Disruptive Disorders Research Articles

Treatment of pediatric behavioral health patients with intravenous and intramuscular chemical restraints: Results from a nationwide sample of emergency departments.

Behavioral health crises in pediatric emergency department (ED) patients are increasingly common. Chemical restraints can be utilized for patients who present imminent danger to self or others. We sought to describe the use of intravenous (IV)/intramuscular (IM) chemical restraints for pediatric behavioral health ED patients across a nationwide sample of hospitals and describe factors associated with restraint use. This was a retrospective study of patients ages 8-17 treated at 822 EDs contributing data to the Premier Healthcare Database between January 1, 2018, and December 31, 2020, with a behavioral health discharge diagnosis. The primary outcome was the use of IV/IM chemical restraint medication. We developed a hierarchical model to examine patient and hospital-level factors associated with treatment with IV/IM chemical restraint medications. Of 630,384 cases, 4.8% received IV/IM chemical restraint. Patient factors associated with higher odds of chemical restraint were older age (ages 13-17 years [adjusted odds ratio {AOR} 1.53, 95% confidence interval {CI} 1.48-1.58]), anxiety disorders (AOR 1.69, 95% CI 1.64-1.74), disruptive disorders (AOR 1.61, 95% CI 1.53-1.69), suicide/self-injury (AOR 1.3, 95% CI 1.26-1.34), substance use (AOR 1.24, 95% CI 1.20-1.28), and bipolar disorder (AOR 1.23, 95% CI 1.17-1.30). Participants with complex comorbidities were more likely to receive chemical restraint (AOR 1.32, 95% CI 1.26-1.39). After patient and hospital factors were adjusted for, the median OR indicating the influence of the individual hospital on the odds of chemical restraint was 1.43 (95% CI 1.40-1.47). We found that age and certain behavioral health diagnoses were associated with receipt of IV/IM chemical restraint during pediatric behavioral health ED visits. Additionally, whether a patient was treated with chemical restraints was strongly influenced by the hospital to which they presented for treatment.

Mood disorders among adolescents in conflict with the law and in custody

The high prevalence of psychiatric symptoms among juvenile delinquents is a well-replicated international finding. This study aimed to find the prevalence of mood disorders and their relationship with serious criminal acts in a population of adolescents in conflict with the law and in custody. A total of 123 male inmates aged 14 to 17 years were interviewed and assessed. Mood disorders were diagnosed in 15% of the sample for current episode and 31% for lifetime, making them third most prevalent after dependence disorders and disruptive disorders. The psychopathological profile of the adolescents who had committed violent crimes corroborates other studies reporting a high prevalence of mood disorders in this population. Several factors have been found to influence the formation of juvenile delinquency, including absence of family structure, social inequality, lack of quality school education, alcohol and drug abuse/addiction and disruptive disorders. The present results confirm mood disorders as another such factor.

Appetite hormone dysregulation and executive dysfunction among adolescents with bipolar disorder and disruptive mood dysregulation disorder.

Appetite hormone dysregulation may play a role in the pathomechanisms of bipolar disorder and chronic irritability. However, its association with executive dysfunction in adolescents with bipolar disorder and those with disruptive mood dysregulation disorder (DMDD) remains unclear. We included 20 adolescents with bipolar disorder, 20 adolescents with DMDD, and 47 healthy controls. Fasting serum levels of appetite hormones, including leptin, ghrelin, insulin, and adiponectin were examined. All participants completed the Wisconsin Card Sorting Test. Generalized linear models with adjustments for age, sex, body mass index, and clinical symptoms revealed that patients with DMDD had elevated fasting log-transformed insulin levels (p = .023) compared to the control group. Adolescents with DMDD performed worse in terms of the number of tries required to complete tasks associated with the first category (p = .035), and adolescents with bipolar disorder performed worse in terms of the number of categories completed (p = .035). A positive correlation was observed between log-transformed insulin levels and the number of tries required for the first category (β = 1.847, p = .032). Adolescents with DMDD, but not those with bipolar disorder, were more likely to exhibit appetite hormone dysregulation compared to healthy controls. Increased insulin levels were also related to executive dysfunction in these patients. Prospective studies should elucidate the temporal association between appetite hormone dysregulation, executive dysfunction, and emotional dysregulation.

