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Objective: Chronic illness of a child puts healthy children of the family at risk of distress. Previous studies have demonstrated that healthy children's psychological symptoms can be reduced when the child knows more about the disease. So far, there is limited evidence of the effectiveness of psychoeducational interventions for healthy children., Aims: To compare the effectiveness of an inpatient family-oriented rehabilitation program with vs without additional psychoeducational sessions for healthy children of families with children with cancer., Patients and Methods: We performed a controlled study in 4 German family-oriented rehabilitation clinics. The outcomes of n = 73 healthy children (mean age: M = 9.55; SD = 3.14; range: 4-18), who participated in 5 additional psychoeducational sessions, were compared with the outcomes of n = 111 healthy children (mean age: M = 8.85; SD = 3.28; range: 4-17), who underwent the usual inpatient rehabilitation program. Primary outcomes were the healthy children's cancer-specific knowledge and their emotional symptoms. Secondary outcomes were family satisfaction and quality of life., Results: Intention-to-treat analyses showed that both groups improved significantly from preintervention to postintervention. Improvements comprised knowledge about cancer (F(1,174) = 11.03, p < 0.001), self-reported emotional symptoms (F(1,135) = 31.68, p < 0.001), and parent-proxy-reported emotional symptoms (F(1,179) = 37.07, p < 0.001). The additional psycho-educational program did not significantly enhance the outcomes. The same pattern of significant improvement in both conditions emerged for all secondary outcomes. The immediate effects of the intervention persisted until 2 months after discharge from the rehabilitation program., Conclusions: Inpatient family-oriented rehabilitation is effective in improving multiple psychosocial outcomes of healthy children in families which have a child with cancer. Additional psycho-educational sessions did not show any substantial additional improvement., (Copyright © 2017 John Wiley & Sons, Ltd.)

Child maltreatment represents a major risk factor for the development of emotional and behavioral problems, especially posttraumatic stress disorder (PTSD). While effective trauma-focused treatments are available, little is known about the usual mental healthcare for abused youths in Germany. The present study compared the utilization of mental healthcare in abused youths who had developed a PTSD (N = 95) with a group presenting other mental disorders (N = 146). Semistructured interviews were used to assess maltreatment histories, current mental health, and healthcare utilization. In addition, potential child factors associated with access to mental healthcare (age and level of functioning) were examined. Results showed that 65 % of both diagnostic groups currently fail to use any mental healthcare service. Of the participants with PTSD, 43 (45 %) had never received any mental healthcare intervention. Investigations on potential barriers are necessary to close the huge gap between clinical services and evidence-based, trauma-focused interventions.

The Sibling Perception Questionnaire (SPQ) measures the impact a cancer disease of a child has on a sibling's interpersonal relations in the family, communication, intrapersonal perceptions and fear of the disease. Aim of this study was the psychometric evaluation of the German version of the SPQ. For this purpose, data of 216 healthy siblings including 164 self-reports and 212 parent reports were gathered. For further analyses the 4 subscales "interpersonal difficulties", "intrapersonal difficulties", "open communication" and "fear of the disease" with overall 23 items were evaluated. Sufficient internal consistencies in the parent report (Cronbach's α between 0.73 and 0.87) and in the self-report version (α between 0.59 and 0.80) were found for all subscales except the subscale fear of the disease (α=0.35 and 0.16). Regarding external validity, significant correlations emerged between scales of the SPQ and scales of the Strengths and Difficulties Questionnaire (SDQ) and the Quality of Life Inventory for Children (LQ-KID) (r=- 0.37; r=0.63; p≤0.001). The German version of the SPQ can be regarded as a reliable and valid instrument for the assessment of emotional responses of healthy children on their sibling's cancer disease. Further investigations on different samples are recommended., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Chronic paediatric heart disease is often associated with residual symptoms, persisting functional restrictions, and late sequelae for psychosocial development. It is, therefore, increasingly important to evaluate the health-related quality of life of children and adolescents with chronic heart disease. The aim of this study was to determine medical and socio-demographic variables affecting health-related quality of life in school-aged children and adolescents with chronic heart disease. Patients and methods The Pediatric Cardiac Quality of Life Inventory was administered to 375 children and adolescents and 386 parental caregivers. Medical information was obtained from the charts. The socio-demographic information was provided by the patients and caregivers., Results: Greater disease severity, low school attendance, current cardiac medication, current parental employment, uncertain or limited prognosis, history of connection to a heart-lung machine, number of nights spent in a hospital, and need for treatment in a paediatric aftercare clinic independently contributed to lower health-related quality of life (self-report: R2=0.41; proxy-report: R2=0.46). High correlations between self-reports and parent-proxy reports indicated concordance regarding the evaluation of a child's health-related quality of life., Conclusions: Beyond medical treatment, integration into school is important to increase health-related quality of life in children and adolescents surviving with chronic heart disease. Regular screening of health-related quality of life is recommended to identify patients with special needs.

Recent research has shown that unaccompanied young refugees (UYR) encounter a wide range of traumatic events during preflight, flight, and resettlement. Although many UYR are resourceful, many develop posttraumatic stress symptoms (PTSS). However, only a small number of vulnerable UYR have access to trauma-focused interventions. Trauma-focused group interventions, adapted to the needs of UYR, may be one way of improving their mental health. A total of 29 male UYR between 14 and 18 years of age, mainly from Afghanistan, participated in the evaluation study of a trauma-focused group intervention entitled Mein Weg (My Way). The intervention included six sessions of psychoeducation, relaxation, trauma narrative, and cognitive restructuring. Pre-post comparisons of PTSS assessed by the Child and Adolescent Trauma Screen (CATS) were used. At study entry, participants endorsed, on average, eight traumatic events. After the group intervention, the participants reported significantly fewer overall PTSS preintervention mean = 27.6, SD = 7.9; postintervention mean = 20.7, SD = 6.3; t(28) = 4.2, p = .001, Cohen's d = 0.97. Improvement was especially pronounced in the domains of reexperiencing and avoidance, as well as negative alterations in cognitions and mood. There were 14 participants preintervention and 7 postintervention who fulfilled the PTSD criteria. This pilot study presented initial evidence of the efficacy of the trauma-focused group intervention with regard to PTSS reduction., (Copyright © 2017 International Society for Traumatic Stress Studies.)

