Dikkat eksikliği hiperaktivite bozukluğu tanısıyla izlenmekte olan çocuklarda akran örselemesi/ zorbalık

ÖZET Dikkat Eksikliği ve Hiperaktivite Bozukluğu (DEHB), dikkat problemleri, hiperaktivite ve dürtüsellik çekirdek belirtilerinin beraberinde sosyal zorlukları da bünyesinde barındıran çocukluk çağının en sık görülen nörogelişimsel bozukluklarındandır. DEHB’ li çocuklarda akran istismarı/zorbalığın daha fazla olduğu bilinmekle birlikte sosyal alandaki zorluklarda düzelme sağladığı gösterilmiş metilfenidat tedavisinin zorbalık düzeyine etkisi araştırılmamıştır. Bu çalışmada yeni tanı konan ve henüz ilaç kullanmamış DEHB’li çocuklarla en az iki okul dönemi düzenli ilaç kullanmış DEHB’li çocukların zorbalık durumlarının değerlendirilmesi amaçlanmıştır. Yeni tanı alan ve henüz ilaç tedavisi başlanmamış olan (n=34) ve iki dönemden uzun süredir metilfenidat tedavisi almakta olan (n=30) 8-16 yaş arası çocukların Okul Çağı Çocukları için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi- Şimdi ve Yaşam Boyu Şekli ile DEHB tanısı ve eştanıları değerlendirildi. Zorbalık durumlarını değerlendirmek için çocuklara Olweus öğrenciler için akran zorbalığı anketi, çocukların ebeveyn ve öğretmenlerine de anket temel alınarak hazırlanmış bir zorbalık değerlendirme formu verilmiştir. Zeka geriliğini dışlamak için WISC-R testi ile birlikte klinik ve gelişimsel parametreler değerlendirilmiş, DEHB şiddetini belirlemek için Conners’ anababa ve öğretmen derecelendirme ölçekleri kullanılmıştır. Değerlendirmeler sonucunda özbildirim ölçeklerinde yeni tanı alan grubun % 44’ü kurban, %8,8’i zorba/kurban olarak saptanmış, hiç zorba belirlenmemiştir. Tedavi alan grubunsa %23,3’ü kurban, %6,7’si zorba, %10’u zorba/kurban olarak saptanmıştır. Özellikle yeni tanı grubu ile tedavi alan grubun kıyaslanmasında kurban oranında saptanan fark istatistiksel anlamlılığa ulaşmadı. Cinsiyet, DEHB şiddeti, içselleştirici ve dışsallaştırıcı bozukluk eştanısı olup olmaması zorbalığa maruz kalan grupla kalmayan grup arasında değişmemekteydi. Ebeveyn ve öğretmen formlarına göre saptanan zorbalık oranları her iki grupta da çok düşüktü. Ebeveynlerin %26,7’si ile öğretmenlerin %50’si tedaviyle zorbalıkta azalma olduğu görüşündeydi. Sonuç olarak bu çalışmada yeni tanı konan ve tedavi alan DEHB olgularında zorbalığa maruziyet düzeyleri arasında fark saptanmış olup, iki grup arasındaki fark istatistiksel olarak anlamlı değildi. Öğretmen ve ebeveynler zorbalık davranışlarının büyük oranda farkında olmamalarına rağmen tedavinin zorbalık üzerine olumlu etkisi olduğu düşünmektedirler. Çalışmamızın bulguları literatür eşliğinde düşünüldüğünde zorbalığa katılan çocukların DEHB açısından değerlendirilmesi ve uygun tedavi yaklaşımlarının önerilmesinin, bu davranış problemlerinin azaltılmasında önemli olduğu sonucuna varılabilir. Anahtar kelimeler: Dikkat Eksikliği ve Hiperaktivite Bozukluğu, zorbalık, akran örselemesi, metilfenidat, çocuk ve ergenABSTRACT With regard to the Attention Deficit Hyperactivity Disorder (ADHD), consisting of attention problems, hyperactivity and impulsivity as core symptoms together with social diffuculties, is one of the most common neurodevelopmental disorders of childhood. Although increased peer victimisation/bullying rates in children with ADHD are known, to the best of our knowledge there are no studies about the effects of methylphenidate on bullying, which is a drug demonstrated to improve the accompanying social problems of ADHD. The purpose of this study is to compare the presence of bullying behavior (both being a bully and being a victim) in newly diagnosed ADHD children who are dug-naive with children who have a past ADHD diagnosis and who are on a regime of regular methylphenidate treatment for at least the past two school terms. Drug-naive, newly diagnosed children with ADHD (n=34) and children taking methylphenidate regularly for the past two school terms (n=30) who were between 8 to16 years, were evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL) for diagnoses of ADHD and coexisting psychiatric disorders. Children completed the Revised Olweus Bully/Victim Questionnaire and their parents and teachers completed a form prepared based on the self-report to determine the bullying involvement of the children. WISC-R test as well as clinical and developmental parameters of cognitive competence were used to rule-out intellectual disability and Conners’ parent and teacher scales were used to rate symptom severity. In self-report measures 44% of the newly diagnosed children were identified as victims, and8,8% were identified as bully/victims, where they were not bullied. In the treatment group, 23,3% of the children were identified as victims, 6,7% as bullies and 10% as bully/victims, based on a self-report. The difference in victimization rates between the two groups did not make statistical difference. Gender, ADHD symptom severity, coexisting intenalizing and externalizing disorders didn’t differ between the groups. Bullying involvement rates were very low according to the parent and teacher-rated bullying questionnaires. 26,7% of the parents and 50% of the teachers reported a decrease in bullying involvement with methylphenidate treatment. In conclusion, there was a difference in rates of victimization between the newly diagnosed ADHD group and the ADHD group under methylphenidate treatment, but this didn’t reach any significant statistical difference. Although parents and teachers were not very well in recognizing victimized children, they reported an improvement in bullying involvement in children who are on methylpehnidate. Considering our findings with the current literature on this topic, one can conclude that clinical evaluation of children involved in bullying (either as a victim, as a bully or both) for the presence of ADHD and appropriate treatment for those diagnosed with ADHD could be important in the management of these behavioral problems. Key Words: Attention Deficit Hyperactivity Disorder, bullying, peer victimization, methylphenidate, child and adolescen

