Clinical Population Of Children Research Articles

Učinkovitost uvođenja potpomognute komunikacije kod djeteta s prirođenim malformacijama mozga

The clinical population of children with congenital brain malformations is very heterogeneous, being defined by the location and severity of the damaged part of the brain. Developmental profiles range from severe intellectual difficulties and inability to express through speech to milder clinical presentation that imply difficulties in the development of communication, language and speech. Children with congenital brain malformations often rely on augmentative and alternative communication (AAC) methods which enable them to express themselves or better understand language. The aim of this study is to describe the characteristics of communication, language and speech in a boy with congenital brain mal- formations and primary microcephaly and to determine the effectiveness of the introduction of augmentative and alternative com- munication on his communication, language and speech development. The speech therapy intervention was organized for 5 months. A low-tech tool (a communication book) and a high-tech communication tool (a nonspecialized tablet) were used to achieve the set goals of the intervention. Communication development was recorded using video analysis, and comprehension and word production data were collected using the MacArthur—Bates Communicative Development Inventory (CDI). During the five months of intervention, positive changes were observed in the boys’: a) patterns of communication functions, i.e., the frequency with which he communicate for specific functions, b) language production: increase in vocabulary size and language complexity, and c) use of speech as a primary mean of communication. The changes in communication tool use pattern, particularly the significant gains in the use of speech after the introduction of augmentative and alternative communication, are consistent with previous re- search on the importance of augmentative and alternative communication as an evidence-based intervention.

Envisioning translational hyperscanning: how applied neuroscience might improve family-centered care.

From the very beginning of their life, human beings are immersed in a social and interactive environment that contributes to shaping their social and cognitive development under typical and at-risk conditions. In order to understand human development in its bidirectional relationship with the social environment, we need to develop a 'complexity-sensitive' approach in neuroscience. Recent advances have started to do so with the application of hyperscanning techniques which involve recording adult and child neural activity simultaneously and highlighting the presence of similar patterns of brain activity in the dyad. Numerous studies focused on typically developing children have been published in recent years with the application of this technique to different fields of developmental research. However, hyperscanning techniques could also be extremely beneficial and effective in studying development in atypical and clinical populations. Such application, namely translational hyperscanning, should foster the transition toward a two-brain translational neuroscience. In this paper, we envision how the application of hyperscanning to atypical and clinical child populations can inform family-centered care for children and their parents.

Le shiatsu : une médecine complémentaire au service de l’apaisement et de la verbalisation des traumatismes

ObjectivesIn child and adolescent psychiatry, symptoms such as aggressive behaviors directed against others or self, anxiety, impulsivity, oppositional behaviors, sleep disorders, and impairments in emotional regulation or social interaction can resist conventional therapies, particularly in children with autism spectrum disorder and/or intellectual disability, early childhood trauma, or attachment disorders. Among complementary medicine, yoga and mindfulness meditation, which are relatively well documented, provide interesting avenues especially for emotional control in adolescents or any individuals with oppositional behaviors, anxiety, impulsivity or hyperactivity in males with attention deficit/hyperactivity disorder. Less well known is shiatsu, a Japanese medicine based on traditional Chinese medicine using deep pressure on the paths of the acupuncture meridians. Clinical observations and rare studies on this topic were encouraging, especially for the treatment of sleep and conduct disorders, but there is a lack of empirical data. The objective of this study was to examine better the possible therapeutic effects of shiatsu in a clinical population of children treated in child and adolescent psychiatry. MethodsThe present research, a qualitative descriptive and non-interventional study, was conducted on children treated in daycare hospital units and outpatient clinical settings. Shiatsu was administered, at least during 3 sessions, to children with autism spectrum disorder or other disorders according to ICD-11 criteria (such as conduct disorders with impulsivity or attention deficit). The evaluation was performed by two independent researchers (a child psychiatrist and a psychologist who were not the caregivers) based on a direct observation of children during the shiatsu sessions, combined with semi-structured non-inductive interviews with their parents, and data collected from focus groups conducted with the children's caregivers. A phenomenological interpretive analysis (IPA) approach with Nvivo coding software was used to analyze the data. ResultsBased on semi-structured interviews with 13 parents cross-referenced with data from 2 focus groups and direct observations of 7 children during 2 full shiatsu sessions for each observation, the results show that shiatsu has positive effects on internal tension (a relief effect, notably on aggressive behaviors directed against others or self), sleep (including improvement of sleep quality), social interaction, attention, verbalization of affects and verbalization of traumatic memories of early childhood, as well as on the perception of bodily limits. As these children benefit from several treatments, it cannot be proved that the positive effects observed in this study are related specifically to shiatsu practice in a effect-cause relationship. Shiatsu may participate and facilitate the effects of other treatments. It is noteworthy that most of the children came willingly to the shiatsu sessions, ask their parents to repeat the shiatsu sessions at home, and indicate to the practitioner, from one session to the next, their elective body points where they wish to receive the application of shiatsu. ConclusionsThe findings suggest therapeutic benefits of shiatsu, especially on externalize violence with a relief of aggressive behavior directed against others or self (knowing, moreover, that internal tension, sleep disorders and non-verbalization of affects or traumatic memories, all improved by shiatsu, are also all risk factors for externalize violence). These results highlight, therefore, the need to develop a daily practice of shiatsu in child and adolescent psychiatry. Further research is required to clarify the effects of shiatsu and ascertain better its underlying mechanisms based on this exploratory pilot study.