Family-Based Trauma-Focused Cognitive Behavioral Therapy with Three Siblings of a Refugee Family The possibility and relevance of a joint trauma-therapy with siblings has yet received little attention in research and clinical practice. The following case study presents a joint family-based trauma-focused therapy process with a refugee family. All three siblings suffered from post-traumatic stress disorder (PTSD) before treatment. The treatment followed the manual of Trauma Focused Cognitive Behavioral Therapy (TF-CBT; Cohen, Mannarino, Deblinger, 2009). Measures were the short version of the Child and Adolescent Trauma Screen (CATS 7-17), as well as the Teacher's Report Form (TRF). After 18 treatment sessions together with the mother, all three children did no longer meet PTSD criteria. Benefits of the joint therapy were for all three siblings to be sharing and imitating each other's coping strategies. Furthermore, the protective factor of social support after experiencing a traumatic event became evident. The apprehension of the therapist not being sufficiently neutral towards all three siblings was not observed.

Trauma-focused cognitive behavioral therapy (Tf-CBT) is an evidence-based trauma therapy for children and adolescents aged 3–17 years with posttraumatic stress disorder (PTSD). One supportive caregiver is regularly included in the therapeutic process. Tf-CBT consists of eight components and can be summarized by the acronym P.R.A.C.T.I.C.E: Psychoeducation and Parenting skills, Relaxation skills, Affective modulation skills, Cognitive coping skills, Trauma narrative and cognitive processing of the traumatic event(s), In vivo mastery of trauma reminders, Conjoint child-parent sessions, and Enhancing safety and future developmental trajectory. Based on a total of 13 randomized controlled trials, several meta-analyses and systematic reviews confirm the efficacy of Tf-CBT, which received evidence level Ia in several international guidelines and is therefore recommended as first-line treatment for children and adolescents with PTSD.

Background: Child abuse and neglect (CAN) is a risk factor for the development of psychiatric disorders. Untreated, disorders can sustain into adulthood., Objectives: This study compares rates of psychiatric disorders to mental health care utilization in victims of CAN., Methods: From three regions in Germany, 322 children and adolescents aged between 4 and 17 and a non-abusive caregiver were assessed for the child's history of CAN, mental health and mental health care utilization via semi-structured interviews., Results: Approximately two thirds of the participants (present state 64.29 %; lifetime 69.57 %) suffered from a psychiatric disorder classifiable with ICD-10. Posttraumatic stress disorder (25.16 %), conduct disorders (21.34 %) and attention and hyperactivity disorders (16.15 %) were most frequently diagnosed. Merely 19.88 % were using mental health care at the time of the assessment., Conclusions: The provision of mental health care for victims of CAN is insufficient. To improve access to appropriate services for this vulnerable clientele, cooperation between psychiatrists and psychotherapists and the child welfare system is essential. The implementation and dissemination of evidence-based diagnostic methods and treatments must be further advanced.

Background: Trauma-focused cognitive behavioral therapy (Tf-CBT) is efficacious for children and adolescents with posttraumatic stress symptoms (PTSS). Its effectiveness in clinical practice has still to be investigated., Aims: To determine whether Tf-CBT is superior to waiting list (WL), and to investigate the predictors of treatment response., Method: We conducted a single-blind parallel-group randomized controlled trial in eight German outpatient clinics with the main inclusion criteria of age 7-17 years, symptom score ≥35 on the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA), and caregiver participation. Patients were randomly assigned to 12 sessions of Tf-CBT (n = 76) or a WL (n = 83). The primary outcome was the CAPS-CA symptom score assessed at 4 months by blinded evaluators. The secondary measures were diagnostic status, the Children's Global Assessment Scale (CGAS), self-reported and caregiver-reported PTSS (UCLA-PTSD Reaction Index), the Child Posttraumatic Cognitions Inventory (CPTCI), the Children's Depression Inventory (CDI), the Screen for Child Anxiety- Related Emotional Disorders (SCARED), the Child Behavior Checklist (CBCL/4-18), and the Quality of Life Inventory for Children., Results: Intention-to-treat analyses showed that Tf-CBT was significantly superior to WL on the CAPS-CA (Tf-CBT: baseline = 58.51 ± 17.41; 4 months = 32.16 ± 26.02; WL: baseline = 57.39 ± 16.05; 4 months = 43.29 ± 25.2; F1, 157 = 12.3; p = 0.001; d = 0.50), in terms of secondary measures of the CGAS, UCLA-PTSD-RI, CPTCI, CDI, SCARED, and CBCL/4-18, but not in terms of quality of life. Age and comorbidity significantly predicted treatment response., Conclusions: Tf-CBT is effective for children and adolescents with heterogeneous trauma types in German service settings. Younger patients with fewer comorbid disorders show most improvement., (© 2016 S. Karger AG, Basel.)

