Psychiatric Conditions In Children Research Articles

Event segmentation in ADHD: neglect of social information and deviant theta activity point to a mechanism underlying ADHD

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is one of the most frequently diagnosed psychiatric conditions in children and adolescents. Although the symptoms appear to be well described, no coherent conceptual mechanistic framework integrates...

Feasibility and Acceptability of Implementing a Transdiagnostic Cognitive Behavioral Therapy for Children Impacted by Trauma Within a Residential Treatment Facility

The Unified Protocol (UP) is a flexible, transdiagnostic form of cognitive behavioral therapy that effectively treats diverse psychiatric conditions in children, adolescents and adults. However, the UP has not been rigorously evaluated among children who have experienced severe trauma and may have limited caregiver involvement in their life. The present research project was a single arm, open trial examining the feasibility of utilizing the UP within a residential treatment facility in Calgary, Canada for children involved with child welfare authorities who often have limited caregiver involvement. Children (n = 19; age 9–13) and their caregivers (n = 18; age 32–60) participated in 15 weekly therapy sessions of the UP for Children with minor structural and content modifications. Trauma exposure was high among children, especially physical neglect and emotional abuse (89% exposed to each). Fidelity to the manualized intervention was high (88% for children; 89% for caregivers), indicating the intervention was feasible to deliver and that the adaptations did not interfere with fidelity. All children and caregivers completed the intervention, suggesting high acceptability for recipients. Improvements over time in maladaptive cognitions and behaviors (among children and caregivers) provide preliminary evidence for efficacy. The present study provides support for the notion that the UP for Children can be utilized for children who live in residential care and/or those who have experienced high levels of trauma.

Breaking It Down: A Systematic Review Unravelling the Impact of Attention Deficit Hyperactivity Disorder and Methylphenidate on Childhood Fractures.

Limb fractures are a common cause of pediatric hospital admissions and surgeries, with a significant prevalence in the United Kingdom across all injury categories. Among psychiatric conditions in children, attention deficit hyperactivity disorder (ADHD) stands out as frequently associated with fractures, particularly those involving extremities. ADHD, with diagnoses prevalent among a significant proportion of school-age children and adolescents, has witnessed a growing global incidence. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist for our systematic literature search, using various databases and specific search terms related to ADHD and fractures. We considered articles from 2018 to 2023, focusing on English language papers with free full-text access. Our selection process used the PRISMA flowchart. We began with 1,890 articles and, after deduplication, title screening, abstract assessment, and quality evaluation included nine research papers in our review. Our primary focus was on examining fracture-related outcomes in individuals with ADHD compared to those without, considering medication status. These studies encompassed various designs, with a focus on the ADHD-fracture relationship and methylphenidate's (MPH) impact. Our study confirms that ADHD increases fracture risk and suggests that MPH may help mitigate this risk. Early ADHD detection is vital for nonpharmacological interventions. Orthopedic surgeons should proactively identify ADHD, while healthcare professionals should offer injury prevention guidance, particularly for at-risk groups.

The association between pain and psychiatric conditions in adolescents: The impact of gender and ADHD diagnosis

Background and objectivesThe relationship between pain and psychiatric conditions in children and adolescents has been understudied. This study aimed to investigate the influence of gender on the association between pain and psychiatric diagnoses, as well as the specific relationship between pain and attention deficit/hyperactivity disorder (ADHD), in a sample of adolescents from the general population. Additionally, the study explored whether pain frequency or intensity in individuals with ADHD was influenced by coexisting psychiatric disorders and ADHD medications. MethodsThis cross-sectional study included 1608 conveniently sampled Swedish upper secondary school students aged 15–19 years. Data were collected at the end of 2020 using the electronic "Mental and Somatic Health without borders" survey. ResultsA significant positive association (p < 0.001) was observed between pain frequency, intensity, and the presence of any psychiatric diagnosis. Female adolescents reported more frequent and intensive pain in the groups with or without any psychiatric diagnosis and in those with ADHD, however the presence of a psychiatric diagnosis had a comparatively lesser impact on pain frequency in females when compared to males. In adolescents with ADHD, pain frequency, but not intensity, showed a significant further increase. Moreover, the presence of coexisting depression and/or anxiety further heightened the association between pain frequency and ADHD. Notably, common ADHD medications did not have a significant impact on pain experiences. Headache emerged as the most prevalent type of pain across all groups of adolescents. Back pain specifically appeared as the next most common type of pain among adolescents with ADHD. ConclusionThe findings suggest a positive association between pain and the presence of psychiatric diagnoses, including ADHD, in adolescents. Gender modified this association. Back pain arised specifically coupled to ADHD. Common ADHD medications did not show a significant impact on pain experiences in this study. These results highlight the importance of a holistic approach to child and adolescent care.