Disruptive Mood Dysregulation Disorder in a Norwegian Clinical Child Population.

Disruptive Mood Dysregulation Disorder was included in DSM-5 to accommodate new research addressing aspects of emotional dysregulation in children suffering from disruptive behavior problems. Despite growing interest in Disruptive Mood Dysregulation Disorder, few studies have looked at prevalence rates in European clinical populations. The primary objective of this study was to examine the prevalence and characteristics associated with Disruptive Mood Dysregulation Disorder in a Norwegian clinical sample. The present study assessed children 6-12 years of age referred to a mental health clinic for evaluation and treatment (N = 218, Mage = 9.6, 60.4% boys) and compared those who did and did not meet Disruptive Mood Dysregulation Disorder diagnostic criteria. Diagnoses were determined using K-SADS-PL 2013. Associated difficulties at home and in school were measured by Achenbach Systems of Empirically Based Assessment battery. In this clinical sample, 24% met the diagnostic criteria for Disruptive Mood Dysregulation Disorder. Children with Disruptive Mood Dysregulation Disorder were more likely than those without Disruptive Mood Dysregulation Disorder to be male (77% vs. 55%, p = .008), be living in poverty, have multiple mental health diagnoses (79% vs. 53%, p = .001), and have lower global functioning levels as measured by Children's Global Assessment Scale (range 0-100, M = 47, SD = 8.5 vs. M = 57, SD = 11.4, p=<.001). Finally, parents and teachers of children with Disruptive Mood Dysregulation Disorder reported lower overall competence and adaptive functioning, and higher total symptom load than children with other diagnoses. Disruptive Mood Dysregulation Disorder is highly prevalent in a Norwegian clinical sample and displays a high symptom load. Our results are in accordance with similar studies. Consistent findings across the world may support Disruptive Mood Dysregulation Disorder as a valid diagnostic category.

Prevalence of Mental Health Diagnoses Among Early Adolescents Before and During Foster Care.

This study aimed to characterize the rates and types of diagnosed mental health (MH) disorders among children and adolescents before and during foster care (FC) overall and by race and ethnicity. We used population-based linked administrative data of medical assistance (public insurance) claims records and child protective services data from a cohort of early adolescents who entered FC at 10 to 14 years old. MH diagnoses were coded according to the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9 and ICD-10) and included adjustment disorders, disruptive disorders, attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, mood disorders, attachment disorders, autism, and other disorders. Before FC entry, 41% of children and adolescents had at least 1 MH diagnosis. Attention-deficit/hyperactivity disorder (25%), mood disorders (18%), and disruptive disorders (15%) were the most common pre-entry diagnoses. Among early adolescents entering FC with no previous diagnosis, 52% were later diagnosed with adjustment disorder (accounting for 73% of all youth with a new diagnosis during FC). White early adolescents had higher rates of diagnosed MH disorders before FC, whereas racial/ethnic minority early adolescents were more likely to receive a MH diagnosis during FC. Black early adolescents were more likely than White and Hispanic early adolescents to be diagnosed with disruptive disorders and less likely to be diagnosed with anxiety or adjustment disorders during FC. Results highlight the high rates of MH needs among early adolescents before entry into FC, whether detected before or during FC. Results also illustrate disparities in pre-entry MH care between racial/ethnic minority and White early adolescents, with minority youth less likely to be receiving services before entry.