Psychological issues associated with cystic fibrosis may arise from the patients' lifelong disease- and treatment-related burden. This Cochrane Review aimed to determine psychosocial and physical outcomes of psychological interventions. Trial registries, databases and professional networks were used to identify relevant studies. Altogether, 16 studies involving 556 participants were included. They were heterogeneous in their methods, design, target groups, and outcomes. Overall, the current evidence for psychological interventions is insufficient. Preliminary evidence was available for interventions targeting specific aspects of the treatment regimen, such as behavioural nutrition interventions., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: Systematic exploration of potentially traumatic events and posttraumatic stress symptoms of patients attending a hospital for child and adolescent psychiatry and psychotherapy., Methods: The UCLA PTSD Reaction Index for DSM-IV was filled in by 413 children and adolescents and 403 caregivers at their first attendance at the clinic., Results: At least one traumatic event was reported by 46.9% of the children and adolescents and/or caregivers. Clinically relevant post-traumatic stress symptoms were reported in 22.9%., Conclusion: In the investigated sample routinely performed screening assessments can identify clinically relevant post-traumatic stress symptoms in almost one of four patients of child mental health services., (© Georg Thieme Verlag KG Stuttgart · New York.)

Victims of child abuse and neglect are more likely to develop emotional and behavioral problems than their non-abused peers. In many cases they do not receive evidence based treatments. Based on pilot studies and clinical experience, a structured and manualized case-management protocol was developed to provide child welfare professionals guidance, direction and support in helping these families find and engage in appropriate treatment. The protocol is described. A survey among child welfare workers indicates a lack of knowledge about mental disorders in victims of child abuse as well as an insufficient cooperation between the child welfare and the mental healthcare system. Child welfare workers who have applied the manual evaluate it positively. This study shows that the structured case-management can be implemented in a child welfare setting.

The risk for children and adolescents to be exposed to a potentially traumatic event (PTE) is high. The present study examines the frequency of PTEs in children and adolescents with Posttraumatic Stress Disorder (PTSD), the type of index trauma, and its relation to PTSD symptom severity and gender. A clinical sample of 159 children and adolescents between 7-16 years was assessed using the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). All reported PTEs from the checklist were analyzed according to frequency. The index events were categorized according to the following categories: cause (random vs. intentional), relation to offender (intrafamilial vs. extrafamilial), patient's role (victim, witness or vicarious traumatization), and type of PTE (physical or sexual violence). Relation between categories and PTSD symptom severity and sex were analyzed with inferential statistics. On average participants reported five PTEs, most frequently physical violence without weapons (57.9%), loss of loved person through death (45.9%), and sexual abuse/assaults (44%). The most frequent index traumata were intentional (76.7%). Regarding trauma type, there was a significant difference concerning higher symptom severity in children and adolescents who experienced sexual abuse/assault compared to physical violence (t=-1.913(109), p=0.05). A significantly higher symptom severity was found for girls compared to boys for the trauma categories extrafamilial offender (z=-2,27, p=0.02), victim (z=-2,11, p=0,04), and sexual abuse/assault (z=-2,43, p=0,01). Clinical and diagnostic implications are discussed in relation to the amendments of PTSD diagnostic criteria in DSM-5.

Background: Individuals with chronic diseases and parent caregivers are at increased risk for symptoms of depression and anxiety. Prevalence of psychological symptoms was evaluated in adolescents and adults with cystic fibrosis (CF) and parent caregivers across nine countries., Methods: Patients with CF, ages 12 years and older, and caregivers of children with CF, birth to18 years of age, completed measures of depression and anxiety across 154 CF centres in Europe and the USA. Psychological symptoms were compared across countries using χ(2). Logistic regression examined extent of comorbid symptoms, predictors of depression and anxiety, and concordance between parent and adolescent symptomatology., Results: Psychological symptoms were reported by 6088 patients with CF and 4102 parents. Elevated symptoms of depression were found in 10% of adolescents, 19% of adults, 37% of mothers and 31% of fathers. Elevations in anxiety were found in 22% of adolescents, 32% of adults, 48% of mothers and 36% of fathers. Overall, elevations were 2-3 times those of community samples. Participants reporting elevated anxiety were more likely to report depression (ORs: adolescents=14.97, adults=13.64, mothers=15.52, fathers=9.20). Significant differences in reports of depression and anxiety were found by patient age and parent respondent. Concordance between 1122 parent-teen dyads indicated that adolescents whose parents reported depression were more likely to be elevated on depression (OR=2.32). Similarly, adolescents whose parents reported anxiety were more likely to score in the elevated range on the anxiety measure (OR=2.22)., Conclusions: Symptoms of depression and anxiety were elevated in both patients with CF and parents across several European countries and the USA. Annual screening of psychological symptoms is recommended for both patients and parents., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Purpose: Long-term survivors of pediatric cancer have an increased risk of post-traumatic stress symptoms (PTSS) and dysfunctional anxiety. However, there is a lack of evidence-based psychotherapy tailored to the needs of this target group. In this single-arm pilot study, an Internet-based psychological intervention ("Onco-STEP") for adolescent and young adult survivors was developed, and its efficacy in reducing PTSS and anxiety was evaluated., Methods: Former patients of pediatric cancer older than 15 years manifesting clinically relevant PTSS or anxiety were eligible. The cognitive-behavioral treatment consists of ten writing sessions and comprises two modules: the first aiming to reprocess the traumatic cancer-related experiences and the second aiming to build coping strategies with current cancer-related fears. Treatment was delivered via written messages on a secure Internet platform. Outcomes were assessed by the Post-traumatic Stress Diagnostic Scale, the Hospital Anxiety and Depression Scale, and the Fear of Progression/Relapse Questionnaire., Results: A total of 20 participants completed the intervention (mean age 27.3 ± 4.8 years at study; 13.8 ± 4.7 years since diagnosis; 70 % female). PTSS, anxiety, and fear of progression/relapse significantly declined at the end of the intervention, with pre-post effect sizes of 0.63, 0.74, and 0.48. In addition, we found a significant decrease in symptoms of depression. Except for the improvement in depression, all effects were sustained 3 months after the end of treatment., Conclusions: The results show that the intervention is efficacious in reducing symptoms of post-traumatic stress and anxiety. Onco-STEP is a promising new way to treat young adult long-term survivors of pediatric cancer with late psychological effects. Future efforts need to focus on investigating specific evidence of the intervention in a randomized controlled trial.

