Adolescent Mental Health Clinic Research Articles

Regressive autism with autoimmune encephalitis: case report and literature review of subtype of autism spectrum disorder

About one-third of individuals with autism spectrum disorder (ASD) show a sudden loss of acquired skills between the 2nd or 3rd years of life. The primary areas of loss were grouped into language skills, social interest, adaptive functioning, and motor skills. A 4-year and 2-month-old boy presented to the child and adolescent mental health and disease outpatient clinic with his parents with complaints of decreased eye contact, and regression in speech. His developmental milestones were within the typical range of three years and two months. During the investigation into the organic etiology of regression, serum anti-CASPR2 positivity was detected, and intravenous immunoglobulin administration was initiated. After 6 months of treatment and special education, there was a slight decrease in the CARS score along with improvements in adaptation to change, visual response, and non-verbal communication. This rare case of regressive autism accompanied by autoimmune encephalitis provides further evidence in the field that autoimmune encephalitis may influence the development of the regressive subtype of ASD. Differential diagnosis is crucial because additional immunotherapy may be beneficial in these cases. Further investigation is needed to identify the relationship.

Complaints, Diagnosis, Follow-up and Treatment of Patients Applying to 0-6 Years Old Child Psychiatry and Developmental Pediatrics Outpatient Clinic

Aim: By studying children aged 0-6 with outpatient and health board admissions, we aimed to contribute valuable insights to the literature on early childhood support, focusing on admission complaints, diagnosis distribution, treatments, and patient follow-ups. Materials and Methods: Between 01.08.2022 and 01.02.2022, patients aged 0-6 from Diyarbakir Gazi Yaşargil Hospital's Pediatric and Adolescent Mental Health and Developmental Pediatrics clinic, including those seeking health board evaluations, were studied. This prospective analysis examined patient demographics, complaints, diagnoses, health board interactions, treatments, and additional medical conditions. Patient follow-up data were scanned from the system for analysis before concluding the retrospective study. Results: Of the 600 patients included in the study, 337 patients came to the health board outpatient clinic, 160 to the child psychiatry outpatient clinic and 103 to the developmental pediatrics outpatient clinic. 220 (36.7%) were female and 380 (63.3%) were male. The most common presenting complaints of the patients were speech delay, mobility, report renewal and irritability. In our study, the presenting diagnoses were global developmental delay, isolated speech delay, ASD, ADHD, articulation disorder, behavioral problems, stuttering and specific learning disorder (SLD) with decreasing frequency. It was observed that 77.5% of the patients had no follow-up and the highest rates of follow-up were ADHD (67.4%) and ASD (56.9%). It was observed that 87.5% of the patients with a health board application had no follow-up. Conclusion: Determining the diagnosis, follow-up and treatments of the patients may guide the areas in which child psychiatrists and developmental pediatricians should work more intensively in the future. Early diagnosis, screening initiatives, awareness campaigns, and training for parents, teachers, and health professionals, along with telehealth, multidisciplinary strategies, and school collaborations, enhance health board applications and patient follow-up.

Intensive community care services for children and young people in psychiatric crisis: an expert opinion