Pathways to Suicidal Behavior in Children and Adolescents: Examination of Child Maltreatment and Post-Traumatic Symptoms.

Suicide in youth exacts significant personal and community costs. Thus, it is important to understand predisposing risk factors. Experiencing adverse childhood experiences (ACEs), such as child maltreatment (CM-ACE), and the presence of post-traumatic stress disorder has been identified as a risk factor of suicidal behaviors among adults. Theoretical models of suicide suggest that the presence of painful experiences such as CM-ACEs increase the risk of suicidal behaviors. The relation between child maltreatment, post-traumatic stress symptom clusters (PTSS) and suicidal behaviors has not been explicitly examined among youth. The present study examined the relations between CM-ACEs, PTSS clusters, and suicidal behaviors in a clinical population of children. Children, male, ages 6 to 14, enrolled in a residential treatment program completed self-report measures to evaluate variables of interest. Path analyses revealed statistically significant direct effects of CM-ACEs and PTSS clusters on suicidal behaviors. Significant total indirect effects and marginally significant individual indirect effects of intrusion and avoidance symptoms were observed for the relation between CM-ACEs and suicidal behavior. Findings suggest that symptoms associated with specific PTSS clusters might help explain the relation between CM-ACEs and suicidal behavior, and therefore, present important implications for clinical practice and future research.

Outcomes of a 12-week ecologically valid observational study of first treatment with methylphenidate in a representative clinical sample of drug naïve children with ADHD.

Randomized placebo-controlled trials have reported efficacy of methylphenidate (MPH) for Attention-deficit/hyperactivity disorder (ADHD); however, selection biases due to strict entry criteria may limit the generalizability of the findings. Few ecologically valid studies have investigated effectiveness of MPH in representative clinical populations of children. This independently funded study aims to describe treatment responses and their predictors during the first 12 weeks of MPH treatment using repeated measurements of symptoms and adverse reactions (ARs) to treatment in 207 children recently diagnosed with ADHD. The children were consecutively included from the Child and Adolescent Mental Health Centre, Mental Health Services, The Capital Region of Denmark. The children (mean age, 9.6 years [range 7-12], 75.4% males) were titrated with MPH, based on weekly assessments of symptoms (18-item ADHD-rating scale scores, ADHD-RS-C) and ARs. At study-end 187 (90.8%) children reached a mean end-dose of 1.0 mg/kg/day. A normalisation/borderline normalisation on ADHD-RS-C was achieved for 168 (81.2%) children on the Inattention and/or the Hyperactivity-Impulsivity subscale in week 12, and 31 (15.0%) children were nonresponders, which was defined as absence of normalisation/borderline normalisation (n = 19) or discontinuation due to ARs (n = 12), and eight (3.8%) children dropped out from follow-up. Nonresponders were characterised by more severe symptoms of Hyperactivity-Impulsivity and global impairment before the treatment. ARs were few; the most prominent were appetite reduction and weight loss. A decrease in AR-like symptoms during the treatment period questions the validity of currently available standard instruments designed to measure ARs of MPH. This ecologically valid observational study supports prior randomized placebo-controlled trials; 81.2% of the children responded favourably in multiple domains with few harmful effects to carefully titrated MPH. Clinical trial registration: ClinicalTrials.gov with registration number NCT04366609.