Dikkat eksikliği hiperaktivite bozukluğu tanısıyla izlenmekte olan çocuklarda akran örselemesi/ zorbalık

Dikkat Eksikliği ve Hiperaktivite Bozukluğu (DEHB), dikkat problemleri, hiperaktivite ve dürtüsellik çekirdek belirtilerinin beraberinde sosyal zorlukları da bünyesinde barındıran çocukluk çağının en sık görülen nörogelişimsel bozukluklarındandır. DEHB’ li çocuklarda akran istismarı/zorbalığın daha fazla olduğu bilinmekle birlikte sosyal alandaki zorluklarda düzelme sağladığı gösterilmiş metilfenidat tedavisinin zorbalık düzeyine etkisi araştırılmamıştır. Bu çalışmada yeni tanı konan ve henüz ilaç kullanmamış DEHB’li çocuklarla en az iki okul dönemi düzenli ilaç kullanmış DEHB’li çocukların zorbalık durumlarının değerlendirilmesi amaçlanmıştır. Yeni tanı alan ve henüz ilaç tedavisi başlanmamış olan (n=34) ve iki dönemden uzun süredir metilfenidat tedavisi almakta olan (n=30) 8-16 yaş arası çocukların Okul Çağı Çocukları için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi- Şimdi ve Yaşam Boyu Şekli ile DEHB tanısı ve eştanıları değerlendirildi. Zorbalık durumlarını değerlendirmek için çocuklara Olweus öğrenciler için akran zorbalığı anketi, çocukların ebeveyn ve öğretmenlerine de anket temel alınarak hazırlanmış bir zorbalık değerlendirme formu verilmiştir. Zeka geriliğini dışlamak için WISC-R testi ile birlikte klinik ve gelişimsel parametreler değerlendirilmiş, DEHB şiddetini belirlemek için Conners’ anababa ve öğretmen derecelendirme ölçekleri kullanılmıştır. Değerlendirmeler sonucunda özbildirim ölçeklerinde yeni tanı alan grubun % 44’ü kurban, %8,8’i zorba/kurban olarak saptanmış, hiç zorba belirlenmemiştir. Tedavi alan grubunsa %23,3’ü kurban, %6,7’si zorba, %10’u zorba/kurban olarak saptanmıştır. Özellikle yeni tanı grubu ile tedavi alan grubun kıyaslanmasında kurban oranında saptanan fark istatistiksel anlamlılığa ulaşmadı. Cinsiyet, DEHB şiddeti, içselleştirici ve dışsallaştırıcı bozukluk eştanısı olup olmaması zorbalığa maruz kalan grupla kalmayan grup arasında değişmemekteydi. Ebeveyn ve öğretmen formlarına göre saptanan zorbalık oranları her iki grupta da çok düşüktü. Ebeveynlerin %26,7’si ile öğretmenlerin %50’si tedaviyle zorbalıkta azalma olduğu görüşündeydi. Sonuç olarak bu çalışmada yeni tanı konan ve tedavi alan DEHB olgularında zorbalığa maruziyet düzeyleri arasında fark saptanmış olup, iki grup arasındaki fark istatistiksel olarak anlamlı değildi. Öğretmen ve ebeveynler zorbalık davranışlarının büyük oranda farkında olmamalarına rağmen tedavinin zorbalık üzerine olumlu etkisi olduğu düşünmektedirler. Çalışmamızın bulguları literatür eşliğinde düşünüldüğünde zorbalığa katılan çocukların DEHB açısından değerlendirilmesi ve uygun tedavi yaklaşımlarının önerilmesinin, bu davranış problemlerinin azaltılmasında önemli olduğu sonucuna varılabilir. Anahtar kelimeler: Dikkat Eksikliği ve Hiperaktivite Bozukluğu, zorbalık, akran örselemesi, metilfenidat, çocuk ve ergen ABSTRACT With regard to the Attention Deficit Hyperactivity Disorder (ADHD), consisting of attention problems, hyperactivity and impulsivity as core symptoms together with social diffuculties, is one of the most common neurodevelopmental disorders of childhood. Although increased peer victimisation/bullying rates in children with ADHD are