BackgroundChildren and young people’s (CYP) mental health is worsening, and an increasing number are seeking psychiatric and mental health care. Whilst many CYPs with low-to-medium levels of psychiatric distress can be treated in outpatient services, CYPs in crisis often require inpatient hospital treatment. Although necessary in many cases, inpatient care can be distressing for CYPs and their families. Amongst other things, inpatient stays often isolate CYPs from their support networks and disrupt their education. In response to such limitations, and in order to effectively support CYPs with complex mental health needs, intensive community-based treatment models, which are known in this paper as intensive community care services (ICCS), have been developed. Although ICCS have been developed in a number of settings, there is, at present, little to no consensus of what ICCS entails.MethodsA group of child and adolescent mental health clinicians, researchers and academics convened in London in January 2023. They met to discuss and agree upon the minimum requirements of ICCS. The discussion was semi-structured and used the Dartmouth Assertive Community Treatment Fidelity Scale as a framework. Following the meeting, the agreed features of ICCS, as described in this paper, were written up.ResultsICCS was defined as a service which provides treatment primarily outside of hospital in community settings such as the school or home. Alongside this, ICCS should provide at least some out-of-hours support, and a minimum of 90% of CYPs should be supported at least twice per week. The maximum caseload should be approximately 5 clients per full time equivalent (FTE), and the minimum number of staff for an ICCS team should be 4 FTE. The group also confirmed the importance of supporting CYPs engagement with their communities and the need to remain flexible in treatment provision. Finally, the importance of robust evaluation utilising tools including the Children’s Global Assessment Scale were agreed.ConclusionsThis paper presents the agreed minimum requirements of intensive community-based psychiatric care. Using the parameters laid out herein, clinicians, academics, and related colleagues working in ICCS should seek to further develop the evidence base for this treatment model.

Prevalence and Factors Associated with Mental Distress among Caregivers of Children with Mental Illness Attending Child and Adolescent Clinic at Muhimbili National Hospital, Dar Es Salaam

Background: Caregivers play an exceptionally important role in the lives of those they provide care for as well as to the healthcare system. The burden of caring for children with mental illness (CWMI) often falls on their caregivers, especially the mothers. Caregivers of CWMI experience significant challenges and are at an increased risk of experiencing mental distress than the general population. Resilience, emotion regulation, and social support are identified as protective factors against mental distress among caregivers. Objective: To determine the prevalence and factors associated with mental distress among caregivers of CWMI attending the child and adolescent mental health clinic at Muhimbili National Hospital (MNH) in Tanzania. Methodology: Hospital-based descriptive cross-sectional study was conducted at MNH Dar es Salaam, Tanzania. A purposive and convenient sample of 120 caregivers of CWMI attending the child and adolescent mental health clinic at MNH were recruited in the study. Interviewer-administered paperless questionnaire consisting of a socio-demographic questionnaire, self-reporting questionnaire (SRQ), 10-item Connor- Davidson Resilience Scale (CD-RISC), Emotion Regulation Questionnaire (ERQ), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to collect data. Data were analyzed using SPSS version 28.0.1.1, where descriptive, bivariate and multivariate analyses were conducted. Results: Among the 120 caregivers studied, 97 (80.8%) were female, and 43 (35.8%) were aged between 35 – 44 years. Among the 120 participants 27 (22.5%) had mental distress, 35 (29.2%) had low resilience, 22 (81.7%) had low cognitive reappraisal, 27 (47.5%) had high expressive suppression, and 5% (6) had low perceived social support. All variables with a p-value of < 0.20 in the bivariate analysis were entered into the multivariate analysis model, where the independent risk of mental distress was four times higher amongst those living out of ..........

70. Description of an Integrated Adolescent Mental Health Clinic for Inner-City Youth at a School-Based Health Center (SBHC) in Washington, DC: An Innovative Approach

70. Description of an Integrated Adolescent Mental Health Clinic for Inner-City Youth at a School-Based Health Center (SBHC) in Washington, DC: An Innovative Approach

Meanings of nurses' role in Child and Adolescent Psychosocial Care Centers.

to analyze the meaning attributed to nurses' role in mental health care in Child and Adolescent Psychosocial Care Centers. qualitative research, anchored in the paradigm of complexity. Data collection was carried out through online semi-structured interviews with ten nurses from São Paulo, between March and September 2022, being analyzed thematically. the diversity and specificity of a child and adolescent mental health clinic, with the need for expanded, territorial and intersectoral care, were unveiled in addition to a fragmented training in the area. There was a need for a deconstruction of being a nurse to make it possible to produce more inclusive and salutogenic practices. the need for training nurses with adequate knowledge and skills to care for the mental health of children, adolescents and their families is reinforced as well as permanent education of working teams.

