checking dimension and comorbid tic disorders. In small children, insight into symptoms may be limited.

Objective To explore the empirical support for a reclassification of the eating disorders NOS (EDNOS) category. Methods In a cross-sectional design eight specific subgroups of EDNOS were compared to anorexia nervosa (AN) and bulimia nervosa (BN) on interview-based data and questionnaire measures. The sample consisted of 965 patients in the age 13–54 years admitted to treatment for an eating disorder. Results According to the DSM-IV 176(18%) presented with AN, 290(30%) with BN and 499(52%) with EDNOS. Of all EDNOS cases 34% could be reclassified as AN or BN. Three specific subgroups emerged as separate diagnostic entities. A heterogeneous subgroup of 122 patients (13% of all) was proposed as ‘true’ EDNOS. Implications of the results on the DSM-V are discussed. Conclusions The results support a broader definition of AN and BN and suggest subgroups of EDNOS as separate diagnostic entities. This results in a substantial reduction of the heterogeneous EDNOS group. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

The frequency of epileptiform abnormalities (EAs) and correlates of EAs in children with attention deficit/hyperactivity disorder (ADHD) was investigated in a retrospective study. The total sample consisted of 607 children with ADHD from the only center diagnosing and treating ADHD in the region. EEGs were obtained in 517 cases, and EAs were found in 39 (7.5%) children. Of these, 21(53.9%) showed generalized EAs, 16 (41%) had focal EAs, and 2 (5.1%) had both. Rolandic spikes were observed in 9 cases (1.7% of the total group). A previous history of epileptic seizures was reported in 14 (2.5%) children, and was more common in those with EAs than in those without. The group with ADHD and EAs had a larger proportion of girls and the ADHD inattentive subtype, independent of a history of epilepsy. Future research should focus on the clinical consequences of EAs in children with ADHD.

The aim of the present study was to examine gender differences in children with inattention, hyperactivity, and impulsivity on the Five to Fifteen (FTF) parent questionnaire. First, non-referred girls (n = 43) and boys (n = 51) with problems of attention and hyperactivity-impulsivity and then clinic-referred girls (n = 35) and boys (n = 66) with hyperkinetic disorder (HKD) were compared on the FTF. Results suggested that non-referred boys were more hyperactive-impulsive than non-referred girls, whereas clinic-referred boys and girl with HKD were more similar than dissimilar on the FTF questionnaire. Secondly, it was examined whether the application of gender mixed norms versus gender specific norms would result in varying proportions of clinic-referred children with HKD being identified as impaired on the subdomains of the FTF questionnaire. Based on results it was concluded that the use of a gender mixed normative sample may lead to overestimation of impairment in boys with HKD, but the type of sample applied to define impairment on the FTF should depend on the purpose for applying the questionnaire.

The study investigates behavioural, academic, cognitive, and motivational aspects of functioning in school-age children with attention-deficit/hyperactivity disorder (ADHD) with and without an executive function deficit (EFD).Children with ADHD--EFD (n = 22) and children with ADHD + EFD (n = 26) were compared on aspects of ADHD behaviour, school functioning, general cognitive ability, intra-individual response variability, affective decision-making, and delay aversion.Children with ADHD--EFD and children with ADHD + EFD were comparable in terms of ADHD symptomatology and school functioning. However, children with ADHD + EFD had significantly lower IQ and more intra-individual response variability than no EFD counterparts. Children with ADHD alone appeared more delay averse on the C-DT task than children with ADHD + EFD.Some children with ADHD were primarily characterised by problems with executive functions and variability others by problems with delay aversion supporting multiple pathway models of ADHD. Given the exploratory nature of the study, results are in need of replication.

BackgroundThere is no long-term prospective study (> 20 years) of the mental health of any refugee group.AimsTo investigate the long-term course and predictors of psychological distress among Vietnamese refugees in Norway.MethodEighty Vietnamese refugees, 57% of the original cohort previously interviewed in 1982 (T1) and 1985 (T2), completed a self-report questionnaire prior to a semi-structured interview. Mental health was measured using the Symptom Checklist–90–Revised (SCL–90–R).ResultsThe SCL–90–R mean Global Severity Index (GSI) decreased significantly fromT1toT3(2005–6), but there was no significant change in the percentage reaching threshold scores (GSI =1.00). Trauma-related mental disorder on arrival and the trajectory of symptoms over the first 3 years of resettlement predicted mental health after 23 years.ConclusionsAlthough the self-reported psychological distress decreased significantly over time, a substantial higher proportion of the refugee group still remained reaching threshold scores after 23 years of resettlement compared with the Norwegian population. The data suggest that refugees reaching threshold scores on measures such as the SCL–90–R soon after arrival warrant comprehensive clinical assessment.