Neuropsychological mechanisms of social difficulties in disruptive mood dysregulation disorder versus oppositional defiant disorder

ABSTRACT Children with Disruptive Mood Dysregulation Disorder (DMDD) or Oppositional Defiant Disorder (ODD) are characterized by irritability and social difficulties. However, the mechanisms underlying these disorders could be different. This study explores differences in social cognition and executive function (EF) across DMDD and ODD and the influence of these factors and their interaction on social problems in both groups. Children with DMDD (n = 53, Mage = 9.3) or ODD (n = 39, Mage = 9.6) completed neuropsychological tasks measuring social cognition (Theory of Mind and Face-Emotion Recognition) and EF (cognitive flexibility, inhibition, and working memory). Parents reported social problems. More than one-third of the children with DMDD and almost two-thirds of those with ODD showed clear difficulties with Theory of Mind. Most children with DMDD (51–64%) or ODD (67–83%) showed difficulties with EF. In children with DMDD, worse EF (β = –.36) was associated with more social problems, whereas in children with ODD, better EF (β = .44) was associated with more social problems. In those with ODD, but not in those with DMDD, the interaction between social cognition and EF contributed to the explained variance of social problems (β = –1.97). Based on the observed interaction pattern, enhanced EF may lead to increased social problems among children with ODD who also exhibit social cognition difficulties. This study suggests the existence of distinct neuropsychological mechanisms underlying the social issues observed in children with DMDD versus those with ODD.

Policies Affecting Pregnant Women with Substance Use Disorder

Policies Affecting Pregnant Women with Substance Use Disorder

Role of individualised homoeopathic medicine in the management of disruptive mood dysregulation disorder - A case report

Disruptive Mood Dysregulation Disorder (DMDD) is a common behavioural dysfunction. The primary features of DMDD are chronic, non-episodic, persistent irritability and temper tantrums disproportionate with the trigger. We present a case of DMDD that was managed with homoeopathic medication and auxiliary measures. A 17-year-old male patient presented to the Psychiatry Outpatient Department of National Homoeopathy Research Institute in Mental Health with symptoms of anger outbursts, abusiveness, persistent irritable mood and laziness. The consultant psychiatrist diagnosed him with DMDD. He was treated with individualised homoeopathic medicine. The outcome was assessed at baseline and further using the Irritability — Parent/Guardian of child age 6–17 affective reactivity index (ARI). The patient’s ARI score reduced drastically within 2 months. His anger, abusiveness, propensity to hurt and irritability also reduced markedly. Behavioural aspects and social interactions showed good outcomes.Individualised homoeopathic medicine is useful in managing of DMDD by improving the susceptibility and modifying the patient’s state of reactivity.

Robust caregiver-youth discrepancies in irritability ratings on the affective reactivity index: An investigation of its origins

ObjectiveThe Affective Reactivity Index (ARI) is widely used to assess young people's irritability symptoms, but youth and caregivers often diverge in their assessments. Such informant discrepancy might be rooted in poor psychometric properties, the differential conceptualization of irritability across informants, or reflect sociodemographic and clinical characteristics. We use an out-of-sample replication approach and leverage longitudinal data, available for a subset of the participants, to test these hypotheses. MethodAcross two independent samples (NCohort-1 = 765, 8–21 years; NCohort-2 = 1910, 6–21 years), we investigate the reliability and measurement invariance of the ARI, examine sociodemographic and clinical predictors of discrepant reporting and probe the utility of a bifactor model for cross-informant integration. ResultsDespite good internal consistency and 6-week-retest-reliability of parent (Cohort-1: α = 0.92, ICC = 0.85; Cohort-2: α = 0.93) and youth forms (Cohort-1: α = 0.88, ICC = 0.78; Cohort-2: α = 0.82), we confirm substantial informant discrepancy in ARI ratings (3 points on a scale from 0 to 12), which is stable over six weeks (ICC = 0.53). Measurement invariance across informants was weak, indicating that parents and youth may interpret ARI items differently. Irritability severity and diagnostic status predicted informant-discrepancy, albeit in opposing directions: higher severity was linked to relative, higher irritability-ratings by youth (Cohort-1: β = −0.06, p < .001; Cohort-2: β = −0.06, p < .001), while diagnoses of Disruptive Mood Dysregulation Disorder (Cohort-1: β = 0.44, p < .001; Cohort-2: β = 0.84, p < .001) and Oppositional Defiant Disorder (Cohort-1: β = 0.41, p < .001; Cohort-2: β = 0.42, p < .001) predicted relative higher irritability-ratings by caregivers. In both datasets, a bifactor model parsing informant-specific from shared irritability-related variance fit the data well (CFI = 0.99, RMSEA = 0.05; N2: CFI = 0.99; RMSEA = 0.04). ConclusionParent and youth ARI reports and their discrepancy are reliable and reflect different interpretations of the scale items; hence they should not be averaged. This finding also suggests that irritability is not a unitary construct. Future work should investigate and model how different aspects of irritability might differ in their impact on the responses of specific informants.