Complex PTSD and treatment outcomes in TF-CBT for youth: a naturalistic study

ABSTRACT Background: Complex posttraumatic stress disorder (CPTSD) has recently been added to the ICD-11 diagnostic system for classification of diseases. The new disorder adds three symptom clusters to posttraumatic stress disorder (PTSD) related to disturbances in self-organization (affect dysregulation, negative self-concept, and disturbances in relationships). Little is known whether recommended evidence-based treatments for PTSD in youth are helpful for youth with CPTSD. Objectives: This study examined whether Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is useful in reducing PTSD and CPTSD in traumatized youth. Methods: Youth (n = 73, 89.0% girls, M age = 15.4 SD = 1.8) referred to one of 23 Norwegian child and adolescent mental health clinics that fulfilled the criteria for PTSD or CPTSD according to ICD-11 and received TF-CBT were included in the study. Assessments were conducted pre-treatment, and every fifth session. Linear mixed effects models were run to investigate whether youth with CPTSD and PTSD responded differently to TF-CBT. Results: Among the 73 youth, 61.6% (n = 45) fulfilled criteria for CPTSD and 38.4% (n = 28) fulfilled criteria for PTSD. There were no differences in sex, age, birth country, trauma type, number of trauma types or treatment length across groups. Youth with CPTSD had a steeper decline in PTSD and CPTSD compared to youth with PTSD. The groups reported similar levels of PTSD and CPTSD post-treatment. The percentage of youth who dropped out of treatment was not different across groups. Further, the groups did not differ significantly in number of received treatment sessions. Conclusions: This is the first study to examine whether TF-CBT is helpful for youth who have CPTSD using a validated instrument for measuring CPTSD. The results suggest that TF-CBT may be useful for treating CPTSD in youth. These are promising findings that should be replicated in studies with larger sample sizes.

70.4 UTILIZING SCREENING, BRIEF INTERVENTION, AND REFERRAL TO EVALUATION FOR SUBSTANCE USE (SBIRE) IN THE ADOLESCENT OUTPATIENT MENTAL HEALTH SETTING

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based method to identify patients with substance use disorders and help refer them to treatment. SBIRT can be carried out in a variety of ambulatory and primary care outpatient settings. Referral to treatment, the last arm, is designed to allow clinicians to connect patients to services that can appropriately help them. However, it is often difficult to use and underutilized in these settings. Screening, Brief Intervention, and Referral for Brief Consultative Evaluation (SBIRE) may be a more effective approach to help connect patients with treatment. In this program, the audience will understand current gaps in clinical care in the outpatient setting and review how SBIRE can be applied to help patients receive appropriate care. Scott Krakower, DO, will review current approaches and limitations to managing patients with dual diagnosis in an outpatient child and adolescent psychiatry clinic. He will also briefly discuss ways in which the SBIRE model may be adapted for implementation in this setting to enhance substance treatment engagement among youth referrals. Dr. Krakower will specifically identify training, procedures, and components of existing clinical operations that would need to be modified or adapted to improve substance screening and treatment engagement in an outpatient child and adolescent mental health clinic. SBIRE is a practical and effective approach that can be adapted in pediatric outpatient mental health clinical settings to identify and engage substance-involved youth in earlier or more timely treatment intervention.