Description of Daily Living Skills and Independence: A Cohort from a Multidisciplinary Down Syndrome Clinic.

Levels of independence vary in individuals with Down syndrome (DS). We began this study to describe the current life skills in our clinic population of children and adults with DS. We collected and reviewed demographics, living situation, and life skills from an electronic intake form used in clinic procedures. Descriptive statistics for this cohort study included mean, standard deviation, and frequencies. From 2014–2020, 350 pediatric and 196 adult patients (range 0–62 years) with a first visit to the Massachusetts General Hospital Down Syndrome Program are described. Pediatric patients were most often enrolled in school, and in an inclusion setting. Adult patients were most often participating in a day program, living with family, and wanted to continue living with family in the future. Most (87%) of adults with DS communicated verbally, though fewer could use written communication (17%). Life skills of greatest importance to adolescents and adults with DS included: learning about healthy foods (35%), preparing meals (34%), providing personal information when needed (35%), and describing symptoms to a doctor (35%). Life skills for patients with DS are varied; those associated with a medical appointment, such as sharing symptoms with the doctor, could improve for greater independence.

Narrative Review of COVID-19 Impact on Obsessive-Compulsive Disorder in Child, Adolescent and Adult Clinical Populations.

Background: The COVID-19 pandemic and quarantine had a significant impact on mental health which resulted in an increase of anxiety and depression in adult, child and adolescent clinical populations. Less is known about the potential effect of pandemic on obsessive-compulsive disorder (OCD) so there is a lack of review work to illustrate the impact of the COVID-19 pandemic on OCD.Purpose: The main objective is to review all the empirical contributions published after March 2020 that dealt with the impact of the COVID-19 pandemic on OCD in adults, children and adolescents, investigating the state-of-the-art literature concerning the impact on OCD and detailing limitations.Methods: The literature search was conducted using PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, PubMed, and Google Scholar. This review analyzed all studies from January 2020 to 8 January 2021, focusing on clinical populations of children, adolescents, and adults with OCD.Results: A total of 102 articles were screened, resulting in the identification of 64 full-text articles to be further scrutinized. Upon closer examination, there was consensus that 39 articles met the study inclusion criteria and 14 of these were selected for study. Analysis of the results revealed that COVID-19 had an impact on OCD in both adults and young people and seems to have caused exacerbation of symptoms, especially of the contamination/washing subtypes. Eight studies in adult samples showed an increase in the severity of obsessive-compulsive symptoms; two studies underlined a minimal impact of COVID-19 on OCD patients and one study showed a slight improvement in symptoms. Two out of three studies on children and adolescents showed an exacerbation of OCD and a worsening even in the presence of an ongoing treatment.Conclusions: The studies reviewed are few. There are more studies on adult OCD than on children and adolescents. The results are controversial: few studies examined OCD subtypes; in most studies the typology of treatment was not clear and the samples covered a wide age range; a large number of studies did not use the same monitoring period or quantitative measures, both of which make it difficult to compare or rely on the results.

Limited Prosocial Emotions in a Clinical Population of Children and Adolescents: Proposal for Core and Ancillary Characteristics.

Limited prosocial emotions (LPE) has been recently incorporated into international classifications as a specifier for conduct disorder in the DSM-5 and for all disruptive behavioural disorders in the ICD-11. The aims of the current work were to determine (a) the accuracy of each of the characteristics used to assess the LPE specifier and (b) whether the manner in which symptoms group together supports the idea of LPE having core characteristics. Trained clinicians conducted interviews and determined LPE characteristics using responses from 74 parent/guardian and child/adolescent participants. The distribution of LPE characteristics among those participants with LPE (n = 13) was compared to those with only one LPE characteristic (n = 11). The proposal of callous lack of empathy (CLE) and shallow deficient affect (SDA) as core characteristics was supported by strong associations with the presence of the LPE specifier, larger specificity, and sensitivity indices than those for unconcerned about performance and lack of remorse or guilt, as well as by a robust aggregation in a latent class analysis. CLE and SDA could be considered as core characteristics of LPE in children and adolescents.

Distribution of Visual and Oculomotor Alterations in a Clinical Population of Children with and without Neurodevelopmental Disorders.