Network analysis of ecological momentary assessment identifies frustration as a central node inirritability.

Irritability presents transdiagnostically, commonly occurring with anxiety and other mood symptoms. However, little is known about the temporal and dynamic interplay among irritability-related clinical phenomena. Using a novel network analytic approach with smartphone-based ecological momentary assessment (EMA), we examined how irritability and other anxiety and mood symptoms were connected. Sample included 152 youth ages 8-18 years (M ± SD = 12.28 ± 2.53; 69.74% male; 65.79% White) across several diagnostic groups enriched for irritability including disruptive mood dysregulation disorder (n = 34), oppositional defiant disorder (n = 9), attention-deficit/hyperactivity disorder (n = 47), anxiety disorder (n = 29), and healthy comparisons (n = 33). Participants completed EMA on irritability-related constructs and other mood and anxiety symptoms three times a day for 7 days. EMA probed symptoms on two timescales: "since the last prompt" (between-prompt) versus "at the time of the prompt" (momentary). Irritability was also assessed using parent-, child- and clinician-reports (Affective Reactivity Index; ARI), following EMA. Multilevel vector autoregressive (mlVAR) models estimated a temporal, a contemporaneous within-subject and a between-subject network of symptoms, separately for between-prompt and momentary symptoms. For between-prompt symptoms, frustration emerged as the most central node in both within- and between-subject networks and predicted more mood changes at the next timepoint in the temporal network. For momentary symptoms, sadness and anger emerged as the most central node in the within- and between-subject network, respectively. While anger was positively related to sadness within individuals and measurement occasions, anger was more broadly positively related to sadness, mood lability, and worry between/across individuals. Finally, mean levels, not variability, of EMA-indexed irritability were strongly related to ARI scores. This study advances current understanding of symptom-level and temporal dynamics of irritability. Results suggest frustration as a potential clinically relevant treatment target. Future experimental work and clinical trials that systematically manipulate irritability-related features (e.g. frustration, unfairness) will elucidate the causal relations among clinical variables.

Do environmental effects indexed by parental genetic variation influence common psychiatric symptoms in childhood?

Parental genes may indirectly influence offspring psychiatric outcomes through the environment that parents create for their children. These indirect genetic effects, also known as genetic nurture, could explain individual differences in common internalising and externalising psychiatric symptoms during childhood. Advanced statistical genetic methods leverage data from families to estimate the overall contribution of parental genetic nurture effects. This study included up to 10,499 children, 5990 mother–child pairs, and 6,222 father–child pairs from the Norwegian Mother Father and Child Study. Genome-based restricted maximum likelihood (GREML) models were applied using software packages GCTA and M-GCTA to estimate variance in maternally reported depressive, disruptive, and attention-deficit hyperactivity disorder (ADHD) symptoms in 8-year-olds that was explained by direct offspring genetic effects and maternal or paternal genetic nurture. There was no strong evidence of genetic nurture in this sample, although a suggestive paternal genetic nurture effect on offspring depressive symptoms (variance explained (V) = 0.098, standard error (SE) = 0.057) and a suggestive maternal genetic nurture effect on ADHD symptoms (V = 0.084, SE = 0.058) was observed. The results indicate that parental genetic nurture effects could be of some relevance in explaining individual differences in childhood psychiatric symptoms. However, robustly estimating their contribution is a challenge for researchers given the current paucity of large-scale samples of genotyped families with information on childhood psychiatric outcomes.