Although adolescents in juvenile residential facilities are at high risk for mental disorders, not all of these adolescents develop psychiatric symptoms. The aim of our study was to define traits protecting these adolescents. A total of 314 adolescents of 20 juvenile residential facilities were examined using standardized assessment instruments (Child Behavior Checklist (CBCL), Junior Temperament and Character Inventory (JTCI)). Educators of the facilities filled out a sociodemographic questionnaire for each participant. Adolescents were divided into two groups (resilient vs. mental problems) by CBCL-Cut-off-Scores. Analyses were based on these two groups. Resilient youth differed from youth with psychiatric symptoms in temperament- and character-traits (e. g. self-directedness F = 28.4, p < .001, d = 0.64) with small to moderate effect sizes (d = 0.36 to 0.64). Resilient adolescents lived in larger facilities (U = 9080, p = .025). No associations were found between gender and resilience, as well as age at placement in the facility and duration of the stay in the facility and resilience. Significant differences in temperament- and character-traits between resilient adolescents and adolescents with mental problems were identified. Especially character-traits could be a basis for developing strategies for promoting mental health and further resilience factors, as social support.

Foster children are exposed to multiple psychosocial and biological risk factors and have an elevated risk for developmental delays and the development of mental disorders. Many children experienced compromising situations such as neglect, physical abuse, or sexual abuse before out-of-home placement. Consequently, they show a higher need for mental health services than other children. However, out-of-home placement is often considered as the sufficient measure to help these children. Hence this project had the aim to sensitize child welfare agencies and foster parent organisations for the special needs and history of foster children, to provide them with instruments for the assessment of emotional and behaviour problems and to promote the cooperation at the interface between child welfare system and mental health system. Twenty-four child welfare agencies and four foster parent organisations participated. The control group consisted of 16 non-participating child welfare agencies. After one year, participants recorded more often children's social history (p = .023), conducted more often standardized psychosocial assessments (p = .001), assessed more often the medical needs of foster children (p = .029), and informed foster parents more often about behaviour problems of their foster child (p = .034). In summary, child welfare agencies were very interested, could be sensitized for mental disorders following traumata and implemented the offered instruments in their work. Limits of resources could be observed due to the case workers' high case load.

Purpose: Significant improvements in survival of patients with cystic fibrosis lead clinicians and researchers to focus on how patients can be enabled to lead as normal a life as possible throughout their entire life span. The study aimed at analyzing the vocational and social achievement, life satisfaction, and psychological well-being of adolescents and adults with cystic fibrosis., Methods: During a routine clinic visit, 670 German patients with cystic fibrosis (12-64 years, M = 23.1) completed questionnaires on their vocational and social achievement, life satisfaction, and symptoms of anxiety and depression. Cross-sectional analyses were applied across four age-groups (12-20 years, 21-30 years, 31-40 years, and 41 years and older)., Results: Most patients with cystic fibrosis reached employment and independence from their parents during adulthood. Life satisfaction was negatively associated with age, with the largest difference between the second and third life decade. A strong negative association of anxious and depressive symptoms with life satisfaction was found. Lung function was significantly positively related to life satisfaction, even though this association was less pronounced., Conclusions: Most patients with cystic fibrosis achieve ordinary social and vocational development into adulthood. A favorable mental health status seems more important than pulmonary function to maintain a good satisfaction with life.

Background: To examine the prevalence of symptoms of anxiety and depression and the concordance of these symptoms in adolescents with Cystic Fibrosis (CF) and their caregivers, and to analyze their healthcare utilization for mental health problems., Methods: 162 German adolescents with CF (aged 12-17 years) and their parental caregivers (88.3% mothers) completed screening measures for anxiety and depression and described their mental healthcare utilization., Results: Compared to adolescent patients with CF, caregivers reported significantly more anxious and depressive symptoms. An association between adolescent and caregiver anxiety was found. Only a minority of affected patients and caregivers received any form of specialist treatment for their mental health problems., Conclusions: Screening for anxiety/depression and addressing mental health issues within the framework of a family perspective is recommended as an element of routine healthcare for adolescents with CF., (Copyright © 2011 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Objective: To evaluate the short- and medium-term effectiveness of an inpatient parent-child rehabilitation program in reducing symptoms of psychological distress and in increasing the quality of life of parents and children., Methods: Psychological problems and quality of life of parents and children were assessed 4 weeks before admission, at admission and discharge from the program, and 3 months post discharge using standardized questionnaires. The sample consisted of 256 parents, parent ratings of 397 children and self reports of 124 school-aged children., Results: Compared to the waiting period prior to admission significant decreases in psychological problems as well as improvements in quality of life were found for both, parents and children. These effects proved to be stable over the follow-up period., Conclusions: Inpatient parent-child rehabilitation programs are effective in improving the psychological well-being and quality of life of parents and children., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To assess the prevalence of symptoms of anxiety and depression and the extent of life satisfaction in parents caring for children with cystic fibrosis (CF) in Germany., Methods: The study included 650 caregivers of 564 children with CF ages 0-17, who completed the Hospital Anxiety Depression Scale (HADS), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Questions on Life Satisfaction (FLZ(M) )., Results: More than one-third (37.2%) of parents showed elevated levels of anxious symptoms, compared to 18.9% of a population sample (P≤0.001) and significantly more parents reported elevated levels of depressive symptoms compared to a community sample (28% vs. 21%, P=0.01). Higher levels of anxious and depressive symptoms were associated with lower life satisfaction (P<0.001)., Conclusions: High levels of anxious and depressive symptoms among parents of children with CF suggested that annual symptom screening is warranted. This will facilitate identification of those at risk and provide referrals and intervention for those who are in need of it., (Copyright © 2011 Wiley-Liss, Inc.)