Expectations and perspectives of cognitive behavioural therapy for childhood anxiety and related disorders.

Anxiety disorders are the most frequently diagnosed psychiatric conditions in children and adolescents. Cognitive behavioural therapy (CBT) is a well-established and effective treatment for anxiety and related disorders across the lifespan. Expectations of psychotherapy have been demonstrated to affect outcomes, yet there is sparse existing literature on adolescent patient and parent perspectives of CBT prior to engagement with treatment. This study aimed to qualitatively explore the expectations and perceptions of CBT for anxiety and related disorders among adolescent patients and parents. Fourteen adolescent patients and 16 parents participated in semi-structured individual interviews or focus groups consisting of 2-3 participants. Interview transcripts were analysed using inductive analysis. Three themes were identified: worries about CBT, expectations and knowledge of the CBT process, and the role of parents and families. Overall, we found that adolescents and parents had generally positive views of CBT. The outset of CBT saw adolescents and parents express concern about stigma as well as the ambiguity of CBT. Parents continued to express a lack of understanding of what CBT entailed during their child's treatment course. These results suggest that both adolescents and parents would benefit from early discussion and reinforcement of expectations for CBT treatment. Further research efforts are warranted and should be directed towards determining appropriate expectations for parental involvement in a child's CBT course and effective communication of treatment expectations to both adolescents and parents.

The effect of psycho-education given to mothers of children with attention deficit hyperactivity disorder on mother-child interaction and family functionality.

One of the most prevalent psychiatric conditions in children is attention deficit hyperactivity disorder (ADHD). Regular psycho-education for people with chronic illnesses and their families is beneficial for prevention, treatment, and rehabilitation. This study aimed to determine the effect of psycho-education given to mothers of children with ADHD on mother-child interaction and family functionality. The sample of the study consisted of 98 mothers and children (50 participants for the intervention group and 48 participants for the control group). Mothers in the intervention group were given psycho-education. Pre and post-tests were completed by mothers. Post-test mean scores in terms of warmth/affection, hostility/aggression, indifference/neglect, and control subscales of the Parental Acceptance-Red/Control Scale were statistically significantly lower among the intervention group. Post-test mean scores in terms of communication, showing interest, and the behavior control subscales of the family assessment device were statistically significantly lower in the intervention group. For families dealing with a child with ADHD, psychoeducation increased mother-child interaction and family functioning Therefore, psychoeducation should be widespread in the treatment of ADHD. When ADHD causes problems with mother-child contact, maternal psychoeducation may be helpful.

A study on psychiatric conditions in children with school refusal- A clinic based study.

School refusal is a broad term that encompasses a child-motivated refusal to attend or remain at school, or a clear and apparent difficulty in doing so. Different factors that may influence the development of school refusal include a genetic predisposition, the home and family environment, the school environment, and social pressures. the present study aimed at examining, the psychiatric diagnostic status of children and adolescents who presented with school refusal. 92 consecutive subjects who attended the Child guidance clinic at Tata Main Hospital Jamshedpur were taken up for this study. The Clinical Diagnosis was based on the classificatory system of the International classification of diseases-10(ICD-10) through interviews. findings show that the mean age of the patient was 9.6 years. The prominent psychiatric co-morbidity present was Childhood emotional disorder unspecified, separation anxiety, conversion disorder, over-anxiety disorder, and somatoform disorder. Among children who refuse school, emotional reasons and anxiety disorders are most prevalent. This calls for early recognition and appropriate culturally relevant intervention to ensure early return to school.