Therapeutic update in the treatment of disruptive disorder with emotional dysregulation in children and adolescents : review of the literature

IntroductionDisruptive Mood Dysregulation Disorder (DMDD) is a new disorder that has been added to the category of mood disorders in the fifth Diagnostic and Statistical Manual of Mental Disorders to distinguish chronic non-periodic irritability from the periodic irritability of bipolar disorder. The main characteristic of DMDD is chronic and severe irritability. Because it is a new diagnostic entity, little research has been done on it and the literature on the subject is still expanding.ObjectivesThe purpose of this review article is to gather information on new therapies for the treatment of this disorder in children and adolescents.MethodsThe studies related to the treatment of DMDD were collected and analyzed. This study retrieved related articles from PubMed, SpringerLink, ScienceDirect, NCBI, The American Journal of Psychiatry, and EBSCO. Use keywords “disruptive” AND “mood” AND “dysregulation” AND “disorder” OR “Treatment” AND “DMDD” OR “Drug” AND “mood” AND “disorder” OR “Treatment” AND “SMD” OR “Treatment” AND “BP” OR “Treatment” AND “ADHD” OR “Antidepressant” OR “Mental”AND “Stabilizer” OR “temper” AND “outburst” OR “aggressive” AND "antipsychotics.ResultsTo date, no medication has been approved by the FDA to treat EDD. Because there are no treatment standards, drug therapy focuses on the primary symptoms of EDD, such as severe chronic irritability, temper tantrums, and comorbidities, such as ADHD. Currently, medications used by clinicians to treat patients with EDD include antidepressants (fluoxetine, sertraline, citalopram), stimulants (methylphenidate), anxiolytics mood stabilizers (sodium valproate) and antipsychotics (haloperidol, risperidone, aripiprazole in combination with methylphenidate in ADHD-EDD comorbidity), atomoxetine, guanfacine, and amantadine.To date, no medication has been approved by the FDA to treat EDD. Because there are no treatment standards, drug therapy focuses on the primary symptoms of EDD, such as severe chronic irritability, temper tantrums, and comorbidities, such as ADHD. Currently, medications used by clinicians to treat patients with EDD include antidepressants (fluoxetine, sertraline, citalopram), stimulants (methylphenidate), anxiolytics mood stabilizers (sodium valproate) and antipsychotics (haloperidol, risperidone, aripiprazole in combination with methylphenidate in ADHD-EDD comorbidity), atomoxetine, guanfacine, and amantadine.ConclusionsAs a new diagnosis, treatment guidelines for DMDD are still unclear. Preliminary results from this study suggest that clinicians tend to prescribe a variety of psychotropic medications. This heterogeneity in treatment choices may reflect the fact that these patients are on a bridge between disruptive behavior disorders (including ADHD) and mood disorders. The relative merits or demerits of these treatment choices should be evaluated in further studies.Disclosure of InterestNone Declared

An Efficacy of Group Dialectical Behavior Therapy for Emotion Regulation and Irritability in Students with Disruptive Mood Dysregulation Disorder

An Efficacy of Group Dialectical Behavior Therapy for Emotion Regulation and Irritability in Students with Disruptive Mood Dysregulation Disorder

Childhood maladaptive coping mechanisms and the subsequent development of depression.

Depression is a major source of symptoms and disability. In adults, maladaptive coping (usually characterized as personality dysfunction) has been shown to be associated with a depression diagnosis and poorer depression outcome. As adults with maladaptive coping difficulties are more prone to depression, we hypothesized that children with childhood disorders that involve poor coping would increase the risk of later developing depressive disorders. Longitudinal studies of conduct disorder (CD), oppositional defiant disorder (ODD) and Disruptive Disorder (DD) that included a later measure of depressive disorder were reviewed. Meta-analyses of CD and ODD + DD were performed to predict increased odds of depression. Eight longitudinal studies were found where there was a measure of CD followed by depressive disorder assessment and nine studies for the variables ODD + DD. All of these studies showed these diagnoses were a significant risk factor for later depression. For the studies included in the meta-analysis CD predicted depression OR = 3.9 (1.6-9.3) (six studies), while ODD + DD also predicted depression OR = 5.6 (2.7-11.8) (five studies). Childhood disorders with maladaptive coping may increase the odds of later development of a depressive disorder diagnosis. If so, these diagnoses might also indicate an early intervention possibility to prevent depression.