Background: Adolescence involves graduating from school and preparing one's professional career. The accomplishment of these tasks may be hampered by the experience of cancer. This study investigates the educational and professional achievements of German long-term survivors of adolescent cancer., Procedure: Adult survivors of cancer during adolescence (n = 820, age at onset between 15 and 18 years; M = 15.8, SD = 0.9 years; age at follow-up: M = 30.4, SD = 6.0 years) were recruited through the German Childhood Cancer Registry. They completed self-reports with standard items on their educational and vocational level and their current occupational situation. Outcomes were compared to an age-matched sample from the general population (German Socio-Economic Panel, n = 820, age: M = 30.4, SD = 6.7). Risk factors for educational and vocational underachievement were identified by subgroup analyses., Results: Compared to peers from the general population, survivors of cancer during adolescence achieved higher educational and vocational levels. A higher proportion of survivors was employed; however, survivors were significantly older when starting their first occupation. Subgroup analyses revealed that neuropsychological late effects were associated with reduced rates of graduation from university and of employment among the survivors. No such effect of neuro-cognitive late effects occurred for high school graduation., Conclusions: Most German survivors of cancer during adolescence participate in school and vocational life without major difficulties. Problems particularly arise for survivors with neuropsychological sequelae. Further research should investigate whether these results can be attributed to the German support system for pediatric cancer patients or to sample effects., (© 2010 Wiley-Liss, Inc.)

Evidence-based psychotherapy (EBP) proposes the fit between a specific treatment, therapist, patient and mental disorder. At the same time, the generalization of psychotherapy research findings is intended. In this conflict between individualized and standardized treatment the search for specific active components of psychotherapy is essential to improve intervention methods as well as training of therapists. Many manualized treatments for children and adolescents are considered evidence-based, proven by its outcome. However, their active ingredients often remain unclear. The following methods to identify necessary active components for successful treatments are described: classical comparative randomized controlled trials, dismantling studies, add-on studies, meta-analyses, and the multiphase optimization strategy. Consequences for the future agenda for child and adolescent psychotherapy research are discussed.

Background: Chronic illness is a significant risk factor for the development of internalizing psychopathology; however, evidence for the prevalence of these symptoms in patients with cystic fibrosis (CF) is limited. We investigated the prevalence of symptoms of anxiety and depression in German-speaking patients with CF and the association of these symptoms to physical health status., Methods: A representative sample of German patients with CF (N = 670; age range, 12-64 years; 52.7% men) completed the Hospital Anxiety and Depression Scale. Their medical data were taken from the German CF registry. Data on the study sample were compared with data on a control group from the German general population., Results: Elevated anxiety scores were found in 20.6% of the patients with CF, and 9.6% reported high levels of symptoms of depression. Adult patients with CF reported more elevated symptoms of anxiety than healthy control subjects, whereas no age group of patients was more or less depressed than the general population. Younger patients reported fewer symptoms of anxiety and depression than older patients, and women reported more symptoms of anxiety than men. Recent hemoptysis/pneumothorax and recent diagnosis of diabetes were associated with anxiety, whereas impaired lung function and transplant listing status were associated with depression., Conclusions: Anxiety in particular is an important issue for a large proportion of patients with CF. The risk of depression increased with greater impairment in pulmonary function. Annual screening of symptoms of anxiety and depression as well as appropriate referrals for those in the clinically elevated range are recommended.

Objective: Foster children often experience compromising situations such as neglect, physical abuse, or sexual abuse before out-of-home placement. This article aims to give a literature review related to the development and mental health of foster children with special consideration of trauma history., Methods: A computer-based literature search was conducted in the databases Medline, PsycINFO, PSYNDEXplus, and SCOPUS. We determined a time frame from 1998 to 2009., Results: The literature search resulted in 32 articles reporting empirical data about development and mental health in foster children. Very high rates of exposure to maltreatment, developmental delays and mental disorders were found. A broad spectrum of externalizing as well as internalizing symptoms and a high prevalence of comorbid mental disorders were found., Conclusions: Foster children exhibit a broad pattern of developmental problems and psychopathology. The etiology of these disorders is discussed in the context of multiple risk factors, especially that of persistent maltreatment.

Objectives: Measuring life satisfaction in children is becoming more and more important in clinical practice. This is the first study to evaluate the psychometric properties of the "Questions on Life Satisfaction for Children and Adolescents" FLZ(KJ) based on a student sample., Methods: 1 312 German students ( M=13.7 years, SD=1.4) filled in the FLZ(KJ). Item characteristics, reliability, convergent and discriminant validity were assessed. Age- and gender-specific reference data were reported., Results: Items were well accepted by the students. Selectivity and internal consistency of the two modules were acceptable, with alpha scores of alpha=0.70 and 0.75. Associations with the KIDSCREEN-10 Index support the convergent valid-ity of the instrument. The FLZ(KJ) differentiated well between children with and without chronic conditions., Conclusions: The FLZ(KJ) are reliable and sufficiently valid, with psychometric properties comparable to the adult version of the instrument. The instrument is a useful tool in measuring life satisfaction in children and adolescents., (Georg Thieme Verlag KG Stuttgart.New York.)