National assessment of anti-epileptic drug exposures among pre-teens and adolescents, 2000–2020

Background and objectives Anti-epileptic drugs (AEDs) are increasingly used to treat psychiatric conditions, exposing many children to potentially harmful medications. This includes adolescents, who are at higher risk for self-harm. The purpose of this study was to describe the epidemiology of pediatric AED poisonings and assess which AEDs are associated with more severe clinical outcomes. Methods This retrospective cross-sectional analysis examined single-substance AED exposure cases in pre-teens (10–14 years) and adolescents (15–19 years) reported to the National Poison Database System (NPDS) between 2000 and 2020 (cases through 2019 were included for trend analysis due to incomplete population data). We described characteristics of ingestions by age group, including AEDs implicated. Results There were 74,818 AED exposure cases reported to the NPDS, including 25,928 (34.7%) in pre-teens and 48,890 (65.3%) in adolescents. Among adolescents, 35,570 (72.8%) exposure cases were intentional, with 27,655 (56.6%) specifically related to a suspected suicide attempt. The most common AEDs implicated in poisonings were clonazepam (19.8%), valproic acid (15.3%), and lamotrigine (13.8%). The odds of hospitalization (adjusted odds ratio [aOR] 2.0 [95% confidence interval [CI], 2.0–2.1]), intubation (aOR 2.1 [95% CI, 1.8–2.4]), seizure (aOR 1.6 [95% CI, 1.4–1.9]), and serious outcome (aOR 1.8 [95% CI, 1.7–1.9]) were higher in the adolescent group compared to the pre-teen group. Intentional ingestions increased by a yearly rate of 2.8% (95% CI, 2.3–3.2). Intentional tiagabine exposure was associated with the greatest increased odds of serious outcome (aOR 4.7 [95% CI, 3.6–6.3]). Discussion In this cross-sectional analysis of pediatric AED exposure cases reported to the NPDS, AED poisonings among pre-teens and adolescents increased significantly between 2000 and 2019. Of particular concern is the large increase in intentional exposure cases related to AEDs. With the population-adjusted rate of epilepsy diagnoses remaining relatively unchanged, these results may indicate that the rise in AED exposure cases may be related to increased prescribing of AEDs for psychiatric indications as opposed to epilepsy. Conclusions Pediatric AED poisonings reported to the NPDS are increasing, especially among adolescents engaging in intentional ingestions. These findings provide additional information for consideration in risk-benefit assessments when selecting medications for the treatment of psychiatric conditions in children.

A review of the diagnosis and management of pediatric psychodermatologic conditions: Part II.

Pediatric psychodermatologic conditions encompass both primary dermatologic conditions with psychiatric comorbidities and primary psychiatric conditions with self-induced dermatologic manifestations. Detection, diagnosis, and management of primary psychiatric conditions with dermatologic manifestations are challenging due to patient-perceived stigma and lack of educational opportunities for dermatology providers. This two-part series highlights the most up-to-date evidence-based data and management techniques of some of the more common dermatoses of primary psychiatric conditions in children. Part I includes trichotillomania, skin picking disorder, and onychophagia, and part II covers dermatitis artefacta, body dysmorphic disorder, and delusions of parasitosis by proxy, with special considerations for family dynamics.

Review of the diagnosis and management of pediatric psychodermatologic conditions: Part I

Pediatric psychodermatologic conditions encompass both primary dermatologic conditions with psychiatric comorbidities and primary psychiatric conditions with self-induced dermatologic manifestations. Detection, diagnosis, and management of primary psychiatric conditions with dermatologic manifestations are challenging due to patient-perceived stigma and lack of educational opportunities for dermatology providers. This two-part series highlights the most up-to-date evidence-based data and management techniques of some of the more common dermatoses of primary psychiatric conditions in children. Part I includes trichotillomania, skin-picking disorder, and onychophagia, and part II covers dermatitis artefacta, body dysmorphic disorder, and delusions of parasitosis by proxy, with special considerations for family dynamics.

Psychiatric conditions in children with atopic dermatitis.

Psychiatric conditions in children with atopic dermatitis.

Efficacy and Safety of Medication for Attention-Deficit Hyperactivity Disorder in Children and Adolescents with Common Comorbidities: A Systematic Review.