A prospective, non-randomized comparative study was conducted to compare the distribution of oculomotor and visual alterations in children with neurodevelopmental disorders and healthy children without such disorders. Sixty-nine children (aged 6–13 years) were enrolled and divided into three groups: a control group (CG) of 23 healthy children; a group of 18 healthy children with oculomotor abnormalities (OAG); and a group of 28 children with a neurodevelopmental disorder (NDDG), with 15 cases of dyslexia, 7 cases of developmental coordination disorder (DCD) and 6 cases of attention deficit/hyperactivity disorder (ADHD). Significantly worse near stereopsis was found in NDDG compared with CG (p < 0.001) and OAG (p = 0.001). Likewise, a significantly lower amplitude of accommodation was found in NDDG compared with CG in both the right (p = 0.001) and left eyes (p < 0.001). No statistically significant differences between groups were found in the measurement of near and distance phoria (p ≥ 0.557), near point of convergence (p = 0.700) and fusional vergences (p ≥ 0.059). Significantly impaired oculomotor test scores were found in NDDG compared with CG (p < 0.001), with no significant differences between OAG and NDDG (p ≥ 0.063). The comparison between the three types of neurodevelopmental disorders included revealed the presence of a significantly lower amplitude of accommodation in children with DCD compared with dyslexics. Furthermore, less exophoria at near was present in children with dyslexia compared with children with ADHD (p = 0.018) and DCD (p = 0.054). In conclusion, children with dyslexia, ADHD and DCD show an altered oculomotor pattern and a more reduced amplitude of accommodation, not always compatible with the diagnostic criteria of an accommodative insufficiency. Accommodative and binocular vision problems are not always present in these children and cannot be considered an etiologic factor.

Enfants victimes de violences sexuelles en consultation de pédopsychiatrie

IntroductionChild sexual abuse is a major health problem that remains under-declared and under-reported worldwide. In this paper we have taken an interest in establishing the profile of the victims in a clinical population of children consulting for sexual abuse. MethodWe conducted a descriptive retrospective study in the child and teenager psychiatry department of the Mongi-Slim hospital (Tunis, Tunisia). We included all patients referred for treatment or medical expertise during the period from January 2013 to June 2019 and recorded sociodemographic data and clinical characteristics on pre-established charts from patient files. ResultsThe total number of consultants was 150 patients with 61,33 % of female subjects (n=92). The average age was 9,9 years old with extremes ranging from 2 to 18 years old. The assault was unique in 62,7 % and happened in a place known by the victim in 47,33 %. Sexual abuse with non-penetrating contact was the most frequent (48 %). The average age at which the first sexual abuse happened was 9 years old. In the vast majority of cases, the abuser was a male. Concerning the identity of the abuser, he was someone of the family in 37,3 % of the cases and in half of these cases, he was the father. In the other cases where the abuser wasn’t a family member, the identity was known by the child and/or his family in 48,66 %. A psychiatric diagnosis was made in 58 % of the cases with a percentage of 52,1 % among girls and 60,3 % among boys. Main diagnoses were acute stress disorder in 10,6 %, post trauma stress disorder in 19,3 %, adjustment disorder in14,6 % and a major depressive disorder in 8 %. ConclusionKnowing the profile of victims of child sexual abuse and taking into consideration the social and psychiatric impact can help in adapting the means to intervene properly in order to take care of the victims and prevent such abuse.

Assessment of the cognitive attentional syndrome in children: an adaptation of the CAS-1.

Research suggests that the metacognitive model is applicable to clinical child populations. However, few measures related to the model are available for younger age groups. A key concept of the model is the cognitive attentional syndrome (CAS), which encompasses the individual's worry and rumination, maladaptive coping strategies, and metacognitive beliefs. While the CAS has been successfully measured in adults, this has not yet been attempted in children. The aim of this study was to adapt a measure of the CAS for use with children and investigate the measure's associations with anxiety, worry, depression and metacognitions. Our study included 127 children with anxiety disorders aged 7-13 years. The adult measure of CAS was adapted for use with children and administered at pre- and post-treatment. We examined the correlations between variables and the ability of the CAS measure to explain variance in anxious symptomatology, as well as the measure's sensitivity to treatment change. The adapted measure, CAS-1C, displayed strong associations with overall anxiety, depression, worry and metacognitions. The CAS-1C explained an additional small amount of variance in anxiety and worry symptoms after accounting for metacognitions, which may be due to the measure also assessing thinking styles and coping strategies. Furthermore, the measure displayed sensitivity to treatment change. The child measure of the CAS is a brief tool for collecting information on metacognitive beliefs and strategies that maintain psychopathology according to the metacognitive model, and it can be used to monitor treatment changes in these components.