Complex Posttraumatic Stress Disorder and Developmental Trauma Disorder are discussed as new diagnostic entities representing the broad spectrum of trauma-related symptoms of children and adolescents. However, the psychotherapy of severe and complex trauma during adolescence is challenging because trauma-associated symptoms like attachment problems, the expectation of self-inefficacy and dissociation may complicate therapeutic work and limit treatment outcome. Therefore it is necessary to develop evidence-based treatment approaches for these mental disorders. Trauma-focused cognitive-behavioral therapy has been successfully evaluated for the treatment of posttraumatic stress disorder. Actual treatment approaches combine strategies from Dialectal Behavioral Therapy (DBT) with cognitive behavioral techniques of trauma therapy for the treatment of complex trauma disorder. This article gives a practical overview about cognitive-behavioral treatment approaches and discusses problems of their implementation in the clinical routine of child and adolescent psychiatrists/psychotherapists.

Objective: Psychoeducation of parents and caregivers is an important component of treatment for ADHD. So far, standardized instruments to indicate an evaluate psychoeducation are scarce. This study describes the development of a parent questionnaire to assess ADHD-specific knowledge and motivation for treatment., Method: Items were generated based on scientific evidence, comprising knowledge about symptoms, etiology and treatment for ADHD, as well as willingness to adhere to concrete treatments. The questionnaire was developed based on theoretical assumptions and on principles of classical test construction. The psychometric analysis of the final version was performed in a sample of 105 parents of children with suspected diagnosis ADHD., Results: The questionnaire comprises 37 Items on three scales basis knowledge, differentiated knowledge, and motivation for psychosocial treatment. Motivation for medical treatment is assessed separately., Conclusions: Preliminary psychometric analyses support the multi-dimensional representation of ADHD-specific knowledge and motivation for treatment. Further analyses of the validity of the questionnaire and on the sensitivity for changes should be undertaken.

Objective: To investigate the cognitive functioning of low-risk singletons born after intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF) at the age of 5 or 10 years., Methods: Sixty-nine children (35 ICSI, 34 IVF) participated voluntarily in the study that had been approved by the local IRB. Their intellectual functioning was examined by the Kaufmann Assessment Battery for Children., Results: The IQ of the study group fell in the normal range (mean = 98.2; SD = 12.2). ICSI children (IQ = 94.1, SD = 13.8) had statistically lower intellectual abilities compared to IVF children (IQ = 102.0, SD = 9.1; t = -2.81, p = .005), especially in simultaneous mental processing. 23.5% ICSI children, but only 2.9% IVF children (p = .011) had at least borderline delayed cognitive development., Conclusions: Most artificially conceived singletons show a normal cognitive development, however the method of fertilization seems to have an impact on their IQ. ICSI might be associated with the risk for a slightly delayed cognitive development compared to IVF.

Objective: To provide a review of the evidence base of family measures relevant to pediatric psychology., Method: Twenty-nine family measures were selected based upon endorsement by Division 54 listserv members, expert judgment, and literature review. Spanning observational and self-report methods, the measures fell into three broad assessment categories: Family functioning, Dyadic family relationships, and Family functioning in the context of childhood chronic health conditions. Measures were categorized as: "Well-established", "Approaching well-established", or "Promising.", Results: Nineteen measures met "well-established" criteria and the remaining ten were "approaching well-established." "Well-established" measures were documented for each of the broad assessment categories named above., Conclusions: Many measures deemed "well-established" in the general population are proving to be reliable and useful in pediatric samples. More evidence of the validity of family measures is needed in this context. This review should prove helpful to clinicians and researchers as they strive to make evidence-based decisions regarding family measures.

A revised version of the Beck depression inventory (BDI-II) has been translated into German. Until now the BDI-II has only been evaluated in several American studies with clinical and nonclinical samples of adolescents. 111 adolescent psychiatric patients (ages ranged from 15-18 years) participated in a study to evaluate reliability, construct and factorial validity, as well as the diagnostic discrimination of the BDI-II. Internal consistency was high (alpha=0.92), showing the homogeneity of the instrument. Associations with other clinical (parent and self report) instruments point in the expected direction and support the external validity of the BDI-II. A factor-analysis generated inconclusive results. The BDI-II differentiated very well between a subsample of depressed adolescents (n=46), a subsample of non-depressed adolescent patients (n=53) and a nonclinical sample (n=31). The results of this study support the use of the BDI-II as a severity measure of depressive symptoms among adolescent psychiatric patients.

Based on a systematic review of the recent literature (2000-2006) we describe the results of 22 empirical studies of the development of children born after assisted reproduction. We considered the somatic, functional and psychosocial development and found some consistent outcomes. With regard to the somatic health, higher incidences of perinatal complications, major birth defects and chromosomal aberrations are repeatedly described. In most cases the studies of the functional and psychosocial development found no statistically differences to naturally conceived children. However some preliminary results demonstrate tendencies to emotional symptoms. The findings suggest the well-being and well-functioning of these children, but further empirical data especially to assess the psychosocial development are needed, especially for schoolage children and adolescents.

