Total Problem Score Research Articles

Neonatal fatty acid status and neurodevelopmental outcome at 9 years

BackgroundLong-chain polyunsaturated fatty acids (LCPUFA) are important for prenatal brain development. Previous studies of others assessed outcome until 7years. The associations between neonatal LCPUFA status and long-term developmental outcome are debated. AimTo investigate the relationship between fatty acid status at birth and neurodevelopment at 9years. Age 9 is a unique age after a significant neurodevelopmental transition. Study designCorrelation study. Multivariable analyses were carried out to adjust for potential confounders. Subjects317 children who participated in a trial on effects of postnatal LCPUFA supplementation were eligible. 235 children (74%) were reassessed at age 9. Outcome measuresAt birth, docosahexaenoic acid (DHA) and arachidonic acid (AA) were determined in the wall of the umbilical vein. We primarily studied the correlation between DHA and AA with the complex form of minor neurological dysfunction (cMND). Secondary correlations that were studied were DHA and AA levels with cognitive development in terms of full IQ, and with behavioural development in terms of a total problem score. ResultsBoys with cMND showed lower DHA values in the umbilical vein than children with better neurological condition (p=0.033). A similar association was absent in girls. Neonatal AA values were not associated with neurological outcome. Neither neonatal DHA nor AA values were associated with cognition and behaviour at 9. ConclusionsHigher umbilical DHA levels in boys are associated with better neurological development at 9years. AA status at birth was not associated with neurodevelopment at 9years.

Relationship between Machiavellianism and emotional and behavioral difficulties in adolescence

Machiavellianism is a personality trait that is characterized by intense interpersonal manipulation in order to achieve personal material goals. Previous studies revealed a relationship between Machiavellianism and diverse forms of psychological difficulties in adults. Studies also revealed such relationships in adolescents as well, but studies investigating the relationship between Machiavellianism and psychological difficulties in adolescents are still absent in Hungary. In this study 502 secondary school students (356 girls) filled out questionnaires that measured Machiavellianism and psychological and behavioral difficulties. Machiavellianism was associated with higher total problem score. This resulted mainly from higher scores on scales measuring emotional and behavioral problems. Moreover, hyperactivity and lack of prosocial behavior were also associated with Machiavellianism. At the same time, Machiavellian adolescents did not differ in self-reported loneliness from their peers. The author discusses the results in the light of previous research and from the perspective of emotion and behavior regulation. Practical aspects of the results are also discussed in the context of prevention.

Incontinence in children with autism spectrum disorder

Autism spectrum disorder (ASD) and incontinence (nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI)) are relevant disorders in childhood. In general, children with special needs such as intellectual disability (ID) or ASD are more often affected by incontinence than typically developing children. In the few studies conducted on children with ASD, gastrointestinal (GI) symptoms have received more attention than NE, DUI and lower urinary tract symptoms (LUTS). The aim of the present study was to assess the prevalence of incontinence, LUTS and psychological symptoms/disorders in children with ASD compared to controls. Forty children with ASD (12 children with infantile or childhood autism, 15 with atypical autism and 13 with Asperger's syndrome) (mean age 11.3 years) and 43 age-matched control children (mean age 10.7 years) were assessed. A questionnaire referring to incontinence and the International Consultation on Incontinence Questionnaire-Pediatric LUTS (ICIQ-CLUTS) were administered. Child psychopathology was assessed with the Child Behavior Checklist (CBCL/4-18). Child psychiatric ICD-10 diagnoses were based on a structured psychiatric interview (Kinder-DIPS). Children with ASD showed increased rates of NE (30.0% vs 0%) and DUI (25.0% vs 4.7%) compared to controls. Among children with ASD, daytime bladder control (≥5 years of age: 20.5% vs 0%) and bowel control (≥4 years of age: 42.5% vs 7.5%) were delayed compared to controls. Children with ASD had a higher LUTS score. Additionally, children with ASD were more often affected by psychological symptoms and disorders. Rates of clinically relevant externalizing symptoms (32.5% vs 0%), internalizing symptoms (67.5% vs 9.3%) and total problem score (70.0% vs 2.1%) were higher in children with ASD than the controls (see table). Children with ASD had more ICD-10 diagnoses than the controls (47.5% vs 4.7%). The present study showed that children with ASD are more at risk of DUI and NE than healthy controls. In addition, children with ASD had more LUTS, especially urgency and postponement, and they needed a longer time to become dry and continent. Additionally, according to the parental CBCL questionnaire, children with ASD showed higher rates of clinically relevant psychological symptoms (externalizing and internalizing symptoms), and according to the psychiatric interview, they had higher rates of comorbid psychological disorders. Autism spectrum disorder is an incapacitating disorder with significant impairment in social functioning. In most cases, psychological symptoms and disorders co-occur. Additionally, children with ASD are at a greater risk of being affected by different forms of incontinence and LUTS. Therefore, screening for incontinence and, if indicated, treatment of these disorders is recommended.