The new psychiatric dignosis: disruptive mood dysregulation disorder

The DSM-5, adopted in 2013, presents an updated list of affective disorders, which opens with a fundamentally new psychiatric diagnosis of a disruptive mood dysregulation disorder. Disruptive mood dysregulation disorder is diagnosed in children and adolescents aged 6 to 18 years and is manifested by chronic severe and persistent irritability or anger, as well as outbursts of anger disproportionate to the cause. It is obvious that the condition of a significant part of children and adolescents with a disruptive mood dysregulation disorder before the appearance of this diagnosis was mistakenly regarded as manifestations of bipolar disorder. The criterion of the fundamental difference between disruptive mood dysregulation disorder and bipolar disorder is the absence of manic or hypomanic in the first of them. Disruptive mood dysregulation disorder is characterized by high comorbidity and is often combined with oppositional defiant disorder, conduct disorder and attention deficit with hyperactivity, as well as anxiety. The course and prognostic significance of a disruptive mood dysregulation disorder, as well as the choice of the most effective methods of pharmacological treatment and psychotherapy require numerous further studies.

Executive function in children with disruptive mood dysregulation disorder compared to attention-deficit/hyperactivity disorder and oppositional defiant disorder, and in children with different irritability levels.

Addressing current challenges in research on disruptive mood dysregulation disorder (DMDD), this study aims to compare executive function in children with DMDD, children with attention-deficit/hyperactivity disorder (ADHD), and children with oppositional defiant disorder (ODD). We also explore associations between irritability, a key DMDD characteristic, and executive function in a clinical sample regardless of diagnosis. Our sample include children (6-12years) referred to child psychiatric clinics. Measures of daily-life (parent-reported questionnaire) and performance-based (neuropsychological tasks) executive function were applied. Identifying diagnoses, clinicians administered a standardized semi-structured diagnostic interview with parents. Irritability was assessed by parent-report. First, we compared executive function in DMDD (without ADHD/ODD), ADHD (without DMDD/ODD), ODD (without DMDD/ADHD) and DMDD + ADHD (without ODD). Second, we analyzed associations between executive function and irritability using the total sample. In daily life, children with DMDD showed clinically elevated and significantly worse emotion control scores compared to children with ADHD, and clinically elevated scores on cognitive flexibility compared to norm scores. Children with DMDD had significantly less working memory problems than those with ADHD. No differences were found between DMDD and ODD. Increased irritability was positively associated with emotional dyscontrol and cognitive inflexibility. For performance-based executive function, no diagnostic differences or associations with irritability were observed. We discuss how, in daily life, children with high irritability-levels get overwhelmed by feelings without accompanying regulatory capacities.

Disruptive Mood Dysregulation Disorder Associated with Autism Spectrum Disorder: Literature Review and Case Illustrations

Introduction: Irritability has become increasingly prevalent over the past few decades and is often seen in both children with autism spectrum disorder (ASD), and disruptive mood dysregulation disorder (DMDD). Despite this overlap, there has been scant research on treatment for irritability experienced by individuals with co-occurring ASD and DMDD. Objectives: This paper aims to explore the development of DMDD and to shed light on potential treatment regimens that address irritability through case illustrations of individuals who experience co-occurring ASD and DMDD. Methods: Three patients seen through a specialty clinic were selected based on their co-occurring diagnoses of ASD &amp; DMDD. Conclusions: The case illustrations showed that ASD and DMDD often also occurred in the presence of other disorders. Antipsychotics and CBT have shown the most benefits, but mood stabilizers are becoming more prominent for certain combinations of ASD and DMDD. More research is needed on treatment for irritability across co-occurring disorders.

Mental health-related hospitalizations among adolescents and emerging adults with autism in the United States: A retrospective, cross-sectional analysis of national hospital discharge data.