Evaluation of Internet Gaming Disorder, Social Media Addiction, and Levels of Loneliness in Adolescents and Youth with Substance Use

Background and Objectives Substance use and addictive disorders are among the most significant public health concerns, particularly during adolescence. The current study aims to investigate internet gaming disorder, social media addiction, and loneliness levels in adolescents and youths with substance use. Methods: The study group consisted of 93 adolescents and youths aged 15–24 who presented to the Alcohol and Substance Addiction Research and Application Center or the Child and Adolescent Mental Health and Diseases outpatient clinic for substance use. Ninety-one healthy volunteers who did not use substances during any period of their lives participated as a control group. The participants fulfilled the Social Media Addiction Scale (SMAS), Internet Gaming Disorder Scale – Short-Form (IGDS9-SF), UCLA Loneliness Scale (UCLA-LS), and Drug Use Disorders Identification Test – Extended (DUDIT-E). Results: The symptoms of internet gaming disorder were significantly lower in the patient group compared with the control group. Although it was not significant, social media addiction was higher in the patient group than in the control group. The experience of loneliness was significantly higher in the patient group than in the control group. A significant negative correlation was found between treatment motivation and loneliness. Conclusions: School guidance teachers should monitor children who do not have friends or are lonely and be aware of the potential for substance use because it can emerge as a method of coping with the feeling of loneliness among adolescents. In future studies, investigating comprehensive factors contributing to different addictive behaviors may help to clarify the co-occurrence.

Effect of an Internet-Delivered Stepped-Care Program vs In-Person Cognitive Behavioral Therapy on Obsessive-Compulsive Disorder Symptoms in Children and Adolescents

In most countries, young people with obsessive-compulsive disorder have limited access to specialist cognitive behavioral therapy (CBT), a first-line treatment. To investigate whether internet-delivered CBT implemented in a stepped-care model is noninferior to in-person CBT for pediatric obsessive-compulsive disorder. A randomized clinical noninferiority trial conducted at 2 specialist child and adolescent mental health clinics in Sweden. Participants included 152 individuals aged 8 to 17 years with obsessive-compulsive disorder. Enrollment began in October 2017 and ended in May 2019. Follow-up ended in April 2020. Participants randomized to the stepped-care group (n = 74) received internet-delivered CBT for 16 weeks. Nonresponders at the 3-month follow-up were then offered a course of traditional face-to-face treatment. Participants randomized to the control group (n = 78) immediately received in-person CBT for 16 weeks. Nonresponders at the 3-month follow-up received additional face-to-face treatment. The primary outcome was the masked assessor-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score at the 6-month follow-up. The scale includes 10 items rated from 0 (no symptoms) to 4 (extreme symptoms), yielding a total score range of 0 to 40, with higher scores indicating greater severity. Assessors were masked to treatment allocation at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up assessments. The predefined noninferiority margin was 4 points on the CY-BOCS. Among the 152 randomized participants (mean age, 13.4 years; 94 [62%] females), 151 (99%) completed the trial. At the 3-month follow-up, 34 participants (46%) in the stepped-care group and 23 (30%) in the in-person CBT group were nonresponders. At the 6-month follow-up, the CY-BOCS score was 11.57 points in the stepped-care group vs 10.57 points in the face-to-face treatment group, corresponding to an estimated mean difference of 0.91 points ([1-sided 97.5% CI, -∞ to 3.28]; P for noninferiority = .02). Increased anxiety (30%-36%) and depressive symptoms (20%-28%) were the most frequently reported adverse events in both groups. There were 2 unrelated serious adverse events (1 in each group). Among children and adolescents with obsessive-compulsive disorder, treatment with an internet-delivered CBT program followed by in-person CBT if necessary compared with in-person CBT alone resulted in a noninferior difference in symptoms at the 6-month follow-up. Further research is needed to understand the durability and generalizability of these findings. ClinicalTrials.gov Identifier: NCT03263546.

