[Show abstract][Hide abstract] ABSTRACT: This study aimed to investigate the factor structure and external correlates of the constructs Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The following were addressed: First, do our data support the DSM-5 conceptualization of RAD/DSED as two separate constructs? Second, are RAD and DSED distinct from other well-established dimensions of child psychopathology? Third, what are the external correlates of RAD/DSED in this sample? The study sample included 122 foster children aged 6-10 years. Foster parents completed the Strengths and Difficulties Questionnaire (SDQ), and the RAD/DSED-scale from the Developmental and Well-Being Assessment. Child protection caseworkers completed a questionnaire regarding exposure to maltreatment and placement history. Confirmatory factor analysis (CFA) of the RAD/DSED items identified a good fit for a model with a two-factor structure, which is congruent with the DSM-5 definition of RAD and DSED. A new CFA model, which included the RAD and DSED factors together with the four problem factors of the SDQ (emotional, conduct, hyperactivity-inattention, and peer problems), also demonstrated a good fit with our data. RAD and DSED were associated with the SDQ Impact scale and help seeking behavior. This was partly explained by the SDQ externalizing and peer problem subscales. Our findings lend support for the DSM-5 conceptualization of RAD and DSED as separate dimensions of child psychopathology. Thus, the assessment of RAD and DSED provides information beyond other mental health problems.
[Show abstract][Hide abstract] ABSTRACT: The aim was to investigate predictors of treatment dropout among 182 children (aged 8–15 years) participating in an effectiveness trial of manual-based 10-session individual and group cognitive behavior therapy (CBT) for anxiety disorders in community clinics. The dropout rate was 14.4%, with no significant difference between the two treatment conditions. We examined predictors for overall dropout (n = 26), early (≤session 4, n = 15), and late dropout (≥session 5, n = 11). Overall dropout was predicted by low child and parent rated treatment credibility, and high parent self-rated internalizing symptoms. Low child rated treatment credibility predicted both early and late dropout. High parent self-rated internalizing symptoms predicted early dropout, whereas low parent rated treatment credibility predicted late dropout. These results highlight the importance of addressing treatment credibility, and to offer support for parents with internalizing symptoms, to help children and families remain in treatment.
[Show abstract][Hide abstract] ABSTRACT: Background: Previous meta-analyses of paediatric obsessive–compulsive disorder (OCD) have shown much higher effect size for standard individual cognitive behaviour therapy (SI-CBT) compared with control conditions than for serotonin reuptake inhibitors (SRIs) compared with placebo. Other factors, such as systematic differences in the provided care or exposure to factors other than the interventions of interest (performance bias) may be stronger confounders in psychotherapy research than in pharmacological research. Aims: These facts led us to review SI-CBT studies of paediatric OCD with the aim to compare the effect estimates across different comparisons, including active treatments. Method: We included only randomized controlled trials (RCTs) or cluster RCTs with treatment periods of 12–16 weeks. Outcome was post-test score on the Children's Yale–Brown Obsessive Compulsive Scale (CYBOCS). Results: Thirteen papers reporting from 13 RCTs with 17 comparison conditions were included. SI-CBT was superior to wait-list and placebo therapy but not active treatments. Effect estimates for SI-CBT in wait-list comparison studies were significantly larger than in placebo-therapy comparison studies. In addition, the SI-CBT effect estimate was not significantly different when compared with SRIs alone or combined SRIs and CBT. Conclusions: Performance bias may have inflated previous effect estimates for SI-CBT when comparison contingencies included wait-list. However, the calculated SI-CBT effect estimate was lower but significant when compared with placebo therapy. The effects of SI-CBT and active treatments were not significantly different. In conclusion, our data support the current clinical guidelines, although better comparisons between SI-CBT and SRIs are needed.
Nordic Journal of Psychiatry 08/2014; DOI:10.3109/08039488.2014.941395 · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
High prevalence of mental disorders among foster children highlight the need to examine the mental health of children placed out of home. We examined the properties of the Strengths and Difficulties Questionnaire (SDQ) in screening school-aged foster children for mental disorders.
Foster parents and teachers of 279 foster children completed the SDQ and the diagnostic interview Developmental and Well-Being Assessment (DAWBA). Using the diagnoses derived from the DAWBA as the standard, we examined the performance of the SDQ scales as dimensional measures of mental health problems using receiver operating characteristic (ROC) analyses. Recommended cut-off scores were derived from ROC coordinates. The SDQ predictive algorithms were also examined.