Electrographic status epilepticus and neurobehavioral outcomes in critically ill children.

Electrographic seizures (ESs) and electrographic status epilepticus (ESE) are common in children with acute neurologic conditions in pediatric intensive care units (PICUs), and ESE is associated with worse functional and quality-of-life outcomes. As an exploratory study, we aimed to determine if ESE was associated with worse outcomes using more detailed neurobehavioral measures. Three hundred children with an acute neurologic condition and altered mental status underwent clinically indicated EEG monitoring and were enrolled in a prospective observational study. We obtained follow-up data from subjects who were neurodevelopmentally normal prior to PICU admission. We evaluated for associations between ESE and adaptive behavior (Adaptive Behavior Assessment System-II, ABAS-II), behavioral and emotional problems (Child Behavior Checklist, CBCL), and executive function (Behavior Rating Inventory of Executive Function, BRIEF) using linear regression analyses. A p-value of <0.05 was considered significant. One hundred thirty-seven of 300 subjects were neurodevelopmentally normal prior to PICU admission. We obtained follow-up data from 36 subjects for the CBCL, 32 subjects for the ABAS-II, and 20 subjects for the BRIEF. The median duration from admission to follow-up was 2.6 years (IQR: 1.2-3.8). There were no differences in the acute care variables (age, sex, mental status category, intubation status, paralysis status, acute neurologic diagnosis category, seizure category, EEG background category, or short-term outcome) between subjects with and without follow-up data for any of the outcome measures. On univariate analysis, significant differences were not identified for CBCL total problem (ES coefficient: -4.1, p = 0.48; ESE coefficient: 8.9, p = 0.13) or BRIEF global executive function (ES coefficient: 2.1, p = 0.78; ESE coefficient: 14.1, p = 0.06) scores, although there were trends toward worse scores in subjects with ESE. On univariate analysis, ESs were not associated with worse scores (coefficient: -21.5, p = 0.051), while ESE (coefficient: -29.7, p = 0.013) was associated with worse ABAS-II adaptive behavioral global composite scores. On multivariate analysis, when compared to subjects with no seizures, both ESs (coefficient: -28, p=0.014) and ESE (coefficient: -36, p = 0.003) were associated with worse adaptive behavioral global composite scores. Among previously neurodevelopmentally normal children with acute neurologic disorders, ESs and ESE were associated with worse adaptive behavior and trends toward worse behavioral-emotional and executive function problems. This was a small exploratory study, and the impact of ESs and ESE on these neurobehavioral measures may be clarified by subsequent larger studies. This article is part of a Special Issue entitled "Status Epilepticus".

P02 Outcome of mild traumatic brain injury (tbi) in children- results from a prospective uk cohort study