Objective The objectives of this study were to develop and test a systematic medical record review for functional somatic symptoms (FSSs) in paediatric patients and to estimate the inter-rater reliability of paediatricians' recognition of FSSs and their associated impairments while using this method. Methods We developed the Medical Record Review for Functional Somatic Symptoms in Children (MRFC) for retrospective medical record review. Described symptoms were categorised as probably, definitely, or not FSSs. FSS-associated impairment was also determined. Three paediatricians performed the MRFC on the medical records of 54 children with a diagnosed, well-defined physical disease and 59 with ‘symptom’ diagnoses. The inter-rater reliabilities of the recognition and associated impairment of FSSs were tested on 20 of these records. Results The MRFC allowed identification of subgroups of children with multisymptomatic FSSs, long-term FSSs, and/or impairing FSSs. The FSS inter-rater reliability was good (combined kappa=0.69) but only fair as far as associated impairment was concerned (combined kappa=0.29). Conclusions In the hands of skilled paediatricians, the MRFC is a reliable method for identifying paediatric patients with diverse types of FSSs for clinical research. However, additional information is needed for reliable judgement of impairment. The method may also prove useful in clinical practice.

OCD is a more prevalent disorder than was once thought at a point prevalence from 0.6–1.5% in older children and young adolescents (Heyman et al. 2001) often running a chronic course as found in a meta-analysis of available outcome studies (Stewart et al. 2004). While a third of those who still were ill did fairly well, the other 2/3 had significant impairment and suffering. However, the patients had received very different therapies ranging from those known to be ineffective, such as psychodynamic psychotherapy, ‘‘classical’’ family therapy or drugs as benzodiazepines to therapies that had included CBT and/or serotonine active drugs at some point. The range of outcome did not differ as much as one would have hoped, given the range of treatments (see also Nissen and Thomsen 2008). Those who had had an inadequate first treatment tended to do worse. More than 50% of adults with OCD report onset in childhood/adolescence (Rasmussen and Eisen 1992), and we really do not know to what extent adults with OCD had been in treatment as children, nor if they had, to what extent it helped. The question of chronic pediatric OCD is not a trivial one, children with OCD grow up and many adults with OCD had childhood onset (Rasmussen and Eisen 1992). Adult OCD is the 10:th most common cause of disability from illness, including somatic illness (Lopez 1996, cited in Haynes et al. 2006).

Some borderline cases of obsessive-compulsive disorder (OCD), schizophrenia, and manic-depressive disorder in whom the diagnosis had been difficult to assess in adolescence are presented. The records of 27 OCD patients with admission both in adolescence and adulthood were compared to a group of manic-depressive and schizophrenic patients with an admission in adolescence where the OCD diagnosis had been given. Some differential diagnostic considerations and difficulties in the borderline area between OCD, manic-depressive psychosis and schizophrenia at the time of the first manifestation in adolescence are described. The symptomatology in the three groups of patients as it was presented in adolescence only showed a few differences, and the patients offered differential diagnostic difficulties to the clinicians.

Background There are conflicting results on whether immigrant children are at a heightened risk of mental health problems compared with native youth in the resettlement country. The objective of the study To compare the mental health of 94 Norwegian-born children from a community cohort of Vietnamese refugees, aged 4 - 18 years, with that of a Norwegian community sample. Methods The SDQ was completed by two types of informants; the children's self-reports, and the parents' reports, for comparison with Norwegian data from the Health Profiles for Children and Youth in the Akershus study. Results The self-perceived mental health of second-generation Vietnamese in Norway was better than that of their Norwegian compatriots, as assessed by the SDQ. In the Norwegian-Vietnamese group, both children and parents reported a higher level of functioning. Conclusion This surprising finding may result from the lower prevalence of mental distress in Norwegian-Vietnamese children compared with their Norwegian peers, or from biased reports and cultural differences in reporting emotional and behavioural problems. These findings may represent the positive results of the children's bi-cultural competencies.

Udgivelsesdato: 2009-Mar-10 This study analyzes changes in reasons for referral, diagnoses, age at referral and waiting times when the capacity of child and adolescent mental health services in an area was doubled over an 8-year period. In the region studied, there is a population of 60,000 children in the age-range 0-13 years. The treatment capacity rose from treating 0.9% of the population per year to 1.8%. There were only slight changes in the distribution of reasons for referral. Among diagnoses, there was a significant increase in the proportion of hyperkinetic disorder, at the expense of stress-related disorders, conduct disorders and emotional disorders with onset in childhood. Furthermore, the study found that the wait duration and age at referral remained almost unchanged. The results of the study support that the capacity of the services in 2004 is still not sufficient to meet fully the population needs, and that awareness should be directed towards early intervention and children with emotional disorders.