IntroductionComorbid psychiatric conditions in children and adolescents with attention-deficit hyperactivity disorder (ADHD) occur frequently, complicate management, and are associated with substantial burden on patients and caregivers. Very few systematic reviews have assessed the efficacy and safety of medications for ADHD in children and adolescents with comorbidities. Of those that were conducted, most focused on a particular comorbidity or medication. In this systematic literature review, we summarize the efficacy and safety of treatments for children and adolescents with ADHD and comorbid autism spectrum disorders, oppositional defiant disorder, Tourette’s disorder and other tic disorders, generalized anxiety disorder, and major depressive disorder.MethodsWe searched MEDLINE, Embase, and ClinicalTrials.gov (to October 2019) for studies of patients (aged < 18 years) with an ADHD diagnosis and the specified comorbidities treated with amphetamines, methylphenidate and derivatives, atomoxetine (ATX), and guanfacine extended-release (GXR). For efficacy, placebo-controlled randomized controlled trials (RCTs) or meta-analyses of RCTs were eligible for inclusion; for safety, all study types were eligible. The primary efficacy outcome measure was ADHD Rating Scale IV (ADHD-RS-IV) total score.ResultsOf 2177 publications/trials retrieved, 69 were included in this systematic literature review (5 meta-analyses, 37 placebo-controlled RCTs, 16 cohort studies, 11 case reports). A systematic narrative synthesis is provided because insufficient data were retrieved to combine ADHD-RS-IV total scores or effect sizes. Effect sizes for ADHD-RS-IV total scores were available for ten RCTs and ranged from 0.46 to 1.0 for ATX and from 0.92 to 2.0 for GXR across comorbidities. The numbers and types of adverse events in children with comorbidities were consistent with those in children without comorbidities, but treatment should be individualized to ensure children can tolerate the lowest effective dose.ConclusionLimited information is available from placebo-controlled RCTs on the efficacy (by ADHD-RS-IV) or safety of medication in children with ADHD and psychiatric comorbidities. Further studies are required to support evidence-based drug selection for these populations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40120-021-00249-0.

The impact of child psychiatric conditions on future educational outcomes among a community cohort in Brazil.

Mental health problems early in life can negatively impact educational attainment, which in turn have negative long-term effects on health, social and economic opportunities. Our aims were to: (i) estimate the impacts of different types of psychiatric conditions on educational outcomes and (ii) to estimate the proportion of adverse educational outcomes which can be attributed to psychiatric conditions. Participants (N = 2511) were from a school-based community cohort of Brazilian children and adolescents aged 6-14 years enriched for high family risk of psychiatric conditions. We examined the impact of fear- (panic, separation and social anxiety disorder, specific phobia, agoraphobia and anxiety conditions not otherwise specified), distress- (generalised anxiety disorder, major depressive disorder and depressive disorder not otherwise specified, bipolar, obsessive-compulsive, tic, eating and post-traumatic stress disorder) and externalising-related conditions (attention deficit and hyperactivity disorder, conduct and oppositional-defiant conditions) on grade repetition, dropout, age-grade distortion, literacy performance and bullying perpetration, 3 years later. Psychiatric conditions were ascertained by psychiatrists, using the Development and Well-Being Behaviour Assessment. Propensity score and inverse probability weighting were used to adjust for potential confounders, including comorbidity, and sample attrition. We calculated the population attributable risk percentages to estimate the proportion of adverse educational outcomes in the population which could be attributed to psychiatric conditions. Analyses were conducted separately for males and females. Fear and distress conditions in males were associated with school dropout (odds ratio (OR) = 2.76; 95% confidence interval (CI) = 1.06, 7.22; p < 0.05) and grade repetition (OR = 2.76; 95% CI = 1.32, 5.78; p < 0.01), respectively. Externalising conditions were associated with grade repetition in males (OR = 1.66; 95% CI = 1.05, 2.64; p < 0.05) and females (OR = 2.03; 95% CI = 1.15, 3.58; p < 0.05), as well as age-grade distortion in males (OR = 1.66; 95% CI = 1.05, 2.62; p < 0.05) and females (OR = 2.88; 95% CI = 1.61, 5.14; p < 0.001). Externalising conditions were also associated with lower literacy levels (β = -0.23; 95% CI = -0.34, -0.12; p < 0.001) and bullying perpetration (OR = 3.12; 95% CI = 1.50, 6.51; p < 0.001) in females. If all externalising conditions were prevented or treated, we estimate that 5.0 and 4.8% of grade repetition would not have occurred in females and males, respectively, as well as 10.2 (females) and 5.3% (males) of age-grade distortion cases and 11.4% of female bullying perpetration. The study provides evidence of the negative impact of psychiatric conditions on educational outcomes in a large Brazilian cohort. Externalising conditions had the broadest and most robust negative impacts on education and these were particularly harmful to females which are likely to limit future socio-economic opportunities.