Aim To use prospectively collected data to investigate the outcomes up to 16 years of TBI in childhood. Methods Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) were analysed. Background demographics and developmental and behavioural profile of the children were derived from questionnaires completed by the mother in pregnancy, at 6 weeks and at 18 and 42 months. Injury data were derived from questionnaires completed by the child’s carer at 4½ 5½ 6½ 8 ½ and 11½ years of age. Outcomes were collected when the child was 11–16 years old, from ALSPAC questionnaires and research clinics, and from linked educational data. TBI cases (n = 410), defined as any head injury resulting in loss of consciousness and/or a skull fracture before the age of 11, were compared with children of the same age (n = 1819) who suffered traumatic orthopaedic injuries (fractures- excluding skull fractures). Controls (n = 8770) were all children with available injury data who did not have a TBI or orthopaedic injury. Results 410 ALSPAC participants (59% male) had a TBI before 11; 154 (38%) had a fractured skull, and 36 (9%) had multiple TBIs. Orthopaedic injuries were reported for 1819 participants (52% male) before 11. Compared to controls, children who had a TBI came from families living in adversity, with mothers with lower educational qualifications and a history of depression. The children who suffered a TBI had higher hyperactivity and conduct scores age 42 months, but no differences were apparent for those who later suffered orthopaedic injuries. Outcomes at 13–16 which remained associated with TBI after adjustment were the total behavioural problems score, the hyperactivity score and the conduct problems score of the SDQ, and high levels of anxiety and depression. Adjustment for pre-injury SDQ scores attenuated the associations with the SDQ scores but these remained significantly different from controls. Weak associations were also observed between orthopaedic injuries and later conduct problems. Conclusions TBI in childhood was associated with increased behavioural problems up to 16 years, and increased hyperactivity and conduct problems which were not explained by pre-injury characteristics. Depression and anxiety were also more common in TBI survivors.

Knowledge of Emotion Regulation Strategies, Problem Behavior, and Prosocial Behavior in Preschool Age

The present study examines the relation between knowledge of emotion regulation strategies and social behavior in preschoolers. Knowledge of emotion regulation strategies of 210 children (mean age 55 months) was assessed. Teachers rated children's social behavior with SDQ. Linear regression analysis examined how knowledge of emotion regulation strategies influenced social behavior of children. Significant effects of gender on SDQ scales "prosocial behavior", "hyperactivity", "behavior problems", and SDQ total problem scale were identified. Age was a significant predictor of SDQ scales "prosocial behavior", "hyperactivity", "problems with peers" and SDQ total problem scale. Knowledge of emotion regulation strategies predicted SDQ total problem scores. Results suggest that deficits in knowledge of emotion regulation strategies are linked with increased problem behavior.

Psychiatric treatment outcomes of preschool children in a family day hospital.

This study describes the treatment outcomes of preschoolers with severe mental health problems who were treated at the child psychiatric family day hospital for preschool children in Münster, Germany. The eclectic multi-modal treatment combines behavioral and psychodynamic techniques for both parents and children in various settings within an intermittent attendance structure provided by a multi-disciplinary team. This study evaluated 185 children with the Caregiver-Teacher Report Form (C-TRF/1.5-5), which was completed by therapists, and the Child Behavior Checklist (CBCL/1.5-5), which was completed by mothers, at admission and discharge. The mothers' ratings of their children were statistically adjusted for the distortion caused by their own psychopathology. After treatment, the patients showed significant improvement on the C-TRF/CBCL Total Problem score with an average Cohen's d=-0.50 based on therapists' ratings, d=-0.97 for the non-adjusted maternal ratings, and d=-0.68 for the adjusted maternal ratings. We conclude that specialized family day hospitals may successfully treat preschool psychiatric patients.

Mental health needs and availability of mental health care for children and adolescents with intellectual disability in Berlin.

The increased risk of mental health problems in children and adolescents with intellectual disability (ID) has been reported in several studies. However, almost no research has been conducted on parents' experiences with the general mental health system. We have investigated the prevalence of emotional and behavioural problems in children with ID as well as the availability and quality of mental health care from the parents' point of view. Teachers of specialised schools for ID in Berlin were asked to complete the Teacher's Report Form (TRF) of the Child Behavior Checklist. Information was collected for 1226 children and adolescents aged 6-18 years with mild to profound ID (response 70.5%). The availability and quality of mental health care was assessed by a questionnaire given to parents who had already been seeking help for their children. A total of 330 parents completed the questionnaires (response 62.0%). In addition to univariate analysis, we conducted multiple logistic regressions regarding the psychopathology reported by teachers (TRF-syndrome scales) and difficulties concerning mental health care reported by parents for a paired sample of 308 children. Overall, 52.4% of the children and adolescents with ID had a total problem score on the TRF in the deviant range (47.1% when eliminating four items reflecting cognitive deficits). Compared with the general population normative sample of children, this is a three-time higher prevalence. The most striking problems were thought problems (schizoid and obsessive-compulsive), aggressive behaviour, attention problems and social problems. Parents whose children had more severe behavioural or emotional dysfunction reported more difficulties with the mental health system. From the parents' point of view, mental health professionals frequently did not feel responsible or were not sufficiently skilled for the treatment of children with ID. As a consequence, 96% of all parents were longing for specialised in- and outpatient services. This study confirms the findings from other studies regarding the high rate of co-occurrence of ID and mental health problems in youths. Results indicate that both are strongly requested by parents: specialised in- and outpatient services, as well as more professional general services and equitable treatment for all children, with and without ID.