Who Reports What? A Comparison of Child and Caregivers\xb4 Reports of Child Trauma Exposure and Associations to Post-Traumatic Stress Symptoms and Functional Impairment in Child and Adolescent Mental Health Clinics

Identifying trauma-related symptoms is important for treatment planning at child and adolescent mental health services (CAMHS), and routine trauma screening may be a first step to ensure appropriate treatment. Studies with community samples have found modest agreement between children’s and caregivers´ report of exposure to potentially traumatizing events (PTEs). However, studies from clinical populations are scarce and the evidence base for screening recommendations is insufficient. The current study explores child and caregiver agreement on the child’s exposure to PTEs and its relationship with the child’s post-traumatic stress symptoms (PTSS) and functional impairment. The sample consist of 6653 caregiver-child dyads referred to Norwegian CAMHS between 2012–2017. The children were 6 to 18 years of age (M = 12.03, SD = 3.14) and 47% were boys and 45% were girls (8% missing). Children reported significantly more exposure to accidents or illness, community violence, and sexual abuse than their caregiver, but there were no differences for reports of domestic violence. Kappa results were fair to moderate, with the highest agreement rate for reports of sexual abuse, followed by domestic violence, community violence, and lowest agreement for accidents or illnesses. There were higher agreement rates among caregivers and older children, and caregivers and girls. In general, the child had higher PTSS and functional impairment scores when child exposure to PTEs were reported by both the caregiver and the child. Both children and caregivers should be included in trauma screening procedures at CAMHS to collect a more complete picture of the child’s experiences and treatment needs.

Psychometric properties of the Inventory of Interpersonal Problems (IIP-C) used with a clinical sample of adolescents: a preliminary study.

Interpersonal problems are consistently identified with psychopathology that often has its onset in adolescence. Most of the commonly used instruments in child and adolescent psychiatry target non-interpersonal problems. The Inventory of Interpersonal Problems (IIP) is a widely studied and utilized instrument in the adult mental health field. This study aimed to examine the psychometric properties of the IIP (circumplex version) used with a clinical adolescent population. Method: Sixty-two adolescents (13-17 years) who received treatment in a child and adolescent mental health clinic (CAMHS) were included in the study. To establish reliability and validity, we conducted confirmatory factor analyses, internal consistency, and validity analyses. Confirmatory analyses did not show optimal model fit. However, other indices like CFI and TLI were promising. The reliability of the eight scales was in the same range as previous studies and acceptable. There were expected significant correlations between IIP-C scales and the broadband scales of Youth Self-report (YSR). The pioneer nature and its clinical focus are strengths however, there is a need for more research. The promising results are encouraging, and future research could also explore how best to bring the instrument into the digital age.

Maternal Attitudes, Irritability, Problem Solving Skills and Decision Making in Adolescents with Substance Use: Case-control Study

Multiple risk factors affect the emergence of substance use disorders among adolescents and their families. To the best of our knowledge, the effects of irritability, problem solving, decision making skills and maternal attitudes on the severity of the substance use have not been evaluated on the same population. We aimed to evaluate the presence and the effects all of these variables on the severity of substance dependence. The study included 40 adolescents, between 14 and 17 years of age, consulting the Child and Adolescent Mental Health and Diseases outpatient clinics with complaints of substance use and 40 age and gender matched healthy controls. The diagnoses were based on the DSM-5 diagnostic criteria. Both groups completed a sociodemographic questionnaire, the Parent Attitude Research Instrument (PARI), the Adolescent Decision Making Questionnaire (ADMQ), the ProblemSolving Inventory (PSI) and the DSM-5 Level 2 Irritability Scale. The patient group were also tested on the Addiction Profile Index for Adolescents (API-AF). Problem solving skills scores of the patients were lower and the scores on the irritability scale completed by the patients and their parents were higher as compared to the control group. Complacency (indifference) in decision-making predicted the severity of the addiction. As the complacency in decision-making increased, the severity of addiction also increased. Our results indicated that problem solving and decisionmaking skills and irritability levels of the adolescents together with the family attitudes, affect substance use disorder in adolescence. These variables should be considered in preventive and therapeutic approaches.

Health Personnel's Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study.

BackgroundApproximately 10%-15% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel’s attitudes to perceived usefulness of internet-based interventions.ObjectiveThe purpose of this study was to examine health professionals’ perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful.MethodsBetween May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: “How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?” The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often).ResultsThe participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006).ConclusionsInternet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support.