Anesthetic Management During Electroconvulsive Therapy in Children: A Systematic Review of the Available Literature

Electroconvulsive therapy (ECT) is indicated in a myriad of pediatric psychiatric conditions in children, and its use is increasing. Literature on the clinical features salient to anesthetic care is lacking. The objective of this systematic review is to describe the available literature on the anesthetic considerations of pediatric ECT. Original publications were screened for inclusion criteria: (1) manuscript written in English; (2) persons under 18 years of age; and (3) use of ECT. Data tabulation included demographic information, details of anesthetic management and ECT procedure, and adverse events. The mean age was 15 years, 90% were 12-17 years of age, and no cases involving children <6 years of age were identified. The psychiatric diagnoses most commonly represented were major depressive disorder (n = 185) and schizophrenia/schizoaffective disorders (n = 187). ECT was also used to treat many neurological disorders. Medical comorbidities were reported in 16% of all cases. Common coexisting conditions included developmental delay (n = 21) and autism (n = 18). Primary ECT indications included severe psychosis (n = 190), symptoms refractory to pharmacotherapy (n = 154), and suicidality (n = 153). ECT courses per patient ranged from 2 to 156. Duration averaged 91.89 ± 144.3 seconds. The most commonly reported induction agents were propofol and methohexital, and the most commonly reported paralytic agent was succinylcholine. Reported adverse events included headache, nausea, sedation, and short-term amnesia, as well as rare cases of benign dysrhythmias and prolonged seizure. Negative perception and diminished access to care result in treatment delays; thus, these children present in an advanced state of disease. In examining the details of modern ECT performed in 592 children, no major anesthetic morbidity was identified. Further study should start with retrospective analysis of anesthesia data during ECT to compare various effects of anesthesia medications and technique on adverse events and outcomes.

Telomere Length and Psychopathology: Specificity and Direction of Effects Within the Bucharest Early Intervention Project.

Telomere length (TL) has been linked to several psychiatric conditions in children and adults. Telomere shortening is accelerated by early adversity, including maltreatment and psychosocial deprivation. These experiences also increase the risk of psychopathology in many domains. Two fundamental issues remain unresolved. The first concerns the specificity of the relations between TL and different dimensions of psychopathology; and the second relates to the direction of association between TL and psychopathology. This study addressed these shortcomings in a 2-fold manner. First, the association between TL and statistically independent general, internalizing, and externalizing psychopathology factors was examined to determine the specificity of this relation. Second, a 2-wave longitudinal cross-lagged model was used to explicitly examine the direction of the relation between TL and each psychopathology factor. Data were drawn from the Bucharest Early Intervention Project, a longitudinal study exploring the impact of severe psychosocial deprivation on child health and development (N= 195). At 8 to 10 and 12 to 14 years of age, buccal DNA was collected and teachers and/or caregivers reported on different domains of psychopathology. Longitudinal path analyses showed that shorter TL was specifically associated with higher internalizing psychopathology at 8 to 10 years of age. In contrast, at 12 to 14 years, shorter TL was associated with higher general psychopathology. Most telling, internalizing psychopathology at 8 to 10 years predicted shorter TL at 12 to 14 years, with no reciprocal effects. Results suggest that telomere erosion could be a consequence of distress-related psychopathology rather than a selection mechanism for later psychiatric problems. The Bucharest Early Intervention Project; https://clinicaltrials.gov/; NCT00747396.

Neurobehavioral effects of chronic low-dose risperidone administration in juvenile male rats

Despite substantial increases in the use of antipsychotics to treat various psychiatric conditions in children, there is a lack of literature regarding long-term effects of early treatment. Some studies have indicated that early administration results in differential alterations to neurotransmission systems, but few studies have investigated whether there are long-term behavioral modifications. Therefore, the aim of the current study was to investigate the neurobehavioral effects of low dose risperidone (a commonly prescribed antipsychotic) treatment using juvenile rats. Twenty-four male Sprague-Dawley rats were either subcutaneously implanted with a continuous release risperidone pellet (.04 mg/day) or a placebo pellet. To encompass the peri-adolescent to adolescent timeframe (postnatal day 40–70) thought to be important for brain development, male rats began risperidone treatment at post-natal day 35. Six weeks following commencement of risperidone treatment, all rats were tested on a battery of behavioral assessments including open field, object recognition, Morris Water Maze, and Y-Maze tasks. Risperidone treatment did not affect performance on the open field, object recognition, or Morris Water maze. A significant effect was found on the Y-maze. Although all rats exhibited normal spontaneous alternation, risperidone treated rats demonstrated significantly higher same arm returns, indicative of a working memory deficit. Continued research is needed to determine whether early exposure to risperidone may lead to differences in working memory at longer time-points. These results seem to indicate that early low dose risperidone treatment during the peri-adolescent and adolescent period does not severely impair behavior.

Mental health disorders, participation, and bullying in children with cerebral palsy.