Behavioral phenotype in children with 22q11DS: agreement between parents and teachers.

Patients with the 22q11-deletion syndrome (22q11DS) are at an increased risk of developing schizophrenia. Besides the effects of genetic variation, environmental factors could also be important in modifying the risk of schizophrenia in 22q11DS patients. In particular, previous studies have shown the importance of stress as a precipitating factor of psychosis. An incongruence between the perceived and actual severity of behavioral and cognitive domains could lead caregivers, and even the children themselves, to make demands that are insufficiently adapted to the child's abilities, causing stress and anxiety. Here, we investigate whether such diagnostic discrepancies are indeed present by comparing parent and teacher reports on behavioral concerns in children with 22q11DS. Behavioral questionnaires (CBCL and TRF) were prepared for both parents and teachers of 146 children with 22q11DS. We found that in line with previous reports, internalizing behavior was more frequently reported than externalizing behavior. While the behavioral profiles reported by parents and teachers were remarkably similar, the teachers' ratings were significantly lower (Total problem score p = .002). Age and IQ were not significantly associated with the severity of reported concerns. Our results indicate that indeed a disparity often exists between parents' and teachers' perceptions of the severity of a child's behavioral deficits. This may result in (substantially) different demands and expectations being placed on the child from the two fronts. We speculate that the stress resulting from this lack of cohesion between parents and teachers could precipitate, at least in some 22q11DS children, the emergence of psychosis.

Children with Multi-Trauma Histories: Special Considerations for Care and Implications for Treatment Selection

The complex symptom profiles of young children with histories of trauma exposure underscore the importance of matching individual child characteristics and symptom needs with existing evidence-based treatment protocols. Children (N = 134) between the ages of 2–12 and their caregivers were administered the Child Behavioral Checklist, Trauma Symptom Checklist for Young Children, and the Trauma Symptom Checklist for Children-Alternate Version at baseline and end of treatment. ANCOVA analyses examined the relationships between the number of different types of trauma exposures, child gender, placement status, child age, type of treatment received, and end of treatment symptom scores. Child age at the start of treatment was found to influence externalizing and total problem scores at the end of treatment when baseline scale scores were held constant. Older children were found to have significantly higher levels of externalizing and total problem scores at the end of treatment compared to younger children in the sample. Significant improvements were found between baseline and termination outcome scores regardless of treatment type, however, results suggest that differences in severity of symptoms may vary by treatment type. Study findings suggest that latency age children and their caregivers may have differing trauma-related treatment needs compared to younger children and may benefit from an adjusted focus in treatment. The matching of individual child characteristics and need can help maximize emotional and behavioral outcomes and the addition of a cognitive-based treatment modality may be indicated for some children.

Consumer satisfaction with the Child and Adolescent Mental Health Service and its association with treatment outcome: A 3–4-year follow-up study

Background: Consumer satisfaction studies with the Child and Adolescent Mental Health Service (CAMHS) have mainly assessed evaluations in a short-term follow-up perspective. Adolescent reports with CAMHS have not been included nationally. Aims: The purposes of this study were to explore adolescent and parental satisfaction with the CAMHS in a 3–4-year follow-up perspective, and to examine the relationships between reported consumer satisfaction and clinical parameters such as reason for adolescent referral, emotional/behavioral symptoms and treatment outcome. Methods: Of 190 adolescent–parent pairs in a sample of CAMHS outpatients, 120 completed a Consumer Satisfaction Questionnaire. Parents assessed adolescent emotional/behavior problems both at baseline and at follow-up by completing the Child Behavior Checklist (CBCL). Correlations were examined between adolescent and parental evaluations. The relationships between service satisfaction and symptom load at baseline and follow-up and treatment outcome at follow-up were explored. Results: Overall, adolescents and parents were satisfied with the services received from the CAMHS. The correlations between adolescent and parent consumer satisfaction ratings were low to moderate. Consumer satisfaction was significantly and negatively correlated with symptom load on the CBCL Total Problems scores at baseline, but not at follow-up. There was no difference in satisfaction levels between those who improved after treatment and those who did not. Conclusions: Given the differences in informant ratings of consumer satisfaction, it is important to include both adolescent and parental perceptions in evaluations of CAMHS services and treatment outcomes. Consumer satisfaction should serve as a supplement to established standardized outcome measures.