Impact of ADHD symptoms on family functioning, family burden and parents’ quality of life in a hospital area in Spain

Background and objectivesThe aim of this study was to evaluate whether ADHD symptom severity and ADHD subtype are associated with family functioning, family burden and quality of life, in a sample of parents of children diagnosed with ADHD. MethodsSeventy-four parents of children diagnosed with ADHD were recruited at an Outpatient Child & Adolescent Mental Health Clinic in Madrid (Spain) and afterwards completed four electronical self-administered scales to determine their perceived family functioning, family burden and quality of life, as well as the severity and subtype of ADHD symptoms in their children. ResultsSeverity of children’s ADHD symptoms negatively affected parents’ quality of life, family functioning and family burden. Higher scores in inattention and combined subtypes were correlated with lower results in those domains. In adjusted correlations, the SWAN hyperactivity/impulsivity subscale significantly correlated with the four scales. ConclusionsThese results suggest that severity of the ADHD symptoms has a negative impact on parent’s quality of life and family functioning in inattention and combined subtypes. Family therapy and other interventions targeted towards improving family relationships and caregivers’ wellbeing should be considered when managing ADHD in the clinical practice. Electronic measurement tools are a promising method of evaluation in mental health research.

Vitamin and mineral levels in children with autism spectrum disorder

The aim of this study was to compare the vitamin and mineral values of the patients followed up in the Child Psychiatry Outpatient Clinic with the diagnosis of autism spectrum disorder to healthy controls in the same age group and to investigate whether vitamin-mineral values were related to autism weight (CARS score).Between September 2017 and September 2018, we worked at Bak?rköy Dr. Sadi Konuk Training and Research Hospital Children and Adolescent Mental Health and Diseases outpatient clinic with autism spectrum disorder patients with childhood autism assessment scale (CARS) was weighted. Age, gender, height, weight, blood Iron, Vitamin B12, Folate and 25 (OH) Vitamin D levels of all patients included in the study were recorded. Mann-Whitney U, Pearson chi-square and Fisher's exact test were used to evaluate the data. In this study, 108 patients with ASD were compared with 115 normal cases. There was no statistically significant decrease in Vitamin B12, Folate, Iron and Vitamin D levels in patients with ASD compared to normal patients. According to CARS score, there was no statistically significant difference in vitamin B12, Folate, Iron and Vitamin D levels in children with mild and severe ASD. In our study, it was concluded that vitamin B12, Folate, Iron and Vitamin D levels in children with ASD were not lower than healthy children, and there was no difference between mild and severe cases according to CARS score.

Engaging with Parents in Child and Adolescent Mental Health Services

This paper asks the question: How can child and adolescent mental health clinicians constructively engage parents as a resource in the young person's treatment? It draws from qualitative research data that explore parents' experience of their involvement in their adolescent's mental health treatment program. The paper especially focuses on challenges for clinicians in engaging with parents as part of the treatment program for young people. Clinicians' input about their perceptions of interacting with parents is utilised alongside parents' experiences of their involvement in clinical processes. The clinician data revealed key challenges were managing their reactions to parent defensiveness; broadening the focus from just alleviating symptoms in the young person; not taking sides with the young person; and resisting becoming an expert instructor. The paper discusses Murray Bowen's original family research about engaging parents in treatment with the symptom bearer and addresses how clinicians can build a positive alliance with parents that avoids blame while constructively opening exploration of the family relationship process as part of a collaborative approach.

Pre-schoolers Referred to a Child and Adolescent Mental Health Clinic: A Hospital Quality Improvement Report.