To examine how social factors might mitigate the elevated risk of mental health disorders in children with cerebral palsy (CP). This cross-sectional study included 6- to 17-year-olds with (n=111; 40.4% 6-11y, 59.6% 12-17y) and without (n=29909; 50.2% 6-11y, 49.8% 12-17y) CP from the 2016 National Survey of Children's Health. Mental health disorders included depression, anxiety, behavior/conduct problems, and attention-deficit/hyperactivity disorder. Social factors included participation in activities, bully victimization, and difficulty with friendships. After adjusting for sociodemographic factors and the presence of chronic pain, children with CP had higher odds of anxiety (odds ratio [OR] 4.4; 95% confidence interval [CI] 1.9-8.5), behavior/conduct problems (OR 3.9; 95% CI 1.4-11.3), and multimorbidity (OR 2.8; 95% CI 1.1-7.0), but not depression (OR 1.4; 95% CI 0.6-3.8) or attention-deficit/hyperactivity disorder (OR 1.7; 95% CI 0.6-4.6), compared to controls. With adjustment for participation in activities, the odds of anxiety, behavior/conduct problems, and multimorbidity remained increased in children with CP. With adjustment for difficulty with friendships, the odds of anxiety, behavior/conduct problems, and multimorbidity were no longer increased in children with CP. With adjustment for bully victimization, the odds of behavior/conduct problems and multimorbidity were attenuated in children with CP; however, the odds of anxiety remained increased. The elevated prevalence of certain mental health disorders in children with CP is partly associated with modifiable social factors. Difficulty with friendships predicts an elevated prevalence of psychiatric conditions in children with cerebral palsy (CP). Bully victimization predicts an elevated prevalence of behavior/conduct problems in children with CP. Low participation does not predict mental health disorders in this population.

Clinical Practice Guidelines for Child Sexual Abuse.

Child sexual abuse (CSA) is the involvement of children and adolescents in sexual activities (usually for adult sexual stimulation or gratification) that they cannot fully comprehend and to which they cannot consent as a fully equal, self-determining participant, because of their early stage of development [Box 1]. Open in a separate window Box 1 Defining child sexual abuse

Validation of the Preschool Anxiety Scale-Traditional Chinese (PAS-TC) in Hong Kong

Anxiety disorders are the most common type of psychiatric conditions in children. Early identification and intervention during preschool years is critical for minimizing their detrimental long-term effects. The Preschool Anxiety Scale (PAS) is a developmentally-sensitive and symptom-specific instrument that has been commonly used and widely validated in the west. The current study tested the psychometric properties of its Traditional Chinese version (PAS-TC) in Hong Kong. The study sample consisted of a total of 1317 Hong Kong parents, recruited from 12 local preschools, with preschool children aged from three to six years old. Results showed that a correlated five-factor model demonstrated a good fit for the data. PAS-TC also demonstrated acceptable reliability and satisfactory validity. Furthermore, gender but not age effects were found in Hong Kong. Additionally, similar to previous studies, items from physical injury fears were the most reported in the top-ten frequently endorsed items. Finally, the anxiety level of our Hong Kong sample was found to be between the Mainland China and western countries. Clinical implications of the above findings concerning PAS-TC are discussed.

Psychometric properties of the Ndetei–Othieno–Kathuku (NOK) Scale: A mental health assessment tool for an African setting

Background: Research suggests that psychiatric conditions in children and adolescents are highly debilitating, with sparse resources for assessment and treatment in low- and middle-income countries (LMICs).Objectives: The primary aim of this study was to evaluate the reliability, validity, and latent factor structure of an ethnographically-grounded assessment instrument for detecting common mental health complaints among rural Kenyan children and adolescents.Methods: The Ndetei–Othieno–Kathuku Scale (NOK) was delivered to 2 282 children aged 10 to 18 years old. Exploratory factor analysis identified four latent factors. This structure was confirmed in subsequent confirmatory factor analyses. External validity was explored by investigating associations among NOK factors and Youth Self-Report DSM-oriented scales.Results: Findings suggest the NOK possesses good internal reliability and a four-factor latent structure corresponding to depression, anxiety, somatic complaints, and a mixed factor. Significant associations ranging from small to medium effect sizes were noted between NOK factors and YSR DSM-oriented scales.Conclusions: Exploratory findings suggest that the NOK possesses adequate psychometric properties among this population. This ethnographically-grounded instrument may be uniquely suited to screening for mental health complaints among Kenyan children and adolescents.