Levels of polychlorinated biphenyls in settled house dust from urban dwellings in China and their neurodevelopmental effects on preschool-aged children

We investigated the levels of polychlorinated biphenyls (PCBs) in settled house dust (SHD) from urban dwellings with resident preschool-aged children in Nanjing, China. The possible neurodevelopmental effects of house-dust PCBs were also explored. SHD was collected from 114 urban houses. The levels of 39 PCB congeners were measured by gas chromatography–tandem mass spectrometry. The Child Behavior Checklist and the Gesell Development Inventory were used to evaluate the child's development. All 39 target congeners measured were detected. The mass percentage of di-PCBs was the highest at 47.8%, followed by tetra- and tri-PCBs at 16.8% and 13.0%, respectively. Spearman's rho correlation showed that di-, tri-, hexa-, hepta-, nona- and total PCBs were positively associated with somatic, thought problem and total problem scores (0.24<r<0.36). After dichotomization at the 75th percentile PCB concentration, we found that the higher PCB3, 6, 12, 25, 44, 71, 174 and 203 might increase the risk of certain behavior problems. Moreover, among the lower-chlorinated PCBs, PCB3 and PCB4 showed some risk of adaptive and gross motor abnormality, respectively. In conclusion, PCBs (especially lower-chlorinated PCBs) are ubiquitous in urban SHD in Nanjing and may carry a risk of certain developmental abnormalities. The potential adverse effects of postnatal exposure to PCBs on the behavior and neurodevelopment of preschool-aged children need to be studied in larger follow-up studies.

Psychometric Properties and Standardization of the Korean Version of the Eyberg Child Behavior Inventory

The Eyberg Child Behavior Inventory (ECBI) is a parent rating scale widely used to assess disruptive behaviors in children and adolescents. The purpose of this study is to assess psychometric properties and conduct standardization of the Korean ECBI. The Korean version of the ECBI was administered to parents of 707 children between the ages 2 and 12 (grade 6) from five areas of South Korea. For Korean children, the means of Intensity and Problem Scale raw scores were 70.7 and 3.5, respectively, much lower than the US norms. Cronbach’s alpha was 0.93 for the Intensity Scale and 0.93 for the Problem Scale of the Korean ECBI, indicating high internal consistency. The test–retest reliability was 0.92 and 0.97 for the Intensity and Problem Scales (n = 66), respectively. Convergent validity was assessed and confirmed by comparing the ECBI and the Child Behavior Checklist (CBCL). The ECBI Intensity Scale score correlated with the total problem score (0.81), externalizing problem score (0.85), and internalizing problem score (0.50) of the CBCL. Both Intensity and Problem Scale scores were significantly different between typical children and children receiving counseling services (n = 88): t = −13.365, t = −11.215, both p = .001, respectively. The factor structure of the ECBI indicated eight factors. Results indicated that the Korean ECBI is psychometrically sound. Further study is recommended to explore and confirm factor structures of the Korean version of the ECBI.

Behavioural and emotional problems in moderately preterm children with low socioeconomic status: a population-based study.