Objective: Adolescence is a developmental phase associated with significant somatic and psychosocial changes. So far there are few studies on developmental aspects of life satisfaction. This cross-sectional study examines the effects of age and gender on adolescent's life satisfaction., Methods: 1,274 German adolescents (aged 11-16 years) participated in a school-based survey study. They completed the adolescent version of the Questions on Life Satisfaction (FLZ(M) - Fragen zur Lebenszufriedenheit), a multidimensional instrument measuring the subjective importance and satisfaction with eight domains of general and eight domains of health-related life satisfaction. Effects of gender and age were analysed using ANOVAs., Results: Girls reported significantly lower general (F = 5.0; p = .025) and health-related life satisfaction (F = 25.3; p < .001) compared to boys. In both genders and across nearly all life domains, there was a significant decrease in general (F = 14.8; p < .001) and health-related life satisfaction (F = 8.0; p < .001) between 11 and 16 years. Satisfaction with friends remained on a high level, whereas satisfaction with family relations decreased. Only satisfaction with partnership/sexuality increased slightly, however this effect cannot compensate the general loss of satisfaction., Conclusions: Decreasing life satisfaction has to be considered as a developmental phenomenon. Associations with the increasing prevalence of depression and suicidal ideation during adolescence are discussed. Life satisfaction should be considered a relevant aspect of adolescent's well-being and functioning.

Background: To investigate the feasibility of monitoring quality of life (QL) with cystic fibrosis (CF) in a clinical setting, to explore changes in subjective health and to describe the impact of multiple medical and psychosocial factors on the patients' QL., Methods: 108 adolescent and adult outpatients (age 15-47 years, FEV(1) 20-125% of the predicted) answered the Questions on Life Satisfaction repeatedly parallel to each pulmonary function test (2-16 assessments per patient within 18 months). Multiple regression analysis determined the contribution of medical and psychosocial factors to the patients' QL., Results: Good acceptance of the instrument was observed. The completion time was between 5 and 29 min per assessment (median 11 min). QL remained quite stable (r(tt)=.69) with the previous QL score predicting most of the variance of the present score. Additionally, a longer interval between assessments, new colonization with Pseudomonas aeruginosa, infection exacerbations, partnership, vocation and living separately from parents significantly predicted QL at the second assessment. Pulmonary function varied independently of QL., Conclusions: Medical factors such as pulmonary exacerbation and social living circumstances have an impact on the QL of patients with CF. Repeated QL assessments in clinical routine are feasible and useful to recognize the individual patient's adaptation to the disease.

Illness beliefs of children and adolescents (age: 8-18 years) with somatoform disorder or asthma bronchiale and of their parents were compared. 25 patients of each diagnostic group and their parents participated independently in semi-structured interviews. The answers were categorized after qualitative content analyses. The frequencies of specific illness beliefs in each group were compared, coefficients of similarity between patients' and their parents' illness beliefs were calculated. Illness beliefs are mostly multi-dimensional, but not consistent. We discriminated seven categories of causal attributions: genetic, mental, somatic, developmental, behavioural, social, and physical/environmental. Children and adolescents reported less complex attributions compared with their parents, moderate similarity between patients' and their parents' illness beliefs is demonstrated. Disease specific attributions were most prominent in the parental perspective, with a preference for psycho-social illness attributions in parents of patients with somatoform disorders and a preference for genetic, physical-external and somatic attributions in parents of patients with asthma. Patients with somatoform disorder considered significantly more often psycho-social illness causes, compared with patients in the asthma-group. Differential apriori assessment of patients' and parents' illness beliefs may contribute to effective cognitive-behavioral interventions.

Asthma has been found related to a higher risk of psychological problems. Inconsistent results have been reported with respect to the quality of life of children with asthma. So there may be a complex relationship between asthma severity, quality of life, and psychological factors. The aim of this study was to examine the impact of asthma severity and emotional/behavioral problems on the quality of life of children and adolescents and on their need for support. Eighty-one children and adolescents (7-18 years old, 62 boys, 19 girls) with asthma participating in different intervention and rehabilitation programs completed the Ulm Inventory for Children, an instrument for assessing health-related quality of life. Psychological problems were rated using the Child Behavior Checklist (CBCL). Caregivers judged the patients' need for support due to asthma and due to psychosocial problems. Asthma severity was rated according to the GINA classification. The participants showed elevated caregiver-reported emotional and behavioral symptoms compared with the normative sample (mean CBCL total score T=63). Quality of life and the need for social support were significantly correlated with psychological symptoms. Asthma severity was neither correlated with quality of life nor with emotional/behavioral symptoms, but it was associated with the need for support due to asthma. Therefore, in our study, comorbid emotional and behavioral symptoms rather than disease severity predicted quality of life of children and adolescents with asthma. Treatment should be adjusted to the special needs of children with asthma and comorbid mental health problems., ((c) 2006 Wiley-Liss, Inc.)

Objective: Parental functioning and well-being are important aspects of a family's adaptation to chronic paediatric conditions. This study investigates the effects of diagnosis (cancer vs. diabetes/epilepsy) and time since diagnosis on parental quality of life (PQL)., Methods: 122 parents (66 mothers, 56 fathers), whose children were diagnosed and treated for one chronic disease, filled in the Ulm Quality of Life Inventory for Parents twice within the first three months after the initial diagnosis. The effects of diagnosis and time (1-2 weeks and 2-3 months after diagnosis) on PQL were analysed separately for mothers and fathers., Results: Parents of a child with cancer consistently reported lower PQL compared with parents of a child with diabetes/epilepsy. Only the fathers' well-being increased significantly within the first three months after the child was diagnosed for a chronic disease. However, in most of the PQL domains there was a persistent impairment within the time-frame of this study. Parents of children with a chronic disease were more satisfied with their family situation than healthy controls. Age of the child was positively correlated with PQL., Conclusions: A diagnosis of cancer, especially in young children, has a strong negative effect on PQL. Measuring PQL in a preventive approach would help to identify vulnerable parents and to provide psychosocial support in time.