Autistic young people are more likely to have mental health conditions, like depression and bipolar disorder, than people without autism. These mental health issues sometimes lead to hospitalizations, which can be expensive and traumatic. Because of this, we wanted to understand mental health-related hospitalizations among autistic young people aged 10-20. We found that the main mental health reasons for the hospitalization of autistic young people were neurodevelopmental, disruptive, depressive, and bipolar disorders. These hospitalizations cost an average of US$7401.23 per stay, for a total of US$106 million in service delivery costs in 2016. Mental health-related hospitalizations were compared between young people with autism, young people with complex and chronic conditions, and young people with no chronic conditions. Autistic young people were almost 11 times more likely to be hospitalized for mental health reasons than young people with complex and chronic conditions, and two times more likely than young people with no complex and chronic conditions. We believe the United States needs better community-based mental health care for young people with autism.

Problematic screen media use in children and adolescents attending child and adolescent psychiatric services in a tertiary care center in North India.

The present clinic-based study aimed to evaluate screen media use among children and adolescents who had a mental disorder. Two hundred twelve parents of children and adolescents attending the child and adolescent psychiatric services were approached. They were asked to rate the screen media use of their child brought for psychiatric consultation using the Problematic Media Use Measure-Short Form (PMUM-SF). The DSM-5 criteria of internet gaming disorder (IGD) were applied using the PMUM-SF, which contained nine items equivalent to nine items of IGD. The mean age of the patients was 13.16 years (SD: 4.06; range: 0.8-18). Only 28.3% (n = 60) were aged less than 12 years. The most common primary diagnosis was neurodevelopment disorder (n = 82; 38.7%), followed by neurotic disorder (n = 62; 29.2%) and mood disorder (n = 30; 14.2%). The most common screen media used was television (n = 121; 57.1%) followed by the mobile phone (n = 81; 38.2%). The average screen time was 3.14 hours, with a range of 0.5-7 hours, and more than two-third of children and adolescents used screen gadgets for more than the recommended duration. Slightly more than one-fourth (22.2%) of children and adolescents with mental disorders fulfilled the DSM-5 criteria of IGD. When those with and without screen media addiction were compared, those with screen media addiction were more often male, from joint or extended families, more often diagnosed with neurodevelopmental disorders and disruptive disorder, and were less often diagnosed with neurotic disorders. About one-fourth of the children and adolescents with mental disorders had screen media addiction, and two-thirds of them used screen media for more than the recommended duration.

Parental Attitude as a Determinant of Psychological Disorders among Young Adults

Background: Psychological disturbance among young adults is a critical challenge nowadays and the reasons for this group being suffered from such issues are complex. Aim: To explore the determinant of psychological issues among Pakistani youngsters. Focusing on the causes of mental turbulences related to anxiousness, oppositional defiance disorder, intermittent explosive disorder, borderline personality, bipolar disorder, and psychosocial stressors, the attempt investigated: understanding of the problem and risk factors, social support and contextual factors, factors being perceived as alleviating low mood, despair, rage, pain, hopelessness, et cetera. Method: Three case studies of two boys and one girl aged 20-25 having been diagnosed with the above-mentioned disruptive and depressive disorders are presented incorporating a qualitative approach. It includes semi-structured interviews, a survey, and phenomenological considerations. Finding: The thematic analysis and thorough review of case studies present the indifferent attitude of parents and their harshness are the dominant and consistent determinants of ill-functioning among the involved participants. All complaints of participants were directly or indirectly associated with familial practices, particularly with parental attitude. Practical Implications. The significant role of parents in the childs’ development can never be denied. Therefore, the study provides an insight for the proper exploration of the parent-child relation and attempts to reduce or vanish the discrepencies, must be the goal of therapy. Also, awarness or the specified sessions as a reminder for good parenting regarding thepotential influence of parental attitude and involvement might be the effective attempt for the healthy functioning of the child. Conclusion.Consequently, a comprehensive model with parental involvement and realization of their influences on an individual’s mental health should be formulated and emphasized for the prevention of further cases and management of current ones. Keywords: Case studies, determinants, disorders, mental health, parental attitude.