Moderately preterm (MP) birth is associated with higher rates of behavioural and emotional problems. To determine the extent to which low socioeconomic status (SES) contributes to these higher rates, we assessed independent and joint effects of MP birth and low SES, overall and by gender. Dutch preventive child health care centres provided a population-based sample of 915 MP children (32-36 weeks gestation) and 543 term-born children, born in 2002/2003. In multivariable logistic regression analyses, we determined the risk of behavioural and emotional problems per standard deviation (SD) decrease in gestational age and SES, using standardized measures for both. We also assessed three SES categories, being low (1SD or more below mean of standardized SES), intermediate (mean ± 1SD), and high (greater than mean + 1SD). The Child Behavior Checklist for 1.5-5 years was used to assess behavioural (externalizing), emotional (internalizing), and total problems at age 4 years. MP children with low SES had significantly higher total problem scores than those with high SES (11.3 vs. 5.1%, respectively). Each SD decrease in SES was associated with a 42% higher odds of elevated total problem scores (OR 1.42, 95% CI 1.14-1.77). No joint effects were found, meaning that lower gestational age independently added to the risk of behaviour problems (OR 1.24, 95% CI 1.00-1.56). Effects of MP birth and low SES were more pronounced in girls. In conclusion, MP birth and low SES multiply the risk of behavioural and emotional problems. The combination of risk factors identifies children who could benefit greatly from early intervention.

Preliminary evidence for good psychometric properties of the Norwegian version of the Brief Problems Monitor (BPM)

Background: Methods to assess intervention progress and outcome for frequent use are needed. Objective: To provide preliminary information about psychometric properties for the Norwegian version of the Brief Problems Monitor. Method: Cronbach's alpha scores and intra-class correlation coefficients as indicators for internal consistency (reliability) and Pearson correlation coefficients between corresponding subscales of the long and short ASEBA form versions as well as multiple regression coefficients to explore the predictive power of the reduced item-set related to the corresponding scale-scores of the long version were calculated in large, representative data sets of Norwegian children and adolescents. Results: Cronbach's alpha scores of the Norwegian version of the BPM subscales varied between 0.67 (attention BPM-youth) and 0.88 (attention BPM-teacher) and between 0.90 (BPM-youth) and 0.96 (BPM-teacher) for its total problem score. Corresponding subscales from the long versions and the BPM as well as the total problems scores were closely correlated with coefficients of high effect size (all r > 0.80). The variance of the items of the BPM explained about three-quarters or more of the variance in the corresponding subscales of the long version. Conclusions: The Norwegian BPM has good psychometric properties in terms of 1) being acceptable to good internal consistency and in terms of 2) regression coefficients of high effect size from the BPM items to the problem-scale scores of the long versions as validity indicators. Its use in clinical practice and research can be recommended.

Validity Study of the CBCL 6–18 for the Assessment of Emotional Problems in Youth With ASD

Youth with autism spectrum disorder (ASD) often present with emotional problems such as anxiety and depression (American Psychiatric Association, 2013). A recent study of the Child Behavior Checklist 6-18 (CBCL; Achenbach & Rescorla, 2001) indicated good sensitivity but relatively low specificity for identifying emotional problems in youth with ASD. The current study examined the extent to which variance in the CBCL’s Anxious/Depressed, Withdrawn/Depressed, Internalizing Domain, and Total Problems scales was accounted for by symptoms of emotional problems relative to ASD symptoms. Correlation and multiple regression analyses indicated that these scales measured anxiety and depression but a small statistically significant proportion of variance in Total Problems scores was also accounted for by ASD symptoms. Results contribute to the emerging evidence base for the inclusion of the CBCL in assessment protocols for assessing emotional and behavioral problems in youth with ASD.

PO-0825 Do Young Adults Born With Very Low Birth Weight Have Poor Emotional, Behavioural And Social Function?

Objective To study emotional and behavioural problems, relations to friends and substance use in young adults born with very low birth weight (VLBW: ≤1500 g) compared to controls. Design/methods A hospital-based follow-up study of 34 VLBW young adults and 35 term-born controls at 23 years of age. Data was collected using the Achenbach System of Empirically Based Assessment – Adult Self-Report (ASR) and the Beck Depression Inventory (BDI). Results The ASR total problems score was 38.6 (21.7) in the VBLW group compared with 29.0 (18.7) in the control group (p = 0.08). The VLBW group had higher scores for anxious/depressed (p = 0.04), attention problems (p = 0.03), aggressive behaviour (p = 0.05), internalising problems (p = 0.02) and critical items (p = 0.02). BDI scores did not differ between the groups. The VLBW group reported lower mean substance use (p = 0.04), mainly due to less use of alcohol. Furthermore, they reported having fewer friends, less closeness to friends, and less time spent with friends compared with controls (p = 0.05). When excluding 11 participants with cerebral palsy and/or low intelligence quotient ( Conclusion The VLBW group reported more emotional problems than controls, and also a higher level of clinically relevant psychiatric symptoms. The findings may indicate that anxiety symptoms and a cautious lifestyle with regard to substance use are characteristics of VLBW individuals in young adulthood.