ROC analyses supported the screening properties of the SDQ Total difficulties and Impact scores (AUC = 0.80–0.83). Logistic regression analyses showed that the prevalence of mental disorders increased linearly with higher SDQ Total difficulties scores (X2 = 121.47, df = 13, p<.001) and Impact scores (X2 = 69.93, df = 6, p<.001). Our results indicated that there is an additive value of combining the scores from the Total difficulties and Impact scales, where scores above cut-off on any of the two scales predicted disorders with high sensitivity (89.1%), but moderate specificity (62.1%). Scores above cut-off on both scales yielded somewhat lower sensitivity (73.4%), but higher specificity (81.1%). The SDQ multi-informant algorithm showed low discriminative ability for the main diagnostic categories, with an exception being the SDQ Conduct subscale, which accurately predicted the absence of behavioural disorders (LHR− = 0.00).
The results support the use of the SDQ Total difficulties and Impact scales when screening foster children for mental health problems. Cut-off values for both scales are suggested. The SDQ multi-informant algorithms are not recommended for mental health screening of foster children in Norway.
PLoS ONE 07/2014; 9(7):e102134. DOI:10.1371/journal.pone.0102134 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Conducted a randomized controlled trial to investigate the effectiveness of cognitive behavioral therapy (CBT), and compared the relative effectiveness of individual (ICBT) and group (GCBT) treatment approaches for anxiety disorders in children and adolescents.
Referred youth (N = 182, M age = 11.5 years, range 8-15 years, 53% girls) with separation anxiety, social phobia, or generalized anxiety disorder were randomly assigned to ICBT, GCBT or a waitlist control (WLC) in community clinics. Pre-, post-, and one year follow-up assessments included youth and parent completed diagnostic interview and symptom measures. After comparing CBT (ICBT and GCBT combined) to WLC, ICBT and GCBT were compared along diagnostic recovery rates, clinically significant improvement, and symptom measures scores using traditional hypothesis tests, as well as statistical equivalence tests.
Significantly more youth lost all anxiety disorders after CBT compared to WLC. Full diagnostic recovery rate was 25.3% for ICBT and 20.5% in GCBT, which was not significantly different. There was continued lack of significant differences between ICBT and GCBT at one year follow-up. However, equivalence between GCBT and ICBT could only be demonstrated for clinical severity rating of the principal anxiety disorder and child reported anxiety symptoms post-treatment.
Findings support the effectiveness of CBT compared to no intervention for youth with anxiety disorders, with no significant differences between ICBT and GCBT. However, the relatively low recovery rates highlight the need for further improvement of CBT programs and their transportability from university to community settings.
Behaviour Research and Therapy 03/2014; 57C(1):1-12. DOI:10.1016/j.brat.2014.03.007 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Boys with sex chromosome aneuploidies (SCA) represent an understudied group. We examined
parent-reported physical and socio-emotional problems in 25 boys with SCA (Mean age = 11.7
years, SD = 4.5). The majority had no severe physical health problems. One third of the sample had sleep problems and half of them had weekly or monthly pain. Total emotional and behavior
problems, as assessed with the Strengths and Difficulties Questionnaire, was at the same level as
reported for boys referred to child mental health clinics. Thus, boys with SCA may have the
same need for psychological assessment and intervention as clinic-referred boys.
Children s Health Care 01/2014; 44(1). DOI:10.1080/02739615.2013.876538 · 0.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to examine the prevalence of mental disorders in 6- to 12-year-old foster children and assess comorbidity and risk factors.
Information on mental health was collected from foster parents and from teachers using Developmental and Well-Being Assessment (DAWBA) Web-based diagnostic interview. Child welfare services provided information about care conditions prior to placement and about the child's placement history.
Diagnostic information was obtained about 279 (70.5%) of 396 eligible foster children. In total, 50.9% of the children met the criteria for one or more DSM-IV disorders. The most common disorders were grouped into 3 main diagnostic groups: Emotional disorders (24.0%), ADHD (19.0%), and Behavioural disorders (21.5%). The comorbidity rates among these 3 main groups were high: 30.4% had disorders in 2 of these 3 diagnostic groups, and 13.0% had disorders in all 3 groups. In addition, Reactive attachment disorder (RAD) was diagnosed in 19.4% of the children, of whom 58.5% had comorbid disorders in the main diagnostic groups. Exposure to violence, serious neglect, and the number of prior placements increased the risk for mental disorders.