Early-Onset Schizophrenia in a paediatric population of French psychiatric and medico-social care centres: A cross sectional study.

BackgroundEarly-Onset Schizophrenia (EOS) is rare but severe mental health disorder in children and adolescents. Diagnosis of schizophrenia before the age of 18 years remains complex and challenging, especially in young children. In France, there are no recent reliable epidemiological data about the prevalence of EOS. The present study evaluates the EOS rate in a target clinical population of children and adolescents in psychiatric and medico-social care centres in the South-East of France.MethodsPsychiatric and medico-social centres for children and adolescent in the geographical area have been contacted, and after receiving their agreement to participate in the study, eligible patients corresponding to inclusion criteria were selected based on patients’ medical records. Main inclusion criteria were age 7 to 17 years and intelligence quotient > 35. EOS categorical diagnosis was assessed by Kiddie-SADS Present and Lifetime psychosis section.Results37 centres participated and 302 subjects have been included in the study. The main result was the categorical diagnosis of EOS in 27 subjects, corresponding to a rate of 8.9% in the study population. Half of the patients presented mild to moderate intellectual deficiency. Interestingly, only 2.3% had a diagnosis of schizophrenia spectrum disorder noted in their medical records before standardized assessment.ConclusionsThe results of the study highlight the importance of using a standardized diagnostic tool for the diagnosis of schizophrenia in the paediatric population. In fact, EOS might be underdiagnosed in children and adolescents with neurodevelopmental disorders and subnormal cognitive functioning.Trial registrationNCT01512641. Registered 19 January 2012; https://clinicaltrials.gov/ct2/show/NCT01512641

Healthy Habits Questionnaire Feasibility and Utility for High-Risk Children.

The American Academy of Pediatrics provides guidance for pediatric primary care providers to promote healthy weight during childhood. Screening questions on diet and activity habits can help provider assessment and assist counseling for targeted behavior change. We implemented the parent completed, 10-item 5210 Healthy Habits Questionnaire (Ages 2-9 year) in our primary care practice serving low-income minority children with high rates of overweight and obesity. Adherence to the intervention protocol was high, and providers found the content and method of assessment useful for their counseling of individual patients. The aggregate Healthy Habits Questionnaire data provided a snapshot of the health habits in our local clinic population of children, prompting greater awareness for providers and informing their patient care.

Characteristics and Prevalence of Gravitational Insecurity in Children with Sensory Processing Dysfunction

BackgroundChildren with sensory processing challenges often demonstrate a specific vestibular dysfunction characterized by an irrational fear of movement experiences referred to as gravitational insecurity. Procedures/OutcomesThis descriptive, exploratory study of existing de-identified data examined characteristics and prevalence of symptoms indicative of gravitational insecurity and the relationship among gravitational insecurity, gender, age, and other types of sensory-motor problems in 689 children, aged 4–12 years, with Sensory Processing Disorder (SPD) and related parent-reported co-morbid diagnoses of Attention Deficit-Hyperactivity Disorder, Anxiety Disorder, Learning Disabilities and Autism Spectrum Disorder. Gravitational insecurity was identified by the sum of eight items on a parent-report clinical questionnaire of sensory processing and motor skills in children. Results/ConclusionsThe number and patterns of gravitational insecurity symptoms were not significantly different across age, gender or comorbid diagnoses. Prevalence of symptoms of gravitational insecurity in a clinical population of children with SPD was 15 – 21%. Cluster analysis found two groups with and without gravitational insecurity. In the gravitational insecurity group all eight items examined occurred “sometimes/often” and four or more symptoms were reported by individuals in this group. ImplicationsGravitational insecurity is an important vestibular-based dysfunction to identify and treat in children with SPD. Future studies should examine the relationship between these symptoms and objective measures of gravitational insecurity.