known, to the best of our knowledge there are no studies about the effects of methylphenidate on bullying, which is a drug demonstrated to improve the accompanying social problems of ADHD. The purpose of this study is to compare the presence of bullying behavior (both being a bully and being a victim) in newly diagnosed ADHD children who are dug-naive with children who have a past ADHD diagnosis and who are on a regime of regular methylphenidate treatment for at least the past two school terms. Drug-naive, newly diagnosed children with ADHD (n=34) and children taking methylphenidate regularly for the past two school terms (n=30) who were between 8 to16 years, were evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL) for diagnoses of ADHD and coexisting psychiatric disorders. Children completed the Revised Olweus Bully/Victim Questionnaire and their parents and teachers completed a form prepared based on the self-report to determine the bullying involvement of the children. WISC-R test as well as clinical and developmental parameters of cognitive competence were used to rule-out intellectual disability and Conners’ parent and teacher scales were used to rate symptom severity. In self-report measures 44% of the newly diagnosed children were identified as victims, and8,8% were identified as bully/victims, where they were not bullied. In the treatment group, 23,3% of the children were identified as victims, 6,7% as bullies and 10% as bully/victims, based on a self-report. The difference in victimization rates between the two groups did not make statistical difference. Gender, ADHD symptom severity, coexisting intenalizing and externalizing disorders didn’t differ between the groups. Bullying involvement rates were very low according to the parent and teacher-rated bullying questionnaires. 26,7% of the parents and 50% of the teachers reported a decrease in bullying involvement with methylphenidate treatment. In conclusion, there was a difference in rates of victimization between the newly diagnosed ADHD group and the ADHD group under methylphenidate treatment, but this didn’t reach any significant statistical difference. Although parents and teachers were not very well in recognizing victimized children, they reported an improvement in bullying involvement in children who are on methylpehnidate. Considering our findings with the current literature on this topic, one can conclude that clinical evaluation of children involved in bullying (either as a victim, as a bully or both) for the presence of ADHD and appropriate treatment for those diagnosed with ADHD could be important in the management of these behavioral problems. Key Words: Attention Deficit Hyperactivity Disorder, bullying, peer victimization, methylphenidate, child and adolescen

Television-viewing Habits in a Preschool Age Clinical Population with Autism Spectrum Disorders and Other Clinical Groups

Objective: We aimed to compare the television (TV)-viewing habits in a clinical sample of children with autism spectrum disorders (ASD) and those diagnosed with language delay, disruptive behavior disorders, and depression/anxiety and those who had no clinical diagnosis (no dx)

Examination of risk factors for dropout in a child and adolescent psychiatry outpatient clinic