Foster children in Norway have a high prevalence of mental disorders, compared to the general child population in Norway and to other societies. The finding that 1 in 2 foster children presented with a mental disorder with high rates of comorbidity highlight the need for skilled assessment and qualified service provision for foster children and families.
Child and Adolescent Psychiatry and Mental Health 11/2013; 7(1):39. DOI:10.1186/1753-2000-7-39
[Show abstract][Hide abstract] ABSTRACT: This study examined the role of parental emotional well-being and parenting practices as mediators of the association between familial socioeconomic status (SES) and child mental health problems. The sample included 2,043 5th-7th graders (50.7 % female) participating in the second wave of the Bergen Child Study. Children completed the Strengths and Difficulties Questionnaire, parents reported family economy and education level, emotional well-being (measured with the Everyday Feelings Questionnaire), and the use of negative disciplinary and affirmative parenting practices (measured using the Family Life Questionnaire). Path analyses were conducted to examine the associations between SES and externalizing and internalizing problems. Results supported a model where family economy was associated with externalizing problems through parental emotional well-being and parenting practices, whereas maternal education level was associated with externalizing problems through negative discipline. The direct association between paternal education level and externalizing problems was not mediated by parenting. For internalizing problems, we found both direct associations with family economy and indirect associations with family economy through parental emotional well-being and parenting. The results suggest that parental emotional well-being and parenting practices are two potential mechanisms through which low socioeconomic status is associated with child mental health problems.
[Show abstract][Hide abstract] ABSTRACT: Depressive disorders are disabling conditions striking at all ages. In adults, subthreshold depression (SD) is viewed as being on a continuum with major depressive disorder (MDD). Whether this holds for children and adolescents, is still unclear. We performed the first systematic review of SD in subjects below 18 years, in order to explore if childhood SD and MDD share causal pathways, phenomenology and outcomes, supporting a dimensional view.
A critical systematic review in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. A review protocol was developed a priori, and all reports were assessed by two reviewers.
The literature search generated 941 eligible references and 24 studies were included. Although diagnostic criteria for SD showed great variability, similarities for SD and MDD were striking. Both were common conditions with similar risk factor patterns. Clinical characteristics in both groups were depressed mood, suicidal ideation and high comorbidity. Outcomes were almost equally poor, with increased psychiatric morbidity and health service use. SD intervention studies showed promising results.
Reports with data on SD not reported in keywords or abstract may have been missed by the search strategy.
A dimensional view of depressive disorders is also supported in children and adolescents, suggesting SD to be a precursor to MDD. Although SD is a somewhat milder condition than MDD, it has severe outcomes with psychopathology and impairment. There is a need of identifying cost-efficient and longlasting interventions in order to prevent development of early SD into MDD.
Hvordan sikre angstpasienter kunnskapsbasert behandling, Edited by Gerd Kvale; Odd Einar Havik; Tone Tangen; Einar Røsholt Heiervang; Bente Mowatt Storm Haugland, 01/2013: chapter Angstlidelser hos voksne og barn - behov for økt innsats; Universitetsforlaget., ISBN: 978-82-15-01879
[Show abstract][Hide abstract] ABSTRACT: This study examined the agreement between diagnoses and severity ratings assigned by clinicians using a structured web-based interview within a child and adolescent mental health outpatient setting.
Information on 100 youths was obtained from multiple informants through a web-based Development and Well-Being Assessment (DAWBA). Based on this information, four experienced clinicians independently diagnosed (according to the International Classification of Diseases Revision 10) and rated the severity of mental health problems according to the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the Children's Global Assessment Scale (C-GAS).
Agreement for diagnosis was κ=0.69-0.82. Intra-class correlation for single measures was 0.78 for HoNOSCA and 0.74 for C-GAS, and 0.93 and 0.92, respectively for average measures.
Agreement was good to excellent for all diagnostic categories. Agreement for severity was moderate, but improved to substantial when the average of the ratings given by all clinicians was considered. Therefore, we conclude that experienced clinicians can assign reliable diagnoses and assess severity based on DAWBA data collected online.
Clinical Practice and Epidemiology in Mental Health 03/2012; 8:16-21. DOI:10.2174/1745017901208010016