Are ‘‘Dichotic’’ Deficits Uniquely Dichotic? Investigating Dichotic Performance with the Dichotic Digits Difference Test (DDdT) in a Large Clinical Population of Children Referred for an Auditory Processing Assessment

Background: Previous studies in a large population of typically developing (TD) children and a smallclinical group showed high correlations between the dichotic and diotic conditions of the Dichotic Digitsdifference Test (DDdT), as well as between DDdT performance and measures of memory and attention.Purpose: The purpose of the study was to investigate the performance on the DDdT in a large clinical sample.Research Design: Correlational analysis between the DDdT diotic condition and the dichotic free recall (FR)right-ear, left-ear, and total (ear-averaged) conditions, as well as between DDdT and memory performance.Study Sample: One hundred one children (6 years, 3 months to 15 years, 0 months, mean 9 years, 6 months)were referred for assessment to the Australian Hearing Central Auditory Processing Disorder (CAPD) service.Results were compared with data from 112 TD children collected from previously published studies.Data Collection and Analysis: Z-scores were used to account for the effect of age on performance.Mean differences between clinical and TD children were investigated using analysis of variance(ANOVA). Pearson product-moment correlations determined the strength of relationships between DDdTconditions and the number memory forward (NMF) and reversed (NMR) subtests of the Test of AuditoryProcessing Skills—Third Edition.Results: Performance by the clinical group on the DDdT dichotic FR (RE, LE, and total) conditions wassignificantly correlated with the diotic condition (r = 0.7; 0.7, 0.8; p &lt; 0.001). Significant correlations werefound between the DDdT diotic and dichotic FR conditions and the NMF (r = 0.5–0.6, p &lt; 0.001) andNMR (r = 0.2–0.5, p &lt; 0.025–0.001). ANOVA revealed no significant difference between the TD andclinical groups (p = 1.0000) in respect to the advantage they got from dichotic listening (calculated asdichotic FR total minus diotic score). Multiple regression revealed that diotic performance and short-termmemory accounted for 68% of the variation in dichotic performance. Random measurement erroraccounted for a further 16%.Conclusions: Factors other than dichotic performance strongly impact a child’s ability to perform a dichoticdigit listening task. This result has widespread implications in respect to the interpretation of CAPDtest results.

Clinical Validation of The Portuguese Version of the Children's Sleep Habits Questionnaire (CSHQ-PT) in Children with Sleep Disorder and ADHD

The Portuguese version of the Children's Sleep Habits Questionnaire showed adequate psychometric properties in a community sample but the American cut-off seemed inadequate. This study aimed to validate this questionnaire in clinical populations of children with sleep disorders and with attention deficit/ hyperactivity disorder. The study sample included 148 Portuguese children aged 2 to 10 years old that where divided in 3 groups: 1. Clinical group with sleep disorders (behavioral insomnias, parasomnias or sleep-related breathing disorders); 2. Clinical group with attention deficit/ hyperactivity disorder; 3. The sleep habits and sleep problems were evaluated using the Children's Sleep Habits Questionnaire. Sleep-related disorders were confirmed by polysomnography. The questionnaire's internal consistency (Cronbach α) in the clinical sample (sleep disorders and attention deficit/ hyperactivity disorder) was 0.75 and ranged from 0.55 to 0.85 for the subscales. Children with sleep disorders and attention deficit/ hyperactivity disorder had a higher sleep disturbance index (full scale score) compared to the control group. The subscales presented significant differences between the subgroups with different sleep disorders showing discriminative validity. The receiver operating characteristic analysis of the sleep disturbance index comparing the sleep disorder and control sample determined a cut-off of 48 (sensibility 0.83; specificity 0.69). Children with sleep disorders and attention deficit/ hyperactivity disorder evidenced higher Sleep Disturbance Index (full scale score) comparing to the control group. The subscales presented significative differences between the subgroups with different sleep disorders showing discriminative validity Conclusion: The Portuguese version of the Children's Sleep Habits Questionnaire showed adequate psychometric properties for children with sleep disorders and/or attention deficit/ hyperactivity disorder. The cut-off value 48 is better adjusted for the Portuguese population.