정신보건시스템 내에서의 아동청소년 기능평가척도 개발을 위한 예비연구

Objectives：The aim of this study was to develop an assessment tool for measurement of children’s functioning in the mental health service. We conducted a preliminary study to develop a sensitive and inclusive scale focused on the functional changes of children rather than just focusing on their symptoms or screening. Methods：The Child and Adolescent Functional Assessment Scale and the Korean-Child Behavior Checklist (K-CBCL) were both administered to 134 parents of children with emotional or behavioral problems who participated in the Aizone program and also to 186 parents of elementary school children in the Seoul metropolitan area as a control group. SPSS version 12.0 was used for statistical analysis. Results：Most of the reliability coefficients were over 0.70 except those of the conduct behavior items, which showed rela tively high internal consistency. The corrected item-total correlations ranged from .411 to .758, except those of conduct behavior items and special measure items. In a concurrent validity test with K-CBCL, the total behavior problem score of K-CBCL was highly correlated with the total score of the Child and Adolescent Functional Assesment Scale (r=.610). For the construct validity, confirmatory factor analysis was performed for each of four areas, including behavior (at home/school), achievement, peer re lationship, and emotion. Conclusion：The results showed that the scale was statistically reliable and valid, except for conduct behavior items. This study was conducted only for parents with elementary children. An adolescents group should be included in future studies.

Specific behavioral comorbidity in a large sample of children with functional incontinence: Report of 1,001 cases.

Psychological comorbidity among children with functional incontinence is high: 20-30% of children with nocturnal enuresis (NE), 20-40% of those with daytime urinary incontinence (DUI) and 30-50% of those with fecal incontinence (FI) have clinically relevant comorbid disorders. The aim of this study was to analyze specific comorbid behavioral symptoms for different subtypes of incontinence in a large group of children. All 1,001 consecutive children and adolescents (67.5% boys) with a mean age of 8.5 years presented at a tertiary outpatient department between 2004 and 2011 were examined with a full pediatric and child psychiatric assessment. Prevalence of different subforms of incontinence and associated behavioral symptoms were analyzed. The internalizing, externalizing, and total problem scores of the Child Behavior Checklist (CBCL) were evaluated. Of all children, 70.1% (702 children) had NE, 36.1% (361 children) had DUI, and 36.8% (368 children) were affected by FI. More than 43% of all children had clinically relevant psychological symptoms (CBCL total score, cut-off at 90th percentile). Children with non-retentive FI had highest rates of clinically relevant psychological symptoms (58.8%). Children with combined subtypes of incontinence (any combination of NE, DUI, and FI) were more affected by psychological comorbidities than children with isolated subtypes (NE or DUI or FI). Children with incontinence have high rates of comorbid behavioral symptoms-three to six times higher than norms. Especially children with FI and combined subtypes of incontinence were affected. As behavioral symptoms and disorders will interfere with incontinence treatment, a general screening is recommended.

Attachment Characteristics and Behavioral Problems in Children and Adolescents with Congenital Blindness.

This study aimed to assess the behavioral problems and the attachment characteristics of children and adolescents with congenital blindness (CB). Forty children and adolescents aged 11-14 years with CB were included as the case group. Forty healthy children and adolescents who were matched for age, gender, and socioeconomic status with the case group served as the comparison group. Behavioral problems were assessed by the Child Behavior Checklist for ages 4-18 (CBCL 4/18). Attachment characteristics were assessed via the Short Form of Inventory of Parent and Peer Attachment (s-IPPA). The case group had lower CBCL total problems scores as well as anxiety/depression, withdrawal/depression, and attention problems subscales scores with respect to the comparison group. There were no significant differences between the two groups in s-IPPA scores. Children and adolescents with CB did not differ from the comparison group in terms of attachment, whereas, they had lower scores on behavioral problems than the comparison group. Although previous studies indicate that children and adolescents with CB may be at the risk of insecure attachment, our study suggested that adaptive mechanisms of their families together with professional help from specialized teachers and services provided by schools for children and adolescents with CB may play compensatory roles.