Objective: Dropout from the ongoing treatment is defined as premature termination of the treatment against the clinician's advice. Dropout may lead to insufficient treatment, endurance of the disorder and worse quality of life. The aim of the present study is to investigate relationship of dropout with a list of possible predictive factors including; diagnosis, treatment modality, previous contact with services and child and family-related sociodemographic characteristics related to the child and their families. Methods: The sample consisted of a total of 954 children and adolescents, aged 6-18 years, attended to Bezmialem University Hospital, child and adolescent psychiatry outpatient clinic between July 2015 and May 2016. A semi-structured clinical examination was used to endorse clinical diagnosis. Results: Dropout rate in the total sample was 52.0% (29.0% for early; 23.0% for late drop out). Almost 70% of the subjects, who were treated with a combination of medication and psychotherapy continued with their treatment. Diagnosis of an externalizing disorder or attention deficit hyperactivity disorder (ADHD) were significantly higher in the late dropout group, while internalizing disorder was higher in those who engaged with treatment. Mother's higher education attainment showed positive relationship with service engagement. Previous psychiatric diagnosis in the child was an independent protective factor for discontinuation of treatment (OR=1.251,CI= 1.05-1.49, p=0.011). In terms of the treatment modalities, most of those who were treated with medication only dropped out late (74.6%), however pharmacological treatment on its own also appeared to be an independent predictor of dropout (OR=0.586, CI=0.47-0.72, p<0.001). Discussion: Dropout rates were higher than previous studies. Motivation to contact the service and treatment modality offered to the patient can predict their service engagement. Further local studies are needed to address factors related to dropout and the role of the current mental health system and lack of resources in poor service engagement needs to be clarified

Assessment of electronic media use in children and adolescents with attention deficit hyperactivity disorder

Objective: Electronic media use is an emerging area of research interest, however its relationship with Attention Deficit hyperactivity disorder (ADHD) is neglected in Turkish literature. We therefore aimed to examine its relationship with certain variables and ADHD subtypes. Methods: A total of 360 participants aged between 6-18 years, who attended Bezmialem University, Child and Adolescent Psychiatry Outpatient Clinic between January 2016 and October 2016, were screened with the Schedule for Affective Disorders and Schizophrenia for School Age Children K-SADS) interview to ascertain diagnoses and a sociodemographic information tool was used to collect the relevant data. Results: The mean age of the sample was 9.47 +/- 2.67 years, and 81.9% of them consisted of males. 20.6% of the sample was reported to spend between 2 and 4 hours a day using electronic media gadgets (TV viewing, cell phone and/or tablet/computer use), while 4-6 hours of use was reported in 15.8%, 6-8 hours in 11.4%, 8-10 hours in 9.4% and more than 10 hours/day in 18.2% of the total sample. Heavy users of electronic media (> 6 hours/day) reportedly had significantly higher academic achievement and lower socioeconomic status as compared to those who used it at medium (2-6 hours/day) and low levels (< 2 hours/day). Gender, the content of TV viewing and total electronic media use within the household also significantly differed between the heavy, medium and low intensity users. Regression analyses revealed that total daily electronic media use for 10 hours and above was significantly and independently associated with the current family psychiatric illness and low academic achievement of the child. Conclusion: To the best of our knowledge, this is the first study reporting use of a variety of electronic media gadgets in a Turkish clinical sample of children and adolescents with ADHD. Results are in line with the existing international literature and highlights the excessive electronic media use in this clinical population. We recommend a routine screening for electronic media exposure in ADHD minors and increase awareness in their families and schools. Longitudinal and methodologically more robust studies are needed to examine cause-effect relationships

Comparison of the effects of treadmill and vibration training in children with attention deficit hyperactivity disorder: A randomized controlled trial

OBJECTIVE: The aim of this study was to compare the effects of treadmill training (TT) and whole body vibration training (WBVT) on attention, severity of attention deficit hyperactivity disorder (ADHD) symptoms and impairment of executive function behaviors, and quality of life in children with ADHD.METHODS: Thirty children (7-11 years of age) with ADHD were randomly assigned to either the 'TT' group or the 'WBVT in addition to TT' group (TT + WBVT). Both groups received TT for 8 weeks (3 days/week). The TT + WBWT group also received WBVT for 15 minutes. Stroop Test TBAG form, Behavior Rating Inventory of Executive Function (BRIEF), Conners' Rating Scale (CRS) and Pediatric Quality of Life Inventory (PedsQL) were applied at baseline and after 8 weeks of training.RESULTS: All assessment results significantly improved in both groups at the end of the program compared to baseline values (p < 0,05). There were significant differences between groups regarding improvements in CTRS-R/L and BRIEF-Teacher form in favor of the TT + WBVT group.CONCLUSIONS: The findings suggest that exercise training including TT and WBVT might be used in the treatment of ADHD but further research is required to provide evidence of the effectiveness of the whole body vibration training in the management of ADHD

Diagnostic and demographic characteristics of patients referred to a child and adolescent psychiatry clinic

Objective: The aim of the present study is to examine the diagnostic categories of the patients referred to a child and adolescent psychiatry outpatient clinic and the relationship of such categories with age and gender