Udgivelsesdato: 2009-Jul-26 Research on somatisation or functional disorders, characterised by the subjective report of physical symptoms in the absence of clear physical pathology, in young children is limited. This study investigates the distribution, types and co-occurrence of parent-reported functional somatic symptoms (FSS) and their impairment in a population-based sample of Danish 5-7-year-old children. Data were obtained from a 5-7-year follow-up of the Copenhagen Child Cohort 2000. The entire study population included 3,000 randomly sampled children from the cohort. Among these FSS measures were obtained for 1,327 children. The newly introduced parent interview, the soma assessment interview, was used to assess the child's FSS. Impairing symptoms were defined as FSS that caused substantial discomfort, impairment of everyday life, absence from day-care or school and/or help-seeking in the health care system. The 1-year prevalence of any FSS was 23.2% (N = 308) and higher in girls than boys (27.6 vs. 18.8%, P < 0.0001). Impairing FSS were found in 4.4% (N = 58). Pain complaints, i.e. limb pain, headache and abdominal pain, were the most frequently reported FSS. Among the 308 children with FSS, 66 (21.4%) presented with two or more of these functional pain complaints, while 15 (4.9%) had all three types. The findings indicate that FSS are common health complaints in 5-7-year-old children. A subgroup with impairing FSS with a likely need of clinical intervention was identified. This suggests that a somatisation pattern may start early in life and call for future studies to include associated impairment in the investigation of childhood FSS.

Udgivelsesdato: 2009-May OBJECTIVE: Medically unexplained or functional somatic symptoms (FSS) in children constitute a major clinical problem. Epidemiological studies of this phenomenon are, however, hampered by a lack of good standardized measures. The objective of this study was therefore to (1) develop a parent-report measure of FSS in children aged 5-10 years and (2) perform an initial validation. METHODS: A parent interview, the Soma Assessment Interview (SAI), for FSS detection in young children was developed for lay interviewers with subsequent clinical assessment. A preliminary validation was based on interview tests of the parents of 54 children with well-defined physical disease, 59 with likely functional disorder and 105 from the community. Independent measures of the somatic complaints were completed before the interview, and children from the clinical samples were also assigned independent FSS diagnoses based on medical record review. RESULTS: The Kappa value for two clinical assessors' agreement on FSS recognition was 0.86. Good discrimination was obtained between a community sample and a clinical sample with an expected high prevalence of FSS. In the former convergent validity with independent measures of somatic complaints was found. In the latter substantial agreement (89%) appeared between a medical record diagnosis of FSS and SAI detection of FSS. CONCLUSION: The SAI offers comprehensive description of FSS in young children in population-based studies and may also prove useful in clinical settings. It is readily accepted and relatively quickly completed, and preliminary assessment of its validity is promising.

The charts of 61 children and adolescents admitted to the Psychiatric Hospital for Children in Aarhus, Denmark, in the period 1970-1986 fulfilling the DSM-III criteria for obsessive-compulsive disorder were reviewed for obsessive/compulsive symptoms. The symptoms were divided into form and content. The most common form of compulsion was rituals seen in 39 of the patients, and the most common compulsive content was washing. The most frequent obsessive content was thoughts about dirt and contamination followed by concern about death, illness and harm. The phenomenological feature of boys and girls was very similar, and only a few significant differences between boys and girls were found. One quarter of the boys and 12.5% of the girls had only obsession, whereas 27.0% of the boys and 37.5% of the girls had only compulsion and no obsession. The number of obsessive/compulsive symptoms was not found to correlate with the time spent each day on the symptom. It is concluded that there do not seem to be any intercultural differences between Denmark, India, and Japan as to the content of obsessional thoughts and compulsive behaviour in children and adolescents.

This study is retrospective and based on the charts of 146 patients (72 boys and 74 girls) admitted to a Danish adolescent psychiatric department in the period 1976 to 1986. Reasons for admission, previous treatment, and arrangements at discharge are presented. The commonest reason for admission was conduct disorder resulting in truancy (30% About 28% were referred with conditions of anxiety, phobias, and obsessions as major problems. No significant differences between boys and girls emerged, except for eating disorders, in which girls predominated. Almost half of the adolescents had consulted a school psychologist before referral to psychiatric hospital. More boys than girls had been in a day and night institution before referral. About 50% of the patients returned to their home at discharge. About 35% were referred to an institution, a youth pension, or professional family care. The reasons for admission to a psychiatric hospital and the need for further psychiatric treatment after discharge are discussed.