Objective: Patient satisfaction with in-patient treatment and other aspects of process quality is usually examined cross-sectionally (e.g. at discharge). Therefore, the knowledge about changes in patient satisfaction and related issues, such as participation and motivation during the treatment period, is limited. This study describes the development of a questionnaire covering these topics and the course and variability in these domains for different subgroups., Method: The study group comprises 88 adolescents (48 females, 40 males; aged 13 to 18 years) who delivered altogether 1,003 data points (median per person is 8). The questionnaire consisted of 16 items that were administered to them by computer twice a week at adolescent wards in two psychiatric departments. Statistical analysis was done using hierarchical linear modeling (growth curve models), which is well suited for the analysis of data with different numbers of assessment points and missing data., Results: Psychometric properties of the questions were good. The trajectories for all items are very heterogeneous with regard to the level.. The trends (slope of the growth curves) are around 0 in general satisfaction, i.e. the adolescents stay on their different levels during the treatment period. Concerning participation, however, there are diverging trends, in particular between the two departments, which may reflect the difference in the treatment experience of the teams, whereas age, gender and diagnosis (internalizing vs. externalizing) play a minor role., Conclusion: Evaluation of process characteristics has turned out to be feasible in clinical routine and promising for further insights into process quality.

Multiple psycho-social risk factors are common in children and adolescents in the youth welfare system. Residential care and day care are two intensive support measures of the German child welfare act. The indication for one of these two interventions depends from age, psychosocial burdens, regional disposability of day care and scholastic achievement or need for support in this area. The aim of this study is to compare psychiatric symptoms of 86 (mean age 11.6 years, SD = 2.8, 23% female) children and adolescents in day care and 689 (mean age 14.4 years, SD = 2.9, 30% female) in residential care. The psychiatric symptoms were assessed with the child behavior checklist and related to the German reference population. Both study groups reached high average scores in almost all scales and subscales of the CBCL. 72% (residential care) respectively 85% (day care) scored within the clinical range. The children in day care showed more symptoms in the Child Behavior Checklist then the children in residential care.

Within a family perspective on quality of life (QL) with congenital heart disease, the study investigates parental QL, and patients' health-related QL as reported by themselves and by their parents. We examined the hypotheses that parental QL moderates the parental proxy reports. Sixty-nine patients (7-20 years, 61% male) and their caregivers participated in a computer-assisted QL-assessment. Children's self-rated and proxy-rated QL correlated moderately, with the highest intra-class correlation on the subscale psychological well-being/functioning (r = 0.61; p < 0.001), less convergence in physical well-being/functioning (r = 0.49; p < 0.001) and absent correlation in the evaluation of intra-family relationships. Parental QL was correlated both with the children's self-rated QL (r = 0.42; p < 0.05) and children's parent-rated QL (r = 0.60; p < 0.001). Support for the moderator hypotheses is indicated by the results of regression analyses demonstrating a significant interaction effect of parental QL and patients' self-reported QL in predicting parental proxy reports on their children's QL. Post-hoc tests reveal that parents with low own QL agree significantly more with their children than parents with high QL. Parent-child agreement on the children's QL is limited and reflects complementary subjective viewpoints. Psychosocial interventions should be family-focused and provide support for patients' and their caregivers' QL.

Children and adolescents in residential care represent a high risk population for mental disorders. We examined in an epidemiologic survey the level of professional psychopharmacological and psychotherapeutic treatment in relation to the prevalence of mental disorders among this group. The study includes 689 children and adolescents living in 20 residential care institutions in a two-step design. Participants with elevated scores in a screening questionnaire were then assessed by a standardized clinical examination. Data on psychopharmacological and psychotherapeutic treatment were obtained and correlated with the prevalence of mental disorders. Wishes for cooperation with psychiatry on the part of the child welfare providers were recorded by a self-constructed questionnaire. 57.1% of the children and adolescents of our sample fulfilled the criteria for one or more ICD-10 F diagnosis. As most frequent disorders we found conduct disorders (CD), ADHD and depressive disorders. Highest levels of psychopharmalogical treatment were found in ADHD (25 to 33.3%), half of the children and adolescents with ICD-10 F diagnosis got psychiatric or psychotherapeutic treatment. Compared to the high prevalence of severe mental disorders in children and adolescents living in residential care the levels of psychopharmacological and psychiatric/psychotherapeutic treatment seem to be low, especially in those with conduct disorders (CD) and ADHD. Cooperation between the child welfare providers and child and adolescent psychiatry services should get intensified. Adequate psychiatric diagnostic and multimodal therapeutic procedures are necessary.

Objective: To investigate the effectiveness of autogenic relaxation training in a mildly disturbed outpatient population of children and adolescents with mostly internalizing symptoms, and/or some aggressive, impulsive, or attention deficit symptoms., Method: Fifty children and adolescents from southern Germany (mean age 10.2 years; range 6-15 years; mostly intact middle class family background) participated in a group intervention program. Fifteen patients were randomly assigned to a waiting-list control group. Behavior symptoms (Child Behavior Checklist), psychosomatic complaints (Giessen Complaint List), and level of stress were assessed before and after the intervention or after the waiting phase. Individual goal attainment was evaluated at the end of the intervention and in a 3-month follow-up., Results: The parent report on CBCL reflected reduced symptoms compared with control. The child report indicated reduced stress and psychosomatic complaints both in the intervention and control group, and no significant group x time interaction effects occurred on these scales. Effect sizes of 0.49 in the CBCL and 0.36 in the complaint list indicated clinically relevant effects of the intervention compared with the control group. At the end of the intervention, 56% of the children and 55% of the parents reported partial goal attainment, 38% of the children and 30% of the parents reported complete goal attainment; 71% of the parents confirmed partial goal attainment 3 months postintervention., Conclusions: Autogenic relaxation training is an effective broadband method for children and adolescents.