Predicting Child Behavior: A Comparative Analysis between Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder

Understanding factors that impact child adjustment is imperative. Parental adjustment, parenting behaviors, and environmental factors (e.g., child routines) have been linked to child behavior. In clinical child populations, these factors are particularly important given the increased demands the child’s disorder often places on caregivers. Furthermore, children in clinical populations often engage in increased levels of internalizing and externalizing behaviors both related to and in addition to the core symptoms of their disorder. Two such clinical child populations are Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). The first goal of the present study was to elucidate parental and environmental factors that predicted child behavior in ADHD and ASD. Based on Sameroff’s Transactional Model of Development (2009), it was hypothesized that parental adjustment, parenting behaviors and child routines would collectively predict child behavior. A second goal was to examine differences in patterns of association between ADHD and ASD groups. Due to differences in the core symptoms of each disorder, it was hypothesized that the strength of associations would vary between groups. Researchers examined the impact of parental adjustment, parenting behaviors, and child routines on internalizing and externalizing child behavior using parent-report measures (CBCL, CRQ, HSCL-25, APQ) of children ages 6 to 12. Results indicated that for both groups, poor parental adjustment directly predicted externalizing child behavior and indirectly through harsh/disengaged parenting behavior. Fewer warm/supportive parenting behaviors predicted internalizing behavior, and more harsh/disengaged parenting predicted externalizing behavior. Higher levels of child routines predicted internalizing behavior for both groups but had a significantly stronger effect for children with ASD than ADHD. Findings have important implications for interventions on several levels (e.g., parental adjustment, parenting behaviors, and environmental supports) in both the ADHD and ASD populations.

An examination of direct, indirect and reciprocal relationships between perfectionism, eating disorder symptoms, anxiety, and depression in children and adolescents with eating disorders

ObjectivePerfectionism is a transdiagnostic factor across eating disorders, anxiety, and depression. Previous research has shown anxiety mediates the relationship between perfectionism and eating disorders in adults. The aim of this study was to investigate the relationships between anxiety/depression, perfectionism and eating disorder symptoms in children and adolescents with eating disorders. MethodStructural equation modeling was used to investigate three models in a clinical sample of children and adolescents (N = 231, M age = 14.5, 100% female): (1) anxiety and depression as mediators of the relationship between perfectionism and eating disorder symptoms, (2) eating disorder symptoms as a mediator of the relationship between perfectionism and anxiety and/or depression, and (3) perfectionism as a mediator of the relationship between anxiety/depression and eating disorders. ResultsResults indicated that both models 1 and 2 fit the data well, while model 3 provided a poor fit. These findings suggest that in clinical populations of children and adolescents, anxiety and depression mediate the relationship between perfectionism and eating disorder symptoms, and there is also a reciprocal relationship whereby eating disorders mediate the association between perfectionism, and anxiety and/or depression. DiscussionThe results highlight the importance of further research to determine whether targeting perfectionism is helpful in the treatment of eating disorders and comorbid anxiety and depression in young people. It would be useful for clinicians to consider assessing for and treating perfectionism directly when it is elevated in children and adolescents with eating disorders.

Yield of Genetic Testing Including Targeted Gene Panel in a Clinical Population of Children with Autism Spectrum Disorder (P1.303)

Yield of Genetic Testing Including Targeted Gene Panel in a Clinical Population of Children with Autism Spectrum Disorder (P1.303)

Construct validity and parent–child agreement of the six new or modified disorders included in the Spanish version of the Kiddie Schedule for Affective Disorders and Schizophrenia present and Lifetime Version DSM-5 (K-SADS-PL-5)

Changes to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) incorporate the inclusion or modification of six disorders: Autism Spectrum Disorder, Social Anxiety Disorder, Intermittent Explosive Disorder, Disruptive Mood Dysregulation Disorder, Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder. The objectives of this study were to assess the construct validity and parent-child agreement of these six disorders in the Spanish language Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL-5) in a clinical population of children and adolescents from Latin America. The Spanish version of the K-SADS-PL was modified to integrate changes made to the DSM-5. Clinicians received training in the K-SADS-PL-5 and 90% agreement between raters was obtained. A total of 80 patients were recruited in four different countries in Latin America. All items from each of the six disorders were included in a factor analysis. Parent-child agreement was calculated for every item of the six disorders, including the effect of sex and age. The factor analysis revealed 6 factors separately grouping the items defining each of the new or modified disorders, with Eigenvalues greater than 2. Very good parent-child agreements (r>0.8) were found for the large majority of the items (93%), even when considering the sex or age of the patient. This independent grouping of disorders suggests that the manner in which the disorders were included into the K-SADS-PL-5 reflects robustly the DSM-5 constructs and displayed a significant inter-informant reliability. These findings support the use of K-SADS-PL-5 as a clinical and research tool to evaluate these new or modified diagnoses.