Objective:Aim of the study was to evaluate the patient pathway from referral to assessment and diagnosis of pre-schoolers referred to a Child and Adolescent Mental Health Clinic (CAMHC) in Norway.Method:Following data were collected retrospectively from medical records over a 2-year study period: data from clinical interviews for diagnostic evaluation, observation findings in kindergartens and the CAMHC, and results from medical examinations. The times taken from referral to first contact with the CAMHC, then to the first evaluation, and finally to diagnosis were assessed.Results:Of 13 402 pre-schoolers, 88 (0.7%) were referred to the CAMHC, of which 15 refused assessment and 69 completed a diagnostic assessment. Of the assessed children, 15 (21%) did not meet any criteria for an International Classification of Diseases, Tenth revision (ICD-10) diagnosis, 26 (38%) were diagnosed with developmental disorders, and 10 (14%) were given a non-specific diagnosis. For those children without a specific diagnosis, the mean time taken from referral to CAMHC assessment and diagnosis was longer, although not statistically significant, compared with those with a specific diagnosis (P = .52). No significant correlation between referral symptoms and final diagnosis was found.Conclusions:Pre-schoolers referred to the CAMHC have an increased risk of having developmental disorders. Furthermore, 1 in 5 of the children had comorbidities. We propose more effective health care service by developing an interdisciplinary approach for the management of these children.

Sivas İlinde Suça Sürüklenen Çocuk Olguların Sosyodemografik ve Klinik Özellikleri

Amaç: Bu çalışmada suça sürüklenen çocukların sosyodemografik özelliklerinin, işledikleri suç tiplerinin ve zeka düzeylerinin belirlenmesi ve bu çocukları suça iten nedenlerin saptanması amaçlandı.&#x0D; Gereç ve Yöntem: Adli makamlarca 01.01.2017-01.06.2018 tarihleri arasında adli rapor düzenlenmesi için Cumhuriyet Üniversitesi çocuk ve ergen ruh sağlığı ve hastalıkları polikliniğine yönlendirilen 86 olgunun dosyası geriye yönelik olarak incelendi. Olguların yaş, cinsiyet, sosyoekonomik düzeyi, eğitim durumu, zekâ seviyesi ve DSM-5’e göre ruhsal tanıları; işlenen suça ait özellikler ve adli rapor sonuçları değerlendirildi.&#x0D; Bulgular: Olguların %90.6’sı erkekti. Suç tarihindeki yaş ortalamaları 13.76±0.89 idi. Büyük çoğunluğu sosyoekonomik düzeyi düşük ve orta düzeydeki ailelerin çocuklarıydı. %72’sinde herhangi bir ruhsal hastalık saptanmadı. Davranım Bozukluğu (DB) en sık saptanan ruhsal bozukluktu. Büyük çoğunluğunun (%82.5) zekası normaldi. En sık işlenen suç “hırsızlık” (%50) suçuydu. Olguların %30,2‘sinin tekrarlayan suç öyküsü vardı. Bu olgulardan sadece %25.5’i işlediği fiilin hukuki anlam ve sonuçlarını algılayabilme ve fille ilgili davranışlarını yönlendirme yeteneğine sahipti.&#x0D; Sonuç: Çocuk suçluluğu ülkemizde her geçen gün artmakta olan bir sorundur. Bu nedenle çocukları suç işlemeye iten risk faktörlerinin belirlenmesi ve bu hususta gerekli önlemlerin alınması önem arz etmektedir.

POSITIVE PSYCHIATRY AND POSITIVE PSYCHOLOGY: TRANSLATION TO CLINICAL PRACTICE

Child and adolescent mental health clinicians generally practice in a framework that emphasizes identification and treatment of mental illness toward a goal of symptom reduction. However, this method of treatment neglects the substantial and growing literature that demonstrates the benefits of positive psychosocial factors not only in alleviating suffering but also in building resilience and beyond, cultivating flourishing. Additionally, engagement in mental health care often is hampered by stigma associated with diagnoses; this stigma may be reduced through focusing on building character strengths and seeking to thrive rather than simply ameliorating problematic symptoms.